1. family and parenting
2. children

Birmingham Children’s Hospital NHS Foundation Trust
Quality Account 2012-13
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Chief Executive’s Statement on Quality
Our organisation is committed to putting the quality of care we provide at the centre of everything
that we do. We have ensured that this remains at the forefront of our agenda by embedding it as
the first of our six strategic objectives.
This commitment is not just about maintaining the status quo but about continual learning and
improvement. There is no health care organisation worldwide that can’t in some way improve the
services it provides for its patients and our hospital is no exception.
During the year our Quality Committee has become central to this agenda, ensuring that there is a
continual oversight and challenge as to how we can further improve what we do. This is enhanced
through the work programme of the Board of Directors - its agenda is structured to focus on service
quality and safety first and foremost. This is achieved through a range of methods, for example a
detailed quality report is scrutinised, discussed and debated on a monthly basis. We also use patient
stories and quality walkabouts to ensure that we look beyond the figures within the report.
We are proud of some of the initiatives and innovations that have been developed over the past
year to improve quality. We recognise that feedback from our staff about the services that we
provide and their own experience of working at the Trust is invaluable in the quality agenda. For
example, we have developed tools to support junior doctors (Training Advice & Liaison Service) and
to capture their experience of training at the hospital.
Recognising the hard work and commitment of staff as our most valuable asset is important to the
Trust. We launched a monthly ‘Star of the Month’ award during the last year and some of the stories
of staff working in a diverse range of roles are truly inspirational. Each year we celebrate the work of
our staff with an annual awards event saying thank you for their contribution over the past twelve
months.
We have also used technology to improve the quality of the patient experience. Our App for Smart
Phones allows us to capture the experience of our patients and their families in real time and quickly
address any issues. All these responses are captured live on our public website increasing
transparency of the whole process.
We are rightly upheld at a local, regional and national level for the work that we do on patient
experience. We are proud of the various ways in which we engage with children and young people
to address how we can improve our services. Our Young Persons Advisory Group (YPAG) has been
visited most recently by Dr Hilary Cass, president of the Royal College of Paediatrics and Child
Health, and had input into a range of service areas and initiatives. For example, the group helped
design a new Dignity Giving Suit to replace the traditional backless robes used in hospitals.
To the best of my knowledge the information contained in this Quality Account is accurate.
………………………………………………
David Melbourne, Interim Chief Executive
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Priorities for Improvement
At Birmingham Children’s Hospital, ensuring that we provide a high quality service is central to
everything we do and this is embedded within our strategy. We are always looking for ways that we
can improve the quality of our services. This can include making the experience better for the
patients and families that use our services; changing the way we work so we can treat every patient
that needs or chooses to come to BCH without any delays; making things safer than ever before and
improving health outcomes for the diverse range of children and young people that we see every
day.
It is important that we focus our resources on making improvements where they are needed most,
so we continually monitor and analyse a wide range of information that tells us where we could do
better. This includes:
Listening to the children, young people and families that use our services There are lots of
ways they can tell us what they think, and we take account of it all to work out what’s most
important to them:
Complaints, comments and concerns
Feedback cards
Surveys
Patient stories
Feedback App
Websites like NHS Choices and Patient Opinion
Consultations
Mystery Shoppers
Listening to our staff The views of the staff who work in our hospital every day are vital and
we encourage them to tell us what they think through surveys, consultations and feedback
events. It’s also really important that we keep an eye on their happiness and make sure
they’re fully supported so that they are able to deliver the best services they can.
Listening to others The views of BCH groups like the Young Person Advisory Group help us
focus on how to make the improvements that are needed.
Analysing information about the quality of services, such as patient safety incidents and
clinical audits.
Using best practice examples, national targets and learning from and benchmarking with
other organisations.
Using this information has helped us to identify Quality Priorities, which are the main areas we want
to focus on to improve quality. Each priority has a goal and a way of measuring our progress in
reaching it. These relate to the three elements of quality: Patient Experience, Clinical Effectiveness,
and Safety. The priorities we are reporting on this year are:
Patient Experience
Clinical Effectiveness
Emergency Department Transfers
Staff Survey
Food and Nutrition
Nursing Care Quality Indicators
CAMH Service User Satisfaction
Asthma Care
Tertiary Inpatient Referrals
Play and Activities
Cancelled Operations
Health Promotion
Safety
Pressure Ulcers
Preventing MRSA
Reducing Acute Life Threatening Events, and
Cardiac and Respiratory Arrests
Reducing Healthcare Acquired Infections in PICU
Reducing MSSA
Zero Avoidable Deaths
Reducing rates of Clostridium Difficile
Reducing Medication Incidents Resulting in Harm
WHO Safe Surgery Checklist Completion
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In 2013/14 we will also report on some additional priorities that we have been developing during
2012/13:
Safety:
Extravasation Injuries
Patient Experience:
Friends and Family test (for children and young people)
Clinical Effectiveness: Implementing the Sepsis Care Bundle
These priorities and what we’ve achieved in 2012/13 are set out over the next few pages of this
Quality Account.
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Listening to Patients and Families: Food & Nutrition
A healthy diet can help patients get better quicker and go home earlier. Having tasty food, with
plenty of choice, which meets everyone’s needs, is vital to the wellbeing of our children and
young people, and ensures they have a good experience while they are in hospital.
Figure 1 Percentage of patients weighed and measured per Quarter 2011/12-2012/13
How have we done?
We have continued to perform really well with this measure. We will continue to monitor this but as
we have demonstrated sustained high performance we will not report it separately from the other
Nursing Care Quality Indicators (NCQIs) next year. In 2013/14 we will be focusing on offering
appropriate healthy eating advice where it is needed. We will also be using a new electronic process
to collect the NCQI data which will allow us to monitor this every month rather than quarterly, which
will help us address issues more quickly.
Everything is good
except for the food.
Food needs to be
improved.
I like the way my food order
follows me round the hospital on
MAPLE so when I move wards I still
get the meals I've ordered.
Figure 2: Percentage of patients who choose what they
want and are happy with their choice – 2009/2012/13
The food is
alright – better
than I expected.
Generally the
food tastes nice.
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How have we done?
Until 2012 these questions were answered through a Food Survey but in 2012 we started asking the
questions during our regular Catering Quality Walkabouts when we carry our checks on food service
on wards and address any immediate issues. This way we can only ask a few children and young
people at a time, so next year we want to develop new ways of getting views from as many people
as possible.
What are we doing to improve?
In 2012/13 we introduced a new electronic food ordering system called MAPLE which was
developed with local software developer Ambinet and our caterer Sodexo. MAPLE is an interactive,
fun way for our patients to order their meals and is programmed to meet individual dietary
requirements. MAPLE has been really successful – our patients and families say it is practical and
easy to use and it has received five awards.
The MAPLE food ordering system means that children and young people will now always be able to
order what they want from the menu. We will consult with our Young Person Advisory Group (YPAG)
about new questions we should ask children and young people to ensure we get the information we
need to help us improve. Food will also be a theme of YPAG walkabouts in 2013/14.
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Listening to Patients and Families: Play & Activities
Play and activities are important for the wellbeing of all children and young people
who spend time in hospital. They can also provide an essential distraction from
distressing aspects of care. It’s important that activities, toys and equipment are of
good quality, are age appropriate, and easily accessible. We categorise feedback
about play and activities as either ‘positive’ or ‘need to improve’.
Although my child enjoyed
playing in the playroom it was
quite small and not easily
accessible if the patient is on
IVs etc, and have a drip-stand
attached to them.
I liked that the nurses
gave me colouring
books and pens when
I was bored.
There was no
adolescent
room like
there is on
other wards.
Figure 3: Percentage of positive and ‘need to improve’ comments received 2011/12 & 2012/13
How have we done?
The picture is very similar to last year. Having the right toys, equipment and activities continues to
be really important to people who visit and stay at our hospital. ‘Need to Improve’ comments can
include things we need to change or do better, like provide more things to do for older children and
young people. These comments also include lots of suggestions about different toys, games and
activities that children and young people would really like to be available. It’s important that we
continue to monitor everything that people are saying so we know where we need to do better and
understand what it is that children and young people want and need.
What are we doing to improve?
We will be investing all our 2013/14 allocation for improving patient experience to upgrading
the ward play areas.
We have a new weekly Stay and Play group to provide patients and siblings the opportunity to
play in a supportive environment. Feedback from initial sessions is really positive.
We will run a 'promoting happy parenting' course to help parents with the challenges they face
when their children are in hospital.
We will improve information about play and activities so that children, young people and
families know what is available at the hospital.
We will share our play and activity resources better between wards to ensure that more
children and young people in the hospital have opportunities use everything that is available.
We will ask our volunteers to support improvements in play and activities.
We are developing an activity book for children and young people who come to the Emergency
Department to entertain and educate them about what they might see and what might happen
to them while they are there. This is linked to activities in schools to educate young people
about accessing health care.
We are creating a Play Charter which will allow us to set some specific, measurable objectives
to support improvements in play.
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Listening to Patients and Families: Emergency Department Transfers
Until 2010/11 patients who came to our Emergency Department were regularly transferred to other
hospitals after treatment because there were no inpatient beds available. This was a really bad
experience for patients and their families so we adapted our processes and procedures to ensure
this would change.
Figure 4: Patients transferred out of ED per month 2010/11-2012/13
How have we done?
We have continued to follow the processes we set in 2010/11 and maintained our objective for most
of the year. In July 2012 one patient was transferred out. This has been reviewed, and while the
decision to transfer was clinically right, there were processes that could have been followed that
would have avoided the need for this transfer.
We will continue to monitor this indicator but we will not report this as a quality priority in our next
Quality Account if we continue to perform well.
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Listening to Patients and Families: Tertiary Inpatient Referrals
When a child or young person needs to come to BCH for urgent inpatient care
from home or from another hospital, it’s important that their admission is not
delayed as this could have a negative impact on their care. In 2010/11 we
decided to make sure delays did not happen and put processes in place to meet
our goal.
Figure 5 number of patients not offered a BCH bed within 24 hours 2010/11-2012/13
How have we done?
With more people than ever before wanting to access our services, 2012/13 was a really challenging
year and our staff had to work very hard to meet our goal.
What are we doing to improve?
Meeting our goal while demand for our services increases means we need to increase the capacity in
our hospital. This does not necessarily mean creating physical space for more beds. It’s also
important that we find ways of reducing the time that people need to spend in hospital, and the
number of times they need to be admitted, so that more beds are available. Some examples of what
we are doing to achieve this are:
 Developing services like Hospital @Home so some children can be discharged earlier;
 Improving discharge processes so that once a child is ready to be discharged this happens
much quicker;
 Developing our outpatient services so that children with long-term conditions like Diabetes
and Asthma are less likely to deteriorate and need admission to hospital;
 Improving flow through the hospital so that people can get into wards quicker and can be
discharged earlier;
 Establishing new services like our PACE team (see page 11) which supports high dependency
patients on wards and allows earlier access to PICU for children and young people who need
it.
Other examples can be found on page 11 in the section about cancelled operations.
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Listening to Patients and Families: Cancelled Operations
Patients, families and staff have told us that when an operation has to be cancelled
by the hospital this can have a huge impact. It might mean travel arrangements
and time off school and work have to be rearranged and could also mean that
tests and assessments have to be done again. We know this can be very stressful
and inconvenient. There are times when we can’t avoid cancelling operations
because of emergencies like transplants which can’t wait, or when another
operation is more complex than expected, so it takes longer than planned.
Sometimes an operation can’t go ahead because there aren’t enough beds that day
on PICU to care for the patient after the operation. Over the last few years we have been working
hard to try to reduce the number of operations that we cancel, especially those that we cancel on
the actual day. At the same time we have been finding ways to make the experience better for
patients and families when we can’t avoid cancelling their operation.
Figure 6 Monthly cancelled operations 2010/11-2012/13
When you’ve been told how
important it is to get the
operation done you start to get
really worried that it’s not
happening and you get more
and more worried that she will
be getting worse.
Whoever told us was
very nice, supportive,
and apologetic.
You learn to understand
that emergencies come
first. You put everything
back into perspective a
little while afterwards
but at the time we were
really upset.
How have we done?
We have not met our target, with 1.68% of operations cancelled on the day. We
have been experiencing our highest ever activity levels, which has put pressure
on our theatres, PICU and wards, and we were therefore unable to meet our
goal in 2012/13. Opening our new PICU extension in November 2012 helped us
improve, and in January 2013 we launched our new Paediatric Assessment
Clinical Intervention and Education (PACE) team which frees up more beds for
our sickest children when they have had an operation.
What else are we doing to improve?
Improving the experience for children, young people and families
Because we know that we will always have to cancel some less urgent operations we have been
talking to patients and families to understand how we can make the experience better when this
happens. We know that communication is really important, so they know what’s going on as early as
possible. We also know we need to make sure our staff are trained in the best ways to talk to
families when their operation is cancelled, so that they give them all the information they need and
are able to support them when they’re upset or angry.
Identifying all the reasons for cancellations and taking action
We have set up a Task and Finish Group which is examining the reasons for all cancelled operations
very closely to identify ways we can improve. They are already making progress, for example
11
patients are now contacted three days before their operation to make sure they have all the
information they need.
Improving processes like discharge, so beds are available more quickly
We have changed the model of care on the Medical Day Care Unit so that it is now nurse-led. This
means that each child and young person is admitted, treated and discharged by a named nurse. This
has reduced delays for these patients along every step of their pathway, ensuring not only a speedy
stay with us, but a fantastic patient journey.
Reviewing patient pathways, to improve flow through wards
The Surgical Day Care Unit cares for children requiring short stay surgery. We have changed the way
we work on this Unit to a 23-hour model which means that some children can have procedures later
in the day, and be discharged up to 11pm, and other children who require an overnight stay can be
discharged at 7am. Patients, parents and carers have given very positive feedback about these
changes as they appreciate being able to return to their home environment as soon as possible. By
switching to this new way of working, we have maximised capacity, ensuring cancellations due to
lack of beds has been significantly reduced.
In 2013/14 we will also be:
Opening more beds to increase capacity
Another five beds are planned in PICU for 2013.
We are opening more day beds/treatment chairs in the Medical Day Unit, which will allow us to
treat more patients in the Unit, freeing up beds on the inpatient wards.
Developing new areas to improve the experience and increase capacity
Some of our parents and children have said that they do not like being in a bed before an operation
as this can make them more anxious. To make this better we are creating a new lounge area in the
Surgical Day Care Unit where children can stay and play until they are ready to walk to theatre for
their operation. Only once they have had their operation will they need to be in a bed to recover.
This new way of working will help us free up more beds, allowing us to do more operations every
day.
Expanding our Pre-Admission Service to prevent avoidable delays
We are developing this service to ensure that all children and young people will have access to it,
which will help prevent cancellations caused by things like:
Families changing their minds about having an operation;
Incorrect listing of an operation;
Children having eaten too close to the planned operation.
Developing plans to increase physical capacity
We know we need more physical operating capacity due to increasing demand so we are working on
plans to open more theatres.
Working with other children’s hospitals to see what we can learn from the way that they work
Every children’s hospital is unique, with different services meeting a range of different needs, but we
can all learn from each other to make sure all children have a fantastic experience. We have set up a
group with other children’s hospitals around the country to see if we can learn from each other
about ways of reaching our goals.
12
Listening to our Staff: Staff Survey
Staff are our most important resource. Understanding their views about the
quality of our services is crucial to ensuring that we can make improvements
where they are needed.
Figure 7: Key Staff Survey Results 2009-2012
Figure 8: Staff Satisfaction Score 2011/12
How have we done?
There has been very little change in the results but we are disappointed not to have done better.
2012/13 was a challenging year for our staff due to higher levels of activity and more patients with
complex needs, and we know they have been working really hard to make sure children, young
people and their families have safe, high quality care and a fantastic patient experience.
What are we doing to improve?
We are developing new ways to monitor how our staff are feeling - such as sickness absence and
staff turnover - and we integrate this with information about the safety and quality of services. This
helps us predict which areas might be coming under pressure. We are also doing lots more to gather
the views of our staff throughout the year, keep them informed and support them to continue to
provide the best services possible. Other methods we are adopting to improve staff experience
include:
‘Star of the Month’ nominated by staff, patients and families;
Regular polls to help us understand staff mood;
Launch of a new Health and Wellbeing Strategy with lots of opportunities for staff to
improve their health and get support when they need it;
Helping our leaders to support their staff when they feel stressed;
Annual Night of Stars and Long Service Awards to reward outstanding contributions.
Engaging with staff to obtain their views on themes arising out of the Francis report (see
page 106)
13
Providing Even Better Nursing Care: Nursing Care Quality Indicators (NCQIs)
Excellent nursing care is vital to ensuring our patients are safe, have a good experience and have
good clinical outcomes. In 2010/11 we developed quality indicators in the most important areas. A
new indicator was added for cannula care in 2012/13.
Figure 9: NCQI Performance 2010/11-2012/13
How have we done?
We have continued to do
really well, with
improvements in every
indicator in 2012/13,
especially in pain
management. We are also
really pleased with such
high performance in our
first year in monitoring
cannula care.
What are we doing to improve?
We are creating an electronic method to collect performance data which will allow us to monitor
this every month rather than just quarterly. This will enable us to identify and address any issues
much earlier.
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Providing Even Better Nursing Care: Asthma Care
When children and young people with asthma use an inhaler, it’s essential that they use it properly
to get the full benefits.
It’s also important that we ensure that they are involved in decisions about their care and we do this
by agreeing their care plan with them and giving them a copy.
Figure 10: BTS National Audit Performance 2010-2012
How have we done?
We continue to perform
above the national
average (which has
improved), but our
performance has dipped
compared to the last two
years. This is really
disappointing as we
know from previous
years that we are able to
do this well.
What are we doing to improve?
During 2013/14 we will be looking into ways of ensuring that adherence to the asthma care pathway
is embedded in normal clinical practice.
We will also amend the asthma care pathway to reflect the new NICE Asthma Quality Standards.
We will report on our progress in our next Quality Account.
15
Providing Even Better Nursing Care: Pressure Ulcers
Some of our patients - in particular the sickest patients on PICU - are at risk of developing pressure
ulcers which, if left untreated, can become very serious. We are working toward the complete
eradication of pressure ulcers, in line with the ambition of the whole NHS.
Figure 11: Pressure Ulcer rates 2012/13
How have we done?
We have done really well in 2012/13.
Whenever a pressure ulcer is identified the patient’s care is reviewed by a clinical expert. So
far in 2012/13, the care provided in all cases has been appropriate.
There have been no grade 3 or 4 pressure ulcers.
Zero Grade 2 pressure ulcers have been categorised as avoidable.
The number of Grade 2 pressure ulcers has decreased over the year.
What are we doing to improve further?
We have been asked to contribute to the development of NICE guidance on paediatric pressure
ulcers so that the improvements that we have achieved will benefit children and young people in
hospitals across the NHS.
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Improving Health Outcomes: Health Promotion
We have an important role to play in improving general health outcomes and reducing health
inequalities for children and young people. Good general health for the whole family
is even more important when a child becomes ill or has a long-term condition.
How have we done?
We have met all of our goals.
Referrals to Stop Smoking services have
significantly increased.
We have achieved status as a World
Health Organisation (WHO) Health
Promoting Hospital so we now part of an
international network of hospitals that
aim to improve health by developing
structures, cultures, decisions and
processes.
What are we doing to improve?
We are providing training and awareness sessions for staff.
We have established a smoking referral pathway.
We have new data recording systems so that we can monitor the impact of our work.
We are displaying information about alcohol on screens in the main Outpatients department.
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Improving Health Outcomes: CAMH Service User Satisfaction
Measuring the difference our services make to the people who use them helps us to understand
what we are doing well and where we might need to make improvements.
Figure 12: CAMHS Questionnaire Scores 2011/12-2012/13
How have we done?
We have met the national target for all questions except the percentage of service users who feel
the service has helped to make their problems better.
What are we doing to improve?
We are improving the way that we engage with young people to better understand their views on
CAMHS. We have set up focus groups to ensure that we ask young people about the specific care
pathways they are on to support redesign and development. We are also improving our website
with the help of our young people and their families and providing further opportunities for them to
give us their views through the Trust feedback app.
18
Reducing Infection: Reducing Healthcare Acquired Infections in PICU
Our sickest patients on our Paediatric Intensive Care Unit (PICU) are most at risk of
healthcare associated infections (HCAIs). This can be very serious and means they have to
spend more time in hospital. Reducing the risk of infections for these patients can help
them get well quicker and be discharged earlier.
Figure 13: HCAIs in PICU 2011/12-2012/13
How have we done?
We have achieved our goal and improved on last year’s performance in relation to Ventilator
Associated Pneumonia (VAP). We have shared the VAP results with the International Forum on
Quality and Safety in Healthcare.
We have seen a small increase in our Central Venous Catheter (CVC) infection rate in 2012/13.
Although this is still below our target rate of 1.4, we are investigating the reasons for this
to determine what we can do to reduce this rate even further.
What are we doing to improve?
We are now monitoring rates of infections in other areas of the hospital too, with most wards doing
well.
We will continue to develop the practices we have put in place and to learn from every infection that
does occur to reduce the rate of infections in PICU and across the hospital to a minimum level.
19
Reducing Infection: Reducing Rates of Clostridium Difficile
Clostridium difficile are bacteria present naturally in the gut of around twothirds of children and 3% of adults. C.difficile does not cause any problems in
healthy people. However, some antibiotics used to treat other health
conditions can interfere with the balance of 'good' bacteria in the gut. When
this happens, the bacteria can multiply and produce toxins, which cause illness
such as diarrhoea and fever. As C.difficile infections are usually caused by
antibiotics, most cases happen in a healthcare environment. Reducing rates of
C.difficile in hospitals is a national priority.
Figure 14: C.Difficile infections 2010/11-2012/13
How have we done?
We had one case of C.difficile in 2012/13
and made sure that the ward where this
occurred had extra cleaning until there
was no trace of C.difficile in the
environment. We also carried out tests in
other high risk wards and found no
C.difficile at all.
What are we doing to improve?
We have tried out a new sampling technique and now carry out extra testing to identify patients
who do not have true C.difficile infection but might be carrying the bacteria which could put other
patients at risk. Early identification and protection measures reduce this risk.
20
Reducing Infection: Preventing MRSA
Blood stream infections with MRSA can be very serious for people who are unwell and can result in
additional treatment and an increased length of stay.
Figure 15: MRSA infections 2007/08-2012/13
How have we done?
For the second year in a row we have had no MRSA infections at all.
How will we maintain this?
Achieving this goal has been a challenge in 2012/13, particularly with some patients who are at very
high risk of MRSA bacteraemia. We will continue to practice everything we have learned that has
ensured that we have had no MRSA infections since 2010, and we will continue to apply new best
practice and learning from other organisations.
21
Reducing Infection: Reducing MSSA
MSSA is a common bacteria carried on the skin of 30% of the population. MSSA bloodstream
infection is a risk for some of our patients, especially those who have a central venous catheter
(CVC).
Figure 16: MSSA post 48 hours rates 2011/12-2012/13
How have we done?
In 2011/12, our first year of monitoring, we achieved substantial reductions, exceeding our target. In
2012/13 it has been challenging to reduce this any further, with a similar number of infections
during both years. We did not therefore meet our target. We have analysed every MSSA infection to
identify the cause and any opportunity to prevent them.
Dr Jim Gray, Head of Microbiology and his team were recognised at the national NHS Innovation
Challenge Prizes, where they were highly commended for their work in reducing MSSA bloodstream
infections in children who receive their parenteral nutrition at home. The hard work of the team
reduced the numbers of infections by a third and it is hoped that this example of good practice will
be rolled out across the hospital.
What are we doing to improve?
We believe we can improve even further and will focus in particular in 2013/14 on reducing MSSA as
contaminants in blood cultures.
22
Providing the Safest Possible Care: Medication Incidents
We encourage staff to report every incident, from the most serious to near-misses. At BCH we use a
lot of medicines so there are many opportunities for errors to occur, and medication incidents are
the most frequently reported incident type. We want to see a high number of reported medication
incidents at a low level of harm, as this shows a good safety culture.
Figure 17: Medication Incidents (Harm Category) 2012/13
How have we done?
We have met both goals: 0.94% of all medication incidents caused harm. Zero medication incidents
caused serious harm.
We take every incident seriously and next year we want to see a further reduction in the percentage
of incidents that cause any harm at all.
What are we doing to improve?
We have created detailed easy to read staff guidance on all high risk injectable drugs.
We have developed standardised labels for marking high risk drug infusions.
We have reviewed the ward stock arrangements so that most high risk drugs need to be
specifically ordered from our pharmacy department. This means that the pharmacy staff can
highlight any guidance when issuing the drug.
We will deliver additional training on preparing liquid medication.
We will develop standardised guidelines for each drug which will be reviewed at regular
intervals.
We have introduced the role of Medicines Safety Nurses to act as local educators and
champions of best practice.
We have included additional guidance on good prescribing practice on the junior doctors’
induction.
We have produced dose calculators for a number of intravenous medications to minimise
the chance of making a calculation error.
23
Providing the Safest Possible Care: Acute Life-Threatening Events (ALTEs), Cardiac
Arrests and Respiratory Arrests
Good monitoring on wards
means that we will pick up
deteriorating patients more
quickly and avoid preventable
emergency and lifethreatening events.
How have we done?
During 2012/13 there have been no preventable acute life-threatening events (ALTEs), cardiac
arrests or respiratory arrests. We have therefore reached our goal this year.
Figure 18: Emergency Events 2012/13
What are we doing to improve?
We will continue to review each event to identify any learning that could prevent or help
predict events in the future.
We are developing a pre-transfer checklist for Extracorporeal Life Support (ECLS) to ensure
all monitoring functioning is checked.
24
Providing the Safest Possible Care: Mortality
Thankfully, the number of deaths at BCH is very low relative to the number of patients
we treat and the seriousness and complexity of their illnesses. We review every
individual death to see if there is anything we can learn, and to ensure that no death is
avoidable.
Figure 19: Deaths and deaths per 1,000 admissions 2011/12-2012/13
How have we done?
There were more deaths in 2012/13 than in the previous year but the number of deaths per 1,000
admissions has remained at a very similar level, which suggests this reflects the increased number of
patients that we treated. We also, however, look at a wide range of other information, including
details of every individual death to identify any care failings that may have contributed to the death.
Our reviews have found that no deaths during 2012/13 were avoidable.
What are we doing to improve?
We will continue to monitor mortality rates in a number of different ways to ensure that any
concerns are identified and that we learn from every death in case there was anything we could
have done differently.
In 2013/14 we will also commission independent reviews of our mortality review processes to
ensure they are of the highest quality and to identify any ways that they can be improved.
More information about the way we review mortality can be found at page 44.
25
Providing the Safest Possible Care: WHO Safe Surgery Checklists
Research by the World Health Organisation (WHO) has confirmed that the use of the WHO Safe
Surgery Checklist significantly reduces surgical morbidity and mortality. The checklist should be
completed at three stages of surgery.
Figure 20: Overall WHO Checklist Compliance: March 2011-January 2013
How have we done?
In September 2012 our theatres department implemented an e-checklist to improve compliance and
safety by making completion of all fields a mandatory requirement of the system. Since then overall
compliance has been consistently high.
We will continue to monitor completion of the checklist but if compliance continues to be high, we
will not report on this in our next Quality Account.
26
New Priorities for 2013/14: Extravasation
Why is this a priority? When medicine is given into a vein, it can leak into and damage
the surrounding tissue and cause a potentially serious injury. This can be a particular problem
for children.
What have we been doing? We have developed a Nursing Care Quality Indicator (NCQI) for
cannula care which focuses on accurate observations, dressing changes and observations of early
signs of an injury. We are also reviewing medication involved in extravasation incidents, to identify
whether there are specific associations between the medication used and the likelihood of injury.
Goal Reduce the episodes of harm from extravasation injuries by 25% year on year.
Measure We will use a new process: SCAN (Safe Children Audit – No harm) to monitor the number
of extravasation injuries per month.
New Priorities for 2013/14: Sepsis Care
Why is this a priority?
The rate of mortality from Septic Shock in children is approximately 10%. Survival is
significantly increased if antibiotics are given within an hour of diagnosis (as well as other
treatment such as intra-venous fluids). At BCH we treat many patients who are at high risk of
sepsis, such as oncology patients or those who are immuno-compromised. Our complex
patients sometimes need unusual antibiotics. Sepsis can be difficult to detect so it’s essential we act
quickly as soon as it is detected.
What have we been doing? We have developed a Sepsis Care Pathway bundle which describes
what must be done when a patient has sepsis. This has been piloted in the Emergency Department
and is being implemented on PICU before complete roll-out to other areas in 2013/14.
Goal All patients needing antibiotics as defined by the care pathway should receive them within 1
hour of prescription.
Measure 100% compliance with Sepsis Care Pathway monitored by way of audit.
New Priorities for 2013/14: Friends & Family Test
Why is this a priority? A helpful way for any organisation to measure what the users of
their services think of them is to ask them whether they would promote them to their friends
or family.
What have we been doing? Last year our commissioners asked us to ask this question of all
adults within 18-24 hours of discharge. As all of our patients are under 18, it was important to us to
make sure that their views are recorded too. So with the help of a group of young people we
developed a similar more meaningful question for young people and put this to children and young
people from the age of 10. We have also developed a smart phone app, which people can use to give
us their feedback.
Goal Improvement on the first quartile score.
Measure Number of promoters minus the number of detractors.
27
STATEMENTS OF ASSURANCE ON THE QUALITY OF OUR SERVICES
Review of Services
During 2012/13 Birmingham Children’s Hospital NHS Foundation Trust provided and/or subcontracted 37 NHS services.
Birmingham Children’s Hospital NHS Foundation Trust has reviewed all the data available to them on
the quality of care in all of these NHS services.
The income generated by the NHS services reviewed in 2012/13 represents 100 per cent of the total
income generated from the provision of NHS services by Birmingham Children’s Hospital NHS
Foundation Trust for 2012/13.
On a regular basis, the Board reviews the following data which enables a comprehensive
understanding of the three dimensions of quality – patient safety, clinical effectiveness and patient
experience across every service provided by the Trust:
Quality Report – this report includes details of the following:
Major clinical risks
Incident analysis
Mortality
Serious Incidents
Emergency clinical events
Never Events
Performance against Safety Strategy objectives
Patient Feedback
Quality walkabouts
Formal complaints
PALS concerns
Surveys
Resources Report – in addition to financial performance this report includes the following:
Activity
Performance against our objectives relating to access to our services
Workforce indicators including:
o Rates of appraisals
o Mandatory training attendance
o Sickness rates and analysis
o Turnover
o Use of temporary staff
Consideration of these reports together provides an overview of areas in the Trust where there
might be concerns about the quality of care.
Members of the Board, senior hospital staff, Governors and members of the Young People’s
Advisory Group undertake regular Quality Walkabouts to the wards, where the focus is on either
safety or patient experience. The walkabout involves ward observations and discussions with
members of the ward multi-disciplinary teams, patients and families to identify any safety or patient
28
experience issues or concerns. The outcome of the walkabout is fed back to the ward staff with a
requirement to take action where improvements are necessary.
The Clinical Risk and Quality Assurance Committee has delegated responsibility from the Board for
reviewing risks to safety and quality and identifying and monitoring actions to address these risks
and improve quality. This Committee reports to the Quality Committee which is responsible for
driving the Trust’s quality strategy, bringing the three elements of quality together, allowing
integrated reporting to the Board of Directors.
In 2010/11 we developed a Safety Dashboard, which acts as an early warning system. It allows an
aggregated comparison of safety metrics against each ward and department and incorporates a
series of defined ‘triggers’ which, in combination, may indicate problems with safety or quality in a
specific area. The dashboard approach allows us to really focus on the areas where potential for
harm is the highest. Whenever the dashboard identifies a potential concern a more detailed analysis
is provided for the area in question and this is considered in depth at the Clinical Risk and Quality
Assurance Committee.
Participation in Clinical Audit and National Confidential Enquiries
During 2012/13, 15 national clinical audits and one national confidential enquiry covered NHS
services that Birmingham Children’s Hospital NHS Foundation Trust provides.
During 2012/13 Birmingham Children’s Hospital NHS Foundation Trust participated in 100% of
national clinical audits and 100% national confidential enquiries of the national clinical audits and
national confidential enquiries that it was eligible to participate in.
The national clinical audits and national confidential enquiries that the Trust was eligible to
participate in during 2012/13 are as follows: (see table below).
The national clinical audits and national confidential enquiries that Birmingham Children’s Hospital
NHS Foundation Trust participated in, and for which data collection was completed during 2012/13,
are listed below alongside the number of cases submitted to each audit or enquiry as a percentage
of the number of registered cases required by the terms of that audit or enquiry.
Table 1: National Clinical Audits and National Confidential Enquiries 2012/13 – eligibility, relevance,
participation and percentage cases submitted
NATIONAL CLINICAL AUDITS AND NATIONAL CONFIDENTIAL ENQUIRIES IN WHICH THE TRUST
WAS ELIGIBLE TO PARTICIPATE IN 2012/13
Audit
Relevant
Participation
% Cases
submitted
Paediatric asthma (British Thoracic Society)
Childhood epilepsy (RCPH National Childhood Epilepsy
Audit)
Yes
Yes
Yes
Yes
95%
100%
Fever in children (CEM)
Paediatric intensive care (PICANet)
Paediatric cardiac surgery (NICOR Congenital Heart Disease
Audit)
Diabetes (RCPH National Paediatric Diabetes Audit)
Potential donor audit (NHS Blood & Transplant)
Ulcerative colitis & Crohn’s disease (UK IBD Audit)
Cardiac arrhythmia (Cardiac Rhythm Management Audit)
Yes
Yes
Yes
Yes
Yes
Yes
100%
Ongoing
100%
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
100%
100%
100%
100%
29
Renal replacement therapy (Renal Registry)
Renal transplantation (NHSBT UK Transplant Registry)
Severe trauma (Trauma Audit & Research Network)
Bedside transfusion (National Comparative Audit of Blood
Transfusion)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
100%
100%
100%
100%
National review of Asthma Deaths (NRAD)
Maternal, infant and newborn programme (MBRRACE-UK)*
Mental Health programme: National Confidential Inquiry
into Suicide and Homicide for people with Mental Illness
(NCISH)
Yes
Yes
Yes
Yes
100%
100%
Yes
Yes
100%
The reports of 25 national clinical audits were reviewed by the Trust in 2012/13 and the Trust
intends to take the following actions to improve the quality of healthcare provided:
BTS Paediatric Asthma Audit (2012)
The use of the Asthma/Wheeze care pathway will be audited.
Patients admitted with severe/life threatening exacerbation of asthma will now have a
follow up appointment booked following discharge.
Feedback will be given to the BTS regarding the use of peak flow and length of stay and its
use in the national audit.
Paediatric cardiac surgery (NICOR Congenital Heart Disease Audit) (2012)
Continue to liaise with Heart Suite suppliers to rectify the misplacement of co-morbid data
and the placing of more than one code in a diagnostic or procedure field.
Regularly export the BCH data from the Congenital Database to review the procedures
analysis against the algorithm and locally held data (reverse validation).
All therapeutic implantable devices and electrophysiological procedures in patients with
congenital heart disease will now be submitted to congenital CCAD.
Severe trauma (Trauma Audit & Research Network) (2012)
A Working Group is reviewing rehabilitation services including patient journeys.
Collate data for the region, comparing key metrics between each Major Trauma Centre and
Trauma Unit to inform the ongoing development of trauma networks.
Diabetes(2012)
The diabetes PREM questionnaire has been distributed in the diabetes clinics.
Pain Management (College of Emergency Medicine 2012)
Pain set as a priority for the Emergency Department.
Re-evaluation of scores has improved since the implementation of a reminder stamp at
triage.
The reports of 25 local clinical audits were reviewed by the Trust in 2012/13 and the Trust intends to
take the following actions to improve the quality of healthcare provided:
Tissue Viability - Annual Audit of Pressure Ulcers
The tissue viability assessment tool and wound assessment paperwork will be united into a skin care
bundle.
30
Burns Ward - Assessment and Referral of Burns in ED
More education is planned for staff regarding referral guidelines and the level of detail required
during assessment.
Emergency Department - Left before treatment / Triage
Regular triage training for staff to be arranged.
Clarification of police role to be highlighted to all staff.
New doctors to be made aware of the Left Before Triage guideline as part of their induction
training.
Palliative Care - Clinical audit on advanced care plan for management of cardio-respiratory arrest
in children and young person with advanced malignancy
Ensure all staff are aware of the importance of early palliative discussions and are aware of and are
using the Palliative Care Toolkits.
Ophthalmology - An innovative approach to paediatric fundus photography
Continue to use this method as it has been proven successful. Audit results to be published in
Ophthalmology Journal 2013.
Audiology - Bone anchored hearing aids (BAHA) in very young children
The decision to implant a BAHA in children between the ages of three and five years will continue to
be made on a case by case basis with the inclusion of the family and multidisciplinary team.
Neurology - Guillain Barre syndrome (GBS)
Ensure the departmental guidelines are up to date and accessible. MRI scan to be added to the list
of investigations required for patients with GBS.
Participation in Clinical Research
The number of patients receiving NHS services provided by Birmingham Children’s Hospital NHS
Foundation Trust that were recruited during that period to participate in research by a research
ethics committee was 2,863.
This demonstrates our continued improvement in this area over the last four years as we work
towards our aim that every child and young person treated at the hospital is either offered
participation in a research project or is aware that research is a major driver to our desire to deliver
the best and safest clinical care in the country.
Figure 21: Numbers of patients recruited to participate in research 2009/10-2012/13
31
One of our strategic objectives is to strengthen Birmingham Children’s Hospital’s position as a
provider of specialised and highly specialised services, so that we become the leading provider of
Children’s Healthcare in the UK. To help us achieve this, we are implementing a Research &
Development Strategy towards becoming a leader in paediatric clinical research.
Clinical research is important as it helps us to understand conditions and improve and discover new
treatments, resulting in improved quality of care for patients.
A good way of finding out how well we are doing on clinical research is to monitor the number of
peer reviewed research publications - excluding abstracts and letters - that we deliver each year.
When a research publication is reviewed by other professionals, or ‘peers’, this ensures that it is of a
high enough standard to be used to help develop treatments for patients. Another important
indicator of research quality is the impact factor of the journals in which the research is published,
which reflects the number of times the journal is cited by other researchers and the number of
citations of particular publications over a period of time.
Figure 22: Peer Reviewed Publications per year 2008/09-2012/13
Use of the CQUIN Framework
A proportion of Birmingham Children’s Hospital NHS Foundation Trust’s income in 2012/13 was
conditional upon achieving quality improvement and innovation goals agreed between Birmingham
Children’s Hospital NHS Foundation Trust and any person or body they entered into a contract,
agreement or arrangement with for the provision of NHS services, through the Commissioning for
Quality and Innovation (CQUIN) payment framework. The exception to this is the Quality
Improvement Development Innovation Scheme (QIDIS) used by the National Specialised
Commissioning Team to support Trusts to improve the quality of care and clinical outcomes for
nationally designated services, replacing CQUIN arrangements for those services.
Further details of the agreed goals for 2012/13 and for the following 12 month period are available
online at: https://commissioning.supply2health.nhs.uk/eContracts/Documents/cquin-guidance.pdf
32
Table 2: Schemes agreed for Quality Improvement and Innovation 2012/13
Goal Weight Value
Total
Value
End of year
performance
£179,659
1
5%
£92,320
£271,979
Targets met
10%
£179,659
7
5%
£92,320
£271,979
Targets met
3A
4%
£71,863
8a
1%
£23,080
£94,944
Targets met
Friends & Family Test – Board
Minutes
3B
4%
£71,863
8b
1%
£23,080
£94,944
Targets met
Friends & Family Test - Weekly
Reporting
3C
4%
£71,863
8c
1%
£23,080
£94,944
Targets met
Friends & Family Test Performance Improvement
3D
4%
£71,863
8d
1%
£23,080
£94,944
Targets met
Net Promoter - Paediatric Specific 4
16%
£287,454
9
5%
£92,320
£379,774
Targets met
Healthy Lifestyles - Smoking
5A
8%
£143,727
£143,727
Targets met
Healthy Lifestyles - Alcohol
5B
6%
£114,981
£114,981
Targets met
Healthy Lifestyles - Making Every
Contact Count
5C
2%
£28,745
£28,745
Targets met
CAMHS QNCC
6
16%
£287,454
£287,454
Targets met
Antimicrobial Stewardship
7
16%
£287,454
£287,454
Targets met
CQUIN Goal Name
WM PCT Cluster
WMSCT
Goal Weight Value
Safety Thermometer - National
1
10%
Safety Thermometer - Paediatric
Specific
2
Friends & Family Test - Regional
Implementation of clinical
dashboards for specialised
services
2
10%
£184,641
£184,641
Targets met
(PIC) To minimise the number of
patients undergoing unplanned
extubation.
3
10%
£184,641
£184,641
Targets met
CAMHS Tier 4: Education, training
and meaningful activity
4
5%
£92,320
£92,320
Targets met
CAMHS Tier4: Patient Involvement
in Recruitment
5
5%
£92,320
£92,320
Targets met
CAMHS Tier4: Feasibility study for
conversion to single room
accommodation
6
5%
£92,320
£92,320
Targets met
Local CQUIN: Enhancing HDU
10
25%
£461,602
£461,602
Targets met
Local CQUIN: CNS Pathway
11
20%
£369,282
£369,282
Targets met
100%
£1,846,409 £3,642,994
Planned CQUIN income
100%
£1,796,585
Other Commissioners
£276,508
Total Planned CQUIN income
£3,919,502
33
The monetary total for the amount of income conditional upon achieving CQUIN goals in 2012/13
and the monetary total for the associated payment in 2011/12 is detailed below:
Table 3: CQUIN income data 2011/12 and 2012/13
Percentage of income conditional upon achieving goals
(total value £3.92m)
Income not achieved
2011/12
1.5%
2012/13
2.5%
0
0
Table 4: Schemes agreed for Quality Improvement Development Innovation Scheme (QIDIS) 2012/13
Service
Nature of Scheme
Contract
Value
Alstrom Syndrome
Dashboard Scheme 10% / PPE Scheme 20% / No
Strategic Schemes
109,842
824
30%
Bardet Biedl Syndrome
(Children)
Dashboard Scheme 10% / PPE Scheme 20% / Strategic
Schemes 70%
193,017
4,826
100%
Complex Childhood
Osteogenesis Imperfecta
Dashboard Scheme 10% / PPE Scheme 20% / Strategic
Schemes 70%
712,399
17,810
100%
Craniofacial Surgery For
Congenital Conditions
Dashboard Scheme 10% / PPE Scheme 20% / Strategic
Schemes 70%
2,030,299
50,757
100%
Epidermolysis Bullosa
Dashboard Scheme 10% / PPE Scheme 20% / Strategic
Schemes 70%
559,367
13,984
100%
ECMO For Reversible
Respiratory Failure (Children)
No schemes as cost per case and not eligible for QIDIS
payments
273,845
-
0%
Liver Transplantation
(Children)
Dashboard Scheme 10% / PPE Scheme 20% / Strategic
Schemes 70%
3,740,250
93,506
100%
Lysosomal Storage Disorders
(Children)
Dashboard Scheme 10% / PPE Scheme 20% / Strategic
Schemes 70%
428,579
10,714
100%
Retinoblastoma
Dashboard Scheme 10% / no PPE Scheme / Strategic
Schemes 35%
1,207,673
13,586
45%
Small Bowel Transplantation
(Children)
Dashboard Scheme 10% / no PPE Scheme / no
Strategic Scheme
1,215,533
3,039
10%
Specialist Paediatric Liver
Disease
Dashboard Scheme 10% / PPE Scheme 20% / Strategic
Schemes 70%
2,845,056
71,126
100%
Wolfram Syndrome
Dashboard Scheme 10% / PPE Scheme 20% / no
Strategic Scheme
160,048
1,200
30%
13,475,908 281,372
84%
Total
Liver Transplantation
(Children)
Income deferred to 2013/14 to cover costs not yet
incurred
Net Total
QIDIS QIDIS %
Value (of 2.5%)
-54,000
227,372
Care Quality Commission
Birmingham Children’s Hospital NHS Foundation Trust is required to register with the Care Quality
Commission (CQC) and its current registration status is:
Registered to carry out the following legally regulated services:
34
Transport services, triage and medical advice provided remotely
Treatment of disease, disorder or injury
Assessment or medical treatment for persons detained under the Mental Health Act 1983
Surgical procedures
Diagnostic and screening procedures
Management of supply of blood and blood derived products
The Care Quality Commission has not taken enforcement action against Birmingham Children’s
Hospital NHS Foundation Trust during 2012/13.
Birmingham Children’s Hospital NHS Foundation Trust has not participated in special reviews or
investigations by the Care Quality Commission during 2012/13:
On 6 November 2012 the CQC undertook a routine, unannounced inspection of CAMHS at our
Parkview Clinic, to assess compliance with the following standards:
04: Care and welfare of people who use services
06: Cooperating with other providers
07: Safeguarding people who use services from abuse
13: Staffing
The CQC found that the services at Parkview met all these standards.
On 21 November 2012 the CQC undertook a routine, unannounced inspection of the Trust’s services
at our main site at Steelhouse Lane, to assess compliance with the following standards:
04: Care and welfare of people who use services
09: Management of medicines
11: Safety, availability and suitability of equipment
14: Supporting workers
The CQC found that the services at Steelhouse Lane were compliant with the first three of these
standards, but found that action was needed to ensure compliance with standard 14: Supporting
workers. The evidence CQC collected in theatres identified some minor concerns about the risks
relating to how staff were supported in this area. CQC issued a compliance action to ensure that
improvements to support staff are made. We have taken the following actions to ensure we are now
compliant with this standard:
Recruited to vacant posts in theatres;
Changed and improved the way we were implementing our Integrated Theatre Recovery
Team Project;
Strengthened, developed, and added to arrangements for supporting and engaging with
staff in theatres.
Data Quality
Birmingham Children’s Hospital NHS Foundation Trust submitted records during 2012/13 to the
Secondary Uses service for inclusion in the Hospital Episode Statistics which are included in the latest
published data.
The percentage of records in the published data which included the patient's valid NHS Number was:
35
98.6% for admitted patient care;
99.5% for outpatient care; and
98.3% for accident and emergency care
The percentage of records in the published data which included the patient's valid General
Practitioner Registration Code was:
100% for admitted patient care;
100% for outpatient care; and
100% for accident and emergency care
Birmingham Children’s Hospital NHS Foundation Trust’s Information Governance Assessment Report
overall score for 2012/13 was 82% and was graded green (satisfactory).
Birmingham Children’s Hospital NHS Foundation Trust will be taking the following actions to improve
data quality:
Having made significant improvements against the data quality items published centrally we
are now progressing to developing further local data quality indicators. These will include
looking at timeliness of data capture;
We have expanded our Data Quality Group and will use this forum to push forward the data
quality agenda.
Birmingham Children’s Hospital NHS Foundation Trust was subject to the Payment by Results clinical
coding audit during the reporting period by the Audit Commission and the error rates reported in
the latest published audit for that period for diagnoses, treatment and investigation coding (clinical
coding) were:
Diagnosis:
N/A (not part of the 2012/13 audit)
Treatment (procedure):
10.3%
Investigations:
10.4%
150 cases were reviewed within the sample.
Note: the results should not be extrapolated further than the actual sample audited.
Core National Indicators
Due to the time it takes central bodies to collate and publish some of the data, sometimes
comparative figures are not available at all (N/A). It should also be appreciated that some of the
‘Highest’ and ‘Lowest’ performing Trusts on some of the data may not be directly comparable to
Birmingham Children’s Hospital.
There are several core national indicators that are not applicable to Birmingham Children’s Hospital,
because they relate to adult patients/services only, or due to the specialist nature of many of our
services. These indicators include:
Summary Hospital-level Mortality Indicator (SHMI) – though we do provide details of a
different mortality indicator at page 113 which compares our mortality rates with those of a
range of other children’s services;
36
The percentage of patient deaths with palliative care;
The percentage of patients on Care Programme Approach who were followed up within 7
days after discharge from psychiatric in-patient care;
The percentage of admissions to acute wards for which the Crisis Resolution Home
Treatment Team acted as a gatekeeper during the reporting period;
Patient reported outcome measures scores;
The Trust’s responsiveness to the personal needs of its patients;
Patient experience of community mental health services;
The percentage of patients who were admitted to hospital and who were risk assessed for
venous thromboembolism.
Hospital Readmissions: The percentage of patients readmitted to Birmingham Children’s Hospital
within 28 days of being discharged in 2012/13
AGE
2011/12
2012/13
National Average
0 to 14
Highest Trust
Lowest Trust
N/A
15 or over
AGE
2010/11
2011/12
2012/13
National Average
2010/11
0-15
11.14%
10.0%
9.97%
10.15%
16 or over
9.9%
11.0%
7.7%
11.42%
Highest Trust
Lowest Trust
N/A
Birmingham Children’s Hospital NHS Foundation Trust considers that these percentages are as
described for the following reasons:
Between 2010/11 and 2012/13 we undertook a monthly audit including a detailed review of every
emergency readmission and reported this to our commissioners. There have been no concerns with
the discharge decision in any of the cases.
Birmingham Children’s Hospital NHS Foundation Trust intends to take the following actions to
improve these percentages, and so the quality of its services, by:
We will continue to regularly monitor emergency readmissions to identify any concerns.
Staff Survey: Percentage of staff who would recommend the Trust to family or friends
2011
2012
2012 Average Acute Trust
85%
83%
87%
Birmingham Children’s Hospital NHS Foundation Trust considers that this percentage is as described
for the following reasons:
We acknowledge that the result is slightly below the national average and that this has remained
consistent over the last few years.
Birmingham Children’s Hospital NHS Foundation Trust intends to take the following actions to
improve this percentage, and so the quality of its services, by:
We are taking steps to improve the way we support and engage with staff and act on their views and
concerns. Central to these plans in 2013/14 is our approach to responding to the Francis report.
From March 2013 we have been holding listening events with staff, which over 250 staff members
have attended so far. Staff at these events are encouraged to be completely open, demonstrating
37
their commitment to our values – courage, trust, respect, commitment and compassion. The
listening events will culminate in a week of events in September when we will focus on actions to
address the issues that have been raised.
Our Quality Walkabouts now also include a focus on staff health and wellbeing.
We have put in place a process by which anonymous email contact can be made direct to the Chief
Executive Officer to raise any concerns or to provide views.
We have also put in place processes to ensure we listen to and act upon the concerns of specific
staff groups, for example, our Trainee Advice & Liaison Service (TALS) and Safety Hotline for junior
doctors.
During 2013/14 we will be regularly undertaking a staff poll, asking them whether they would
recommend the Trust as a place to be treated to friends and family, so that we can monitor this
more regularly during the year and act on any poor results more quickly. The percentage of positive
responses to this question has risen during the early part of the year to 98%.
C.difficile: rate per 100,000 bed days of cases of C.difficile infection reported within the Trust
amongst patients aged 2 or over
2011/12
2011/12 National
Average
2011/12 highest
Trust
2011/12 Lowest
Trust
1.9
21.8
50.9
0.0
Birmingham Children’s Hospital NHS Foundation Trust considers that this rate is as described for the
following reasons:
There was one case of C.Difficile at the Trust in 2011/12.
Birmingham Children’s Hospital NHS Foundation Trust intends to take/has taken the following
actions to improve this rate, and so the quality of its services, by:
Actions we are taking to minimise the risk of C.Difficile are described at page 89.
Patient Safety Incidents: the number and rate of patient safety incidents reported, and the
number and percentage of such patient safety incidents that resulted in severe harm or death
This year is the first time that this indicator has been required to be included within the Quality
Report alongside comparative data provided, where possible, from the Health and Social Care
Information Centre. The National Reporting and Learning Service (NRLS) was established in 2003.
The system enables patient safety incident reports to be submitted to a national database on a
voluntary basis designed to promote learning. It is mandatory for NHS trusts in England to report all
serious patient safety incidents to the Care Quality Commission as part of the Care Quality
Commission registration process. To avoid duplication of reporting, all incidents resulting in death or
severe harm should be reported to the NRLS who then report them to the Care Quality Commission.
Although it is not mandatory, it is common practice for NHS Trusts to reports patient safety incidents
under the NRLS’s voluntary arrangements.
As there is not a nationally established and regulated approach to reporting and categorising patient
safety incidents, different trusts may choose to apply different approaches and guidance to
reporting, categorisation and validation of patient safety incidents. The approach taken to
determine the classification of each incident, such as those ‘resulting in severe harm or death’, will
38
often rely on clinical judgement. This judgement may, acceptably, differ between professionals. In
addition, the classification of the impact of an incident may be subject to a potentially lengthy
investigation which may result in the classification being changed. This change may not be reported
externally and the data held by a trust may not be the same as that held by the NRLS. Therefore, it
may be difficult to explain the differences between the data reported by the Trusts as this may not
be comparable.
Oct 2011-March 2012
BCH
Number of patient safety
incidents (acute specialist)
Rate of patient safety
incidents per 100 patient
admissions (acute specialist)
Percentage of such patient
safety incidents that resulted
in severe harm or death
(small acute)
Oct 2011-March 2012
Highest Trust
Oct 2011-March 2012
Lowest trust
1,370
1,935
66
7.77
12.03
3.36
0.36%
2.36%
0.00%
Birmingham Children’s Hospital NHS Foundation Trust considers that this number and/or rate is as
described for the following reasons:
We are pleased to note the high number of reported incidents and the low percentage of these that
resulted in severe harm or death compared with the national average, as this indicates an open
safety culture.
Birmingham Children’s Hospital NHS Foundation Trust intends to take/has taken the following
actions to improve this number and/or rate, and so the quality of its services, by:
Actions we are taking to monitor and improve our safety culture are described on page 111;
We investigate and learn from every incident;
We take actions to address safety issues identified through safety monitoring and analysis;
Safety themes identified through incident analysis are addressed through safety targets as
part of our Safety Strategy – for example, extravasation injuries and medication incidents.
39
Other information
Linking our Priorities to the Priorities of the NHS
QUALITY
STRAND
QUALITY DOMAIN
(NHS OUTCOMES FRAMEWORK)
Effectiveness
Preventing people from dying
prematurely
Enhancing quality of life for
people with long-term
conditions
Safety
Patient
Experience
Helping people to recover
from episodes of ill health or
following injury
Ensuring that people have a
positive experience of care
Treating and caring for people
in a safe environment; and
protecting them from
avoidable harm
BCH QUALITY INDICATOR
Nursing Care Quality Indicators
Asthma Care
Health Promotion
Implementing the Sepsis Care Bundle
Food & nutrition
Nursing Care Quality Indicators
Asthma Care
Health Promotion
Food & nutrition
Nursing Care Quality Indicators
Health Promotion
CAMH Service User satisfaction
Implementing the Sepsis Care Bundle
Food & nutrition
Play & activities
Emergency department transfers
Tertiary inpatient referrals
Cancelled operations
Friends & Family Test
Pressure ulcers
Reducing Healthcare Acquired Infections in PICU
Reducing rates of C.Difficile
Preventing MRSA
Reducing MRSA
Medication Incidents
Acute life threatening events, Cardiac Arrests and
Respiratory Arrests
Zero avoidable deaths
WHO Safe Surgery checklists
Extravasation injuries
Overview of Quality of Care
Complaints
We take all complaints about our services very seriously and ensure that the way we respond is
tailored to the individual and that we answer all of their concerns. Our Chief Executive is involved in
every response and writes personally to each individual. Responding to a complaint can include
meetings with clinical staff and senior managers, including the Chief Executive.
Formal complaints often originate in a concern raised with PALS (Patient Advice and Liaison Service)
which supports families in obtaining the response they need in the best way for them. We
encourage people to use our Formal Complaints service and PALS as, if something has gone wrong
we want to know about it so we can try to put it right, learn from it and improve. This information,
when combined with other quality information about our services, can also help us identify when
there are other problems.
40
Fortunately, compared to the numbers of patients we see every day, we receive very few formal
complaints. Each one is considered in detail and incorporated into our Safety Dashboard and our
Quality Report.
Figure 23: Numbers of formal complaints per month/per 1,000 admissions (This data is governed by local
definitions)
15
Complaints
10
Complaints per
1000 Admissions
5
0
In order to see whether there are any themes amongst the complaints we receive, we group the
issues raised in each complaint into categories. The pattern of complaints received about the 5 main
categories is set out below.
Figure 24: Pattern of complaints per top 5 categories, 2010/11-2012/13 admissions (This data is governed by
local definitions)
30
25
Waiting, delays & cancellations
20
Staff Attitude
15
Quality of Treatment
10
Communication
5
0
Other
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
1011 1112 1112 1112 1112 1213 1213 1213 1213
As part of the formal complaints investigation process, we identify any areas in which the quality of
the services could be improved, and make appropriate recommendations. These range from
reminders to staff about proper practices and behaviour, to fundamental changes in practice and
documentation. We regularly follow up on these recommendations to make sure action has been
taken.
As a result of these recommendations a number of changes have been made, including:
Radiology: An area has been identified where families can discuss issues
privately;
Surgical Day Care: To avoid any discrepancy in recording weight and therefore
incorrect calculation of medication, the same member of staff who checks a
child’s weight now also writes the weight on the drug chart;
Communication processes between Radiology and Rheumatology secretaries
about appointments have been improved;
Heart Investigations Unit: A test results tracking process has been introduced;
41
All wards: The handover process has been improved to ensure speciality
patients on outlying wards are more clearly identified;
All clinical areas: A new discharge form has been designed to prevent failure to
follow-up;
The Breast-feeding training programme has been re-launched;
Learning Disabilities: increased awareness has been raised amongst staff about
the importance of the Trust Learning Disabilities Passport and care pathways;
The experience of a family will be used as a learning example for doctors in
training.
In January 2013 the Patient Association published a report: Complaint handling in NHS Trusts signed
up to the CARE campaign, which is based on information about the complaint handling systems and
processes of a random sample of trusts. Birmingham Children’s Hospital was one of the randomly
selected trusts and is included anonymously within the report. The Patients Association wrote to us
and gave us some positive feedback about what they have seen of our systems and processes, in
particular they said: “Birmingham Children’s Hospital appears committed to being a learning
organisation. An example of this is your unique approach of measuring complaints against Trust
values within the Quality Report”.
Incidents
We have robust systems for managing incidents and in 2011/12 were awarded NHSLA level 3, the
highest level for compliance with the NHS Litigation Authority Risk Management Standards. In 2012
we carried out a ‘Lean’ process on our investigation management system to ensure it is as efficient
as it can be. This means investigations can now be concluded more quickly, which is better for the
patients and families involved and allows us to start implementing learning from the incident earlier
than we previously could.
In 2013 our Internal Auditors gave an opinion of ‘significant assurance’ about our incident
management processes.
We encourage all members of staff to report all incidents, errors and near misses so we can make
improvements, work out what went wrong, identify themes and drive quality improvements in
everything we do. We share learning from incidents through our Safety Circular, a staff publication
which provides news on safety issues and changes made as a result of incidents and incident
analysis. Our Quality Report - which is published on our website - also includes information about
incidents, which any member of staff or the public can read.
Some of the major changes we have made as a result of learning from incidents and incident analysis
include:
Development of a sepsis care pathway;
Development of new techniques for weighing patients on PICU to allow us to manage
their nutritional status more effectively;
New guidance documents to allow more effective checking of medication in theatres
when it is prepared by anaesthetists;
Revised training approach and new training package for cannula care to minimise the
risk from extravasation.
42
We monitor the numbers of patient safety incidents and the proportion of those which involve
harm. The high levels of incidents involving low or no harm and the very low proportion of incidents
that involve more than minor harm provide assurance that we have a good safety culture.
Figure 25: Patient Safety Incidents by harm 2011/12-2012/13
Patient Safety Incidents by Harm Category 2011/12-2012/13
Year
Total
Incidents
No Harm
Minor, Non
Permanent Harm
Moderate, Semi
Permanent Harm
Severe, Severe
Permanent Harm
Catastrophic,
Death
2011/12
2012/13
4198
4188
<80%
76.34%
<19%
22.21%
>1%
1.0%
<1%
0.05%
<1%
0.4%
The following will help us ensure we sustain and improve this positive position:
We carry out an annual safety culture survey of all our clinical staff
We carry out regular audits of incident reports to identify any staff groups, wards or
departments that may not be reporting all incidents.
A lower than expected number of reported incidents is one of the measures we use to
identify possible issues on wards or departments through our Safety Dashboard.
We have set up a Safety Hotline which trainee doctors can use to report any safety concerns
and obtain advice.
We have set up an advice service specifically for trainee doctors (Trainee Advice and Liaison
Service – TALS), which mirrors the processes of our Patient Advice and Liaison Service
(PALS).
We will introduce a facility which allows staff to report an incident direct into our online
incident reporting system via a mobile phone.
Implementation of actions arising from reviews of incidents is robustly monitored.
Incidents are analysed to identify themes and significant safety issues.
Our Safety Strategy is updated annually with new safety goals that address issues
highlighted by single incidents and analysis of incidents.
43
Progress against the Safety Strategy goals is monitored by a quarterly report.
Never Events
Never Events are very serious, largely preventable patient safety incidents that should not occur if
the relevant preventative measures have been put in place. There are 25 defined Never Events, 4 of
which are not relevant to BCH due to the services we provide. We have developed processes to
prevent these Never Events happening.
In 2012/13 no Never Events were declared at Birmingham Children’s Hospital.
Mortality
Data about mortality can be presented in a number of ways. By monitoring all the data we can
obtain an overall picture. At page 94 we report the number of inpatient deaths and the number per
1,000 admissions (a simple calculation to overcome any variations in admission numbers over time).
This data helps us compare data over time, but is less helpful in comparing hospitals with each other,
as some hospitals treat different types of patients with very different types and complexities of
illness.
In order to account for this the Standardised Mortality Ratio (SMR) has been developed. This is the
ratio of the actual number of deaths in a hospital within a given time period, to the number that
might be expected if the hospital had the same death rates as a larger reference population. If we
remain in the green section of the graph in figure 26 this indicates that our mortality rates are within
acceptable ranges. If we move into the red section this is a warning of possible concerns which must
be investigated. The graph for February 2013 in figure 26 shows that we remained in the green
section, as we did throughout 2012/13. There was an increase in the number of deaths in March
2013, however, so we have commissioned an independent review to make sure we are not missing
anything.
We also monitor rates of mortality in the PICU and in cardiac and liver services. All this data is
reported in our monthly Quality Report to the Board and is examined closely to see if there are any
concerns. The Board also sees the most important information - a summary of the circumstances
leading to the death of every patient that dies at BCH.
Figure 26: SMR Funnel Plot February 2013
44
Patient Feedback
Listening to what our children, young people and their families tell us about their experiences at BCH
and their views about our services is vital in making sure we continue good practice, and make
changes where improvements are needed.
It is really important that we gather this feedback in lots of different ways so we can make sure we
are taking account of everyone’s views. We call this our Patient Experience Toolbox, and we load all
the information we obtain into our Patient Experience Database which helps us identify themes or
areas that need closer attention. It also helps us make sure that we can let our staff know when we
receive really good feedback.
The toolbox includes patient surveys, quality walkabouts, patient stories, mystery shoppers, focus
groups, feedback cards and direct feedback like letters and comments. Combining this with
information about patient experience from other sources – such as PALS contacts and formal
complaints - provides an overall picture of individual wards and departments and of the whole Trust.
It also helps us see what we do well and identify areas for improvement. As a result of this work we
have set new quality objectives and made service improvements in areas like food, play,
communication, environment and patient information.
As well as looking at what we need to improve, it is also important to look at what patients and their
families tell us we do well. This provides vital learning about how we can improve other areas, and it
is important to take this into account when we are thinking about changing something. Sharing
positive feedback with staff about the work that they do also supports and motivates them to
deliver the highest quality of care that they can.
What are people talking about? This Word Cloud demonstrates by their size the most frequently
used words in all the patient feedback we received in 2012/13. The larger the word, the more
frequently it has been used.
45
Examples of patient feedback
We have spent
over £100 in car
parking which
has had a huge
impact on our
Christmas.
Too many
questions get
asked on
admission. We
should get a day
Very long wait.
or
None of the vending two to settle in.
machines worked
making the stay
even more
unbearable. Waiting
times should be
clearly published.
Caring and
understanding nature of
the nurses was amazing.
Very supportive. Cannot
put into words what it
meant to have this
service so that we could
be at home at Christmas.
(Hospital @Home)
I think that you
need to make
more rooms
for people to
get checked
quicker.
Friendly and helpful,
answered all my
questions even though I
was nervous.
Transfer on to theatre
trolley in corridor slightly
embarrassing even
though staff did their best
to maintain my dignity,
not much space.
Could not fault
the whole stay,
everyone so
helpful, kind &
friendly. We felt a
little sad to leave.
Pain relief monitoring
could be improved
and planned better
when coming to
move a child around
after operations for
the first time.
When I first came to
Parkview I hated it. I
missed my family and
friends. When I left
Parkview, I felt as if I was
leaving behind my family.
The staff are amazing. If it
wasn't for the staff at
Parkview, I wouldn't be
alive today.
An 8 year old girl
To ensure better
communication links were
put into place between
surgeons, specialists, social
services and other services
that the OT dept have to
liaise with on a daily basis,
that will allow a better and
smoother transition
between hospital and
home.
Didn't treat me
like a little kid.
Explained to me
so I understood
and it gave me
confidence.
Your theatre
environment is
brilliant, less
traumatic. You
made us feel at
ease and were
always available to
answer questions.
Thank you for the
fantastic care and
support we received
from the whole
cardiac team.....from
housekeepers on the
ward to surgeons in
theatre were
outstanding.
commented during
her EEG that she was
happy and enjoying
her test, she said
'this test is good, I
am not scared at
all'.
A big thank you to all the
A&E staff on Thursday who
looked after my daughter
who was brought in
wheezing. They were all
very caring and she was
constantly monitored by
the team. They were very
busy but still able to give
her excellent care.
Whenever my
daughter was
scared there
was always
someone that
made her feel
better.
46
Patient Information
The Family Health Information Centre provides a free and confidential health information service for
our children, young people and their families, and support for staff in the production of quality
patient information.
In direct response to feedback from our patients and families - who told us they would like to access
information without leaving the ward - we have looked at new ways of making sure they are able to
access the information they need at the right time along their patient journey. In 2012/13 we piloted
weekly drop-in health information sessions on wards and in the Parent Accommodation, and weekly
health information and awareness sessions in the main Outpatients department. In 2013/14 we will
continue to look for new ways to improve the information service to improve the quality of the
patient experience.
Performance against National Priorities
Table 5: Performance against National priorities 2012/13
National Priority
Target
Performance 2012/13
C-Diff
3 cases or less per year - locally
agreed threshold
2 cases or less per year - locally
agreed threshold
Pre 48 hours
Post 48 hours - 10% reduction
Pre 48 hours
Post 48 hours
Surgery (94%)
Target met – 1 case
Anti cancer drug treatments (98%)
Target met
Radiotherapy (94%)
Target met
From GP referral to treatment (85%)
Target met
Target met
18.3 weeks (as of April
2011)
From consultant screening service
referral (90%)
Referral to treatment waiting times non admitted (95th percentile)
23 weeks (as of April
2011)
Referral to treatment waiting times admitted (95th percentile)
Target met
MRSA
MSSA
E.Coli
All cancers; 31 day wait
for second or subsequent
treatments
All cancers: 62 day wait
for first treatment
Target met – no cases
Monitoring only (but reduced)
Target not met
Monitoring only
Monitoring only
Target met
Target met
All cancers: 31 day wait from diagnosis to first treatment (96%)
All cancers: two week wait from referral to date first seen (93%)
Target met
Target met
Total time in A&E
Target met
18 weeks
Ambulance Turnaround
95% of patients time taken from
arrival to discharge/admission < 4
hours.
90% admitted patients at the end of
each month
95% non admitted patients at the
end of each month
Number over 60 minutes
Target met
Target met
Monitoring only
47
% over 60 minutes
Monitoring only
Number over 30 minutes
Monitoring only
% over 30 minutes
Monitoring only
Operations cancelled on
the day by the hospital
Cancelled operations and
those not admitted within
28 days
Single Sex
Accommodation Breaches
<=0.8% each quarter across the year
Target not met (1.68% full year)
Readmit >95% of those patients we
cancel within 28 days
Target met
0 breaches
Target not met – 2 breaches
Emergency Readmissions
Emergency readmissions within 28
days of discharge from hospital as a
% of all relevant admissions.
Monitoring only:
Age 0-15: 9.97%
Age 16+: 7.7%
Targets Not Met
Single Sex Accommodation Breaches
During 2012/13 we reported two single sex accommodation breaches. In both cases there was
insufficient space for a short period on our Teenage Cancer Trust ward. We discussed this with the
young people involved and offered them single sex accommodation on another ward. Both young
people opted to stay on the ward as their preference was to remain with other people of their age
group.
As part of the planned redesign of our Oncology Unit we will incorporate more single rooms which
will mean this is less likely to happen.
We continue to ask all our children and young people when they are admitted whether they would
prefer single sex accommodation, and in 2012/13 we were able to meet everyone’s wishes except in
the two cases described above. The feedback we have from the majority of children and young
people is that their priority is to be treated with people of a similar age, rather than the same
gender.
Cancelled Operations
Please see page 11 for details.
MSSA
Please see page 22 for details.
48
STATEMENTS FROM STAKEHOLDERS
Commissioners
Birmingham South Central Clinical Commissioning Group (BSC CCG) as coordinating commissioner
for Birmingham Children’s Hospital NHS Foundation Trust (BCH) welcomes the opportunity to
provide this statement for their 2012/13 Quality Account.
A draft copy of the Quality Account was received by BSC CCG on the 22nd April 2013 and the
statement has been developed from the information presented to date. Feedback on the draft
account has been received from Birmingham Cross City CCG, Solihull CCG and NHS England Area
Team as the lead for specialised commissioning.
We have reviewed the content of the Quality Account and confirm that this complies with the
prescribed information, form and content as set out by Monitor and the Department of Health.
This is a comprehensive report that clearly demonstrates progress within the Trust. It identifies
where the organisation has done well, where further improvement is required and what actions are
needed to achieve these goals. The Quality Account sets out the priorities for improving patient
safety, patient experience and clinical effectiveness in 2013/14 across services provided by BCH.
The information provided within this Account presents a balanced report of the quality of healthcare
services BCH provides and is, to the best of our knowledge accurate and fairly interpreted. The range
of services described and priorities for improvement are representative based on the information
that is available to us. We agree with and support the priorities set for this year.
BCH places significant emphasis on its safety agenda, with an open and transparent culture, and this
is reflected throughout the account with work continuing on the development of the safety
dashboard and further implementation of the paediatric version of the safety thermometer (Safety
SCAN). A review of the incident investigation management system to allow earlier implementation
of learning and evidence of changes that have been made as a result of this learning reinforces the
priority the Trust is placing on implementing further quality improvements during 2013/14.
BCH continue to develop innovative ways to capture the experience of patients and their families in
order to drive improvements in the quality of care. Further development and implementation of the
feedback App and the Children and Young Person’s version of the Friends and Family Test are just
two examples of initiatives designed to ensure that users of the service are listened to and issues
addressed can be continually monitored and acted on.
Cancelled Operations continues to be a challenge for the Trust and we will continue to work with
and support BCH to review the effectiveness of the range of interventions currently being
implemented to improve the current position. As part of this work BCH remain focused on the
impact on children and families when operations are cancelled and improving the patient
experience.
The Quality Account reflects a number of the performance quality indicators which are monitored
monthly along with areas for improvement at the CCG / Trust Clinical Quality Review Group
mandated by the service contract. We are also invited to the Trust’s Clinical Risk and Assurance
Committee and any Root Cause Analysis meetings following occurrence of serious incidents.
49
We have made some specific comments to the Trust directly in relation to their plan. Namely, we
would like further information regarding outcomes and levels of improvement they are working
towards, the specific actions being taken to address capacity issues, further narrative and detail to
support analysis of the mortality data, inclusion of an assurance statement on Equality and Diversity
and Safeguarding and alignment of their priorities to the five domains of the NHS Outcomes
Framework.
Through this Quality Account and ongoing quality assurance process, BCH clearly demonstrate their
commitment to improving the quality of care and services delivered for children, young people and
families.
We look forward to continuing to work with and support the Trust in delivering this year’s quality
targets within the Quality Account.
Dr Raj Ramachandram
Chair – Birmingham South Central Clinical Commissioning Group Quality and Safety Committee
Birmingham Health Overview and Scrutiny Committee
Birmingham Health Overview and Scrutiny Committee have declined on this occasion to provide
comments on our draft Quality Account 2012/13.
Healthwatch Birmingham
We sent our draft Quality Account 2012/13 to Healthwatch Birmingham for information. As a newly
established organisation they were not able to provide comments this year.
Council of Governors
The Council of Governors welcomes the opportunity to comment on Birmingham Children’s Hospital
NHS Foundation Trust’s Quality Account 2012/13.
The Quality Account is an excellent demonstration of the commitment of the Board of Directors to
continual quality improvement.
The content of the Quality Account reflects well the matters presented to the Council of Governors
by the Board of Directors and the experience of the Governors in attending Quality Walkabouts to
the Trust’s wards and departments.
The Account provides a well balanced overview of safety, patient experience and clinical
effectiveness and brings the patient experience to life through direct examples of patient and family
feedback, including feedback about areas where the Trust needs to improve. We would welcome
more of the patient voice in next year’s Account.
We are impressed by the achievements described within the report and the Trust’s clear ambition to
go beyond these achievements in the delivery of high quality care and excellent patient experience.
This is demonstrated by the Trust’s innovations, such as the DG suit which replaces backless hospital
gowns, the MAPLE food ordering system and the patient feedback app.
The report is open and transparent, making it clear when the Trust has not met its objectives,
explaining why this is the case and, most importantly, what is being done to improve the situation.
This open culture reflects the experience of Governors at Council meetings where members of the
Board welcome questions, respond positively to challenge and rapidly address issues to a successful
50
conclusion. We also acknowledge and welcome the external scrutiny by the CQC in helping the Trust
identify areas that can be improved.
We endorse the approach of the Board to listening and responding to the concerns and views of
patients, families and staff, which is apparent within the Account. A good example of this approach
is the process adopted to respond to the recent Francis report, which is centred on listening events
with staff. These listening events are part of a wider appraisal of the culture of the organisation as a
whole. This appraisal reflects the Trust’s commitment to promoting a listening culture and the wellbeing of patients and staff
While we won’t compromise on quality of care or patient experience, we recognise that not all our
future aspirations for the hospital and the patients and families it serves can be met within the
current site constraints and governors will be working with the Board on plans for the future
development of the organisation.
We support the Trust in its approach to being a listening and learning organisation and encourage all
patients, families and staff to use the range of methods available to provide their views, in the
knowledge that they will be listened to and acted upon.
Governors’ Scrutiny Committee on behalf of the Council of Governors of Birmingham Children’s
Hospital NHS Foundation Trust
16 May 2013
51
STATEMENT OF DIRECTORS’ RESPONSIBILITIES
IN RESPECT OF THE QUALITY REPORT
The Directors are required under the Health Act 2009 and the National Health Service (Quality
Accounts) Regulations 2010 as amended to prepare Quality Accounts for each financial year.
Monitor has issued guidance to NHS foundation trust boards on the form and content of annual
quality reports (which incorporate the above legal requirements) and on the arrangements that
foundation trust boards should put in place to support the data quality for the preparation of the
quality report.
In preparing the Quality Report, directors are required to take steps to satisfy themselves that:
the content of the Quality Report meets the requirements set out in the NHS Foundation
Trust Annual Reporting Manual 2012-13;
the content of the Quality Report is not inconsistent with internal and external sources of
information including:
o Board minutes and papers for the period April 2012 to June 2013;
o Papers relating to quality reported to the Board over the period April 2012 to June
2013;
o Feedback from the commissioners dated 14 May 2013;
o Feedback from governors dated 16 May 2013;
o The Trust’s complaints report published under regulation 18 of the Local Authority
Social Services and NHS Complaints Regulations 2009, dated 29 April 2013;
o The national staff survey 2012;
o The Head of Internal Audit’s annual opinion over the trust’s control environment
dated;
o CQC quality and risk profile dated February 2013.
the Quality Report presents a balanced picture of the NHS Foundation Trust’s performance
over the period covered;
the performance information reported in the Quality Report is reliable and accurate;
there are proper internal controls over the collection and reporting of the measures of
performance included in the Quality Report, and these controls are subject to review to
confirm that they are working effectively in practice;
the data underpinning the measures of performance reported in the Quality Report is robust
and reliable, conforms to specified data quality standards and prescribed definitions, is
subject to appropriate scrutiny and review; and the Quality Report has been prepared in
accordance with Monitor’s annual reporting guidance (which incorporates the Quality
Accounts regulations) (published at www.monitor-nhsft.gov.uk/annualreportingmanual) as
well as the standards to support data quality for the preparation of the Quality Report
(available at www.monitor-nhsft.gov.uk/annualreportingmanual)).
The Directors confirm to the best of their knowledge and belief they have complied with the above
requirements in preparing the Quality Report.
By order of the Board
29 May 2013
Interim Chairman
Interim Chief Executive
52
How we have engaged people in setting priorities for improving quality
Foundation Trust Governors
At quarterly meetings governors are provided with our Quality Report, Resources Report and
information on Trust developments.
Governors take part in scheduled Quality Walkabouts.
At meetings of the Council of Governors, governors take part in Quality Walkabouts and visit new
developments to better understand the Trust’s services and the issues that are important to
patients, families and staff.
Twice a year we hold a joint meeting between the Council of Governors and the Board of
Directors to consider the future strategy of the Trust and developments within the Trust and the
NHS which are relevant to the Trust’s strategy.
Governors are engaged in our governance structure, with governors as members of committees
and groups.
A Public Governor chairs our Organ Donation Committee.
A new Committee of the Council of Governors, the Governors Scrutiny Committee, has been
established, which provides a forum for more detailed debate and challenge on quality and
resources issues and strategic developments.
The Governors selected one of the quality indicators for review by the External Auditor.
Young Person’s Advisory Group (YPAG)
Consultations on Outpatients redesign.
Consultation on Theatres redesign.
Consultation on Safer Handover at Night project.
Regular Quality Walkabouts.
Reviewing adolescent spaces on wards.
Our Staff
Our Board and Governor Quality Walkabouts involve engagement with staff as well as patients
and families.
Surveys, including the national annual Staff Survey and our own Staff Safety Survey.
Regular staff polls.
Staff attendance at public Board meetings.
Chief Executive Briefings
Francis Report consultation and listening events.
Our patients and families
Quality Walkabouts.
Food walkabouts.
Direct patient feedback through feedback cards, feedback app and other means.
Patient stories which accompany reports to the Board to help bring issues to life.
Focus groups on particular issues.
Mystery Shoppers.
Taking account of concerns raised through formal complaints and the PAL Service
Surveys Consultation on potential new developments
Parent representatives on the Learning Disabilities Steering Group
Feedback from CAMHS parents and young people by way of an exit interview (Chi Esq)
53
Healthwatch Steering Group and Development Group
Our Lead for Patient Experience & Participation is a member of these groups which will oversee the
consultation process for the development of Healthwatch England, which will be established from
the existing Local Involvement Networks in April 2013.
How to provide feedback on the Quality Report
Despite the improvements in the quality of services we have seen over the last year, we know we’re
always learning about how things can be done even better.
At the heart of everything we do are our patients, their families and the communities that we serve.
That’s why we’re always interested in hearing from you – whether you have a suggestion on how we
can provide care more innovatively, or whether you had an experience you think we could improve
on.
We actively encourage people to get in touch and stay in touch with us, so if you have any ideas
about how we could make this Quality Account even better we’d like to hear from you.
To tell us about what you think, please contact our Communications Department on:
 0121 333 8535
 [email protected]
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