-
Patient Equality Report
Report of Public Sector Equality Duty Equality Monitoring
Patient Equality Data Report
December 2016- January 2018
Report produced by: Naheed Nazir, Head of Equality &
Engagement
Date Produced: January 2018
-
Introduction
The aim of the Patient Experience report is to triangulate key
issues relating to care metric
Patient Equality Data Report - January 2018
1. Introduction Many changes have occurred across the NHS over
recent years and these have been reflected
locally across Pennine. Pennine
Acute Hospitals NHS Trust is now part
of the Northern Care Alliance along with
Salford Royal NHS Foundation
Trust. The Northern Care Alliance is
made up of four Care Organisations as
shown in the map, and each Care
Organisation will manage and be
responsible for the day to day
running of the hospitals and
community services of a Care
Organisation.
This new site-based operational management model aims to
strengthen and improve senior
leadership support at hospital-level, strengthen engagement with
staff and clinical teams, and take
operational decisions for each site and services. The four Care
Organisations are; Bury/Rochdale,
Oldham, Salford and North Manchester.
Whilst these changes are underway it is important to note that
whilst Pennine Acute Hospitals NHS
Trust is part of the Northern Care Alliance it remains a
Statutory organisation and remains
responsible for meeting the specific requirements of the Public
Sector Equality Duty of reporting on
our patient diversity.
http://www.pat.nhs.uk/downloads/board/trust-profiles/buryrochdale-care-organisation.htmhttp://www.pat.nhs.uk/downloads/board/trust-profiles/oldham-care-organisation.htmhttp://www.pat.nhs.uk/downloads/board/trust-profiles/salford-care-organisation.htmhttp://www.pat.nhs.uk/downloads/board/trust-profiles/north-manchester-care-organisation.htm
-
2. Local Community Demographics The communities served by the
Trust are diverse in their make-up, but are similar in that their
health is worse than the average for the whole population for
England. With a higher proportion of people who have a long term
illness, mental 1illness. Many areas suffer high levels of
deprivation. Where there are high rates of unemployment and
deprivation, there tends to be poorer health and a greater demand
for health and social care services. There are inequalities in all
the communities that we serve as mentioned above by deprivation,
gender and ethnicity. For example, men and women in the least
deprived areas can expect to live around eight years longer than
men and women from the most deprived areas. Over the last ten years
there have been decreases in the death rate from all causes for
women and in the early death rate from cancer. However, these rates
remain above the national averages and the gaps between these
communities and England death rates have widened over the decade.
For example in Oldham the early death rate from heart disease and
stroke is the third worst in England.2 The health of children and
young people is generally worse than the England average, including
obesity in reception year children and teenage pregnancy. However,
the percentage of children who are physically active is
significantly better than the England average. Rates of obesity,
smoking, cancer and heart disease related to poor general health
and poor nutrition are significantly higher than the national
average, whilst life expectancy at birth in some areas is one of
the lowest in England. Common themes of ill health and death
include circulatory diseases such as coronary heart disease and
stroke, diabetes, cancer, and respiratory diseases such as
pneumonia, asthma, bronchitis and emphysema. The Trust’s local
communities are geographically and culturally diverse, but remain
largely characterised by their industrial past. This has
contributed to significant health inequalities among residents.
Other issues facing the surrounding communities include
proportionately larger numbers of younger and older people, large
and growing ethnic minority populations whose health and access to
healthcare have been poor, and heavy reliance on public transport
and low levels of personal car ownership. For example, Cheetham is
the largest ward in terms of population in Manchester and it is one
of the most deprived wards nationally with the largest ethnic
makeup. For the purposes of this report, local demographic data in
2015 (Office for National Statistics (ONS, 2015) have been used
where it has been available for Oldham, Rochdale, Bury and
Manchester to provide a picture of the Trust’s population
footprint. The lower percentages of the white British population
across Manchester lower the overall estimates for the organisations
catchment area. (See appendix 2 for link to local area demographics
data). It is currently estimated that 23.1% of the population of
Manchester is from a non-white ethnic group. North Manchester in
general has relatively low proportions of people from a non-white
ethnic
1 Public Health Observatories, 2013
2 Public Health Report Oldham www.oldham.gov.uk
-
group, and most wards have less than 10% from non-white groups.
In North West wards, Cheetham (55.6%) and Crumpsall (28.8%) stand
out as the only wards with higher proportions of non-white
residents. The highest proportions of non-white groups found in
North East wards are Bradford (15%) and the city centre (34.1%);
the city centre has a particularly large Chinese community. Asian
groups tend to live largely in Cheetham where there is a large
Pakistani community (Manchester City Council, 2015). The Trust is
not directly responsible for the actual referrals to the services
offered and, as such, the populations seen may differ from the
overall community population. It is, however, valuable to analyse
the population seen at the Trust and to monitor how this changes
over time. Comparison against the local population may also be
useful in suggesting areas for joint work with commissioner
organisations over access to services and other related issues.
Comparison of the Trust’s treated population with that of the
local community is difficult as the Trust is not coterminous with
its patient catchment area across the four hospital sites.
3. Patient data collection
The patient demographics collected routinely by the Trust on its
Patient Administration System (PAS) include age (date of birth),
sex, marital status, ethnicity and religion. The Trust does not
routinely collect sexual orientation, disability status, pregnancy
and maternity history (other than in relation to current maternity
episodes) or gender reassignment.
The quality of the data collected is variable. Age and sex are
collected accurately for all patients but marriage and civil
partnership status, ethnicity and religion rely on patient’s
responses. Some of the data items such as disability are collected
for individual patients but only as an alert on the Trust system,
rather than formally structured data, so that appropriate
arrangements can be made for the patient around facilities and
transport. The data is therefore not representative and cannot be
usefully analysed. In terms of data quality, the accurate recording
of ethnicity is an organisational target and work is being
undertaken to improve the completeness and accuracy of the
data.
The Trust is taking action to improve disclosure of equality
monitoring of all patients accessing services. The Trust will use a
new data monitoring leaflet to support patients when collecting
data on the new protected characteristics and a training programme
will be developed and implemented to support staff to ask these
sensitive questions and encourage patients to provide the
information.
4. Patient data The report provides an overview of the Trust’s
progress against key areas of patient equality:
Access to services Patient support Patient experiences
It highlights key statistical indicators on patient equality.
This information will be used to determine if any practices or
procedures unfairly discriminate staff based upon the protected
characteristics. In particular;
-
To investigate disproportionate disparities for patients based
upon their protected characteristics, these are ethnicity, age,
disability, gender, sexual orientation, religion and belief.
To systematically review services, procedures and practices
using Equality Impact Assessments. This will identify any negative
impacts for patients based upon their protected
characteristics.
To raise awareness of diversity and equality principles amongst
patients and identify and support their rights.
4.1 Access to Services
4.1.1 Admitted patients and DNA’s (DNA – Did Not Attend for
admission)
From the data collated, it can be reported that inpatients are
fairly reflective of the local population with 79.25% of patients
being from a white British background compared to 77.6% of patients
from the surrounding area. It would appear though those patients
from Black and Minority Ethnic (BME) backgrounds are more likely to
not attend for admission. The figures reveal that the same is true
of male patients who are more likely to DNA than female patients.
The sex of inpatients is not representative of the population with
less male patients attending as inpatients at 41.2% compared to
local estimates of the male population at 49.8%. Figures reveal
that inpatients aged between 25 and 49 are more likely to fail to
attend for admission, whilst under 18’s are less likely. 40.84% of
the 25-49 year olds are more likely to fail to attend, this mirrors
the previous year. This year the Trust has been able to breakdown
this information further by site. This will enable us in future to
compare information in more detail and to target projects and areas
of work. The data has revealed that although the males are more
likely to DNA in Rochdale and Oldham we experience quite the
opposite with 58% of females DNA in Rochdale and over 50% in
Oldham. See Appendix 1: Patient Admitted Care 2017.
4.1.2 Outpatients and DNA’S The outpatient data indicates a
white British attendance of 77.21% of patients, a little lower than
the local population estimates of 77.7%, and a Pakistani attendance
of 10%, a little higher than the local population estimate of 7.5%.
Data reveals that a high percentage from White British (65.6%) and
Pakistani (12.7%) fail to attend outpatients; we see an increase in
these figures for failing to attend follow up appointments 70.1%
White British and 12% Pakistani. Data also reveals that patients
aged over 75 have the lowest rates of failing to attend compared to
under 18’s. We also identified that the age category 25-39 year
olds are far more likely to fail to
-
attend at outpatients at 42.35% when compared to the other age
categories and they have the highest percentage of failing to
attend follow ups at 35%. These figures mirror the data from the
previous year. The breakdown of data per site will allow us to make
greater comparisons next year. The data also shows that the
outpatient DNA picture within the acute setting is also mirrored
within the community with 37.32% of DNA amongst the 25-49 age group
and males more likely to DNA at 55%. See Appendix 1: Outpatient
Activity 2017.
4.1.3 Accident and Emergency Attendances The patient data that
has been generated for accident and emergency attendances indicates
a lower than anticipated white British patient attendance, at
72.5%, with an elevated attendance by patients from BME
backgrounds, most significantly in Rochdale at 31.71% and North
Manchester at 24.06 % compared to the national BME population
estimate of 8.3%, however this is reflective of the local
demographics. Sex of patients attending remains representative,
being a fairly even spilt. In terms of the age categories the data
reveals that the 25-39 year olds are the greatest attendees at
32.4%.
4.1.4 Accident and Emergency Breaches (4 hour emergency access
standard) Of the breaches to the 4 hour emergency access standard,
it would appear that the sex of patients breaching was reflective
of those attending the department. The data identifies that a
higher percentage of patients from white British backgrounds had
breaches than had initially attended accident and emergency. The
age group that is most likely to breach is the 25-39 year old. See
Appendix 1: A&E Breaches 2017
4.1.5 Delayed transfers of care Following initial assessment,
medical staff record an expected date of discharge in the patient’s
medical notes. This information is shared with the patient,
relatives or carers where necessary and the multi disciplinary
team. See Appendix 1: Delayed Discharges 2017
4.1.6 Mortality The data relating to mortality by equality
characteristic has been given as a summary total, rather than by
speciality, as the numbers are small and specific patients would be
able to be identified.
-
The breakdown of mortality by the protected characteristics is
fairly representative of the local population for sex. There are
more deaths for white British patients than the local population or
inpatient attendances and less from BME groups, most significantly
Pakistani and Bangladeshi groups. See Appendix 1: Mortality
2017
4.1.7 Disease activity
The health needs of a population derive from the prevalence of
diseases, i.e. the numbers of people suffering from different types
of illness.
Looking only at the numbers of patients currently being treated
for a disease does not show the true prevalence and impact on the
population’s health. At any given time there are many people who
have a disease but are not aware of it because they have not yet
been diagnosed.
The Trust has been able to identify a number of diseases that
are common within the Trust that it will review and compare over
the coming years.
The Trust has provided site breakdowns were they are available.
(Some services are now concentrated on one particular site e.g.
Stroke at FGH) therefore a Trust total is provided. In future
reports we will now be able to compare per site and local
demographics. Please refer to Appendix A for full breakdown per
site.
Disease/specific characteristic Male % Female % White British
%
Other ethnic Group %
Diabetes
We can see here that there has been a percentage decrease in
White British category but an increase in the ethnic groups in
particular the Pakistani group.
50.21(2017)
50.38(2016)
52.19 (2015)
49.79(2017)
49.62(2016)
47.81 (2015)
75.65(2017)
76.31(2016)
74.44 (2015)
23.08(2017)
22.55(2016)
24.49 (2015)
Chronic Obstructive Airways Disease
46.13(2017)
47.12(2016)
47.67(2015)
53.87(2017)
52.88(2016)
52.33(2015)
94.98(2017)
92.22(2016)
91.54(2015)
4.04(2017)
6.92(2016)
7.48(2015)
-
Heart Disease 58.37(2017)
58.32(2016)
52.19(2015)
41.63(2017)
41.68(2016)
47.81(2015)
84.57(2017)
83.18(2016)
82.70(2015)
13.92(2017)
15.52(2016)
15.66(2015)
Stroke 51.66(2017)
51.16(2016)
49.40(2015)
48.34(2017)
48.84(2016)
51.60(2015)
89.15(2017)
85.52(2016)
87.10(2015)
9.01(2017)
12.81(2016)
10.81(2015)
Dementia 41.96(2017)
39.34(2016)
40 (2015)
58.04(2017)
60.66(2016)
60 (2015)
93.60(2017)
91.24(2016)
89.65(2015)
4.25(2017)
6.06(2016)
8.01 (2015)
The data reveals some interesting points: firstly with diabetes;
we have seen higher numbers of patients presenting at the Rochdale
and Oldham sites when compared to North and Fairfield sites,
especially from the Pakistani heritage background. When we compare
the data to the previous year we find that there is no significant
difference apart from the ethnic other category where we have seen
a decrease of 2%. The data also highlights that there has been
significant increase in the age category in the 65+ range who have
overall seen a rise by 10% in the last year. With an ageing
population predicted for the coming years nationally we will see a
steady rise in this particular category across all diseases.
Disease/specific characteristic Male % Female % White British
%
Other ethnic Group %
Peripheral Vascular Disease 55.96(2017)
57.94(2016)
61.27(2015)
44.04(2017
42.06(2016
8.73(2015
94.61(2017)
91.15(2016)
84.42(2015)
9.2(2017)
8.03(2016)
9.79 (2015)
-
Cancer 33.77(2017)
34.4(2016)
33.1(2015)
66.23(2017
66.9(2016)
66.9(2015)
83(2017)
84.61(2016)
84.01(2015)
12.86(2017)
14.57(2016)
14.85(2015)
4.2 Patient Support Accessible Information Standard NHS England
introduced the Accessible Information Standard (the Standard) into
the NHS Contract and made the Standard mandatory for all NHS and
Adult Social Care providers. Organisations were required to fully
implement the Standard by 31 July 2016. The Trust has implemented
the Standard and is continuing to embed the Standard across all
services through the Accessible Information Standard (AIS) Action
Plan which sets out how the Trust will achieve the Standard both
internally and in partnership with other NHS and Adult Social Care
providers and commissioners across the Pennine Footprint. The Trust
is monitoring progress of the implementation through the Equality
Committee.The Trust as part of the Accessible Information Standard
work in partnership with other NHS and Adult Social Care providers
and commissioners across the Pennine Footprint developed a
Communication and Information Needs Passport for patients, service
users, carers and parents. The data set below demonstrates that we
have been able to record flag and meet the communication needs of
patients and service users coming to Pennine Acute Trust. The first
request was received on 16th Augusts and up to 22nd January 2018
there have been 57 requests sent for patients additional
communication requirements. The main issues recorded have been
hearing loop system at Lucy Pugh Outpatients (TROH) and NMGH
Urology department and Day Service Unit. Estates management
confirmed they tested existing loops and replaced old units that
didn’t work.
BSL Hearing Aids Clear Read Letter Lip Reader Electronic
Communication user
15 15 25 1 1
Under the Accessible Information Standard disabled people who
are our patients, service users and their carers and parents must
have access to information that they can understand and any
communication support they need. This includes making sure that
people get information in different formats if they need it, such
as large print, Braille, embossed, easy read, via email and
visual/British Sign Language (BSL) etc. As part of the standard the
Trust must do five things:
-
Ask people if they have any information or communication needs,
and find out how to meet their needs Record those needs in a set
way on patient records Highlight a person’s file, so it is clear
that they have information or communication needs, and clearly
explain how these should be met Share information about a person’s
needs with other Trust Teams/Departments, NHS and adult social care
providers, when they have consent or permission to do so Act to
make sure that people get information in an accessible way and
communication support if they need it. For more information and
guidance around the standard you can visit the NHS England website
or the Trust’s own Accessible Information Standard web page. 4.2.1
Interpreting
Effective communication is key to building any human
relationship, whether in a social or professional context. One of
the main aims of the Trust is to ensure that all our services are
equitable and fair in terms of accessibility. The Trust ensures
increased access to its services and to promote social inclusion,
which will improve patient care. The Trust has adequate support
mechanisms for patients who have additional needs in terms of
communication. The Trust caters where appropriate, for their
guardians and carers, who do not speak sufficient English to
effectively communicate. The Trust has been using interpretation
and translation services for over 17 years to ensure that people
whose first language is not English and those with sensory
difficulties have access to support to enable them to make informed
choices about their healthcare. The provision of these services has
grown to 15 on-site interpreters at The Royal Oldham Hospital and
Fairfield General Hospital and approximately 200 bank staff. These
interpreters speak approximately 90 languages, from the more
requested ones of Urdu, Punjabi and Bengali, to diverse and rare
languages such as Romanian, Lithuanian, Kurdish, and even Yoruba
and Bahfut. Other rarer languages are supported by agency
interpreters or telephone interpreting. We have seen on average a
13% increase in the usage of this service and this is reflected
nationally due to the influx of migration to the UK. Following the
review of the service and also trailing the telephone interpreting
service within the Trust, the Trust has introduced telephone
interpreting service across all sites and all services. This
provides a timely, efficient and effective service ensuring that
all patients have ease of access to understanding their patient
journey and care that they receive. Please see Appendix for data
set 4.2.2 Spiritual Care The Group recognises respects and promotes
the personal beliefs and religious practices of our patients, their
families and staff we serve. There is wide recognition within the
NHS of the benefit to patients’ recovery when we consider them as a
‘whole person’, body, mind and soul. Integral to the delivery of
that approach is the multi-faith Chaplaincy and Spiritual Care
Service (SCT). The importance of providing chaplaincy and spiritual
care is also reflected within the 2010 Equality Act, which states
religion and belief as a protected characteristic, and requires
organisations under
https://www.england.nhs.uk/ourwork/patients/accessibleinfo/http://www.pat.nhs.uk/working-for-us/accessible-information-standard.htm
-
the Equality Duty to consider religion or belief – including
lack of belief – in the provision of its services, where
appropriate. The SCT is well-established within the Group,
providing pastoral and spiritual care to patient, families and
staff, across the five hospital. The service strives to match
patients with a chaplain of their own religion, and when that is
not possible the chaplains are trained to support each person from
within that person’s own religious tradition or belief system. Our
chaplains represent the most requested religions, these being
Christian (including Catholic), Muslim, and Jewish. The SCT has
relationships with local faith group who are available to support
other religions such as Hindu, Sikhs and Buddhists. The Chaplains
will also attend to patients and families of no religion to provide
spiritual and emotional support. The SCT is complemented by 59
volunteers drawn from local communities in our area representing
several different faith groups and belief systems (e.g. humanism).
Four of our volunteers also work with the End of Life (EoL) Team at
NMGH and ROH as a separate, but allied role. The volunteer
chaplains assist with holiday observances, spiritual and emotional
support, memorial services, and celebrations. However, they do not
deliver lifecycle events such as, baptisms, blessings and welcome
rituals for new babies, weddings and commitment ceremonies, which
are only carried out by the ordained chaplains. The SCT provides
teaching at Trust Inductions and input at EoL and Bereavement Study
Days and so that staff are aware of the role that the SCT plays in
a holistic approach to patient care is not just ‘religious’ but
spiritual (in its broadest sense), emotional and pastoral,
especially as the EoL approaches. Staff are required to ask
inpatients or their carer if they have a religion, if any, and
whether they wish to see a representative from the SCT during their
admission. Referral by staff are typically made via an electronic
form accessible on the Intranet or by phone. SCT availability and
contact details are also available on the Trust’s website. In
addition to undertaking ward based visit SCT other key priorities
are as follows:
Attending the Perinatal Bereavement Group which deals with
issues of concern across all sites in the Trust.
Attending the Care After Death Community Group
SCT leads the Trust’s Baby Memorial Services which happen three
times a year (March at RI, July at NMGH and September at ROH).
Responding to requests for Spiritual Care Assessments at End of
Life coming from ward staff and/or the Macmillan Cancer Care
Team.
Lead prayers at anyone of the prayer rooms or chapels.
SCT is represented most weeks at the Specialist Palliative Care
MDTs at Bury, Oldham and North Manchester.
Lead the service at hospital contract funerals.
-
Offer chaplaincy support for those with a North Manchester GP
who were palliative or end of life.
Provide spiritual care to Greater Manchester Mental Health
Service patients as part of a long-standing contract Park
House.
4.3 Equality Analysis The Trust continues to recognise the role
it plays in ensuring that health inequalities are identified and
eliminated and equity and fairness are core qualities and values to
be embedded within the organisation. Equality impact assessments
(EqIA) are the key to achieving this aim. The main features of the
legal requirements are:
To collect information relating to the effect that policies and
practices may or have had on employees, service users and others
from the protected characteristics (groups).
To provide evidence of the analysis that has been undertaken to
establish whether policies or practices will, or have, furthered
the three equality aims of the general duty.
To detail the information used in the analysis
To detail the engagement undertaken with people who have an
interest in the equality duty and who use the hospital
services.
To comply with requirements of the Equality Act, the Trust must
consider the 9 protected characteristics protected by the Act when
undertaking equality impact assessments. The protected
characteristics are: age, disability, gender reassignment, race
(ethnicity), religion and belief, marriage and civil partnerships,
pregnancy and maternity, sex (gender) and sexual orientation. The
Trust will continue to monitor equality for carers and issues
around social deprivation. Human rights remain the highest priority
and must be considered alongside the other protected
characteristics throughout all business planning, development and
implementation.
4.4 Patient Satisfaction 4.4.1 The Northern Care Alliance NHS
Group recognises the importance of patient experience as a
well-established key indicator of quality assurance, as it
highlights whether the organisations’ actions and the effectiveness
of those activities result in, and maintains a high level of
quality, safe care with good patient/service users’ experience.
Over the past twelve months, the Pennine Acute Hospitals and
Salford Royal Hospital patient experience teams have worked closely
to ensure their activities support the Group’s corporate priorities
and strategic goals. This has involved amongst other aspects:
Improving and embedding systems and processes to capture and act
upon both positive and negatives near real and real time feedback
is essential to both improve the patient/ service user
-
experience of the care they receive and to assist Care
Organisations and the Northern Care Alliance in the prioritisation
of resources for service developments where appropriate. Patient
Experience Team, led by the Associate Director of Nursing: Patient
Experience has undertaken visits, ‘walkarounds’, meetings with
Divisional Directors of Nursing, Assistant Directors of Nursing of
wider teams throughout June 2017 to present to support the
implementation of local near real time and real time feedback
across the Care Organisation. Examples of proactive approaches
being undertaken by Care Organisation team and that will need to
continue to be developed to capture and act upon patient experience
include:
Collecting, considering and, where required, acting upon patient
stories.
Supporting and promoting ‘What Matters to Me’; an approach
adopted by ward staff to strengthen their personalisation of each
patient’s care. Staff ask patients, and where necessary, their
carers what is important for them on that day. Their comments are
noted above the their bed and staff do their upmost to meet the
request; this could range from being able to speak to a distant
loved one over the phone to having their favourite newspaper.
Developing improvement plans in response to national and local
patient surveys. Cross referencing the feedback with existing
patient experience metrics such as complaints, and Friends and
Family Test recommendations.
Improving the environment and facilities, through feedback from
patients and/or patient representative groups, such as
Healthwatch.
The Patient Experience team are supporting the development of
public local engagement and partnership working with their Care
Organisation. The ethos is to encourage the local population to be
actively engaged with their local health services, in order to
support the co-production of service improvements.
Always Events - The patient experience team are working with all
Care Organisations to develop a joint approach to ‘Always Events.’
A key distinction of an Always Events® is that patients, their care
partners, and service users have identified the event as
fundamental to improving the patient experience of care. A
fundamental principle in co-designing Always Events® is to move
from “doing for patients” to “doing with patients (Gateway
Reference: 05993, 2016)’. The Patient Experience Team are
scheduling the work at each of the nominated arears at each Care
Organisations; starting with Paediatric Emergency Department at
North Manchester Care Organisation in January 2018.
The Group continues to have in place a Joint Working Protocol
with the Healthwatch organisations covering the Pennine Acute
Hospitals footprint; these being Healthwatch Bury, Healthwatch
Manchester, Healthwatch Oldham and Healthwatch Rochdale. The
protocol is in the process of being updated to reflect the
formation of the Alliance and the inclusion of Healthwatch Salford.
This purpose of this protocol is to clarify how the six
organisations work together to improve the quality of care and
experience of patients, their families and carers who access
services provided by the Group. The Children and Young People’s
Experience Group (C&YPEG) has continued to engage with young
people to interact and inform the Group from a young person’s
perspective. One of the highlights was in November 2017, in which
the Group facilitated the Children’s Commissioner’s
-
Takeover Challenge, during which young people took on the roles
of senior staff for a few hours. C&YPEG will be supporting the
co-production of the Always Event within the Paediatric Emergency
Department. The Group’s Maternity Services are utilising Care
Opinion, a non-profit patient feedback platform for health and
social care, to support their understanding of patient feedback.
This has helped staff to respond to patients concerns in a
relatively short period of time. In February 2018 the Maternity
Service will one of the first maternity services in the country to
by initiating the NHS England supported Maternity Bereavement
Experience Measure (MBEM) questionnaire. This will provide those
parents with the opportunity to offer their opinion of the care and
support surround the stillbirth or death of their baby after birth.
It is hope this will lead to coproduction of service improvements.
The Patient Experience Midwife will also be facilitating the
development of Maternity Voices Partnership (MVP) at ROH. The
vision of Better Births (2016) was to implement Local Maternity
Systems as a way of co-producing maternity services by 2021.
National Maternity Voices is the national group for the Maternity
Voices Partnership (MVP); it will replace any existing Maternity
Service Liaison Committees. The creation of a MVP within the GOUP
will contribute towards framing the future of our maternity service
provision. The MVP will be an independent multidisciplinary
committee including Healthwatch; Maternity Service Users and their
families; Charity Organisations, Clinicians. National Patient
Survey Reports These are one of the key means available to the Care
Organisations and Group in obtaining a snap shot of patient and
service user experience in respect of local performance and an
opportunity to provide a comparison both nationally and locally.
The National Cancer Patient Experience key survey (NCPES) results
for 2016 currently under embargo by the CQC) is one of the means
available to obtain a snap shot of patient experience in respect of
local performance and an opportunity to provide comparison both
nationally and locally. The respective Care Organisations and the
Cancer MDTs have received the results of the survey for review and
consideration of improvements and implementation of actions
including augmentation into both specific Care Organisations and
over-arching patient experience improvement plans. Headline
Results
The experience of cancer patients in Pennine continues to be
generally very positive and when asked to rate their care on a
scale of 0 (very poor) -10 (very good), PAHT was 8.5.
Performed Above average in 7 Questions, same as national average
7, worse in 33 questions.
Performed better than others
91% of patients had all information they needed regarding
tests.
88% of patients felt the time that they had to wait for test was
reasonable.
93% stated at the previous appointment with Cancer Doctor all
required documentation including notes, tests results was
available.
Performed Worse
Patient Trust in the ward nurses is a concern.
Insufficient information about financial support.
Discharge advice from medical & nursing staff is a
particular concern that has been in the NCPES and is raised in many
complaints by the patients and families.
-
The anonymised patient comments have been shared with all
relevant staff to inform a robust and detailed improvement plan.
This is being developed in conjunction with the Macmillan Lead
Cancer & Palliative Care and will be monitored at a Care
Organisation and Group level to ensure its implementation. The
Children and Young People’s Inpatient and Day Case Survey 2016
Indicated areas that required improvement such as the staff
engagement in play with patients. The Women and Children’s Division
have reviewed the survey findings at a national and local action
planning workshop facilitated by Picker, and have discussed actions
for improvement at their divisional quality meeting. Performance
shown a Significant Improvement
Ward staff now has appropriate equipment and adaptions for
children.
Overall 74% of parents scored care 7 out of 10.
65% confidence in Trust treatment of their child (0-15).
76% Treating their child with Privacy and Dignity Performance
requires improvement - Communication
Explanation to child and parents during the procedures.
Explanation to parents before and after procedures.
Improved Information regarding medication required. The Women
and Children’s Division are scheduled to provide an update on the
progress of the development of the implementation plan at the
November 2017 Patient Experience Committee (PEC). . The Care
Quality Commission (CQC) Maternity Survey 2017 (currently embargo
by the CQC) was released in September 2017, and due is for
publication in January 2018. The survey is based on a sample of
mothers who gave birth in February 2017. Picker undertook Pennine
Acute Hospital’s (PAHT) survey who also carried out surveys for
another 67 trusts. A total of 682 mothers from PAHT were sent the
questionnaire, with 671 being eligible of which 140 returned the
completed questionnaire, giving a response rate of 20.9%, with the
Picker average at 35.8%. Performance shown a significantly
improvement
Antenatal - midwives aware of mother’s medical history.
Antenatal - listening to Mother asking about their emotional
health.
Postnatal - who to contact regarding changes in emotional
health. Performed better than others
Choice where to have the baby
Treated with Kindness and dignity during pregnancy Performance
requires improvement
Postnatal care: access to staff help in a reasonable time
To be treated with care and kindness when in hospital
At home discussion regarding mothers health The Women,
Children’s Division, and the Directors of Nursing for the
respective Care Organisations have received a copy of the full
report for their consideration and to inform the development of an
implementation plan.
-
The identification of themes and implementation plans across all
patient surveys into an overarching implementation plan is being
supported by the Associate Director of Nursing: Patient
Experience.
Friends and Family Test The Friends and Family Test hierarchy
(the flow of how we view information) for each of the 3 Care
Organisations, North Manchester General Hospital, Royal Oldham
Hospital, Fairfield General Hospital and Rochdale Infirmary has
been revised to reflect the correct locations of current wards and
departments. This will assist in eliminating difficulties
experienced by clinical teams in locating and extracting their
data. It will ensure all appropriate areas are utilising FFT to
generate patient/service experience feedback and associated actions
including sharing positive experiences regarding the care received.
There are still issues to address between the different sites
including different acronyms. In September 2017 the initial task
and finish membership group was revised and meet on a monthly basis
to provide an overview of the operational improvements using a
‘Test of Change’ approach led by individual Care Organisations to
embed patient feedback and improve patient care experience.
Training for staff to access, review and act upon their data is
available through the Intranet and face-to-face sessions.
Inclusivity cards are available across the Care Organisations and
since their initial roll-out in July 2017 most wards request them
in preference to the standard FFT cards. Staff feedback has been
that patients find them easier to understand and complete. Examples
of positive and adverse patient/service user feedback are being
reviewed and acted upon by staff at ward, community, day-case and
outpatient services including therapy services across all Care
Organisations. Methods used include daily safety huddles,
patient/service user experience feedback display boards, You Said
We Did, What Matters to Me Today and comments/feedback books for
relatives and carers. .
4.4.5 Patient Feedback Compliment, comments and complaints are
encouraged with easy links to the NHS Choices website on the
Internet pages. A process is in place to respond and monitor
responses. The Trust reports and publishes outcomes via Trust Board
papers on the Internet, Local Involvement Networks (LINks) meet
quarterly with the Trust to give feedback and be updated about
Trust developments. 4.4.6 Complaints An equality and diversity
monitoring questionnaire and pre-paid envelope is sent to all
complainants with the acknowledgement letter to complete and return
(completion of the questionnaire is voluntary). The table below
shows the breakdown of the responses received by equality strand
from people who made a complaint from 1st Jan 2017 to 31st Dec
2017.
-
The Trust is required to monitor and evaluate the services we
provide. Completed equality and diversity questionnaires are
returned in a pre-paid envelope to the E&D department in an
attempt to distance from the Complaints Department. New equality
legislation places greater emphasis on the collection of this
information. The tables below show the breakdown of the complaints
received.
The complaints department is aware of the diverse population
served by the Trust and will be further developing the
questionnaire and the way it is recorded on our internal systems in
2018/19.
Row Labels Count of Age Row Labels Count of Age Row Labels Count
of Age
(blank) AA British - White 526 (blank) 664
0-9 49 (blank) 104 Christianity (All Denominations) 41
10-19 31 JJ Pakistani - Asian Or Asian British 30 Not Stated
23
20-29 66 ZZ Not Stated 20 Atheist 4
30-39 77 CC Any Other White 11 Prefer Not To Say 1
40-49 74 BB Irish - White 11 Islam 1
50-59 98 HH Indian - Asian Or Asian British 6 Other 1
60-69 115 GG Other Mixed - Mixed 5 Grand Total 735
70-79 99 SS Other Ethnic Category - Other Ethnic 5
80-89 92 NN Black African - Black Or Black British 4
90-99 33 PP Other Black - Black Or Black British 3
100-109 1 MM Black Carribbean - Black Or Black British 3 Row
Labels Count of Age
Grand Total 735 LL Other Asian - Asian Or Asian British 2
(blank) 668
KK Bangladeshi - Asian Or Asian British 2 Not Answered 63
ZZ 1 Heterosexual 4
DD White & Black Carribbean - Mixed 1 Grand Total 735
EE White & Black African - Mixed 1
Grand Total 735
Row Labels Count of Age
(blank) 705
N 13
Y 11
A 6
Grand Total 735
Row Labels Count of Age
F 429
M 291
(blank) 15
Grand Total 735
Sexual Orientation
Disability
Gender
ReligionEthnic GroupAge Groups
-
. The table below shows the breakdown of the complaints
received.
The complaints department is aware of the diverse population
served by the Trust and is currently collecting data on the number
of complaints received from the various ‘protected groups’ and
identify how complainants access the service and whether any
improvements to the way in which information is distributed to the
population served needs be made (Patient Advice and Liaison (PALS)
and Complaints leaflets explaining the NHS complaints procedure are
available in wards and outpatient clinics, information can also be
accessed via the Trust website and the public can obtain
information by telephoning the PALS/Complaints department).
4.5 Engagement Updates and engagement with local community
groups are ongoing. The Trust has monthly meetings with NHS Oldham,
and other local quality leads and produces a formal quarterly
reporting of PPI activity, equality activity and performance which
is attached to the quarterly Patient Experience Report.
Age Count of Age Age Sexual Orientation
80 9 Age Group Total Percentage Sexual Orientation Total
81 8 0-19 75 11% (blank) 557 83%
82 9 20-39 138 21% Not Answered 112 17%
83 11 40-59 144 21% Heterosexual 4 1%
84 7 60-79 210 31% Grand Total 673 100%
85 6 80+ 106 16%
86 6 Total 673 100%
87 6 Disability
88 9 Gender Sexual Orientation Total
89 8 Gender Total (blank) 661 98%
90 3 F 379 56% N 8 1%
91 7 M 280 42% Y 3 0%
92 4 (blank) 14 2% A 1 0%
93 2 Grand Total 673 100% Grand Total 673 100%
94 5
95 4 Religion
96 1 Religion Total Disability
99 1 (blank) 557 83% Sexual Orientation Count of Age
Grand Total 106 Not Stated 53 8% AA British - White 512 76%
Christianity (All Denominations) 53 8% BB Irish - White 11
2%
Atheist 9 1% CC Any Other White 12 2%
Judaism 1 0% DD White & Black Carribbean - Mixed 1 0%
Grand Total 673 100% EE White & Black African - Mixed 1
0%
FF White & Asian - Mixed 1 0%
GG Other Mixed - Mixed 3 0%
HH Indian - Asian Or Asian British 2 0%
JJ Pakistani - Asian Or Asian British 33 5%
KK Bangladeshi - Asian Or Asian British 3 0%
LL Other Asian - Asian Or Asian British 3 0%
MM Black Carribbean - Black Or Black British 2 0%
NN Black African - Black Or Black British 5 1%
PP Other Black - Black Or Black British 3 0%
RR Chinese - Other Ethnic 2 0%
SS Other Ethnic Category - Other Ethnic 7 1%
ZZ Not Stated 23 3%
(blank) 49 7%
Grand Total 673 100%
-
4.5.1 4.5.2 Disability Awareness week – the Equality and
Diversity team held information stands across all sites.
Representatives from Bury Blind Society also held an information
stand at Fairfield General Hospital to inform staff and
patients/carers about their services. The Bury Blind society
currently run an advisory service in the eye clinic at Fairfield by
taking part in the week it helped to raise awareness of their
services and hopefully will increase the uptake of this service
4.5.3 End of Care Life Volunteers – 5 volunteers are piloting a new
‘end of life’ role whereby they
support patients who have been placed on the end of life care
pathway. Volunteers have received
bespoke training by the End of Life and Chaplaincy teams. Should
this role prove successful,
additional volunteers will be recruited and trained to support
this importance agenda.
4.5.4 Ezra Umarpeh – 18 volunteers from Ezra Umarpeh, which is a
national organisation that
provides a befriending and equipment service for the orthodox
Jewish community have recently
started a befriending service at NMGH. This has been very well
received and it is envisaged this
service will continue to expand.
4.5.5 Multi-faith Care after Death group – This group consists
of representatives from the local
communities surrounding our localities. The group’s membership
largely consists of the Jewish and
Muslim faiths, as these two groups highlighted particular issues
in the delivery of end of life care for
their communities. The Trust has been working with them for the
past 6 months and working
through the issues identified. The Trust will continue to work
with this group..
4.5.7 Jewish Community Engagement Local engagement activity in
the Jewish community at North Manchester General Hospital has been
undertaken during the last year, with meetings and events organised
to support increased communication and partnership working. The
Trust will be working closely with the Jewish community to enhance
the services that we provide; we will be exploring a befriending
service to be offered by Jewish volunteers within the Trust.
Ongoing dialogue exists to support resolution of issues arising and
ensure good communication.
4.5.8 Patients Forum The Trust is currently reviewing the
Patient Experience Forum, to ensure that it has greater
representation from across all the communities that we serve in the
Pennine footprint. The Trust believes in encouraging patients and
the public to act as critical friends and review developments and
initiatives in the Trust.
4.5.9 BME Health forums and Community groups The Trust has been
working with the local BME health forums and community groups to
ensure that they are kept updated with the changes within the
services and also identifying how and where we can work together in
order to meet the needs of our diverse community. Some areas of
concern which have been highlighted are the bereavement services,
patient support in terms of language barriers, dementia and
accessibility. We will continue to work with the local communities
to identify areas of concern and also how we can better meet their
needs and reflect this within our services.
-
4.6 Dignity Events
Dignity Champions There is a designated dignity champion in each
ward and department, and the role of Dignity Champion is open to
anyone within the Trust, whatever their role and responsibilities
and how much people can do will vary depending on their workload
and other commitments. Currently 859 Dignity Champions have been
recruited.
Breach line
Dignity Champions are able to raise any concerns they may have
about the treatment of individuals or practices within the
organisation or report issues they have dealt with by calling the
Dignity Champion breach line.
National Dignity Action Day
The Trust supported the day in 2017 by volunteers giving hand
massages to patients at Fairfield, North Manchester and Oldham.
Reiki treatments were given to patients at The Royal Oldham
Hospital. Information stands were on display across the hospital
sites and Staff were recruited to be champions on the day, with 40
new champions signing up. Patients were also asked to give their
comments about Dignity at the bedside and at the stands in the
hospital main entrances.
4.9 Developments to address concerns of service users 4.9.1
Learning Disability Following the formation of the Pennine Learning
Disability Partnership (PLDP), the Trust has implemented strategies
to ensure that improved services are provided for patients with a
learning disability. The PLDP consists of staff from the acute
trust, the Clinical Commissioning Groups (CCG’S), community
learning disability teams and carers. This ensures that opinions of
service users influence service developments within Pennine Acute.
4.9.2 Patient pagers Following feedback from service users the
Trust has piloted a pager system which allows patients freedom to
move around the hospital and be paged when required for their
appointment or procedure. In particular, this helps patients with
sensory difficulties, parents or carers of people with learning
disabilities and those with language limitations. A successful
pilot has now seen the Trust exploring how it can be used in other
waiting areas and clinics.
-
4.9.3 Text Appointments Following feedback from deaf patients
accessing interpreting services in the Trust, a new text alert
system has been introduced to confirm appointments and continues
to be utilised. January 2018 Naheed Nazir Head of Equality &
Engagement
Appendix 1 Data provided by Contracting Support and
Commissioning Manager (Returns & Reporting):
-
A&E Attendance 2016
A&E Breaches 2016
Admitted Patient Care 20156
Outpatient Activity 2016.
Mortality 2016 Data provided by the Divisional Information
Manager:
Disease Activity 2016 Data gathered by the Equality and
Engagement Team:
Local demographic data summary
Translation and interpretation data - Number of appointments
carried out at all hospitals Jan - Dec 2017
Jan-17
Feb-17
Mar-17
Apr-17
May-17 Jun-17
Jul-17
Aug-17
Sep-17 Oct-17
Nov-17 Dec-17 Annual
RI 554 523 581 504 533 525 515 415 481 523 587 453 6194
NMGH 990 982 1049 876 983 998 934 980 1008 942 994 888 11624
FGH 558 530 565 509 531 610 572 451 474 471 530 436 6237
ROH 1016 984 1260 1181 1212 1194 1337 1199 1260 1387 1340 1063
14433
Totals monthly 3118 3019 3455 3070 3259 3327 3358 3045 3223 3323
3451 2840 38488
-
Appendix 2 Patient Experience Report Quarter 2 201 / 15 To
access the above data files, follow the link below.
(http://nww.pat.nhs.uk/PortalVBVS/Default.aspx?tabindex=2&tabid=517)
Care Quality Commission (2011). National Inpatient Survey Results
(2012). Available at:
http://www.nhssurveys.org/Filestore/benchmark/ip11/IP11_RW6.pdf
Manchester City Council Joint Strategic Needs Assessment (2010).
Available at:
http://www.manchester.gov.uk/info/10020/policies_and_plans/3954/joint_strategic_needs_assessment/1
Office for National Statistics (2011). Available at:
http://www.ons.gov.uk/ons/index.html Pennine Acute Hospitals NHS
Trust. Service Equality Impact Assessments. Available at:
http://nww.pat.nhs.uk/PortalVBVS/Default.aspx?tabindex=2&tabid=2367
Pennine Acute Hospitals NHS Trust. 2013. Trust Board Reports.
Available at:
http://nww.pat.nhs.uk/PortalVBVS/Default.aspx?tabindex=1&tabid=163
http://nww.pat.nhs.uk/PortalVBVS/Default.aspx?tabindex=2&tabid=517http://www.nhssurveys.org/Filestore/benchmark/ip11/IP11_RW6.pdfhttp://www.manchester.gov.uk/info/10020/policies_and_plans/3954/joint_strategic_needs_assessment/1http://www.manchester.gov.uk/info/10020/policies_and_plans/3954/joint_strategic_needs_assessment/1http://www.ons.gov.uk/ons/index.htmlhttp://nww.pat.nhs.uk/PortalVBVS/Default.aspx?tabindex=2&tabid=2367http://nww.pat.nhs.uk/PortalVBVS/Default.aspx?tabindex=1&tabid=163
