Trust Board 2 February 2016 EXECUTIVE SUMMARY...PLACE REPORT 2015 Trust Board 2 February 2016 Director of Facilities G:\BOARD SECRETARIAT\MEETINGS\Board\Meetings\2015-16\02.02.16\Annex

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PLACE REPORT 2015 Trust Board 2 February 2016

Director of Facilities G:\BOARD SECRETARIAT\MEETINGS\Board\Meetings\2015-16\02.02.16\Annex 2.5 Board 02.02.16 - PLACE Assessments v19.01.16.docxPage 1 of 16

EXECUTIVE SUMMARY REPORT TO: Trust Board

DATE: Tuesday 2 February 2016

AGENDA NO: 2.5

AGENDA ITEM: Patient Led Assessments of the Care Environment (PLACE) 2015 –

Results and Actions

SPONSOR: Iain Roy, Director of Facilities

PREPARED BY: Tricia Hawson, Deputy Director of Facilities

PRESENTED BY: Tricia Hawson, Deputy Director of Facilities

1. Purpose and Key Issues

1.1. This paper advises the Trust Board on the result of this year’s Patient Led Assessments of the Care Environment (PLACE) Programme.

1.2. The paper was presented to the Clinical Services Executive Committee on 24 November 2015.

1.3. The paper explains the process, the results of the inspections and key themes together with the actions proposed to ensure continuous improvement.

2. Supporting Information

2.1. The report is attached.

3. Controls and Assurance

3.1. Action Plans with progress reports are in place for all sites together with the knowledge that next year’s inspection will review the current year’s progress.

4. Legal and Regulatory Implications

4.1. PLACE results are published nationally and are in the public domain. The Health and Social Care Information Centre (HSCIC) share the information as required such as the Care Quality Commission. These results are used as a benchmarking tool in the NHS.

5. Equality and Diversity Implications

5.1. The Trust aims to design and implement services, policies and measures that meet the diverse needs of our service, population and workforce, ensuring that none are placed at a disadvantage over others. No adverse or positive impacts have been identified from this report.



6. Patient, Public and Staff Engagement

6.1. The Trust ensures that patients, the public and staff are involved in the decision-making process when appropriate. The inspections included the required number of patient assessors for each inspection as outlined by the Health and Social Care Information Centre ( HSCIC)

7. Cost Implications

7.1. We request that we continue to receive a capital allocation for ‘PLACE’ as this is used to fund flooring, painting and other environment improvements.

8. Potential Risk to the Organisation

8.1. There is no risk to the organisation.

9. Committee Prompts

9.1. Please see the scores achieved for the 5 domains of cleanliness, food, condition, appearance and maintenance, privacy dignity and wellbeing and dementia

9.2. Also see the scores for each site and also the overall Trust score and the comparison with the national average.

9.3. Please note the improvement year on year despite the criteria changing and evolving.

9.4. This paper provides assurance that the PLACE process has been thorough, is an honest reflection of current standards and that we are taking on board action plans to continually improve the patient environment and facilities services.

10. Recommendations

10.1. The Trust Board is asked to RECEIVE the report noting the process, results and key themes identified and provide support in reiterating the fact that PLACE is everyone’s responsibility, not just that of the Facilities Department.

11. References

Patient – Led Assessments of the Care Environment – PLACE. Produced by HSCIC published 11 August 2015

12. Strategic Objectives

12.1. The Trust’s strategic objectives are reviewed by the Board on an annual basis. This paper supports the achievement of the following strategic objectives

Highest Quality Flexible and Multi-Skilled Workforce

Sustainable Services Efficient & Effective

Integrated Health and Social Care Provider of Choice



13. Principal Risks

13.1. The Trust’s principal risks have been identified through the Trust’s risk management processes. They are updated as they are identified by the Risk Management Committee. This paper supports the mitigation of the following principal risks

Financial planning and management Clinical records management

Strategic & business planning Leadership & management

Workforce numbers Unsafe behaviour

Workforce skills External demands

Procedural management Partnership arrangements

Equipment & facilities arrangements Communication



Patient Led Assessments of the Care Environment (PLACE) 2015 – Results and Actions

1. Purpose

1.1. This paper was presented to the Clinical Services Executive Committee on 10 November 2015 to advise of the results of the Patient Led Assessments of the Care Environment (PLACE) Programme for 2015 and is now being presented to the Trust Board.

1.2. Furthermore, it explains the process, the results of the inspections and key themes together with the actions proposed to ensure continuous improvement.

1.3. This is a national initiative required to be undertaken by all Trusts. In North Devon it is particularly challenging having to inspect 12 hospitals spread out over a wide geographical area. The inspection is by self-assessment with equal numbers of Trust staff and patient assessors forming the inspection team.

1.4. The NDHT teams were asked to be rigorous in their assessment in line with the guidance and therefore we believe our scores are a true reflection of the sites on the day. Each PLACE visit generated a score in the 5 separate domains (Appendix 1). Domain 5 (Dementia Standards) was new for 2015. We can confirm that our overall score for each domain has improved on last year’s figures.

1.5. To help give the Trust Board further assurance, Appendix 2 demonstrates a comparative review of a number of other South West hospitals. When compared to these our scores show relatively close comparison. Our Trust figures are benchmarked however it is worth noting that we are an acute and community Trust and therefore often our figures are negatively impacted as for instance we do not have all the facilities at community sites e g individual TV’s for patients.

1.6. The main task now is to complete the action plans which have been developed following every inspection and address the issues raised. The ultimate aim as always is to continuously improve our scores year on year in line with the guidance.

2. Background

2.1. The NHS Constitution establishes a number of principles and values of the NHS in England, which additionally extend to private and voluntary sector providers supplying NHS services.

2.2. Included amongst these are:-



Putting patients first. Actively encouraging feedback from the public, patients and staff to help

improve services. Striving to get the basics of quality of care right. A commitment to ensure that services are provided in a clean safe

environment that is fit for purpose.

2.3. Patient-Led Assessments of the Care Environment (PLACE) are a self-assessment of a range of non-clinical services which contribute to the environment in which healthcare is delivered in both the NHS and independent/private healthcare sector in England. These assessments were introduced in April 2013 to replace the former Patient Environment Action Team (PEAT) assessments which had been undertaken from 2000 to 2012 inclusive. These are the third results from the revised process. However, every year the criteria become more detailed and there has been a greater focus on Dementia Standards this year.

2.4. The PLACE programme aims to promote the above principles and values by ensuring that the assessment focuses on the areas which patients say matter, and by encouraging and facilitating the involvement of patients, the public and other bodies with an interest in healthcare (e.g. Local Health watch) in assessing providers in equal partnership with NHS staff to both identify how they are currently performing against a range of criteria and to identify how services may be improved for the future.

3. The Process

3.1. As part of the process all Trusts are required to include patient assessors as a fundamental part of the assessments .Following last year’s inspection, Patient Assessors continued to show a keen interest to be part of any engagement sessions. As a result the same PLACE inspectors were invited back in addition to recruiting some new assessors. All the assessors were retained again this year. The inspections were patient led, however Trust assessors included representatives from Senior Nurses, Facilities, Hotel Services and Infection Control.

3.2. In the case of NDDH we had four patient representatives on the inspection team , other sites had three. The week by which assessments are to be completed is determined by the Health and Social Care Information Centre (HSCIC). The inspections at NDHT took place between March 2nd and May 29th 2015.

3.3. Each inspection group had to meet and agree the scores on the day and then the patient representatives were given time to complete the ‘free text’ form.

3.4. Within Northern Devon Healthcare Trust 12 hospitals sites were inspected (sites with 10 or more in-patient beds).

3.5. Moretonhampstead, Budleigh, Tyrrell , Crediton, Torrington, and Axminster were excluded this year.



3.6. The aim of PLACE assessments is to provide a snapshot of how an organisation is performing against a range of non-clinical activities which impact on the patient experience of care:

Cleanliness; Condition, Appearance and Maintenance of healthcare premises; the extent to which the environment supports the delivery of care with Privacy

and Dignity; and the quality and availability of food and drink; Dementia Standards (new this year).

The criteria included in PLACE are not standards, but they do represent aspects of care which patients and the public have identified as important. It also represents good practice as identified by professional organisations, for instance in the case of dementia they draw heavily on the work of The Kings Fund and Stirling University

3.7. The assessment of Cleanliness covers all items commonly found in healthcare premises including patient equipment, baths, toilets and showers, furniture, floors and other fixtures and fittings.

3.8. The assessment of Condition, Appearance and Maintenance includes the above items as well as a range of other aspects of the general environment including décor, tidiness, signage, lighting (including access to natural light), linen, access to car parking (excluding the costs of car parking), waste management and the external appearance of buildings and the tidiness and maintenance of the grounds.

3.9. The assessment of Privacy, Dignity and Wellbeing includes infrastructural / organisational aspects such as provision of outdoor / recreation area, changing and waiting facilities, access to television, radio, computers and telephones, and practical aspects such as appropriate separation of sleeping and bathroom / toilet facilities for single sex use, bedside curtains being sufficient in size to create private space around beds and ensuring patients are appropriately dressed to protect their dignity.

3.10. The assessment of Food and hydration includes a range of questions relating to the organisational aspects of the catering service (e.g. choice, 24 hour availability, meal times, and access to menus) as well as an assessment of the food service at ward level and the taste and temperature of food.

3.11. The assessment of Dementia Standards focusses on flooring, décor and signage, but also includes such things as availability of handrails and appropriate seating and to a lesser extent, food.

3.12. An Action Plan which sets out how the organisation expects to improve their services before the next assessment is required and has been undertaken for every site inspected.



4. Scores and Action Plans

4.1. The teams were asked to be rigorous in their assessment in line with the guidance and therefore we feel our scores are a true reflection of the sites on the day. Each PLACE visit generated a score in the 5 separate domains. We have received the results of this year’s inspection in all five areas of the inspection and these are highlighted in Appendix 1. Appendix 1 shows the scores in comparison with last year’s results and also goes on to graphically show the scores per site in each domain against the national average. The positioning of the Trust against other Trusts in the South West is outlined at Appendix 2.

4.2. On the whole the teams were pleased with the inspections. In particular the patient representatives were really impressed with the improvements that the Trust had made to the environments and felt that their involvement in the inspections and feedback was genuinely taken on board and was having a favourable impact on the facilities services offered to patients. It was clear from the inspections that last year’s action plans have been worked on and improvements made. In particular they were pleased to see how much A/E has improved as has Exmouth despite it being an older building.

4.3. The areas where we have spent the PLACE monies have been on general decoration, new flooring for instance in A/E and main NDDH entrance, new sinks (again A/E). In the community settings we done some extensive decorating across all sites, have provided new vinyl flooring at the main entrance, and in the physiotherapy at Exmouth and there is new flooring in the MIU at Honiton.

4.4. Whilst there were improvements this year we have highlighted some areas where we feel further improvement is necessary and this is around “high dusting ” in all areas, general clutter and the apparent obsession with displaying lots of paper signs and notices.

4.5. Okehampton hospital has a problem with the flooring that has air pockets lifting the lino throughout the hospital. This is a problem which goes back some 10 years and should have been addressed at the time of fitting however this does explain why their score has dropped as there have been specific questions about flooring this year.

4.6. On the privacy and dignity front, we have seen an improvement however will still need to work with clinical teams around the importance of preparing patients for lunch and the protected meal time initiative, whereby we try to reduce the amount of “activity” on the ward during the lunch service so patients can eat their food without interruption and with some assistance from nursing staff if required. The Facilities team will be working closely with senior nursing management to address these issues.



4.7. The patient representatives were extremely impressed with the new developments and at the start of the inspections at the NDDH, we invited the capital team to present the refurbishment plans for this year such as KGV and the physio department. This was evidence again that the Trust are taking account of the PLACE inspections and this was ‘informing’ their decision making as to areas that required investment.( the physio area was highlighted in 2013). Unfortunately as we develop new areas such as Seamoor, Fortescue, Ultrasound, and Sidmouth, the older elements of buildings or other sites can appear ‘tired and dated.’ This was particularly apparent in the Ladywell unit, although aware that plans are afoot to improve facilities, we still had to score the environment on the day of the inspections.

4.8. A paper was presented to the Executive team last year outlining that on the food scores we may have difficulty improving these without further investment. There is potential to increase choice and quantities of food in order to achieve higher scores. After undertaking a risk assessment, we felt we could not justify a cost pressure and so worked throughout the year on improving the current food service available. It is pleasing to see that the food service score has increased this year and we continue to work as a united team across all sites on any survey results and can evidence this in our monthly reviews.

4.9. We are at present reviewing the food service across all sites in order to make the most appropriate delivered food service available. The quality and nutritious value of the food service is high on the agenda. This year we have introduced a new supplier for ‘soft diets’ which seems to have been well received particularly for stroke patients. The NDDH menus have all been nutritionally analysed by Sodexo and the Trusts dieticians are currently analysing the community menus across the north and east sites.

4.10. Dementia is a new standard this year. We do have some concerns in this area as the guidance suggests that we should be introducing dementia compliance across the whole Trust not just to specific areas that care for dementia patients e g Fortescue ward. This could potentially impact on our scores going forward for all our flooring, painting, sanitary ware, and signage across the Trust. It will be interesting to see how other Trusts work on this domain and to see if the national score will increase.

5. Key Actions following this year’s inspection (June 2015)

5.1. Actions to take/taken since the inspection in June 2015 include:

Very detailed action plans have again been produced for every site inspected, in addition to this we also have some overarching organisational issues to review such as signage and dementia standards.

Following a de-clutter fortnight in February another one is planned for December



Patient Equipment was found to be dusty and so the A-Z of cleaning for clinical staff needs to be re- emphasised. Some patient seating requires deep cleaning and this will be followed up with the domestic teams.

Food quality surveyed daily, and improvements to service as being actively worked upon following our own surveys but also those from Trust patient experience surveys and the Friends & Family Test. Already replaced ‘soft diet’ supplier and achieving positive feedback

We are currently reviewing the food service delivered for the acute and community sites in order to ensure they meet the needs of the patients.

We have undertaken waste audits and are actively working on this area with clinical colleagues to improve segregation. A new waste policy/procedure was issued in July 2015 and supports this work and we aim to have some onsite training in September.

Work is on-going to improve collaborative working with senior nurses and heads of departments to build the relationships between Hotel Services and other professions to highlight the importance of PLACE e.g. physiotherapy

The Capital and Maintenance teams have the plans for redecoration, flooring and environmental improvement across all sites which have come from the PLACE action plans.

The wards at the Tiverton (PFI) hospital are due for re-decoration, we are therefore visiting the site to provide advice on colour schemes in order to incorporate dementia standards and will work with the PFI contractor to achieve this.

We do need to make some purchases such as bariatric chairs, variable height chairs and shower chairs.

Signage going forward will incorporate words and pictures (if appropriate) to meet dementia good practice

6. Information Governance

6.1. PLACE data will be published as official statistics and will be shared with the following organisations:

Care Quality Commission Department of Health NHS Commissioning Board Clinical Commissioning Board (when requested) National Audit Office (when requested) The Health & Social Care Information Centre (Clinical Quality Indicators)

7. Conclusion

7.1. The HSCIC have noted when reviewing national results that changes have been made to all but the cleanliness score since the assessments in 2014. However it is the nature of the assessment to change and evolve and whilst results between 2014 and 2015 may not be directly comparable, they are included in this report for the sake of completeness and also so the impact of changes from year to year can be identified.



7.2. We have shown that standards have improved compared to last year, despite additional questions. It is clear that all Trusts are also raising their game so the process does indicate benefits to be gained in terms of ‘continual improvement’.

7.3. The recent CQC visits have assured us that our standards are high but we still aim to improve year on year.

7.4. The PLACE process this year was extremely thorough and well organised, and we could see improvements on the previous year where action plans had clearly been worked upon. Some areas did affect the scores and so we need to work on these in particular whilst still maintaining high standards elsewhere. This has to be a multi-disciplinary approach and the message is that all departments must engage in the process and understand the importance of the environment and associated services to patients and visitors.

7.5. Our main task now is to work through the action plans identifying areas where we can make improvements or where decisions need to be made about the practicalities of meeting some of the targets and the benefits of this. Our ultimate aim is obviously to improve our scores.

7.6. We can build on the relationships we have made with the patient representatives and it is our intention to invite them back to see the progress we have made. They have all indicated they are extremely keen to participate in any further exercises where we may need public engagement. We will need to recruit more patient assessors in the coming year.

7.7. Key issues now being worked on by the Facilities team:

Nursing and Hotel Services engagement to improve environmental standards on wards

Quality food delivery at ward level (meal service times to advertised on Bob as well as the wards view about visiting times and assistance with meals for relatives)

Work on mind set for de-clutter (next de-clutter event planned for December 2015)

Review any overarching organisational issues such as delivered meal service and the implementation of good practice ‘dementia’ standards and carry out risk assessments as necessary.

Be aware of areas that may not be being progressed as quickly as expected under the ‘Estates /service strategy’ e.g. Bassett, ED and the Hub work to ensure that they still offer good facilities.

Tendering work for capital expenditure around décor, flooring and environment

One of the key areas for change has to be in creating a mind set for all staff groups on de-cluttering and general engagement on the importance of the environment and facilities services to patients.



In 2015, the national assessments were extended to include criteria on how well healthcare providers’ premises are equipped to meet the needs of caring for patients with dementia.

8. Recommendations

8.1. The Trust Board are asked to accept the report, to be assured that standards are improving and to recognise that we are completing the action plans for each area. There are however 3 key issues where Facilities would like some guidance and support from the Trust Board if we are to progress further and learn lessons from other Trusts. We do still seem to have an issue around accountability and in particular we need senior nurses and heads of departments to take responsibility for

The amount of clutter in wards and departments often based around the need to have things close to hand that in reality are rarely used and could be centrally sourced. To take ownership of their environments and report any issues via the various helpdesks in the Trust.

The amount of paper signs, posters, staff information notices that are displayed on view for the public. Often due to the amount, the posters have limited effect and we should be looking to minimise these in order to present a tidy, smart, fresh clinical space. We really have to stop the culture of “must display”.

There may be some overarching organisational issues whereby we need executive support or otherwise. In particular we are concerned about the Dementia principles within the PLACE assessment ie whether the premises are equipped to meet the needs of dementia sufferers against a specified range of criteria. Whilst we have concentrated on 1 area at the NDDH ie Fortescue ward, the assessment asks us to also consider outpatient areas, and basically any services which may be accessed by dementia patients across all Northern Devon Healthcare Trust sites. This could have a huge financial impact and raises questions around the appropriateness of this roll out.


Director of Facilities G:\BOARD SECRETARIAT\MEETINGS\Board\Meetings\2015-16\02.02.16\Annex 2.5 Board 02.02.16 - PLACE Assessments v19.01.16.docx Page 12 of 16

APPENDIX 1

SCORES FOR THE CURRENT YEAR & PREVIOUS TWO YEARS

CLEANLINESS FOOD PRIVACY, DIGNITY & WELLBEING

CONDITION APPEARANCE & MAINTENANCE

DEMENTIA

2015 2014 2013 2015 2014 2013 2015 2014 2013 2015 2014 2013 2015

National Average

97.57%

97.25%

95.74%

88.49%

88.79%

84.98%

86.03%

87.73%

88.87%

90.11%

91.97%

88.78%

74.51%

SITE

Bideford 98.95 93.01 93.07 79.32 83.05 82.53 81.82 80.51 75.69 88.08 77.27 73.48 71.09

Exmouth 97.20 86.72 82.82 89.34 85.78 78.81 79.76 71.01 81.56 88.64 88.85 66.23 69.35

Holsworthy 96.28 97.49 87.83 86.93 85.68 75.40 87.23 84.29 82.11 88.76 89.74 69.18 77.18

Honiton 98.55 97.27 90.86 86.56 91.84 82.42 89.17 83 74.80 96.06 94.17 78.82 80.47

NDDH 97.13 94.64 94.99 83.73 79.63 80.41 79.40 89.24 85.25 91.16 91.99 83.61 78.40

Okehampton 99.18 96.51 92.42 88.97 87.75 78.73 87.04 75.60 77.50 85.40 90.31 73.66 72.00

Ottery 97.12 98.71 86.91 89.36 91.12 81.87 86.27 84.66 74.78 94.25 98.26 84.78 71.72

Seaton 98.53 94.41 95.64 86.90 88.21 70.92 87.21 82.93 76.76 91.76 96.67 75.33 70.77

Sidmouth 97.33 96.77 83.64 87.39 86.75 76.42 84.44 70.51 71.56 92.93 93.33 70.83 77.09

South Molton 98.93 92.21 92.66 87.42 85.96 84.87 85.42 74.04 75.56 89.13 88.89 86.67 70.93

Tiverton 98.52 98.83 86.68 89.02 84.33 84.63 85.61 86.72 79.35 85.11 88.13 81.74 70.16

Exeter Community

96.89 95.38 91.02 91.06 91.83 86.48 87.50 77.33 82.69 90.30 92.78 80.32 63.95

Trust Score 97.88 95.15 90.03 87.17 83.12 79.54 85.07 84.47 74.96 90.10 90.69 76.13 72.76







APPENDIX 2 SOUTH WEST REGION RESULTS



Documents

Trust Board 2 February 2016 EXECUTIVE SUMMARY...PLACE REPORT 2015 Trust Board 2 February 2016 Director of Facilities G:\BOARD SECRETARIAT\MEETINGS\Board\Meetings\2015-16\02.02.16\Annex