Quality account summary 2023/24

All NHS Trusts are required to produce annual Quality Accounts to describe past and future activities to improve the quality of the services they provide.

This booklet is a summary of the Quality Account report.  You can find the full report on our website at www.homerton.nhs.uk/reports-and-magazines

If you have any queries, please contact huh-tr.enquiries@nhs.net

We have three important quality improvement areas that are core to everything we do. They are:

We have seven quality priorities to help us improve in the above areas. These were agreed in 2022 for a two-year period. The seven priorities are:

1. To reduce the number of community and hospital attributed pressure ulcers
2. Reducing physical violence and aggression towards patients and staff
3. Improved management and reduction in the rate of falls
4. Just Culture and Safe Environment
5. Appropriate identification and management of deteriorating patients, including maternity, paediatrics and community-based services
6. Improving our populations health
7. Improving first impressions and experience of the Trust for patients and visitors

We have completed a review of our quality priorities to align with our Trust strategic priorities, which were published in 2023. 

Our current priorities will be closed and the activity wither transferred to an established working group to become ‘business as usual’ or form part of our new strategic priorities.

Read our Strategy

I am proud to present our Quality Account for 2023/24, which reviews our performance over the past year and sets our goals for 2024/25.

This report reflects on our achievements and allows public scrutiny of our progress in maintaining safety, effectiveness, and patient experience. Despite challenges, we performed well in key areas, including A&E targets, cancer diagnosis, and seven-day service standards.

Our Trust responded well to the challenges faced as a result of the medical industrial action and continued to manage patient care safely. We also made strides in reducing long wait times and improving incident response, particularly with the implementation of the Patient Safety Incident Response Framework in early 2024.

There have been both successes and challenges, such as the suspension of our Fertility Unit’s license due to process failures, but we are working hard to address recommendations and reopen safely. Our maternity services were rated Good by the Care Quality Commission (CQC), and we continue to advance improvements in patient safety, including a focus on deteriorating patients, pressure ulcers, and patient falls.

We are committed to reducing health inequalities and fostering a just and supportive culture for staff, strengthening this commitment through the Freedom to Speak Up initiative. We also remain dedicated to integrated community health and reducing violence and aggression within our Trust.
In the coming year, we will continue to prioritise safety and patient care, working closely with our staff, partners, and community.

I am grateful for the dedication of our 4,000 staff, it is an honour to lead such an inspiring and caring group of people. Their dedication and commitment to providing the best possible care is a tremendous asset to the communities of City and Hackney. I’d like to thank all our staff and local partners who have come together in such an exceptional way to service our communities.

I hope this Quality Account gives you a clear picture of our commitment to quality, safety, and service user and carer experience at Homerton Healthcare NHS Foundation Trust. I look forward to building on our achievements.

Bas Sadiq
Chief Executive Office and Place-Based Leader

We have completed a review of our quality priorities to align with our Trust strategic priorities, which were published in 2023.

Our current priorities will be closed and the activity either transferred to an established working group to become ‘business as usual’ or form part of our new strategic priorities.

Below is a summary of each quality priority, our progress against them, and the next steps.

Patient Safety
How we deliver safe care

1. To reduce the number of community and hospital attributed pressure ulcers.

Target

• Acute inpatient areas: reduce lapses of care category 3 and above pressure ulcers by 60%
• Community: reduce lapses of care category 3 and above pressure ulcers by 40%

Progress and performance in 2023/24

• Increased patient and carer engagement: involvement of service users and carers to ensure patient information materials are accessible and relevant
• Education and training: online education resources for wound care and events such as the ‘Time to Turn’ conference with training in key themes
• Improved incident reporting: using new Datix structure to improve reports and give detailed data by ward and neighbourhood teams
• Performance against targets: targets for hospital and community acquired pressure ulcers not met, but total number of pressure ulcers with lapses in care in below average since February 2023

Next steps

This priority will be carried forward by the Pressure Ulcer Strategy Committee

• Further improvements to reporting with new form to streamline with more accurate data analysis
• Work with supplier to improve supply and maintenance of pressure relieving mattresses, and develop mattress and cushion pathway
• Continued training for staff by Tissue Viability Service, focused on area-specific incident themes, plus progress roll out of the PURPOSE-T risk assessment tools

2. Reducing physical violence and aggression towards patients and staff

Target

• Staff feel safe and are safe at work
• Staff have the skills and confidence to respond to incidents of violence and aggression
• Increase the use of lone worker devices
• Increase the number of staff receiving Maybo training

Progress and performance in 2023/24

• Personal safety and conflict resolution training: personal safety sessions with the Met Police for community staff, alongside regular Maybo conflict resolution training for both new and current staff across care settings, with bespoke sessions for children’s services
• Enhanced support and training for managing complex cases: Collaboration with HPM and ELFT colleagues to provide specialised training focused on supporting staff who work with complex mental health patients
• Environment and reporting improvements: created calming waiting areas, updated guidance for reporting incidents and issues sanctions, and introduced sanctions for violence and aggression in community services
• Performance against targets: incident reporting increased each quarter in 2023/24 and lone worker device usage decreased between July – December 2023

Next steps

This priority will be carried forward by the Violence and Aggression Group

• Reducing physical assaults on staff and empowering staff to report incidents and issue sanctions
• Specialised training, including in-situ simulations, bespoke training for maternity, and continue collaboration with HPM and ELFT
• Launch ‘Respect our Safety’ campaign with improved communications materials, clearer guidance and easier reporting form to ensure all incidents are reported and sanctions issues when needed.
• Review of lone worker devices and pilot of new device

3. Improved management and reduction in the rate of falls

Target

• Reduction of falls rate

Progress and performance in 2023/24

• Falls prevention and monitoring initiatives: comfort rounding, introduction of Enhanced Care Team, member of staff now remains in bay during handovers, and MDT meetings to review and respond to falls with harm
• Training and education: RCP e-learning in place for falls prevention, equipment training and roll out of flat lifting tools, and PSIRF after action debriefs to reinforce learning from falls
• Documentation: EPR ad hoc form launched for better documentation during comfort rounding
• Performance against targets: Rate of falls was unchanged, but increase from 2021 in KPI’s 4 and 6 for severe harm falls

Next steps

This priority will be carried forward by the Falls Strategy Group

• Roll out training programme, including promoting e-learning package available through Royal College of Physicians, and update to bed policy following MHRA alert
• Improve completion rate Multi-factorial Risk Assessment and ensure easy access on EPR, plus review nursing documentation to improve recording of falls prevention measures and comfort rounding
• Regular data reviews for targeted interventions alongside implementation of national audit recommendations to inform the Strategic Falls group priorities for 2024/25

Clinical Effectiveness
How soon patients experience the benefits of treatment

4. Just culture and safe environment

Target

• Develop and promote a just culutre where staff feel safe to raise concerns

Progress and performance in 2023/24

• New strategy and staff wellbeing initiatives: ‘Develop Happy, Healthy and Heard Staff’ priority in new strategy focuses on staff wellbeing and experience, supported by initiatives such as the Psychological First Aid and mandatory Freedom to Speak Up training
• Enhanced patient safety and reporting frameworks: new Patient Safety Incident Response Framework (PSIRF) and national incident reporting system implemented, recruitment of Patient Safety Partners, and introduction of frameworks to analyse complex outcomes and improve safety culture
• Just culture and continuous learning: adopting a Just Culture approach to promote compassionate, learning-based resolutions, streamlined Freedom to Speak Up processes on Datix and ongoing learning from incidents and feedback to ensure continuous improvements across the Trust.
• Performance: 7% increase in Freedom to Speak Up concerns raised.

Next steps

This priority will be integrated into one of the six strategic priorities in the Trust’s ‘Our Future Together’ strategy

• Streamline governance processes for sharing patient safety incident learnings
• Develop training for human factors, and civility training, alongside introduction of ‘Listen Up’    and ‘Follow Up’ Freedom to Speak Up modules for managers and leaders and additional After Action Review training.
• Clarify process for routes taken when concerns are raised

5. Appropriate identification and management of deteriorating patie   nts, including maternity, paediatrics and community-based services.

Target

• Expand on deteriorating adult inpatients work to support maternity, paediatrics, neonatology, and community.

Progress and performance in 2023/24

• Deteriorating patient oversight and learning: Quarterly Deteriorating Patient Oversight Group (DPOG) Meetings bring together progress in different areas, share learning and tackle challenges
• Adult inpatients: Improvements in recording vital signs through EPR updates, automated data entry, and staff training on NEWS scores, with CQUIN standards met.
• Paediatrics: CEWS policy implementation, clinical audits, patient transfer checklists, and preparation for “call for concern” launch.
• Maternity: High compliance in NEWTT and MEOWS audits, rebranding of escalation triggers, and quality improvement projects focused on emergency obstetric care.
• Neonatology: Recent integration with DPOG, with a focus on LMNS data collection, safety metrics in morbidity meetings, and initial moves towards a paperless unit.
• Community: New Community Deteriorating Patient Group to ensure that patient safety and oversight extend beyond hospital settings.

Next steps

This priority will be carried forward by the Deteriorating Patient Oversight Group

• Roll out of 24/7 Critical Care Outreach Team and Call for Concern
• Review sepsis guidance following national updates
• Move from CEWS to PEWS in paediatrics and to NEWTT2 in Maternity, with training in Neonatology.
• Co-produce framework with community services for managing deterioration at home.

6. Improving population health

Target

• Launch new Trust Strategy
• Set up Tobacco Dependence Treatment (TDT) Service
• Extend activity into other areas, such as diabetes and obesity.

Progress and performance in 2023/24

• Improving health and wellbeing goals of the community: New strategy launched with addressing health and wellbeing of our communities as a top priority.
  Smoking cessation and health improvement initiatives: The Trust has launched inpatient smoking cessation services, recruited staff, developed a Smokefree Policy, and strengthened pathways with community health programmes. Additionally, referrals to the Alcohol Care Team are now streamlined via EPR for improved support.
• Performance: Number of inpatients screened between 99-100% for smoking dependent habits and between 80-88% for alcohol dependent habits.

Next steps

This priority will be integrated into one of the six strategic priorities in the Trust’s ‘Our Future Together’ strategy

• Neighbourhoods to work collaboratively with residents and partners to identify and improve population health needs
• Reduce admission rates and length of stay for people with long-term conditions
• Give health and lifestyle advice at every contact, where appropriate

Patient Experience
How patients experience the care they receive

7. Improving the first impression and experience of the Trust for all patients and visitors

Target

• Improve patient satisfaction scores

Progress and performance in 2023/24

• Improving patient, relative and carer experience: launch of ‘Call 4 Concern’ to allow patients, relatives and carers to seek second opinion if they’re concerned, recruitment of patient voices representatives, and successful trial of Homerton Assessment, Accreditation and Recognition Programme (HAARP) on wards.
• Improving access and communication: implented AccessAble access guides to support people with access needs to plan their visit to and around the hospital, new digital inclusion team established, and new resources and booklets developed.
• Improving facilities: relocation of phlebotomy services, opening of refurbished and new intensive care unit, and start of construction of new elective surgical centre.
• Performance: 90% positive feedback and 5% negative feedback in Friends and Family Test

Next steps

This priority will be integrated into one of the six strategic priorities in the Trust’s ‘Our Future Together’ strategy

• Finalise Patient Experience Strategy in collaboration with partners
• Roll out HAARP across inpatient wards and other areas
• Review and improve facilities and buildings in line with Estates Plan
• Improve complaints reponse and deliver training across divisions

Homerton Healthcare NHS Foundation Trust

Homerton University Hospital site

Mary Seacole Nursing Home

The table below shows the Trust’s performance against the national NHS targets for 2023/24.

Performance against national targets

Key Performance Indicators	Target	Performance
Urgent and emergency care
A&E waiting times Patients seen within 4 hours	76%	81.1%
Bed occupancy Reduce adult general and acute occupancy	92%	92.6%
Community health services
Urgent community response (UCR) Meet or exceed 2-hour UCR standard	70%	94.8%
Elective Care
Long waiters Eliminate waits of over 65 weeks by March 2024	0	10
Cancer
62 day target Reduce number of patients waiting over 62 days	24	25
Faster diagnosis standard 75% of patients are diagnosed or have cancer ruled out within 28 days	75%	76.3%
Diagnostics
6 week target Increase number of patients receiving diagnostics test within 6 weeks	95%	91%
Mental Health
Improving Access to Psychological Therapies (IAPT) Increase number of adults and older adults accessing IAPT treatment	2.6%	2.2%

Performance against key metrics is monitored and reviewed by the executive directors at senior team meetings. The Trust Board considers detailed performance and quality information each month.

Clinical research remains a top priority for the UK Government, with continued funding to Clinical Research Networks (CRN) and its integration into NHS operations. The NHS Constitution and Care Quality Commission (CQC) recognise research as essential for improving patient care, not just an optional activity. We aim to open studies that benefit the people we care for as well as the wider popular, and we’re committed to growing our research capacity year on year.

Key research updates:

• Study participation: Homerton’s Reasearch and Innovation (R&I) team is involved in high-profile studies, such as the DIVO study for detecting cataracts in newborns and the HARMONIE paediatric vaccine trial.
• Innovation: the R&I team have been successful in groundbreaking innovations such asthe award-winning VERBO project for Speech and Language Therapy.
• Growth and challenges: while commercial income and grant funding have increased, challenges persist regarding suitable space for lab equipment and research activities, as well as limited imaging capacity.
  
• Community engagement: efforts are underway to improve research access for underserved, ethnically diverse communities, reflecting the local population’s needs and languages.

 

1,244 patients receiving health services by Homerton were recruited into approved research studies 2023/24.

Safeguarding a culture of staff speaking up remains at the heart of the Trust’s people plan.

The Trust has a Freedom to Speak Up: Raising Concerns at Work (Whistleblowing) policy and procedure in place, and one Freedom to Speak Up (FTSU) Guardian supported by FTSU Champions. FTSU training was made mandatory for all staff, plus Listen Up and Follow Up training for managers and senior leaders. 

An online reporting platform (Datix) is used to track concerns, providing better identification of learning and track themes.

• A&E – accident and emergency, the department that provides emergency care for life-threatening illnesses and injury
• Acute hospital / care – medical and surgical treatment provided, mainly in hospital
• Bed occupancy – the number of days a bed is occupied by patients during a given period.
• Call 4 Concern – a patient safety service enabling patients and families to call for immediate help and advice when they feel concerned that the health care team has not recognised their own or their loved one’s changing condition (deterioration).
  
• Care Quality Commission (CQC) – an independent regulator of health and adult social care in England. They monitor, inspect, and regulate services and publish their findings.
• CEWS – stands for ‘Children’s Early Warning Score’. It’s a system used to identify and respond to clinical deterioration in paediatric (children) patients.
• CQUIN – stands for ‘Commissioning for Quality and Innovation’. It’s a framework used to improve the quality of healthcare services and creation of new, improved patterns of care.
• EPR – electronic patient records, a digital system for storing and managing patient’s health information
  
• Freedom to Speak Up (FTSU) – a national initiative that supports health and care staff to speak up if they are concerned about patient safety, quality of care, staff safety, or any other concerns.
  
• Just culture – a system that considers wider systemic issues rather than on an individual basis. It aims to understand why things happen and enables people in the system to learn from mistakes without fear of personal sanctions, developing an environment where people feel safe to report issues.
• MDT – Multi-disciplinary team.  This is a team of professionals drawn from various disciplines who combine their expertise to the benefit of patients.
• MEOWS – stands for ‘Modified Early Obstetric Warning Score’. It’s a system used to monitor pregnant patients for early signs of physical deterioration. It helps identify patients who are at risk of declining health during pregnancy, labour, delivery, and after birth.
• MHRA – the ‘Medicines and Healthcare products Regulatory Agency’, a government agency responsible for ensuring medicines and medical devices work and are acceptably safe.
• Neighbourhood – a national initiative that brings residents, health and care services, voluntary sector, and education services together to improve the health and wellbeing of the community. There are eight Neighbourhoods in City and Hackney who work together on what matters to local people.
• Neonatology / neonatal – neonatal refers to a new born infant and neonatology is the service that cares for those babies
• NEWS – stands for ‘National Early Warning Score’. It’s a system used to identify and respond to clinical deterioration in adult patients
• NEWTT2 – stands for ‘Newborn Early Warning Track and Trigger’. It’s a framework that identifies at-risk newborns and monitors their clinical condition
• Partners – external organisations we work alongside to provide health and care services. This includes other NHS Trusts, GPs and primary care, councils and local authorities, and voluntary organisations
• Phlebotomy – the term for the procedure of drawing blood from a patient using a needle, usually for diagnostic or monitoring purposes
• Population health – an approach aimed at improving the health and wellbeing of an entire population. It focuses on preventative care and reducing health inequalities
  
• Pressure ulcer –  damage to the skin or underlying tissue caused by sustained pressure.
• PURPOSE-T – it stands for Pressure Ulcer Risk Primary or Secondary Evaluation Tool. It is a system used to assess the risk of pressure ulcers in adults.