1. East Lancashire Hospitals NHS Trust : Our improvement plan & our progress Personal statement from the Interim Chair of East Lancashire Hospitals NHS Trust: “I am pleased to share with you our plans to improve the quality of care the Trust provides to our local community. The Board welcomes the findings of the Keogh review, which was as a result of higher than expected mortality rates at the Trust. We, together with our staff, are wholeheartedly committed to improving the quality of our services. This plan sets out short-term improvements on the key areas of concern raised by the Keogh Review Team, however our longer term plans for continuous improvement will go beyond the deadline dates that we have set out in this plan. This will ensure that we are assessed as a high performing organisation when the Chief Inspector of Hospitals, Professor Sir Mike Richards inspects our Trust. Once the actions identified within the Keogh action plan have been completed, we will set out a longer-term plan to maintain progress and ensure that the actions lead to measurable improvements in the quality and safety of care for patients. There will be regular updates on NHS Choices and subsequent longer term actions will be included as part of a continuous process of improvement. Our staff were rightly seen by the Keogh review as our biggest asset and we will work together, and support our staff, to ensure we provide compassionate care that places our patients at the heart of everything we do. We are committed to improving as an organisation and delivering against our improvement plan is fundamental to helping us on this journey.” Martin Hill, Interim Chair

2. What are we doing? The Keogh review made 30 urgent recommendations on the 16 th July 2013 which, if implemented, would improve the quality of our services. Specifically, Keogh said that we need to: - Improve the way in which the Board seeks to ensure high quality services are delivered every time, all of the time. This is important because the Board need to be aware of risks to the quality of our services, to promote patient safety and react swiftly to any emerging issues. In our individual and collective response to the Keogh review we are emphasising the need to put the delivery of sustainable, safe and high quality care for our patients at the heart of everything we do. We have therefore simplified our vision for the organisation to set out a clear ambition for staff, patients, their carers’ and their families: ‘ To provide Safe, Personal and Effective care for every patient, every time’. This is supported by five clear improvement priorities. One of our key improvement priorities is to reduce hospital mortality. Following the Keogh review we took immediate action to reduce our mortality and also ensure we learn from patient deaths. All patient deaths are formally reviewed by a senior clinician and are discussed at weekly share-2-care meetings by multi disciplinary teams. We have a mortality reduction plan which is overseen by a steering group of senior clinical staff from a variety of professions. - Improve the information that the Board receives about savings plans and their impact on the quality of our services. This is important because, although we have to make savings each year so that we don’t spend more money than we receive, we need to be better at checking that the savings we make will not have a detrimental effect on the care we give our patients. The process by which our savings plans are approved has been strengthened to ensure there is no detrimental impact on the quality of care we provide. All of our savings plans are now reviewed and signed off by our Medical Director and Chief Nurse. - Improve the way we use our beds across all of our sites. We will also work more closely with other NHS organisations and the Local Authorities to ensure alternative services can be accessed by patients in a community setting. Both of these points are important because we need to ensure that we can continue to provide high quality care to the increasing number of patients who need to access emergency care. We have developed an ambulatory care service – a patient focussed service where people coming in to hospital as emergency patients can have investigations, exploratory examinations and receive a treatment plan without the need for an overnight stay. This now avoids admission for 20 patients a day and will be extended during the winter period. On Monday the 7th October 2013 we began the ‘Perfect Week’. The Perfect Week was a commitment across the organisation to improve patient experience and to ensure care was being delivered in the most appropriate setting. We particularly worked with our health economy partners in a structured way to remove any barriers in discharging patients. A number of quality improvements have been identified East Lancashire Hospitals NHS Trust : Our improvement plan & our progress

3. What are we doing? - Improve our understanding of the reasons why we have a relatively high number of patients who are readmitted to hospital unnecessarily. This is important because we are now able to move some services into the local community so that they are closer to home which means patients don’t have to go into hospital. This improves the experience for our patients. We have undertaken a comprehensive audit of our readmissions to further establish the reasons why they occurred. We are now working with our partner organisations to address the issues highlighted. We have doubled the capacity in our virtual ward, which now supports 300 patients, 7 days a week to be cared for in their own home rather than having to come into hospital. - Engage more effectively with our patients and their carers and provide an increased opportunity for them to improve our services. We have launched a new programme of ward/departmental walk rounds by our Board members. This new programme has a more informal approach with the focus on having conversations with staff, patients, families and friends to ensure our most senior staff understand how patients feel when they use our services and the issues that staff face when delivering care to our patients. This will promote a culture of feeling able to report when care is not the best it can be and feel supported in putting it right and learning lessons from those experiences. - We will listen to patients’ concerns and respond compassionately and quickly and we will listen to what our patients are telling us. It is important to learn from things which don’t go well so that they don’t happen again. We need to support our staff to continue to learn and develop in order to provide the best possible care for our patients We have extensively communicated with staff in a variety of ways on the importance of complaints and concerns raised by patients and relatives as a mechanism of learning and improving care. We’ve introduced a new education and training programme on how to respond to and learn from complaints. A new complaints handling process is in place that changes emphasis from investigation and formal response to understanding complaint/concern, offering an early meeting, responding empathetically and learning to improve care. We are now using patient stories at a variety of meetings as a learning tool. - Constantly review our workforce numbers and work hard to meet the changing needs of patients in our care. This is important to ensure all the needs of our patients are met and that the care that we give is safe and effective. We have significantly increased the number of nurses on duty at nights on our core medical wards and are continuing to recruit additional trained nurses, health care assistants and midwives. To ensure we have enough nurses on our wards we have also recruited nurses from Portugal and Italy. Our sickness absence levels are improving and levels are significantly below the North West average and below the national average.

4. East Lancashire Hospitals NHS Trust : Our improvement plan & our progress What are we doing? - Strengthen the leadership and support to our nursing staff. This is important so that our nurses and midwives feel valued and ensures excellent and consistent nursing is provided throughout the Trust. We have reenergised our organisational development strategy and have cascaded our leadership development programme to our matrons and specialist nurses. Two cohorts (24 senior nurses) have already completed the programme. This document shows our plan for making these changes and shows how we’re progressing. It builds on the ‘Key findings and action plan following risk summit’ document which we agreed immediately after the review was published. This can be found at: http://www.nhs.uk/nhsengland/bruce-keogh-review/pages/published-reports.aspxhttp://www.nhs.uk/nhsengland/bruce-keogh-review/pages/published-reports.aspx Whilst we make these changes to address the Keogh recommendations, the Trust is in ‘special measures’. More information about special measures can be found at http://www.ntda.nhs.uk/blog/2013/07/16/nhs-tda-places-five-trusts-in-special- measures. The Trust Development Authority are working with us to ensure we have the right support in place to make these changes as quickly as possible.http://www.ntda.nhs.uk/blog/2013/07/16/nhs-tda-places-five-trusts-in-special- measures

5. East Lancashire Hospitals NHS Trust : Our improvement plan and our progress How our progress is being monitored and supported We will update this progress report on the first day of every month while we are in special measures. We will work with our Shadow Council of Governors, members and Healthwatch to ensure that the improvements we are putting in place are effective. We will also hold public meetings and attend listening events, where we will update, face to face, our local community on our progress. We will also produce monthly press briefings which describe how are delivering against our improvement plan. Further details will be announced in updates of this progress report. A senior representative will be appointed by the TDA, who will provide expertise to the Trust Board and check that we're meeting our promises to deliver our improvement plan. (Timescale: By October 2013; Owner: TDA). We will access support from partnership working as appropriate with the Academic Health Science Network, NHS Improving Quality and the NHS Leadership Academy. (Timescale: By April 2014; Owner: NHS England). Martin Hill Interim Chair of the Trust (on behalf of the Board) Who is responsible? Our actions to address the Keogh recommendations have been agreed by the Trust Board. With the Board our Chief Executive, Mark Brearley, is ultimately responsible for implementing actions in this document. Other key staff are our Medical Director, Rineke Schram and our interim Chief Nurse, Hayley Citrine, who are tasked with implementing many of the key actions described below that will help improve the quality of care delivered by our staff and enhance patient experience. Nicky O’Connor from the Trust Development Authority is helping us to implement our actions by supporting and challenging the process by which we will ensure we deliver on our action plan. Ultimately, our success in implementing the recommendations of the Keogh plan will be assessed by the Chief Inspector of Hospitals who is likely to re-inspect our Trust in the next six to nine months. If you have any questions about how we’re doing, please ring Lynne Barton our Head of Communications on 01254 732540, or if you want to contact Nicky O’Connor, as an external expert, you can reach her on nicky.oconnor@nhs.net

6. Our improvement plan This table shows the actions we’re taking to address the concerns about the quality of our services which were raised in the Keogh report. It also shows how we are progressing against our actions. Summary of Keogh ConcernsSummary of Urgent Actions RequiredAgreed Timescale External Support/ Assurance Progress B/G/R/ narrative Improve the way in which the Board seeks to ensure high quality services are delivered every time, all of the time The Board will undertake a specific development programme which focusses on quality and safety. We will work through the information from the listening events carried out by the Keogh Review Team to look very carefully at the issues raised and make sure wherever possible we don’t repeat the same failings. We will share this learning with our CCG colleagues. We will increase the number of spot checks in clinical areas to ensure that the care being provided is of the highest standard. We will work harder to understand the priorities of our patients, their carers and our staff. We will target and address specific areas of concern to drive clinical quality and safety improvements across our organisation. The Board will put in place triggers for all patient safety and quality issues to make it clear to our staff when they need to notify the Board of issues which need closer review. End Aug 2013 End July 2013 End Sept 2013 End July 2013 NHS Improving Quality Improve the information that the Board receives about savings plans and their impact on the quality of our services Our Medical Director and Chief Nurse will review all of our savings plans to ensure there isn’t a detrimental impact on the clinical services we deliver. End July 2013 Improve the way we use our beds across all of our sites Agree our plans for winter and ensure that all of the beds that we use are in environments which support the privacy and dignity of our patients. Continued spot checks on escalation areas when in use. End Aug 2013 Improve our understanding of the reasons why we have a relatively high number of patients who are readmitted to hospital unnecessarily We will comprehensively analyse the data on patients who have been readmitted unnecessarily and put in place an action plan to address any issues identified. Our Board will look at the learning from this work to ensure our discharge processes are safe and effective. End Sept 2013

7. Our improvement plan This table shows the actions we’re taking to address the concerns about the quality of our services which were raised in the Keogh report. It also shows how we are progressing against our actions. Summary of Keogh ConcernsSummary of Urgent Actions RequiredAgreed Timescale External Support/ Assurance Progress B/G/R/ narrative Engage more effectively with our patients and their carers and provide an increased opportunity for them to improve our services A named Board level lead will oversee patients’ concerns alongside the newly appointed Complaints Manager. We will work with our key health partners to share learning and improve the care we provide for our community. End July 2013 End Aug 2013 Constantly review our workforce numbers and work hard to meet the changing needs of patients in our care We have obtained support to help us better understand our nurse staffing levels and how our nursing staff can best meet the care needs of our patients. Develop a process to constantly review the skills of our nursing teams and better understand the impact of vacancies. Review the workforce information which is provided across our organisation and develop reporting on recruitment activity levels, by area and staff group. End Sept 2013 End Aug 2013 External reviewer Strengthen the leadership and support to our nursing staff. We will place particular emphasis on our senior nurses and midwives participating in our Leadership Programme. This programme focusses on the values and behaviours we want to see shown in our organisation and will help to ensure we are consistent in how we deliver high quality care. End Aug 2013 Key for progress reports Blue -delivered Green – on track to deliver Narrative – disclose delays/risks/plan to recover Red – not on track to deliver

8. How we’re checking that our improvement plan is working This table shows how and when we are checking that the actions we’re taking are making a real difference on our wards, in our operating theatres and in our community services. It also highlights how we will be communicating our progress to our local community. Oversight and improvement actionTimescaleAction ownerProgress Fortnightly accountability meeting with Trust Development Authority and our Clinical Commissioning Groups to track delivery of action plan. The Clinical Commissioning Groups are working closely with us to provide assurance to their governing body that we are delivering appropriate actions to make a difference. Aug 2013 to July 2014Trust Chief Executive/Special Measures Director We will use the partnership working with Newcastle Upon Tyne Hospitals NHS Foundation Trust to learn how we can strengthen our leadership and make improvements to the quality of services that we provide. Aug 2013 to July 2014Trust Chief Executive Appointment of an Improvement Director (Marie Noelle Orzel) by TDA, who will provide expertise to the trust Board on how to improve our services and check that we’re meeting our promises to deliver our improvement plan October 2013TDA The monthly meetings of the Trust Board and the Executive Management Board will review evidence about how the trust action plan is improving our services and changing the way we work for the better. There will also be bi-weekly Keogh Action Plan Meetings attended by our Executive Directors who have lead responsibility for implementing the action plan. 2 weekly Sept 2013 to July 2014 Trust Chair Trust Reporting to the public about how our trust is improving through Healthwatch, our Shadow Council of Governors, members, our website, listening events and the local media. We will further develop our communications plan over time MonthlyTrust CE Agreement and regular reporting of quality measures to demonstrate that the actions are leading to improved quality of care for patients. We will use the Commissioning for Quality and Innovation scheme with our commissioners to drive quality up. Our performance will be published on our website. MonthlyTrust CE/TDA Key for progress reports Blue -delivered Green – on track to deliver Narrative – disclose delays/risks/plan to recover Red – not on track to deliver

9. How we’re checking that our improvement plan is working This table shows how and when we are checking that the actions we’re taking are making a real difference on our wards, in our operating theatres and in our community services. It also highlights how we will be communicating our progress to our local community. Oversight and improvement actionTimescaleAction ownerProgress We aim to complete an independent review of the quality and governance systems at the Trust. We aim to have this completed within the next six months. Sept 2013 to Feb 2014.Trust Chief Executive External scrutiny of our new ways of working and of the quality of our services by a Quality Surveillance Group (QSG) composed of the Trust CE, Trust Medical Director, NHS England Area Team and CCGs. Sept 2013 to July 2014.Trust Chief E/Special Measures Director/AT/CCGs Re-inspection.Early July 2014.CQC