1. KEOGH REVIEW – IMPROVEMENT PLAN ULHT MONTHLY UPDATE NOVEMBER 2013

2. On 6 February 2013, the Prime Minister asked Professor Sir Bruce Keogh, NHS England Medical Director, to review the quality of the care and treatment provided to patients by our Trust (along with 13 other NHS organisations). The 14 Trusts were selected because of higher than expected mortality rates between 2010 and 2012. In June 2013, the Keogh Review recommended 57 different ways that we could improve the quality of our services. The full detail these recommendations can be found here: ULHT Rapid Response Review Report. In July 2013, our Trust attended a risk summit to discuss the findings of the Keogh Review and to agree an action plan for our most urgent recommendations. The key findings and action plan can be found here: Risk Summit Action Plan. While we take forward our plans to address all of our recommendations, we have been placed in ‘special measures’.ULHT Rapid Response Review ReportRisk Summit Action Plan This document provides a brief snapshot of the key findings for our Trust, how we are making these improvements and how our progress is being overseen and supported. It focusses on short-term improvements to immediate issues. However, our improvement plans go beyond the Keogh deadline dates – ensuring that when we are inspected by the Chief Inspector of Hospitals, Prof Sir Mike Richards, our progress will be evident. Once the actions identified here 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 our patients. A monthly update to this document will be published on our website, regular updates will appear on NHS Choices and subsequent longer term actions will be included as part of a continuous process of improvement. Every single member of staff employed by our Trust can help improve the quality of our services. The changes we are collectively making for our patients have been agreed by our Trust Board, and are being driven on a day-to-day basis by Jane Lewington, our Chief Executive. Jane is being supported by our dedicated and committed staff, our Executive Team and our Board. Further external support is being provided by Jeff Worrall, Portfolio Director at the NHS Trust Development Authority. In 2014, our success in implementing the recommendations of the Keogh Review will be independently assessed by Professor Sir Mike Richards, the Chief Inspector of Hospitals. If you have any questions about the improvements we are making, you can contact Jane Lewington, our Chief Executive, on jane.lewington@ULH.nhs.uk. If you want to contact Jeff Worrall, Portfolio Director at the NHS Trust Development Authority, as an external expert, you can reach him on jeff.worrall@nhs.net. jane.lewington@ULH.nhs.ukjeff.worrall@nhs.net I look forward to keeping you updated on our improvements over the coming months. Yours sincerely, Paul Richardson Chairman, United Lincolnshire Hospitals NHS Trust November 2013 A message from our Chairman, Paul Richardson:

3. KEOGH FINDINGSWHAT WE HAVE AGREED & WHYTIMESCALE EXTERNAL SUPPORT PROGRESS There is a disconnect between leadership at our Board level and leadership at our clinical levels. We will: implement our Visible Leadership plan. Why? We want our staff to feel confident in raising issues with us, and we want our patients to be confident that we are collectively focussed on improving the care they receive. August 2013, onwards NHS Trust Development Authority ON TRACK Our response to patients who become unwell could be clearer and more consistent We will: ensure that we always identify when a patient’s condition deteriorates, and respond promptly and effectively. Why? Providing a prompt and effective response will improve outcomes for our patients. August 2013, onwards NHS Trust Development Authority DELIVERED Our complaints process is confusing and not fit for purpose. We will: review our current complaints process and introduce a new approach which is more responsive to our patients. Why? We want patients to feel supported in raising concerns with us and to be confident that we will respond promptly and transparently. August 2013, onwards Patients Association NHS Trust Development Authority ON TRACK Patient experience is not at the heart of our strategy. We will: review how we plan to improve patients’ experience of our services, supported by the NHS Trust Development Authority. Why? By seeking, monitoring, and acting upon patient feedback, we will be able to make improvements in the areas that our patients say matter most to them. October 2013 NHS Trust Development Authority ON TRACK Our staffing levels were, in some areas and at certain times of the day, low. We will: implement live reporting of staffing levels (on all wards, across all three sites). Why? So that we can be sure that there are sufficient numbers of staff to care safely for our patients. Immediate and on-going NHS Trust Development Authority ON TRACK Our quality strategy could not be articulated by all staff and non executive directors. We will: clearly communicate our priorities for high quality care to our staff. Why? So that we can be sure that everything we do is consistent with these priorities. Immediate and on-going NHS Trust Development Authority ON TRACK

4. HOW OUR PROGRESS IS BEING OVERSEEN & SUPPORTEDTIMESCALEOWNERPROGRESS Weekly Executive oversight meeting, to drive the delivery of our detailed action planImmediate and on-goingJane Lewington, CEO, ULHT DELIVERED Monthly accountability meeting with the NHS Trust Development Authority and Clinical Commissioning Groups, to monitor our improvements. August 2013 to July 2014Jane Lewington, CEO, ULHT Jeff Worrall, Director, NHS Trust Development Authority CCG Lead Officers ON TRACK Regular updates to Board sub-Committees, to report on the progress of individual improvement programmes. September 2013, onwardsBoard Secretary, ULHT ON TRACK Monthly Board oversight meeting, to review and test the evidence of our improving services – including a regular report on measures of patient care. September 2013, onwardsPaul Richardson, Chairman, ULHT ON TRACK Regular Board-level patient safety walkabouts, meetings with specialist staff and with our wider staff groups to examine how actions are benefiting patients. September 2013, onwardsJane Lewington, CEO, ULHT Paul Richardson, Chairman, ULHT ON TRACK External review of progress at regular locality meetings and listening events.September 2013, onwardsJane Lewington, CEO, ULHT ON TRACK Regular press and media updates on our improvements, including monthly press conferences. September 2013, onwardsJane Lewington, CEO, ULHT Matt Youdale, Comms Advisor, ULHT DELIVERED Working in partnership with Sheffield Teaching Hospitals NHS Foundation Trust – sharing best practice to support improvements in the quality of care. September 2013, onwardsJane Lewington, CEO, ULHT Sir Andrew Cash, CEO, Sheffield Teaching Hospitals NHS FT ON TRACK Appointment of a senior representative by the NHS Trust Development Authority, who will provide expertise to our Trust Board and check that we’re meeting our promises to deliver our improvement plan. By October 2013NHS Trust Development Authority ON TRACK Access support from partnership working, as appropriate, with the Academic Health Science Network, NHS Improving Quality and the NHS Leadership Academy. By April 2014NHS England ON TRACK The Chief Inspector of Hospitals, Professor Sir Mike Richards, will oversee a further intensive inspection of our services to assess our progress. By April 2014Care Quality Commission ON TRACK