Recommendation
Oversight of Urology through Trust governance structures Reporting lines need to be clearly articulated in the terms of reference for each of the groups and committees which have been established for oversight of the Urology service and depicted in an …
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Oversight of Urology through Trust governance structures Reporting lines need to be clearly articulated in the terms of reference for each of the groups and committees which have been established for oversight of the Urology service and depicted in an organogram. Links to the Urology department, care group, committee and Board governance structure should also be confirmed.
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Recommendation
Mortality review (Link to R15 and R26) Every inpatient Urology death must have a case review conducted by Consultant Urologists with external support in using structured judgement review (SJR) methodology (Royal College of Physicians) or other recognised case note review …
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Mortality review (Link to R15 and R26) Every inpatient Urology death must have a case review conducted by Consultant Urologists with external support in using structured judgement review (SJR) methodology (Royal College of Physicians) or other recognised case note review methodology and be subject to Trust level scrutiny (as per Trust Policy). Every death must then be presented without exception to a Urology mortality meeting. These should be separate from audit and multidisciplinary team (MDT) meetings until such time that mortality review becomes an accepted and business as usual activity.
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Recommendation
Professional relationships Intelligence from the InterBe meeting in August 2020 should be used to assess the severity of concerns associated with relationships between senior clinical staff to determine whether issues can be resolved or if other remedial action needs to …
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Professional relationships Intelligence from the InterBe meeting in August 2020 should be used to assess the severity of concerns associated with relationships between senior clinical staff to determine whether issues can be resolved or if other remedial action needs to be taken.
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Recommendation
Pooled model of patient care • There is an urgent need to review the pooling of patient referrals and the way in which patients are allocated to, and reviewed by, clinicians in Urology to ensure that continuity of care is …
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Pooled model of patient care • There is an urgent need to review the pooling of patient referrals and the way in which patients are allocated to, and reviewed by, clinicians in Urology to ensure that continuity of care is optimised. • There should be clear procedures for allocating patients against specific pathways (including in line with Cancer MDT guidance). Any subsequent changes to management plans should be agreed with the Named Consultant/an appropriate clinician especially if there are clinic cancellations or delays to treatment.
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Recommendation
Monitoring of additional activity sessions (AASs) Introduce a robust policy and controls to retrospectively and prospectively review AAS activity in the Urology department, including a quarterly analysis of the number, value, and justification for AASs undertaken on a clinician-by-clinician basis.
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Monitoring of additional activity sessions (AASs) Introduce a robust policy and controls to retrospectively and prospectively review AAS activity in the Urology department, including a quarterly analysis of the number, value, and justification for AASs undertaken on a clinician-by-clinician basis.
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Recommendation
Fluid balance monitoring Fluid balance practice should be audited and a programme of high-quality recording put in place for Urology patients.
Recommendation
Mortality review (Link to R10 and R26) • Following on from our recommendation on mortality review in our Draft Current Controls Assessment Report, the Trust must develop a robust mechanism for identifying deaths by speciality using both admission and treatment …
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Mortality review (Link to R10 and R26) • Following on from our recommendation on mortality review in our Draft Current Controls Assessment Report, the Trust must develop a robust mechanism for identifying deaths by speciality using both admission and treatment function codes and other identifiers. This should include deaths up to 30 days post-discharge. • The HOGAN and National Confidential Enquiry into Patient Outcome and Death (NCEPOD) scoring arising from mortality reviews must be subject to audit and further scrutiny within the Trust. • All NCEPOD or HOGAN scores of 2 or above should give rise to further review by the Trust, investigation where appropriate and the potential need for Duty of Candour processes.
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Recommendation
Named Consultants • Named Consultants, for complex patients, should be introduced in Urology. This should include non-cancer patients. Complex cases without a diagnosis should be discussed at MDT or Radiology meetings. • Clinicians should be allocated clinical responsibility for the …
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Named Consultants • Named Consultants, for complex patients, should be introduced in Urology. This should include non-cancer patients. Complex cases without a diagnosis should be discussed at MDT or Radiology meetings. • Clinicians should be allocated clinical responsibility for the oversight of pathways including by cancer type to develop greater ownership and to drive improvements in services.
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Recommendation
Capacity and best interests: applying the Mental Capacity Act 2005 • Capacity assessment and best interest decision-making should be improved through audit, training, and best practice examples. • An enhanced focus should be given to people presenting with dementia or …
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Capacity and best interests: applying the Mental Capacity Act 2005 • Capacity assessment and best interest decision-making should be improved through audit, training, and best practice examples. • An enhanced focus should be given to people presenting with dementia or confusion and those with a learning disability. • A thematic review examining the pathway, management and replacement of suprapubic catheters should be undertaken.
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Recommendation
Consent • Consent for operations must be completed on every occasion. Any consent not completed correctly must be reported and investigated to improve practice. • Consenting practice should be subject to audit and should include whether the patient dated the …
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Consent • Consent for operations must be completed on every occasion. Any consent not completed correctly must be reported and investigated to improve practice. • Consenting practice should be subject to audit and should include whether the patient dated the consent and the practice of confirmation of consent where the operating surgeon is different from the consenting surgeon. • Theatre staff should be alerted to our concerns regarding consenting practice and be authorised to report all incidents where consent is not compliant with expected practice.
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Recommendation
Lorenzo • All scan and clinical results should be acknowledged by the requester. Clinicians should be trained on the use of Lorenzo to ensure that they are aware of how to complete this activity. • It should be made clear …
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Lorenzo • All scan and clinical results should be acknowledged by the requester. Clinicians should be trained on the use of Lorenzo to ensure that they are aware of how to complete this activity. • It should be made clear to all staff in which part of Lorenzo key documentation should be filed to reduce the amount of time spent finding key clinical information. • A record of stent register status should be clearly marked and visible.
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Recommendation
Quality and safety data in the Integrated Performance Report The quality and safety data in the Integrated Quality and Performance Report (IQPR) should be expanded to include trend and thematic analysis. Key quality and safety metrics should be included in …
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Quality and safety data in the Integrated Performance Report The quality and safety data in the Integrated Quality and Performance Report (IQPR) should be expanded to include trend and thematic analysis. Key quality and safety metrics should be included in a new upfront performance dashboard and hotspot reporting should include more detailed analysis on key risks.
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Recommendation
Recording of ethnicity • The sample provided does not include information on ethnicity other than White or Unknown/Mixed. The Trust should examine whether it is recording ethnicity in its records in line with expected practice.
Recommendation
Case note review There should be a repeat case note review (100 cases) in 12 months (Autumn 2022) to assess if improvements have been sustained and embedded.
Recommendation
Improving the pathway for bladder cancer diagnosis • Where appropriate, conducting a flexible cystoscopy on the day of attending the One Stop Clinic would make this a truly one-stop service. • Patients meeting the two-week wait criteria with visible haematuria …
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Improving the pathway for bladder cancer diagnosis • Where appropriate, conducting a flexible cystoscopy on the day of attending the One Stop Clinic would make this a truly one-stop service. • Patients meeting the two-week wait criteria with visible haematuria and normal estimated glomerular filtration rate (eGFR) should be triaged to have a CT Urogram prior to attending clinic to streamline the service. • Patients requiring ongoing monitoring following chemotherapy/radiotherapy should be referred back via the MDT to a named Consultant at the Trust, on completing their therapy, who is then responsible for coordinating ongoing care (e.g. in this case, being clear about the rationale for examination under anaesthetic (EUA), biopsy, cystoscopy and stenting). The MDT will need to ensure there is a clear management plan and processes put in place to ensure Urology actions are implemented. This will also allow time to plan dates for surgery to meet required timescales. • Lancashire and South Cumbria Cancer Alliance follow up protocols should be agreed and followed. • All patients should be listed on the stent register. If they are transferred to another Trust with the expectation that the stent is removed, this should be explicitly stated; if patients are transferred into the Trust with a stent in situ, they should be added to the Trust’s stent register.
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Recommendation
Clinical monitoring The Trust should continue to embed good practice and use of: • Venous thromboembolism (VTE) assessment. • Nutrition, hydration and associated food/fluid balance monitoring must be enforced as fundamental standards. Use of the Malnutrition Universal Screening Tool (MUST) …
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Clinical monitoring The Trust should continue to embed good practice and use of: • Venous thromboembolism (VTE) assessment. • Nutrition, hydration and associated food/fluid balance monitoring must be enforced as fundamental standards. Use of the Malnutrition Universal Screening Tool (MUST) should be audited at specified intervals to ensure scoring and onward actions are appropriate. • Total Parenteral Nutrition (TPN) guidelines should be reviewed and monitored to ensure that this option is considered early for all patients who are at risk of malnutrition. • The Trust should monitor the recent implementation of the electronic NEWS2 charts to ensure that the new system is successful in identifying and responding to deteriorating patients. • Access to formal on call microbiology advice out-of-hours should be provided.
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Recommendation
Standard operating policies and procedures The Trust must ensure the following are up-to-date and subject to regular audit: • the identification and management of Urosepsis and obstructed kidneys; • the identification and management of sepsis and the deteriorating patient; • …
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Standard operating policies and procedures The Trust must ensure the following are up-to-date and subject to regular audit: • the identification and management of Urosepsis and obstructed kidneys; • the identification and management of sepsis and the deteriorating patient; • the management and registration of stents; • handover of patients between on call Consultants; • consenting guidelines, including actions to be taken when patients cannot consent and when emergency surgery is required; • interspecialty referral processes; and • recording decisions made when a patient is referred to Intensive Treatment Unit (ITU), the escalation of capacity issues and a clear protocol regarding options when ITU is full.
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Recommendation
Nephrostomy service • The Trust and Clinical Commissioning Groups (CCGs) should review arrangements for out-of-hours nephrostomy provision, including over bank holidays and emergency cover. • The arrangements that have been put in place should be assessed to ensure that standards …
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Nephrostomy service • The Trust and Clinical Commissioning Groups (CCGs) should review arrangements for out-of-hours nephrostomy provision, including over bank holidays and emergency cover. • The arrangements that have been put in place should be assessed to ensure that standards for accessing nephrostomy provision out of hours and for returning patients to the Trust are appropriate, agreed, and form part of a standard operating procedure that is audited to confirm compliance.
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Recommendation
Mortality review (Link to R10 and R15) • Any post-operative death should be subject to rigorous and contemporaneous case review and monitored at Trust level. This would also help support accurate reports to the Coroner if required to be written …
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Mortality review (Link to R10 and R15) • Any post-operative death should be subject to rigorous and contemporaneous case review and monitored at Trust level. This would also help support accurate reports to the Coroner if required to be written some months post-death. • Death summaries and sudden death reports to the Coroner should be audited for quality/accuracy. • Every inpatient death within the Surgical and Critical Care Group (S&CC) should be reported and subject to case review, this review should be shared within the department and at Trust level. • Every inpatient death in Urology services and other surgical specialties should be discussed in departmental meetings. • Every inquest involving the Trust must include consideration of whether an incident might have occurred that requires investigation and to prepare statements/reports in an adequate timeframe. • Statements to Coroners written in relation to whole episodes of care involving a team or a Trust service should be subject to validation by legal or corporate services to ensure that all parties have a right of reply (where needed) and that statements made are accurate. This is distinct from an individual health care professional providing a witness statement solely in relation to their own input. • Failures in care identified as a result of producing a Coroner’s statement must be reported as an incident and any named individuals given a right of reply. • The Trust’s Providing Statements to the Coroner Standard Operating Procedure should be revised to include the above. • The Trust must assure themselves that the Providing Statements to the Coroner Standard Operating Procedure is being complied with. Statements should differentiate between fact and opinion. In addition, there should be a clear indication of how the statement has been compiled. • The Trust should ensure that records are retained post-death and copies made for the purposes of review and investigation to mitigate the risk of retrospective entry. • [The Medical Examiner role was introduced in the Trust in April 2020; this function should be assessed against the above recommendations].
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Recommendation
Managing complaints and compound family questions • The Trust’s Management Procedure for the Investigation and Resolution of Complaints should be reviewed to ensure advice is clear on the handling of persistent/compound complaints that are not vexatious. • Repeated approaches/compound questions …
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Managing complaints and compound family questions • The Trust’s Management Procedure for the Investigation and Resolution of Complaints should be reviewed to ensure advice is clear on the handling of persistent/compound complaints that are not vexatious. • Repeated approaches/compound questions from a family in relation to concerns in care, including the death of a loved one, should be formally logged as a complaint. • These cases should be allocated an appropriate single point of contact or family liaison officer to manage the process and support the family. These cases should also be flagged and carefully monitored as they have potential for extended resolution timescales. • Any case involving an inquest or complaint from a family should also be reviewed to determine whether it should be recorded as an incident(s). Any subsequent investigation and complaints processes should be managed in a coordinated fashion. • Compound complaints often arise once medical records are provided as these may be incomplete (due to archiving and multiple patient record systems). The Trust should ensure that full sets of medical records are provided at the outset of the request in line with existing Freedom of Information Act (FOIA), Subject Access Requests (SAR) and Access to Health Records Policies. • Clear guidance on sharing the medical records of deceased patients with families should be set out to ensure that relatives are provided with requested information promptly and in line with the appropriate legislation. • When FOIA or SAR include requests for email-based information, all searches should be formally logged and centrally managed so that the Trust has a full record of searches available to them.
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Recommendation
Consultant relationships • The Trust should pay particular attention to any grievance raised by a Consultant or senior medical member of staff about another peer. Prompt and diligent investigations should be undertaken to ensure that the basis of concerns is …
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Consultant relationships • The Trust should pay particular attention to any grievance raised by a Consultant or senior medical member of staff about another peer. Prompt and diligent investigations should be undertaken to ensure that the basis of concerns is fully understood and properly actioned to resolve peer-to-peer difficulties and concerns in a transparent and effective manner. • The Board should be made aware at an early stage of any specialty where relationships may be failing as this is a key patient safety marker. The Board should monitor actions to achieve improvement. This should be undertaken via the Employee Relations Report. • The Medical Director should be informed of any concerns about Consultant relationships (as Responsible Officer).
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Recommendation
Triggers for external investigations • Terms of reference for all externally commissioned investigations should be scoped individually and quality assured to ensure that patient/family questions are included and that specific Trust concerns are addressed. (This principle should be followed for …
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Triggers for external investigations • Terms of reference for all externally commissioned investigations should be scoped individually and quality assured to ensure that patient/family questions are included and that specific Trust concerns are addressed. (This principle should be followed for all root cause analysis (RCA) and serious incident (SI) reports undertaken internally in line with good practice). • The Trust should develop a set of triggers for external investigations to be undertaken including when departmental dysfunction is apparent. • The Trust should revisit its tolerance for requesting external support in investigations.
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Recommendation
Performance framework for Urology Introduce a performance and accountability framework which clearly sets out the approach to corporate and care group scrutiny of Urology and, where necessary, support from the Enhanced Support Programme (ESP)
Recommendation
Clinical records in the form of emails (Link to R34(E)) • The Trust should add all Consultant staff email accounts to their Very Important Persons (VIP) list for a period of seven years once employment is ended. • The Trust …
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Clinical records in the form of emails (Link to R34(E)) • The Trust should add all Consultant staff email accounts to their Very Important Persons (VIP) list for a period of seven years once employment is ended. • The Trust should revisit its record-keeping policy as regards the use of email communications between clinicians containing clinical information. This should include: - clarification of what is an acceptable use of email in sharing patient specific clinical information, both internally and externally, to the Trust (including in clinical networks); - ensuring that where patient specific clinical information is shared by email (if appropriate) that these communications are retained as part of the clinical record; - revisiting the Trust email archiving policy, in light of the above, to ensure that emails can be retrieved where necessary (for example for SAR purposes); and - that all professionals should record the fact that an onward communication has been made within the clinical record.
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Recommendation
Clinical dispute resolution The Trust should introduce a mechanism of escalation, separate to the existing grievance and Freedom to Speak Up processes, whereby clinical disputes (in MDTs, between individuals or within departments) are formally mediated and resolved. The responsibilities for …
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Clinical dispute resolution The Trust should introduce a mechanism of escalation, separate to the existing grievance and Freedom to Speak Up processes, whereby clinical disputes (in MDTs, between individuals or within departments) are formally mediated and resolved. The responsibilities for professionals involved in the event to engage in this mechanism of escalation should be made clear. This should be supported by a formal policy and should detail timescales for reporting, arbitration, resolution, and the trigger for the involvement of independent clinical adjudicators. Processes to report into other forums (such as Clinical Governance, Mortality Review, Ethics Committee and Revalidation) should be made clear within this policy.
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Recommendation
Review Niche patient case studies The Trust should review all Niche case studies in priority order to contact patients in respect of Duty of Candour or ensure appropriate investigations have been completed to a high standard and actions have been …
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Review Niche patient case studies The Trust should review all Niche case studies in priority order to contact patients in respect of Duty of Candour or ensure appropriate investigations have been completed to a high standard and actions have been implemented.
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Recommendation
Urology pathway priority management • There is a need to redesign follow-up pathways for Urology patients to match capacity and demand to prevent backlogs and balance this with the faster response for new referrals. Clear protocols for long-term active surveillance …
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Urology pathway priority management • There is a need to redesign follow-up pathways for Urology patients to match capacity and demand to prevent backlogs and balance this with the faster response for new referrals. Clear protocols for long-term active surveillance which ensures cases are appropriately seen at the right intervals are required. • Advance booking for long-term surveillance procedures should be introduced (including stent replacement and cystoscopy) and audited to ensure delays are minimised.
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Recommendation
Capacity and demand modelling in Urology The Trust should undertake a capacity and demand modelling exercise (including the use of [Patient Level Information and Costing System] PLICS information) to provide an up to date baseline for the service and to …
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Capacity and demand modelling in Urology The Trust should undertake a capacity and demand modelling exercise (including the use of [Patient Level Information and Costing System] PLICS information) to provide an up to date baseline for the service and to support job planning. This should include: • Medical staffing levels • Junior staffing resources • Administrative resource • Nursing skills and a clinical nurse specialist role review
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Recommendation
Revisit and align all reporting policies The Trust should revisit and recommunicate the following policies to ensure that the purpose is clear, that they are aligned to each other and that they are workable for staff to readily follow and …
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Revisit and align all reporting policies The Trust should revisit and recommunicate the following policies to ensure that the purpose is clear, that they are aligned to each other and that they are workable for staff to readily follow and apply when escalation is required. This should include a flow diagram so staff can see which policy to follow in which situation. • Incident reporting • Raising Concerns • Grievance management • Whistleblowing • Freedom to Speak Up
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Recommendation
A specialty focus The Trust should identify key specialty metrics that enable focus on harms to be triangulated in sub-specialties of the Surgical and Critical Care Group (S&CC). This should include: • A single monthly report on claims, incidents, Parliamentary …
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A specialty focus The Trust should identify key specialty metrics that enable focus on harms to be triangulated in sub-specialties of the Surgical and Critical Care Group (S&CC). This should include: • A single monthly report on claims, incidents, Parliamentary and Health Service Ombudsman (PHSO), Never Events and complaints with a cumulative analysis of themes arising. • At least biannual thematic reviews (regardless of whether complaints or claims are upheld) to understand any concerns being raised at the earliest possible opportunity. • An annual reconciliation of claims and complaints and their conversion to incident reports should be undertaken to ensure all patient safety concerns are logged through the incident reporting process for learning. • Learning and sharing relevant patient safety issues arising from MHPS investigations (which should be logged as incidents where appropriate). • Use of the annual GMC National Trainee Survey results to ensure information on junior doctors’ experience is considered as part of these metrics.
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Recommendation
Urology audit The newly appointed Urology Audit Lead should have dedicated and experienced support to provide best practice guidance on conducting audit and governance meetings. The terms of reference and agendas for the audit meeting should be drawn from best …
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Urology audit The newly appointed Urology Audit Lead should have dedicated and experienced support to provide best practice guidance on conducting audit and governance meetings. The terms of reference and agendas for the audit meeting should be drawn from best practice in other Urology services.
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Recommendation
Implement clinical audit programme (Link to R4, R9, R14, R18, R25, R41, R47) A standard should be set for each of the following against which a clinical audit programme should be implemented: • Handover quality • Emergency surgery including access …
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Implement clinical audit programme (Link to R4, R9, R14, R18, R25, R41, R47) A standard should be set for each of the following against which a clinical audit programme should be implemented: • Handover quality • Emergency surgery including access to and use of theatres out of hours • Emergency transfers from FGH to RLI • Stent register compliance • Results review and acknowledgement • MDT referrals, implementation of actions, attendance and quality of behaviours • Out-of-hours support from junior doctors • Ward round management • Consenting practice • Continuity of care • Harms as a result of delayed follow ups and IRDs • Application of National Institute for Clinical Excellence (NICE) guidance
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Recommendation
Cancer MDT management The Trust, with the Cancer Alliance, should: • Agree and implement new Standards of Care (SoC) in line with the advice of the Streamlining MDT Meetings guidance. • Clarify the expectations of core members at both local …
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Cancer MDT management The Trust, with the Cancer Alliance, should: • Agree and implement new Standards of Care (SoC) in line with the advice of the Streamlining MDT Meetings guidance. • Clarify the expectations of core members at both local and network MDTs and the expectation for named Consultant Urologists to present their cases. A deputy role for the chair of the local MDT should be put in place. • Ensure that all core members attend the MDT as agreed above. • Audit the new processes to ensure alignment with the introduction of the named Consultant. • Ensure responsibility for actioning decisions made at the local MDT is maintained within the Trust. • Ensure there is clarity for responsibility for actioning decisions made at the network MDT. • Ensure that professional behaviours are demonstrated at both local and network MDTs and confirmed through observation and transparent feedback on a regular basis for all attendees.
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Recommendation
104 day cancer breach root cause analysis • Ensure all 104 day cancer waiting time breaches are subject to a root cause analysis (RCA) and thematic reviews are acted upon to ensure pathway problems are properly identified and improved. • …
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104 day cancer breach root cause analysis • Ensure all 104 day cancer waiting time breaches are subject to a root cause analysis (RCA) and thematic reviews are acted upon to ensure pathway problems are properly identified and improved. • The Trust should follow the newly released (October 2021) North West Guideline: Managing Long Waiting Cancer Patients.
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Recommendation
Emergency theatre access • The Trust should monitor the use of emergency theatres out of hours in Urology (building on the analysis provided in this report) to establish whether the existing Standard Operating Procedure (Theatre Access) is effective in changing …
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Emergency theatre access • The Trust should monitor the use of emergency theatres out of hours in Urology (building on the analysis provided in this report) to establish whether the existing Standard Operating Procedure (Theatre Access) is effective in changing the pattern of practice highlighted by this report. • This should be examined in the context of whether some emergency theatre demand could be reduced through the provision of ward based facilities.
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Recommendation
Patient handover Handover of patients between Consultants should include: • A formal handover arrangement between Consultants for out of hours cover. • A handover for patients who are transferred between Consultants.
Recommendation
Managing team dysfunction A uniform approach should be applied to team dysfunction. This should include: • Clear communication from the Trust re the service strategy, goals and objectives - particularly around behavioural standards • Holding to account against professional standards …
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Managing team dysfunction A uniform approach should be applied to team dysfunction. This should include: • Clear communication from the Trust re the service strategy, goals and objectives - particularly around behavioural standards • Holding to account against professional standards in Good Medical Practice • Sustained visible leadership and “sponsorship” from the Board • Intelligent review of patient outcomes and harms • Follow-up, monitoring and review to ensure that behavioural improvements are sustained.
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Recommendation
Duty to monitor staff wellbeing The Trust has a duty to monitor staff stress levels and wellbeing and to intervene to support and understand the underlying issues before burn out affects patient care. The Trust should develop a cultural dashboard …
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Duty to monitor staff wellbeing The Trust has a duty to monitor staff stress levels and wellbeing and to intervene to support and understand the underlying issues before burn out affects patient care. The Trust should develop a cultural dashboard to identify key metrics that can provide early warning of team stress e.g. Occupational Health referral, employee relations concerns, engagement scores.
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Recommendation
Appraisals for medical staff (Link to R40) • Appraisals may identify colleagues who are having difficulties and a protocol should be put in place to safeguard staff when concerns are apparent. • The Responsible Officer should explicitly monitor appraisals which …
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Appraisals for medical staff (Link to R40) • Appraisals may identify colleagues who are having difficulties and a protocol should be put in place to safeguard staff when concerns are apparent. • The Responsible Officer should explicitly monitor appraisals which may demonstrate team dysfunction as a means of early warning and to instigate remedial interventions. • Specialty interests with key outcome measures at unit level should be agreed. Individual Consultants should be given lead responsibility for specialist areas with outcomes linked to the clinical audit programme and fixed into appraisal processes.
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Recommendation
Engagement with Consultant body • Engagement by executive and non-executive members of the Board with the Consultant body should be examined and options provided to facilitate increased opportunities for interaction. • This should include a clear programme of engagement at …
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Engagement with Consultant body • Engagement by executive and non-executive members of the Board with the Consultant body should be examined and options provided to facilitate increased opportunities for interaction. • This should include a clear programme of engagement at sub-specialty level over a rolling programme. This should be in addition to existing Medical Advisory Committee meetings.
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Recommendation
Trust Management of Royal College reports • The Trust should inform regulators (CQC and NHS England and NHS Improvement) and commissioners of any plans for external reviews for quality and safety concerns, including Royal College Invited Service Reviews as soon …
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Trust Management of Royal College reports • The Trust should inform regulators (CQC and NHS England and NHS Improvement) and commissioners of any plans for external reviews for quality and safety concerns, including Royal College Invited Service Reviews as soon as they are confirmed. This will ensure that regulators and commissioners can take this into account in their assurance activity in real time. • Advisory reports from the Royal Colleges should be shared, in full or in summary where appropriate, by the Trust with the Trust Board. • The Trust should formally inform the regional or local NHS England and NHS Improvement team, the Care Quality Commission and relevant fitness to practise investigations conducted by the GMC and commissioners of relevant Royal College reports and share these where appropriate. • Transparent action plans arising from all Royal College reports should be developed by the Trust, shared with the Trust Board and formally monitored through the Trust Quality Committee.
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Recommendation
Safe Today Report The Safe Today Report should be received at department and care group level before presentation to UT&FG [Urology Task and Finish Group] and UQOC [Urology Quality Oversight Committee]. It should also be developed further to provide more …
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Safe Today Report The Safe Today Report should be received at department and care group level before presentation to UT&FG [Urology Task and Finish Group] and UQOC [Urology Quality Oversight Committee]. It should also be developed further to provide more appropriate measures of assurance with: inclusion of an overarching scorecard to enable the reader to understand performance ‘at a glance’; a reduction in the narrative analysis throughout the report; greater emphasis on prospective performance through the use of early warning indicators and forecasting in order to allow timely identification of deteriorating performance; more same causal factor analysis of complaints, litigation, incidents and Patient Advice and Liaison Service (PALS) feedback; an expansion of the quantitative and qualitative data relating to patient and staff experience, including patient feedback in the form of real time and retrospective data collection, staff pulse surveys and a wider range of workforce metrics (e.g. turnover, appraisals, training, use of agency staff, staff sickness, as well as concerns raised by staff).
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Recommendation
Clarify role of governors and escalation mechanisms • Governor training and induction programmes should be revisited to confirm that methods for escalating concerns are clearly set out and understood. • Procedures for escalation should include processes for resolution where governors …
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Clarify role of governors and escalation mechanisms • Governor training and induction programmes should be revisited to confirm that methods for escalating concerns are clearly set out and understood. • Procedures for escalation should include processes for resolution where governors remain dissatisfied with responses to issues raised.
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Recommendation
An intensive programme of externally facilitated development is required to: rebuild trust between the Trust and the governors; establish clear expectations for the role of governors on an individual and a collective basis; ensure there is clarity about how to …
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An intensive programme of externally facilitated development is required to: rebuild trust between the Trust and the governors; establish clear expectations for the role of governors on an individual and a collective basis; ensure there is clarity about how to raise concerns and what to do when governors remain dissatisfied; and to explore the effectiveness of existing governance structures to support the function of the Council of Governors, including the role of Lead Governor.
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Recommendation
Institutional memory Formal handover procedures should be in place for all incoming and outgoing Board members (including postholders with committee chair roles). These handovers should include employee relations issues and sub-specialty summaries
Recommendation
Media articles Revise advice and guidance on dealing with media articles that name individuals and provide support to ensure an appropriate right of reply is sought (also in line with GMC guidance on responding to criticism in the media).
Recommendation
Meeting administration Meeting administration must be improved. This should include: a review of the ToR for all meetings at departmental and care group level to ensure they are in date, aligned to the objectives required of the meeting, and also …
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Meeting administration Meeting administration must be improved. This should include: a review of the ToR for all meetings at departmental and care group level to ensure they are in date, aligned to the objectives required of the meeting, and also other key meetings, with agendas planned to reflect these; the introduction of standardised templates for agendas, minutes, and action logs; and the provision of training for individuals with minute-writing responsibilities and all minutes should be reviewed by the relevant Chair before distribution.
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Recommendation
Risk registers at service, care group and Trust level The challenges currently being faced by the Urology service should be reviewed to determine whether the risks are sufficient to warrant inclusion on the service, care group or Corporate Risk Register …
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Risk registers at service, care group and Trust level The challenges currently being faced by the Urology service should be reviewed to determine whether the risks are sufficient to warrant inclusion on the service, care group or Corporate Risk Register (CRR) or the Board Assurance Framework (BAF); this includes the difficulties with on call cover at Furness General Hospital (FGH) and continuing fractured relationships as a patient safety risk. Departmental and care group meetings should include risk as a standing agenda item and the risk profile of the service should be reviewed at least quarterly.
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Recommendation
Quality of investigations in Urology services All reported incidents and complaints received in relation to Urology services should, for a period of at least 12 months, be investigated by a dedicated independent team outside the department which has access to …
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Quality of investigations in Urology services All reported incidents and complaints received in relation to Urology services should, for a period of at least 12 months, be investigated by a dedicated independent team outside the department which has access to independent Urology advice. This would remove pressure on the existing team to investigate each other and provide room to work on relationship development. It would also help to set a standard for future high-quality investigations. [This recommendation related to incidents and complaints requiring investigation, not all cases].
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Recommendation
Thematic review Quality performance reporting should include thematic and same causal factor analysis of complaints, litigation, incidents, and PALS information to ensure that lessons can be learned, and actions taken to prevent recurrence of the same. Themes should be discussed …
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Thematic review Quality performance reporting should include thematic and same causal factor analysis of complaints, litigation, incidents, and PALS information to ensure that lessons can be learned, and actions taken to prevent recurrence of the same. Themes should be discussed at departmental, care group, and committee level with a clear focus on actioning improvement.
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