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Council of Governors

Council of Governors. January 2019. Our core themes. www.dbth.nhs.uk. Effective Patient Pathways for prisoners A South Yorkshire Collaborative. Fiona Littlewood Senior Programme Manager. www.dbth.nhs.uk. Effective Patient Pathways. Prisons. Escort and bed watch. Care UK. Our Trust.

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Council of Governors

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  1. Council of Governors January 2019

  2. Our core themes www.dbth.nhs.uk

  3. Effective Patient Pathways for prisoners A South Yorkshire Collaborative Fiona Littlewood Senior Programme Manager www.dbth.nhs.uk

  4. Effective Patient Pathways Prisons Escort and bed watch Care UK Our Trust The prisoner Other trusts www.dbth.nhs.uk

  5. Prisons and site healthcare delivery • What prisons and prisoner category • Care UK / FCMS • DBTH on site delivery • DBTH off site delivery • Other trusts • Social care. www.dbth.nhs.uk

  6. Prisons issues • Health when starting custody • Substance misuse • Violence and self harm • Long term conditions • Aging in prison • Primary, secondary and long term needs • Behaviours. www.dbth.nhs.uk

  7. Key issues for DBTH • Prisoner attendance: • DRI emergencies – 1,000 in the last year from five prisons • Percent of not treated patients • Escort impact on elective/ planned care • Use of DBTH ’by default’ • Admissions/ discharge • Onsite risk and management • Business risk – clinical, appointments lost/ DNA, re- booking. www.dbth.nhs.uk

  8. What’s the plan? • Build relationships with prisons and Care UK • Understand THEIR issues • Be clear about what needs to change • Facilitate change • Reduce risk for organisations • Encourage communication and • Feedback between organisations. www.dbth.nhs.uk

  9. Thank you, any questions?

  10. Telephony at DBTH An update on challenges and developments Simon Marsh Chief Information Officer www.dbth.nhs.uk

  11. A summary in 2018/19: • New Voice Over Internet Protocol (VOIP) system in place at DRI and MH, almost complete at BH • Switchboards joined since October 2018. Overflow calls now handled by a virtual switchboard across DRI and BH • No priority on internal or external calls but GPs retain priority calling number. • Direct Dial Inwards (DDI) now available for most extensions and communicated in patient letters and other correspondence – 75% of calls initially via this route • Challenges exist in overall volume of calls and call answering www.dbth.nhs.uk

  12. Total VOIP extensions: 3,591 VOIP Extensions 2,604 691 691 www.dbth.nhs.uk

  13. Total fax lines 3,591VOIP 96 50 14 www.dbth.nhs.uk

  14. Statistics Jan to Dec 18 69.5% external callers, of which 70% answered. 30.5% internal callers, of which 78% answered. Total number of calls handled by DBTH Telephony in 2018. 5.65m Overall, Switchboard has handled 22.8% of all calls, or 1.05m. Direct Dial Inward (DDI) calls, not involving Switchboard. 5.65m 4.6m www.dbth.nhs.uk

  15. Statistics Jan to Dec 18 Average calls per day via DDI and Switchboard – external to internal and internal to internal. 15,479 Doncaster Royal Infirmary Average time to answer: 34 seconds Bassetlaw Hospital average time to answer: 17 seconds www.dbth.nhs.uk

  16. Statistics Jan to Dec 18 Bassetlaw internal to Switchboard: 91.9% answered Bassetlaw external to Switchboard: 92.9% answered DRI/MH internal to Switchboard: 72.4% answered DRI/MH external to Switchboard: 65.5% answered www.dbth.nhs.uk

  17. Calling patterns Oct 18 - DRI Location and abandonment rate ED Reception 42.91% Clinical Therapy Reception 78.29% Orthotics Reception 45.8% Eye Centre Reception 80.02% Fracture Clinic 35.23% Urology Reception 63.39% AMU Reception 29.74% Maternity Reception 26.04% Orthotics 36.54% www.dbth.nhs.uk

  18. Calling patterns Oct 18 - BH Location and abandonment rate A&E Reception 20.56% ATC Nurse Station 9.47% A&E Nurse Station 5.53% Ward B5 Nurse Station 16.1% Our appointment bookers Booking Team Admin 81.87% Booking Team Admin 77.85% Booking Team Admin 74.6% Booking Team Admin 32.32% www.dbth.nhs.uk

  19. Faxes at DBTH • 27,000 per month • 324,000 per year • 17% external, 25% internal • 58% outgoing to ‘others’ • Replacement planned with Electronic Patient Record www.dbth.nhs.uk

  20. Switchboard Rota – 572 hours per week Monday to Friday 10pm to 8am: One whole time equivalent. Monday to Friday 8am to 5pm: Four whole time equivalents, max five seats available Monday to Friday 5pm to 10pm: Two whole time equivalents. Saturday and Sunday 8am to 10pm: Two whole time equivalents. Saturday and Sunday 10pm to 8am: One whole time equivalents. (Call handling now across both sites for incoming calls) www.dbth.nhs.uk

  21. Switchboard Rota – 572 hours per week Monday to Sunday 10pm to 6am: One whole time equivalent. Monday to Sunday 6am to 2pm: Two whole time equivalents. Monday to Sunday 2pm to 10pm: Two whole time equivalents. (Call handling now across both sites for incoming calls) www.dbth.nhs.uk

  22. Meeting our challenges • Training for call forwarding to avoid the ‘merry-go-round’ • Review of staffing and potential merger of booking/reception staff. • New working patterns to cope with peak demand • Awareness training at ward and reception areas • Seek to alter switchboard rotas at DRI to have maximum operators 8-12 Monday to Friday • Better use of communication and messaging - both from external comms and at extension level to inform callers of ward busy times and call queue messages • Rollout of clinical data (via portal) to GP and community staff to avoid calls to discuss/find out about patients whose ongoing care has been transferred from the Trust. (1/2) www.dbth.nhs.uk

  23. Meeting our challenges • Dr Doctor: • Implementation of Dr Doctor for patient communications includes ability to change/cancel appointments • From February - one way text message pilot for respiratory and ophthalmology • From March – two way text messaging (select from a choice of appointment) for gastro • Review pilot end of March • Intelligent AI-based appointment bookings to avoid high DNA rates and calls to reception areas – longer term • Incoming call analysis to identify frequent callers, repeat callers (2/2) www.dbth.nhs.uk

  24. Conclusion • Communication of DDI numbers for reception centres and booking office via appointment letters • Virtual switchboard will start to improve call answering • Booking office is often overwhelmed an unable to cope with volume of calls • Staffing and working patterns across the Trust, particularly at busy times, prevent calls being answered • Call back services are not necessarily the answer and technology is not the problem • Dr Doctor will improve patient choice and be a long term option • Further analysis is needed on incoming call patterns. www.dbth.nhs.uk

  25. Thank you, any questions?

  26. Call centre performance An update on challenges and developments David Purdue Chief Operating Officer and Deputy Chief Executive www.dbth.nhs.uk

  27. Issues within the service • High rate of abandoned and calls waiting • Working environment • Staffing levels for call rate volumes • Moving staff between roles and areas has been problematic. www.dbth.nhs.uk

  28. Impact on the service • Patient dissatisfaction • Poor reputation • Service user complaints • Low staff morale – and further impact upon sickness levels • High patient ’Did not attend’ levels • Loss of income. www.dbth.nhs.uk

  29. Potential solutions • Improve the environment: • Change office layout, soundproofing booth type desk space • Additional screens for use when scrolling through CAMIS screens as this is time consuming • Visual display screen to show calls waiting, average call time and staff buy-in • Introduction of ‘Visual Management Board’ and team briefing at the start of the day (1/4) www.dbth.nhs.uk

  30. Potential solutions • Workforce review: • Establish , based on an agreed average call length that the current establishment is correct – business case if not • Following completion of the admin review start consultation with Booking and Call centre staff about shift pattern changes and rotation through both areas. This will help with managing peaks and troughs in activity. (2/4) www.dbth.nhs.uk

  31. Potential solutions • IT improvements: • Creation of a ’Hunt Group’ with bespoke messages with Call Centre to allow staff in Booking to pick-up calls waiting when team is busy. The bespoke message would be repeated every 30 seconds • Implementation of Dr Dr project and enhanced patient communication. The service also allow us (via a portal) to send along with the text , instructions on traveland site services. A third screen where we can upload Trust speciality specific information for patients on what to expect form the service they are visiting. • Piloting in three specialities commencing in February: Ophthalmology, Respiratory and Gastro. (3/4) www.dbth.nhs.uk

  32. Potential solutions • Further technology: • We are also working with Doncaster Health Watch and Doncaster college to produce videos which we will upload onto the portal: • This will help patients visualise an attendance at the outpatient appointment they will be attending • The responses to the text messages form an IT worklist for the Booking staff to work through • It is expected that this project will reduce DNAs and reduce calls into the call centre. (4/4) www.dbth.nhs.uk

  33. Thank you, any questions?

  34. Managing violence and aggression An update on approach at DBTH Dr Kirsty Edmondson-Jones Director of Estates and Facilities www.dbth.nhs.uk

  35. Directions to deal with violence • Secretary of State for Health Directions – each NHS body must nominate one of its Executive Team as Security Management Director (SMD) to take responsibility for security management matters, including responsibility for measures to deal with violence against NHS staff. • Nominated SMD - Kirsty Edmondson-Jones, who in turn nominated Kerry Williams as the Accredited Security Management Specialist (ASMS) who will work within a clear legal framework as set out in the Secretary of State Directions www.dbth.nhs.uk

  36. NHS Violence Reduction Strategy • At a RCN’s stakeholder event about the Assaults against Emergency Workers (Offences) Act 2018, Matt Hancock - Health Secretary, launched the new NHS Violence Reduction Strategy which will include new Security Standards. • NHS Improvement with NHS England with engagement across NHS • Reinforces Government commitment to NHS staff safety and welfare • Legally security management function remains with Health and Social Care Secretary until it is designated by directions to another NHS body • The Department of Health and Social Care’s legal team have begun this process which should be complete within four to six months. www.dbth.nhs.uk

  37. Current challenges • Violence towards staff is increasing, particularly from younger patients, often through alcohol or drug related admissions • South Yorkshire Police recognise there is an increasing number of gang related crimes and increasing violence with a direct impact on our staff • Doncaster Council’s ‘Public Spaces Protection Order’ (PSPO) displacing rough sleepers, drug/alcohol users to DRI site, and their suppliers. (1/2) www.dbth.nhs.uk

  38. Current challenges • Organised Crime – relating to patients from local prisons • Increases in break-ins and property damage • Increased anti-social behaviour • Should be noted that a high percentage of violence as a result of medication or condition of patients (2/2) www.dbth.nhs.uk

  39. Drugs found on site - January www.dbth.nhs.uk

  40. Rough sleepers on site - January www.dbth.nhs.uk

  41. Statistics: Assaults www.dbth.nhs.uk

  42. We have remained within control figure. Statistics: Violence and aggression (two years) www.dbth.nhs.uk

  43. November to December 2018 Types of violence and aggression www.dbth.nhs.uk

  44. Conflict resolution training • All staff receive a minimum of three hour face-to-face training. • Course Aims: • Describe common causes of conflict. • Describe two forms of communication. • Give examples of communication breakdown. • Discuss communication models when dealing with conflict. • Describe different patterns of behaviour that they may encounter during different interactions. • Explain different warning and danger signs. • Give examples of impact factors. • Describe the use of distance when dealing with conflict. • Explain the use of “Reasonable Force” as it applies to conflict resolution. • Describe the different methods for dealing with conflict resolution. www.dbth.nhs.uk

  45. Breakaway training • The LSMS has undertaken an evaluation of breakaway training and its delivery by the team at RDASH, with a view to a collaborative working arrangement including conflict resolution training provision by DBTH to RDASH staff in return for breakaway training to DBTH staff. • If successful this will enable the Trust to provide enhanced breakaway training to Care Groups with a higher incidence of violence and aggression and other outlying wards on request, for example ED. • All divisions have been sent example risk assessments and a TNA for the proposed 3 levels of conflict resolution training, and a request that risk assessments are completed and returned for evaluation, to ensure staff receive the correct level of training to the needs of the Departments. • Encouragement required to increase uptake. www.dbth.nhs.uk

  46. Police engagement • South Yorkshire Police have requested a meeting with Richard Parker to discuss demand reduction: • Doncaster Royal Infirmary has the highest number of calls to the Police requesting assistance • A local Officer has been tasked with reducing the demand to our site • Local Police Community Support Officers visiting DRI a minimum of a twice a week • Bassetlaw a procedure in place with Nottinghamshire Police Force where bi-monthly meetings are held with the Beat manager • X-ray Arch to be used ad-hoc ED DRI • Sniffer Dogs to visit ad-hoc DRI. www.dbth.nhs.uk

  47. Newly-agreed measures • Following a meeting with South Yorkshire Police 24th Jan, the following has been agreed: • South Yorkshire Police will issue Community Protection Notices (CPN) whilst evidence is collected for a Criminal Behaviour Order (CBO), for persistent offenders. • New Security Officers to wear Body Cameras and record any individuals found sleeping on site and download the footage for evidence file. • Police will increase presence on site – Single Point of Contact is based on local Neighbourhood team • Government legislation for tougher sanctions for those who abuse Health Care Workers – Police will be encouraged to investigate acts of intentional violence towards staff, and promote convictions • To review local Concordat for Care of Prisoners - to include searching from Prison Guards. www.dbth.nhs.uk

  48. Thank you, any questions?

  49. Jonathan Sargeant Director of Finance www.dbth.nhs.uk

  50. Finance at DBTH • Our month nine position was a a small surplus of £59k with the year-to-date position at £11.5m deficit • The Trust has made small surpluses for the past three months, something which has not been achieved since 2015. • In order to reach our overall target for the year we must achieve a better than break-even position every month until March 2019 • As ever, we must make the most of every penny spent! • We continue to work with staff on their cost-saving ideas. www.dbth.nhs.uk

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