Statement by the chief executive on quality

From chief executive Miles Scott

This Quality Account for 2012/13 highlights the good work we have done and our achievements over the last year. It also points out areas where there remains room for improvement. This will guide our efforts to make the changes necessary to improve those services and to continue to deliver the best possible care to the communities and individuals whose care and treatment is entrusted to us.
A lot to be proud of

The Quality Account 2012/13 demonstrates that St George’s Healthcare NHS Trust has a huge amount to be proud of and that our commitment to placing our patients at the heart of everything we do is driving up quality across the trust. Our services have been judged by Dr Foster to be amongst the safest in the country with our mortality rates again amongst the lowest in England.

We have again met all of our annual cancer targets, ensuring that our patients receive timely expert treatment whatever service they require.

It is clear that the foundations for the future are very strong, but we must ensure that we do not allow complacency to creep in. It takes a lot of hard work to become a highly performing trust, and it needs a lot more hard work to maintain those standards.
Room for improvement

As well as showcasing some of our strengths, importantly this report also highlights areas we are clear we need improve. For example, we are extremely disappointed not to have achieved our infection control targets this year, despite seeing rates drop from last year and a 95 per cent decrease in MRSA and C.Difficile infections over the last five years. We are determined to continue reducing the number of infections in our hospitals and to achieve the high standards we set ourselves again this year.

Our patients have told us that we have made improvements to both inpatient and outpatient services in the CQC national patient surveys. However, we still have a lot of work to do before we can say that our patient experience levels match our excellent technical and clinical outcomes. We have seen important improvements in areas like maternity and outpatient services, but making sure that we have consistently high patient experience levels across all of our services is a key priority within our Quality Improvement Strategy.

In January 2013 we were subjected to a routine inspection by the CQC. During their inspection, the CQC found that six of the eight core standards inspected were not always being delivered in practice. This is clearly unacceptable. We have addressed the issues identified by the CQC and will demonstrate improved compliance when they return this summer.
Being open and honest will help us improve

Open organisations are safer organisations, and being open and transparent about where things are not working well and why will help the people who use our services and our partners see that we are working hard to address the issues.

Having an open and honest culture, reviewing performance as part of the education process and learning how to improve our services are all very much part of what we do.

We investigate when things go wrong within an open culture where staff are empowered to report honestly in an effort to find out what went wrong and learn from it rather than solely seeking to apportion blame. We regularly hold staff open forums and patient safety forums which are an important part of reporting and learning from our mistakes. Sharing the lessons learned is the only way we can improve performance across the organisation.

Sadly, things do not always go well in hospitals and when they don’t the consequences can be devastating. In July 2012 a coroner’s inquest into the death of Kane Gorny at St George’s Hospital in 2009 identified a series of failings in our duty of care. We can never bring Kane back, and we can never apologise enough for his death. What we can do is make sure that we learn from this tragic case. Whilst mistakes do unfortunately happen in hospitals, this is a mistake that should never have occurred. When things do not go right, we are committed to being open about our mistakes and doing all we can to learn from them.
A bright future for St George’s

These are exciting times for St George’s. We are on course to achieve Foundation Trust status by next summer, which will give us greater control of our finances and more freedom to design and deliver services that meet the needs of our patients.

This spring saw the launch of the South London Academic and Health Science Network (AHSN), a new partnership that will drive lasting improvements in patient care across south London by sharing innovations across the health system and capitalising on each member’s knowledge, experience and strengths in teaching and research. As well as St George’s, South London AHSN members include King’s Health Partners, The Royal Marsden, London Ambulance Service NHS Trust and The Royal Hospital for Neurodisability as well as a number of local authorities, hospices, community providers, GP practices and academic institutions. The launch of the AHSN positions St George’s at the forefront of research and innovation and will help us to further improve the quality of our services as well as addressing the important public health issues that face people living and working in south London.

We know that giving our staff the best possible facilities and resources to treat our patients is a key factor in improving the quality of our services. Our commitment to providing the best possible environment can be demonstrated by the new neurorehabilitation facilities we are building at Queen Mary’s Hospital and our plans to redevelop Lanesborough Wing at St George’s Hospital into a state-of-the-art specialist children and women’s hospital.
Putting patients at the heart of everything we do

Quality is not a dashboard of statistical measurements. It is also the perception of our patients and their families and carers, and how they feel about their experience whilst under our care.

Our quality indicators are not just numbers on a spreadsheet. Not only is each number an individual patient, the overall picture is a very important tool for helping us to see where things are working and where they are not, and learning from that. We work with other organisations to learn from them as well as internally sharing information and best practice between our varied services so that we can learn from each other.

We have taken note of the Francis report into the failings which occurred in Mid Staffordshire. The most important guidance we have taken from the report is that putting patients at the centre of everything we do will ensure that the quality of our services remains consistently high.

Staff take great pride in the services they deliver and are in the NHS because they care and want to help people. As an organisation we must continue to strive to make sure our staff have the best facilities and environment to deliver the highest quality services possible, and that they are supported at every level.

We aim for a whole systems approach. High quality can only be achieved if everybody is pulling in the same direction, from the porters and healthcare assistants to the most senior consultants and non-executive directors. Of course, this approach will not work if we fail to understand our place in a much wider health and social care system. Our excellent relationships with our partners in our clinical networks, social services and the charity and voluntary sectors are vital to our success.

With this in mind we have agreed a Quality Improvement Strategy which will give all of us at the trust the roadmap we need to achieve our quality priorities during 2013/14.

Schemes such as our Improvement Programme are helping us to work better, safer and smarter — using tools such as lean principles to help us work efficiently and in the most effective way for good patient outcomes. We’re putting the foundations in place to create a stronger, more intelligent organisation in the future, which will help us realise all of our ambitions, including step changes in quality and safety.
A new landscape for the NHS

The changes to NHS structure and the advent of Clinical Commissioning Groups (CCGs) mean that we will be able to work even closer with our GP colleagues to develop services that put patients at their heart whilst consistently delivering the best possible outcomes.

CCGs are now responsible for commissioning and designing local health services focused on delivering better outcomes and responding to the needs and wishes of patients. There are six CCGs in South West London: Croydon, Kingston, Wandsworth, Sutton, Merton and Richmond.

Public Health England has been established to protect and improve the nation’s health and wellbeing, and to reduce inequalities, with responsibility for public health in each London Borough with the respective Local Authorities. The involvement of Local Authorities is exciting for the NHS. We already enjoy a very close relationship with our Local Authorities but this gives us further opportunity to avoid duplication and maximise the potential of our resources to help improve the health and well being of the people we serve.

Miles Scott
Chief executive