Our Performance in 2020 - 21

This section of the annual report will cover:

• Overview - Maz Fosh, Chief Executive
• LCHS 2020/21 Key Facts & Figures
• Financial performance
• Summary of LCHS structure and the services provided
• Challenges facing healthcare in Lincolnshire
• Long term Plan priorities
• Quality summary of performance

Overview - Maz Fosh, Chief Executive

The challenges Covid-19 presented in 2020-21, and continues to do so, has made it one of the most exceptional years we have ever faced as a stand-alone organisation and collectively with our partners.

It has been a privilege to work alongside so many dedicated, caring and driven individuals during this time, for which I give my deepest thanks.

Our essential core services have continued to provide care throughout the pandemic, with colleagues redeployed from different areas of the organisation to ensure additional expertise and support has been available where it has been required.

Colleagues have embraced new ways of working, particularly in the use of digital technology. The Trust became one of the biggest early adopters of Microsoft Teams to support remote working and continue duties in support of patients and other staff members. Services have developed and adapted their offer to use this technology to be more responsive to people in need of care. Great examples are our Cardiac Rehabilitation and Pulmonary Rehabilitation services who have been providing virtual group sessions when routine face-to-face options have not been available.

From the outset of the pandemic the support given to our colleagues by members of the public has been humbling and gratefully received.

A particular highlight was our successful ‘thank you’ postcard competition where young people were invited to design their own thank you card for NHS staff members. More than 90 young people took the time to enter, with some exceptional entries demonstrating local artistic talent, providing a morale boost to our staff and teams.

In support of the national Covid-19 response and associated vaccination programme, LCHS has overseen the launch of two large scale vaccination centres in Lincolnshire, at The Lincolnshire Showground in Lincoln and the Princess Royal Sports Arena in Boston. The Trust is also very proud for The Sidings Medical Practice in Boston to be playing a significant role as a vaccination hub within its local Primary Care Network.

Supporting the individuals that make up our teams and maintaining their health and wellbeing has been a significant priority during 2020-21. LCHS expanded its already well-established programme of activities to join forces with other organisations in Lincolnshire and extend the provision available in light of Covid-19. This included a dedicated Covid-19 helpline, recognised for the part it played in supporting health and wellbeing across Lincolnshire’s partner organisations by winning the Workplace Wellbeing Award in the Lincolnshire Sport and Physical Activity Awards.

The Trust also received the highest score for community trusts for ‘Quality of Care’ with more than 80 per cent of colleagues saying they are satisfied with the quality of care they give. 

Having achieved awards success in 2019 LCHS’s Children’s Rapid Response Respiratory Service continued to impress judging panels in 2020. In October the team won The Council of Allied Health Professions Research (CAHPR) Award for Evaluating Health and Social Care Practice at the Advancing Healthcare Awards. In early 2021 the team was shortlisted in the ‘Paediatric Care Initiative of the Year’ category of the HSJ Value Awards. The winner of this prestigious award is expected to be announced in September 2021.

Among the innovative projects inspired from the impacts of the Covid-19 pandemic was the first-ever drive-through vaccination clinics for young people in need of their HPV vaccine.

The Trust’s School-Aged Immunisation Service had been unable to deliver its usual programme of activity due to school closures in the first wave of the pandemic and delivered the new style of clinics in locations across Lincolnshire as part of the team’s recovery programme.

Within primary care Spalding GP Surgery and The Sidings Medical Practice have been recognised for their improved support to military veterans. Both practices received Armed Forces Veteran Friendly Accreditation by the Royal College of General Practitioners during 2020. This means there is now a dedicated clinical lead for veterans at both surgeries with staff also having additional training to meet the health commitments made within the Armed Forces Covenant.

Another service development highlight has been the further introduction of Urgent Treatment Centres in Lincolnshire. Having launched Urgent Treatment Centres in Skegness, Louth, Lincoln, Boston and Peterborough during the previous financial year the Trust has opened two new centres at Gainsborough and Spalding, offering convenient, bookable appointments for patients by using NHS 111.

LCHS has also been delivering services temporarily at Grantham’s Urgent Treatment Centre in support of a Covid-19 initiative, led by United Lincolnshire Hospitals NHS Trust, to facilitate Grantham and District Hospital as a Covid-19-free ‘green’ site.

During 2020 the Trust also launched its ‘Talk Before You Walk’ campaign encouraging the public to access support virtually via NHS 111 before travelling to services in person. This means people can access timely, appropriate advice and treatment from the right services before they have left home.

The ethos of the campaign was continued within the ambitions of ‘Let’s Do This Together’ – a countywide initiative supported by all of Lincolnshire’s NHS organisations - asking people to follow five acts to support local services. These included eating healthily and moving more, visiting a pharmacy before a GP, making and maintaining appointments, using telephone or video appointments and using the NHS 111 service.

It has long been an ambition of the NHS locally and nationally to encourage and develop closer working partnerships to respond to local needs and deliver care more effectively. The Covid-19 pandemic has brought Lincolnshire’s organisations closer than ever before with bolder ways of working without the constraints of organisational boundaries.

This progress is further celebrated through the development of the Better Lives Lincolnshire Alliance, Lincolnshire’s Integrated Care System. The county’s successful bid was confirmed in March 2021 and took effect from 1 April 2021. 

LCHS’s health and wellbeing and staff engagement programmes also scored highly in the results of the national NHS Staff Survey in 2020 with the Trust achieving the top score for community trusts nationally in both categories. Despite the additional challenges presented by Covid-19, 63 per cent of staff took the time to answer the survey - a figure higher than the national average response rate.

Dedication, inspiration and innovation remain at the heart of our approach and to the way we deliver services, helping us to do more despite the significant challenges of Covid-19.

LCHS 2020/21 Key Facts & Figures

Financial performance

During 2020-21 LCHS has focused on responding to the challenges presented by the Covid-19 pandemic while supporting our staff and patients to deliver services. Normal NHS operating framework rules for financial performance were paused and/or simplified for 2020-21 to enable Trusts to focus on responding to the pandemic and subsequent restoration of services to pre-Covid-19 levels and ongoing response needs.

LCHS’ track record is strong in effectively managing its financial performance and delivering against our financial plan commitments. We have worked with system partners to ensure money received was deployed in response to Covid-19 and service delivery priorities in Lincolnshire. Our year-end financial position met the required break-even expectations set by NHS England. The Trust supported partner providers to break-even within the allocated financial resources for 2020-21. The Trust also delivered on its planned £1.9m capital investment programme for 2020/21.

Service developments in 2020-21

The Acute Covid-19 Virtual Ward

As part of the LCHS and system response to Covid-19 an Acute Virtual Ward model was developed in partnership with colleagues at United Lincolnshire Hospitals NHS Trust (ULHT). The model enabled the safe discharge of Covid-19 positive patients out of hospital into their own homes. All patients received an oximeter to monitor their oxygen saturation levels three times per day and their recovery supported by daily clinical review phone calls.

Six Covid-19 positive patients were admitted to the virtual ward and none were readmitted to hospital. Patients have shared positive experiences of the virtual ward with the service which will be used to inform developments in non-Covid-19 related services going forward. Innovative options such as the virtual ward support effective and safe discharge processes for patients and reduce pressure for beds across the Lincolnshire system.

Urgent Treatment Centres

The joint delivery with ULHT of temporary Urgent Treatment Centres services at Grantham Hospital in June 2020 was a step forward for partnership working across the Lincolnshire system. Benefits for local patients included a 24/7 walk in service - with the support of NHS 111 – plus more convenient, bookable appointments.

The Trust’s network of Urgent Treatment Centres has expanded to include Gainsborough and Spalding, both former Minor Injury Units.

A successful bid for £1.8 million to upgrade the Lincoln Emergency Department included funding enabling the Lincoln Urgent Treatment Centre to be refurbished and significantly renovated. The new UTC was launched at the beginning of May 2021

Palliative Care and End of Life

The Palliative Care and End of Life (PEOL) programme has continued to go from strength to strength, including personalisation developments across the system. Increasing early recognition of palliative care needs has and continues to be a priority for the Trust. Enabling clinicians to open up opportunities through advanced care planning to support patients to make advanced decisions about the end of their lives and have the difficult conversations with their families through supported conversations with staff. The programme aims to increase the volume of robust care assessments and improve the quality of support provided in the last days of life. Key measures have been the continued emphasis and increased provision of patient-centred care, increased collaboration and co-ordination across the health and care system of palliative services.

Home First Partnership

Established as a component of the response to Covid-19 the Accelerated Discharge group was created which involved all health and care partners across Lincolnshire. This focussed on managing and maintaining patient flow from the acute setting into community hospitals and community care services.

The benefits to this new way of working have been:

• improved communication and collaboration across all providers and partner organisations;
• improved flow of information and a reduction in risk for our patients; and
• enhanced quality control and shared learning from incidents.

Ultimately the project delivered a smoother and efficient patient flow through the system.

Children’s physiotherapy rapid response service

Children with complex physical disabilities who live in Lincolnshire have been supported through this exceptional service to help prevent hospital admissions for acute chest infections. In 2020 the service won the National Advancing Healthcare Awards UK award for Evaluating Health and Social Care and have also been shortlisted in the Health Service Journal (HSJ) Value award for Paediatric Care Initiative of the Year 2020 (results pending).

Leading the digital way

LCHS prides itself on being an innovative NHS Trust and despite the challenges through 2020-21 the Trust still hit the top figures nationally for use of Microsoft Teams, a communication platform developed by Microsoft as part of the Microsoft 365 family of products. Teams primarily offers videoconferencing, calling and messaging through the internet. During the national restrictions and regulations relating to social distancing and the need to work from home where possible, the Trust took full advantage of this technology to maintain business as usual. Microsoft Teams was introduced at pace, embraced by our staff and is now seen as an essential tool to help keep the organisation working together and with system partners. It’s also had a positive impact on reducing journeys and costs to our organisation.

Meetings, training and support networks quickly moved onto Teams minimising the requirement for staff to go into bases unnecessarily, enabled our staff to reduce travel across Lincolnshire and continue to connect effectively with colleagues, patients, community members and partners across the country. 

The possibilities of Microsoft Teams and additional digital options continue to be explored, from live broadcast events of our bi-monthly Trust Board meetings, Talk to Trust Leadership Team fortnightly livestreams to keep in touch with organisational leaders, to health and wellbeing group meetings and online exercise classes for patients.

Office 365 – securely work anywhere at any time

This initiative has improved our ICT security and increased the mobility of staff with access to new ways of working. Office 365 has been introduced across the Trust, ensuring our staff have the latest and safest technology to use, enhancing mobile working and creating a truly agile workforce. This includes, accessing documents on the move via laptops, phones or other devices, and working together on project files while at opposite ends of the county. More is possible with further upgrades to Office 365 and this further reduces the need for travel.

Previous network issues no longer cause delays with data now stored in a virtual cloud, accessible from anywhere with an internet connection using OneDrive and SharePoint. This increased flexibility helps to overcome the geographical setbacks in such a large county as Lincolnshire giving more time to focus on patient needs.

Video consultations

Covid-19 restrictions have significantly increased the demand for video consultations the past 12 months. Video consultations have increased significantly through 2020-21 which is fantastic news for patients who would previously have struggled to physically get to their GP surgery. E-consultations have also enabled patients and the highly vulnerable to still access care and clinical advice whilst they have been shielding.

eLearning and online training

Staff training had to turn a sharp corner in the last year as face to face training was suddenly no longer an option for the Trust. All training for staff was moved online through e-platforms and staff were supported to use digital technology to maintain competencies. E-learning packages and video tutorials for staff can all be accessed remotely. Although progression to increase e-learning across the Trust was planned this was significantly accelerated through Covid-19. We will continue to take full advantage of further training technologies for staff as they become available. Other digital initiatives delivered in 2020-21 include:

• 20% of our IT estate refreshed to ensure fit for purpose equipment for staff.
• HealthRoster is now available for all staff providing an eRostering system to support the managing of staff time and availability. This will realise further efficiencies in workforce deployment in the coming year as well.
• New Voice Over Internet Protocol (VOIP) telephony is now in place replacing out of date equipment, providing a more robust and supported infrastructure across the Trust, also reducing future telephony costs.

Summary of LCHS structure and the services provided

The Trust is managed through five organisational directorates:

• Chief Executive’s Office
• Finance and Business Intelligence Directorate
• Medical Directorate
• Nursing, Allied Health Professionals (AHP) and Operations
• People and Innovation Directorate

The corporate services directorates, which consist of the Chief Executive’s Office, People and Innovation and the Finance and Business Intelligence Directorates, manage the day to day business of LCHS. These directorates also support the work of the Nursing, AHP and Operations Directorate and the Medical Directorate to ensure delivery of high quality, effective and efficient services.

In March 2020, refreshed in March 2021, LCHS published a suite of five-year strategies setting out clear intentions and planned activities for 2020-2025 to enable great care, close to home.

• Clinical Strategy
• People Strategy
• Estates Strategy
• Digital Health Strategy
• Finance and Business Intelligence Strategy

Chief Executive's Office 

This directorate manages the corporate business services of LCHS. Functions include Trust Board, development, logistics and support, corporate assurance and governance, compliance and legal services, registrations and membership with regulating bodies, complaints management, the Patient Advice and Liaison Service (PALS), communications and engagement and freedom of information.

Finance and Business Intelligence Directorate 

The directorate brings together elements within the organisation including strategic commercial engagement, financial management, financial accounting, contracting, performance and information as well as strategy and planning.

Medical Directorate 

The Medical Directorate has successfully recruited and appointed a substantive Medical workforce to meet the developing needs of the Trust. In addition, the Trust now has a fully contracted bank medical workforce to support at times of surge and increased demand. In addition to the Medical Workforce, the Medical Directorate has expanded its portfolio to include Medicines Management, Medical Devices and Medical Gases, Learning from Deaths, Practitioner Performance, Research & Development and Clinical Audit and Quality Guidance.

Nursing AHP and operations: The six service lines

Operational Business Services

The new Trust Operational Business Services includes Primary Care, our Operations Centre and Patient Admin services.

In Primary Care, we provide services for patients registered at Spalding GP Surgery and we also provide interim services for the Sidings Medical Practice in Boston. Working with other PCN partners to manage the local populations health needs.

Working with local health partners we support other practices who may find themselves in difficulty, ensuring all patients in Lincolnshire have access to good quality GP services.

The Operations Centre provides several different services including taking referrals from system partners and patients to LCHS services, organising admissions into our community hospitals and supporting our urgent care services.

Patient admin services provide supportive administrative services to our clinical teams. This service works closely with colleagues to ensure the appropriate admin activities are delivered for our clinicians, giving them more time to care for patients.

Further supporting Lincolnshire response to provide Covid-19 vaccinations, the Trust managed Sidings Medical Practice in Boston gave more than 8,000 first vaccinations to care home residents, people aged over 65, the clinically extremely vulnerable and people with learning disabilities.

The Trust’s successful management of the Spalding GP Surgery is recognised by the Care Quality Commission (CQC), giving a positive review in a transitional monitoring review for the surgery. On top of this, the surgery is an approved research practice.

The Trust managed Spalding and Sidings GP practices have also received Armed Forces Veteran Friendly accreditation recognising the improved support to military veterans in need. Staff at these two GP practices are now able to better identify, treat and support veterans in need of healthcare.

Community Nursing

The community nursing service for adults are organised into 12 Community Teams aligned to Primary Care Networks.

Community nursing teams work closely with a range of services across LCHS including Allied Health Professions and Specialist Services, to provide support to people with long term conditions, people who are frail, and those at the end of life. Community nurses also work closely with a range of professionals from other agencies including Primary Care as part of Neighbourhood Teams to provide integrated care for patients designed to meet local needs.

Primary Care

Working with our Primary Care Network (PCN) partners across Lincolnshire to realign our community services to deliver more joined up services. Employing First Contact Physiotherapists in GP surgeries to help patients to with musculoskeletal problems to see the right person at the right time. LCHS holds the contract for or manages the Spalding Surgery and the Sidings Medical Practice, a PCN vaccination hub for the Boston area in Lincolnshire.

Community Hospitals and Transitional Care

LCHS has four community hospitals; County Hospital, Louth, John Coupland Hospital in Gainsborough, Johnson Community Hospital in Spalding and Skegness Hospital. We also deliver care within the Butterfly Hospice in Boston which we had to close for part of 2020 to enable Butterfly staff deployments to where they were needed most.

Community Hospitals and Transitional Care provide a critical role across services and system providers to ensure that home first principles are proactively viewed as the starting position and not the end point. The service provides an essential function in supporting the emerging Neighbourhood Team models of care to achieve admission avoidance and reduce acute Delayed Transfer of Care (DToC).  Bridging the gap between hospital and home maximises recovery and promotes independence with an emphasis on ‘Home First’ through time-limited rehabilitation and support for older people and adults with long term conditions.

The Operations Centre supports the system with referral handling and demand/capacity management to ensure the right care, first time.

Allied Health Professionals (AHPs) and Children’s Services

AHPs use a holistic approach to assess, treat, diagnose and manage a range of conditions in adults and children across community settings.  The focus is on prevention and improvement of health and wellbeing to maximise the potential for individuals to live full and active lives.  Adult Services are: Occupational Therapy, Physiotherapy, Speech and Language Therapy, Podiatry and the Lincolnshire Stroke Service.

Specialist Services

Services provide care closer to home to reduce hospital admissions and manage long term conditions through self-care.

The Specialist Services are: Diabetes; Heart Failure; Respiratory; Pulmonary Rehab; Macmillan; TB; Tissue Viability; INR; Continence; Lymphedema; Parkinson’s; and MSK Physiotherapy. We provide countywide integrated sexual health and contraceptive health services through LISH (Lincolnshire Integrated Sexual Health).

The Electronic Assistive Technology Service provides a specialist service across the East Midlands including Nottinghamshire, Derbyshire, Leicestershire, Lincolnshire, Northamptonshire and Milton Keynes.

Urgent Care

Urgent care is delivered through urgent treatment centers, walk in centers and an extended range of provision including a; telephone clinical assessment/triage, home visiting and face-to-face consultation. Home visiting is also available for patients meeting the criteria. 

The services provide care to patients with a range of injury and illness related conditions.

Integrated Urgent Care in Lincolnshire

The service offer for LCHS Urgent Care is delivered as:

• Clinical Assessment Service - definitive clinical assessment by telephone.
• Building Based Urgent Care - face-to-face patient consultation – Within Urgent Treatment Centres /GP Out of Hours (OOH)  provision / Acute Primary Care/ Integrated Primary Care GP Hubs.
• Mobile Urgent Care - face-to-face patient consultation in the patient’s own home - GP OOH provision / Acute Primary Care.

LCHS delivers a 24/7 integrated urgent care service that ensures people receive the right care, from the right person, in the right place, at the right time.

People and Innovation Directorate

People and Innovation recognise the value brought to the Trust by its people and the link that exists between an engaged, happy workforce who feel valued, and the quality and efficiency of the care they can deliver.

People and Innovation provide expertise and leadership in the areas of human resources, health and wellbeing, equality, diversity and inclusion, organisational development, learning and development, transformation, digital health and innovation, estates alignment and health and safety.

Challenges facing healthcare in Lincolnshire

Lincolnshire has its ongoing healthcare challenges. The immediate and future impact of Covid-19 is creating further challenges the healthcare system must address

COVID-19 challenges 

• The health and wellbeing of our people post Covid-19 is of utmost importance. Staff have worked flat out for a long period of time in response to Covid-19. There now needs to be a continued but greater focus on their health and wellbeing, particularly psychological support.
• Delivering services in a way that continues to reduce the impact of Covid-19, cares for patients with ongoing Covid-19 related conditions and maintains the efficient use of the funding we get.
• To take the learning from partnership working during Covid-19 and embed these into the way services continue to run so that we ‘build back better’ for our Lincolnshire community.
• To ensure we continue to restore and recover services effectively and in the best way possible for our patients, staff and community. services the restoration and recovery of all services are completed. At LCHS we have restored most of our services and are continuing to assess patient needs for the services that have not yet been restored.
• Supporting the healthcare system to reduce backlogs in patient waiting lists.
• The disproportionate impact of Covid-19 on Black Asian and Minority Ethnic (BAME) communities and colleagues, has shone a light on inequalities and created a catalyst for change.
  • During the pandemic LCHS has supported and continues to support all staff to respond to the challenge by:
    • Being one of the first NHS organisations to complete Risk Assessments for our BAME colleagues, reviewing how C19 impacted on different communities. These were updated more research became available, including assessments for the high-risk groups of people with long term conditions, disability, age, men and obesity.   
    • Additional weekly meetings for the already established BAME staff network and the MAPLE (mental and physical lived experience) staff network with support from the IMPACT group for colleagues with disabilities, long term conditions and those who have shielded.
    • LCHS also now has 7 staff networks and support groups:  BAME and Allies, MAPLE, IMPACT, LGBT+ with Friends, Faith and Belief, Carers, Women’s and a Men’s network.
    • The CEO communicated directly in support of our BAME colleagues both to individuals and their families and collectively to the whole organisation.
    • The CEO and the Chair of LCHS met with the BAME Chair and Vice-chair with a ‘Play List’ (action plan) of actions from the BAME Staff Network which has been implemented.
    • The Trust Board have welcomed the BAME Chair onto the Public Board as a ‘Board BAME Advisor’
    • LCHS funds the BAME chair 7.5 hours release time a week to actively engage in staff network activities, and the BAME vice-chair has 4 hours release time per week to support the Chair.
    • The system celebrated Black History month in October 2020 virtually with local and national speakers with a very good uptake from the organisations.
    • LCHS is involved with System BAME Staff network
    • The EDI LEAD and the BAME staff network chair/vice chair regularly attend regional and national webinars on the BAME agenda to feedback into the organisation.
• Our staff and patients have risen to the challenge of remote working and making best use of digital technology. We need to ensure that the increased productivity and benefits are embedded. Plans are progressing as we work with partners to tackle digital inequalities across Lincolnshire.

The Lincolnshire health and care system

National healthcare policy for the next 10 years is outlined in the NHS Long Term Plan, published in January 2019. Despite the impact of Covid-19 this continues to be the long-term direction that the Lincolnshire Health and Care System is fully aligned to.

In the last year Lincolnshire system partners have planned for and moved to creating an Integrated Care System (ICS). From 1 April 2021 this new partnership, the Better Lives Lincolnshire Alliance, is between the organisations that will meet health and care needs across the Lincolnshire healthcare system. Its main focus will be to coordinate services and to plan in a way that improves population health and reduces inequalities between different groups.

LCHS is fully aligned to the NHS long term direction and ICS through our Operational Plan for 2021-22 supporting the delivery of system change and improvement, with partners. The purpose and ambition of the Lincolnshire’s NHS Trusts, and the agreed healthcare priorities for the next five years were set in 2019 through the system Long Term Plan (LTP). These remain relevant, however, the impact of Covid-19 has meant a focus on shorter to medium term priorities.

Long term Plan priorities

Supporting everyone in Lincolnshire

To Start Well, Live Well and Die Well through supporting: development before starting school; help in navigating the transition to adulthood; healthy lifestyles; urgent help to deal with accidents or acute illness; working together to manage long term conditions; those who are dying and the people who are close to them.

Lincolnshire's four core ambitions for starting, living and dying well

1. Shifting the emphasis to prevention and self-care;
2. Ensuring people have choice and control over the way their care is planned and delivered;
3. Working together across services to better meet people’s needs and improve their experience of care; and
4. Care closer to home.

To deliver the above ambition the system has a number of priorities for patients and the public, our people and the system:

For patients and the public:

Improve cancer screening and outcomes;

• People only go into acute hospital when care cannot be provided in a community setting;  
• Improve prevention and early detection and intervention for heart disease and breathing problems;
• Strengthening the partnership between health and social care services to support people with multiple health conditions;
• Increasing capacity in musculoskeletal services and keeping people well for longer;
• Healthy babies;
• Support for new mothers;
• Improved child health and wellbeing to reduce health inequalities;
• Increasing access to psychological therapy treatment;
• Improving mental health wellbeing for those will depression and dementia;
• Support people with learning disabilities to live well with reasonable adjustments in their support and care;
• Reducing A&E attendances and waiting times; and
• Expand and reform services to ensure patients quickly get the care they need.

For our people:

• Build capacity to care through better supporting and developing staff;
• Making the most of the expertise, capacity and potential of people, families and communities;
• Develop system leaders; and
• Ensure workforce health and wellbeing whilst driving innovation and performance.

For the system:

• Faster, safer and more convenient care;
• Improved access; help patients manage their health;
• Help clinicians to use the full range of their skills;
• Reduce bureaucracy; and
• Improved access to services to ensure people receive the right care, first time.

Shorter term post COVID-19 priorties 

Many of these shorter-term priorities align to the LTP priorities. There is a need for greater focus on them in the coming year:

For our patients and public:

• Delivering the NHS Covid-19 vaccination programme and continuing to meet the needs of patients with Covid-19, and ‘long term’ Covid-19.
• Building on what we have learned during the pandemic to transform the delivery of services, accelerate the restoration of elective and cancer care and manage the increasing demand on mental health services. As well as all other critical services.
• Expanding primary and community care capacity to improve access, local health outcomes and address health inequalities.
• Transforming community and urgent and emergency care to prevent inappropriate attendance at emergency departments (ED), improve timely admission to hospital for ED patients and reduce length of stay.

For our people:

• Supporting the health and wellbeing of staff to recover from the impact of their work during Covid-19.
• Ensuring we take continued positive action on recruitment and retention.

Single Oversight Framework (SOF)

The Single Oversight Framework (SOF) outlines the approach NHS England takes to overseeing the performance of NHS Trusts and identifying where commissioners and providers may need support.

Each Trust receives an overall rating of one to four based on data monitoring and NHSE/I’s judgement of providers’ circumstances across the five themes of quality of care, finance and use of resources, operational performance, strategic change and leadership and improvement capability. SOF segment 1 is the top rating a Trust can receive. For 2020-21, some elements of the underlying SOF metrics (e.g. for financial performance) were suspended to enable full focus on Covid-19 response activities.

LCHS was consistently rated ‘SOF 1’ overall for most of 2020-21, meaning there were no evident concerns and no support needs identified.

Quality account performance

The quality account priorities for 2020/21 were discussed with stakeholders including staff groups and patients and were then agreed with the LCHS Quality and Risk Committee and Trust Board.

The priorities were chosen in consideration of the national audit recommendations, local prevalence and feedback from Lincolnshire Healthwatch and input from Lincolnshire commissioners.

Delivery of the 3 quality priorities agreed for the year have been severely impacted on as our response to the pandemic necessitated that we prioritise clinical delivery and patient safety over the delivery of the quality account. Some progress has been made and the section below describes what has been achieved. The priorities and the achievement of them were:

The following section of the report provides an update on the achievements for each of the priorities:

Quality summary of performance

Safe staffing

Under the leadership of the Director of Nursing LCHS reviews safe staffing across all services on a monthly basis and has developed workforce plans for the next 3-5 years.

These workforce plans reflect both in-year staffing requirements and challenges as well as a clear focus on long term developmental need. Plans will address workforce numbers and the skills required to deliver future services. The plans are being clinically led and implementation in the coming year will, we believe, provide a strong foundation to support safer staffing, providing a significant improvement in many areas of care quality, staff and patient experience.

The Trust has maintained safe staffing levels responding to all capacity and staffing escalations during the pandemic. The Trust will continue to report progress through the Quality and Risk Committee on a bi-annual basis.

Serious Incidents and incidents

The Trust reports all incidents of any type via our Datix system. In 2020-2021 a total of 7,091 incidents were recorded.

Throughout the year the Trust has continued its record of being a consistently high reporter of incidents - reflective of our positive safety culture - recording 2,236 incidents categorised as patient safety with an associated severe harm/death rate 0%.

In 2020-21 LCHS reported 29 serious incidents, 9 of these were Covid-19 outbreaks which, when the criteria for reporting was confirmed, were downgraded by NHS Lincolnshire CCG.  Of the remaining 20 serious incidents there were 9 falls, 7 resulting in a fracture, 1 result of safeguarding enquiry (known as a Section 42 enquiry) and 1 fall with no injuries; 2 treatment delays; 4 diagnostic incidents; 2 care delivery incidents; 2 information governance breaches and 1 near miss.

Pressure ulcers that are recognised as a deep wound that reaches the deeper layers of the skin – a category 3 pressure ulcer – or a very deep wound that may reach the muscle and bone – a category 4 pressure ulcer - are reported as serious incidents. The total figure reported for 2020- 21 was 292. From this figure 47 were rated as category 4 ulcers. These are reviewed through local steering groups to establish if they are attributable to LCHS

Medication errors

The Trust continues to review and scrutinise every medication error that occurs within services and has developed a raft of tools, including thematic reviews, educational webinars and individual staff preceptorship, to ensure errors are minimised. As a Trust LCHS remains well below the national average for medication errors in our Community Hospitals and Community Nursing Teams.

Patient Safety Strategy

The NHS Patient Safety Strategy outlines a collective intent around ongoing improvement of safety and influencing the way we learn, treat staff and involve patients. Emphasis is given to sharing safety insight, empowering patients and staff with the skills, confidence and mechanisms to improve safety, building on the foundations of a safer culture and safer systems.

Patient safety has been paramount in the delivery of the Trust’s Covid-19 response and is a key component of restoration and recovery.

Safety thermometer

Safety Thermometer - the safety thermometer is a national point prevalence tool which allows the trust on one day each month to measure and monitor the number of our patients who may have suffered certain types of harm whilst in our care. The tool looks at four harms: pressure ulcers, falls, blood clots and urine infections for those patients who have a urinary catheter in place. We use this information to help us to understand where we need to make improvements.

Due to Covid-19 the collection of Safety thermometer data was suspended in March 2020 and there are no plans currently to restart the recordings.

All four areas of harm captured by the safety thermometer tool continue to be measured and acted upon separately to this data.

Safety alerts

The Trust has responded to all safety alerts within the required timescales.

Safeguarding

LCHS continues to meet its statutory and contractual safeguarding obligations. The robust reporting, and quality assurance processes continually recognises that our staff demonstrate their duty of care to our patients and service users, with many examples of appropriate multiagency challenge and excellent patient advocacy to enable our patients to live free from harm and abuse.

Performance summary

Despite the significant impact of Covid-19 during the year LCHS continued to deliver safe, high quality community healthcare services to the population of Lincolnshire and urgent care services to the people of Peterborough. The Trust has done this within its financial control total which has enabled us to make a positive contribution to a challenged healthcare system with a substantial financial deficit.

Our staff and services responded brilliantly to the pressures of the pandemic and have recovered the majority of our services to pre-Covid-19 levels. We will continue to invest in the health and wellbeing of our people as we believe that staff who are healthy and feel supported deliver better patient care.

LCHS continues to have a robust, values-based approach to recruiting, retaining and managing our people to ensure we have the right skills, in the right place at the right time.

The Lincolnshire system is working better together than ever before and our collective response to the pandemic has shown how collaboration can provide better services for the residents of the areas we serve. Our focus and priority in delivering great services close to home in partnership with other providers continues now we are part of the Better Lives Lincolnshire Alliance ICS.

Accountable Officer:

Maz Fosh, Chief Executive

Lincolnshire Community Health Services NHS Trust

Signature: 

Date: 8th June 2021