Performance Report

I am delighted to present our Annual Report for 2023/24, which demonstrates the outstanding work of all teams across Lincolnshire Community Health Services NHS Trust. Over the last 12 months, our teams have gone above and beyond to provide innovative community services in Lincolnshire, despite demanding and challenging circumstances.

We have made significant investments and achievements in our services with an aim to work more efficiently whilst continuing to deliver safe and effective care, close to home. A person’s own home is the best place for them to recover after an injury or illness, and we have continued to work with partners across the health and care system to support earlier and more effective discharges into the community.

Our staff remain the cornerstone of our service delivery and we continue to face challenges, in line with the national picture, to recruit registered clinicians. This year we successfully recruited internationally educated nurses and allied health professionals, and continued efforts to grow our own through our award-winning apprenticeship centre and the volunteer to career scheme.

Over the past year, we have reduced agency spend by 28.8%, fully utilised our CPD and apprenticeship levy allocations, and secured additional funding to support staff development.

As an organisation funded by taxpayers, we are committed to offering the best value for money and using our resources efficiently.

I am proud of our collective achievements and look forward to continuing our collaborative efforts to provide exceptional care across Lincolnshire and neighbouring counties.

To the best of my knowledge, the information within this Annual Report is true and accurate.

Andrew Morgan, Chief Executive

The purpose of this overview is to give context to the Annual Report. It outlines and summarises the Trust’s performance over the past year, where we have made improvements and the areas in which we need to continue to improve.

Whilst we are required by law to include technical and financial detail, we have tried to make this overview as easy as possible to read and understand, whilst sharing with you information about our Trust and the services we provide for the residents of Lincolnshire and beyond.

The Performance Report is a summary of what we provide, how we have performed against the national mandated standards for clinical care, what we achieved in 2023/24, and how your money was invested to improve services for patients.

The Accountability Report and the Financial Statements contain a range of other technical details, statements and financial information, which we are required to produce by Parliament and our legal regulators, NHS England (NHSE).

LCHS cares for patients across the whole of Lincolnshire, serving one of the largest geographic areas in England with a population of around 768,400 (Office of National Statistics).  

Our Trust is managed through five organisational directorates: Chief Executives Office, Finance and Business Intelligence Directorate, Medical Directorate, Nursing, Allied Health Professionals (AHPs) and Quality, Operations Directorate, and the People and Innovation Directorate.

We had an annual income for 2023/24 of £143 million and the services we deliver are commissioned by several organisations including NHS Lincolnshire Integrated Care Board (ICB), Lincolnshire County Council (LCC) and NHS England.

Our services are delivered from over 46 different sites; our main sites are:

• Trust Head Quarters – Beech House, Lincoln
• Lincoln County Hospital
• Louth County Hospital
• Pilgrim Hospital, Boston
• Grantham and District Hospital
• Grantham Community Base
• John Coupland Hospital, Gainsborough
• Johnson Community Hospital, Spalding
• Bourne Health Clinic
• Riversdale Health Clinic, Sleaford
• Lindon House, Lincoln.

This year we had over 800,000 contacts with patients in the community.

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, AHPs and Quality, Operations, and Medical directorates to ensure delivery of high quality, effective and efficient services.

In the last quarter of the financial year, several portfolio changes occurred within the executive team, which resulted in innovation, health and safety and estates moving under the Operations directorate and Complaints and Patient Advice and Liaison Service moving into the Nursing, AHPs and Quality directorate.

Chief Executive's Office

This directorate manages the corporate business services of LCHS. Functions include the corporate secretariat and governance of the Trust Board and the Trust Board Committees, including Trust Board development, logistics and support, corporate assurance and governance, administration of freedom of information requests, compliance and legal services, registrations and membership with regulating bodies, and communications and engagement with the public and stakeholders and our volunteering service.

The Complaints and Patient Advice and Liaison team were part of the directorate until 31 December 2023 and moved to sit within the Nursing, Quality and Allied Health Professionals (AHPs) team from 1 January 2024 to support the alignment of portfolios across the Lincolnshire Community and Hospitals NHS Group.

Finance and Business Intelligence directorate

The Finance and Business Intelligence (FBI) directorate exists to create actionable insight that delivers value that supports the effective running of the organisation through strong foundations, and to support sustainability in the long-term.

Our work is a combination of statutory, compliance-related functions and developmental, transformational work; both of which must be consistently resourced.

In 2022 we restructured FBI, creating capacity to deliver our operational, tactical and strategic responsibilities in an integrated, collaborative way. Our structure is underpinned by ways of working including a business partnering approach, shared accountability and collective leadership with a clear line of sight to patients.

Nursing, AHPs and Quality directorate

The Director of Nursing, Allied Health Professionals (AHPs) and Quality leads a team providing the clinical leadership and quality governance of the organisation. The directorate includes the following interdisciplinary teams: patient safety, safeguarding, quality governance, professional and effective practice and infection prevention and control. The Nursing, AHP and Quality team has a visible presence across LCHS, providing support, expert guidance, and supervision to all teams and supporting development and decision-making to influence great care.

Safeguarding - the Safeguarding and Vulnerabilities team works trust-wide to develop and empower our staff to promote the safety and wellbeing of children and adults covering a range of areas including child protection, adult protection, mental capacity, learning disabilities, neurodiversity, autism, dementia and mental health with a public health approach to preventing harm whenever possible.

Quality governance - The Quality team works closely with operational, support and corporate services to ensure the care we deliver is in line with the CQC domains of safe, effective, caring, responsive and well-led and that everything we do is embedded and evidenced. In 2023/24 the Complaints and Patient Advice and Liaison Team moved to be part of the quality governance function. 

Professional and effective practice – Ensuring we have the right staff with the right skills is fundamental to the delivery of safe care. The Effective Practice team leads the development and growth of the clinical workforce.

Infection prevention and control – this highly visible team focuses on support, education, and expert guidance to clinical staff to reduce the risk of healthcare-associated infections to patients, visitors, and staff.

Complaints and Patient Advice and Liaison Service (PALS) – this team manages complaints, concerns and compliments for the Trust.

Operations directorate

Children, young people, and specialist services division 

LCHS’ specialist services are a mix of specialist nursing teams and services led by allied health professionals who 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. 
 
Our services include speech and language therapy, musculoskeletal physiotherapy, diabetes, community cardiology, stroke, respiratory, Macmillan services, tuberculosis, bladder and bowel, podiatry, Parkinson’s and post-COVID rehabilitation. We also provide integrated sexual health and contraceptive health services across Greater Lincolnshire. Children’s and young people services include immunisations and vaccinations, children’s therapy, complex needs rapid response service and health assessments for children in care. 
 
Services provide care closer to home to reduce hospital admissions and manage long-term conditions through self-care. We also run the Electronic Assistive Technology Service (EATS) which provides a specialist service across the East Midlands including Nottinghamshire, Derbyshire, Leicestershire, Lincolnshire, Northamptonshire, and Milton Keynes.

Collaborative community care division 

Delivering our proactive, core community services, collaborative community care is proud to compromise our community nursing, skin integrity, community therapy, community outpatients and surgical services. Community IV service and our community hospital inpatient and hospice services. 

Our district nursing service for adults aged 18+ is organised into community teams aligned to Primary Care Networks (PCNs). Now working closely with our partners around community primary partnerships (CPPs), community nursing teams work closely with a range of services across the system as well as within LCHS, including allied health professionals 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. 
 
LCHS has four community hospitals where we deliver our inpatient and outpatient and surgical services: 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. 
 
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 neighbourhood teams to achieve admission avoidance and reduce acute delayed transfer of care. 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.

Working closely with our system frailty strategy leads, the division is proud and committed to promoting health equality and driving high quality health care to some of our most vulnerable people in Lincolnshire. We are privileged to offer a range of assessment, rehabilitation and end of life services that so hugely impact on the lives of local people.

Integrated urgent and emergency care division

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. Urgent care is delivered through urgent treatment centres and an extended range of provision including a telephone clinical assessment/triage, home visiting and face-to-face consultation, urgent community response, discharge to assess and transitional care. The services provide care to patients with a range of injury and illness related conditions.

People and Innovation directorate

The People directorate recognises 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.

The team provides expertise and leadership in the areas of human resources, health and wellbeing, equality, diversity and inclusion, organisational development and learning and development.

Please find our strategic aims and objectives for the year 2023-24 on the next page.

Aligned to the strategic aims and objectives, the finance and business intelligence directorate established workstreams focused on the following:

• developing foundational insight
• producing a multi-year financial plan including the key service transformation priorities
• driving change, insight and direction
• delivering a multi-year financial plan including the key service transformation priorities
• supporting and providing leadership to the ICS Operating Framework and governance structures
• playing an active role in collaborations that make a difference

Our approach to care and working together is important to us. Our values are described as the ‘LCHS Way’ which reinforces the right behaviours and approach we take in everything we do, contributing to better care for our patients and a better working environment in our Trust.

The LCHS Way is “we listen, we care, we act, we improve.”

We listen: we engage with everyone we work with | we are united | we are always positive

We care: everyone is valued, respected and developed | knowledge and skills are nurtured | success is celebrated

We act: Clear goals and the right resources | freedom coupled with accountability | emphasis on simplicity

We improve: we are creative, resourceful and innovative | integration and collaboration is the way forward | we’re always striving to do better

Over the last 12 months our teams have gone above and beyond to continue provide caring and innovative community services in Lincolnshire. Here are just some of our highlights and achievements:

Our services

• Together with NHS Property Services, LCHS have invested £3.5 million into John Coupland Hospital to improve our estate. The new inpatient ward has been co-designed with the ward team to ensure it meets the needs of staff and patients alike, now and for the future.
• We were successful in our bid for the £53 million Greater Lincolnshire Sexual Health Services, with the support from ULHT and ICB colleagues. An extensive re-model was undertaken on our existing service and a new service in North and North East Lincolnshire will now be delivered by LCHS.
• LCHS UTCs saw almost 178,000 patients last year. 92.3% were seen and treated within four hours. On average, at least 90% of these patients were kept away from Emergency Departments.
• Initial triage performance within the UTCs averaged at close to 89% of patients being seen within the 15-minute window, this significantly outperforms the national average of 53%
• The KPIs for our Urgent Community Response in 2023/24 were at 97.5% with 70% of patients to be seen within the two hour window

Our people

• We successfully recruited 49 internationally educated nurses and 10 AHPs through international recruitment.
• Achieved Timewise Positive accreditation in relation to flexible working.
• A 28.8% reduction in agency spend and shifts when compared to the previous financial year .
• Implemented reverse mentoring scheme with 19 pairings.
• We have fully utilised our CPD allocation of £330k which has supported the development of registered clinicians.
• We have fully utilised all our apprenticeship levy allocation to provide opportunities for both clinical and non-clinical staff.
• We have secured £120k of funding with Lincolnshire County Council to deliver functional skills (maths and English) to our staff.
• We achieved the highest compliance across the system and group with flu vaccinations at 49% for frontline staff.

Awards and accolades

• Our silver Armed Forces Covenant was revalidated in recognition of our work to support armed forces personnel, their families and veterans in LCHS and the community.
• We are recognised as a veterans aware organisation by the Veterans Covenant Healthcare Alliance.
• Our Selective Mutism team were crowned the winner of the Giving Voice Award in the Royal College of Speech and Language Therapy (RCSLT) Awards.
• LCHS celebrated staff at its annual awards ceremony ‘Celebrating Success’ where outstanding teams and individuals at LCHS were recognised for their dedication. A record 205 nominations were received from teams, individuals and volunteers from across Lincolnshire for 10 award categories. 

Our patients

• In collaboration with ULHT colleagues, we addressed the flow of patients out of the acute setting and back home after having a stroke. There were no tilt and space chairs in the community meaning patients were often kept a little longer in the acute wards as these chairs have a great impact on recovery. We now have 14 of these chairs coming to our community hospitals and 10 chairs in the community which will be delivered to patients’ place of discharge for six to eight weeks to support recovery, rehabilitation and support flow. 
• The Trust has achieved its forecasted delivery of a £1.38 million surplus position at 2023/24 year end in response to system requirements/
• £6.9 million of CIP has been fully delivered.
• LCHS achieved Future Focused Finance (FFF) Level two accreditation in recognition of being an NHS organisation that has the high quality finance skills development culture and practices in place.
• Better Payment Practice Code: BPPC (by volume) score in February was 81.1% against a target of 95% sowing a steady improvement as prior year impacts are falling off.

Our partners

• We began working towards a Group with ULHT and established Lincolnshire Community and Hospitals NHS Group since 1 April 2024
• We worked with partners to pilot a Discharge Medicines Service across Lincolnshire
• We started a pilot for system-wide specialist palliative/end of life pharmacist in conjunction with system partners
• We worked with partners on pharmacy input into virtual wards and the Discharge to Assess Service

Media highlights

Ward improvements at Gainsborough Hospital hit halfway point 

Work to enhance patient care and future-proof Scotter Ward in John Coupland Hospital in Gainsborough reached the halfway point in November 2023. The ward has been receiving significant upgrades to provide a modern and improved environment for patients and staff, including new inpatient accommodation and nurse’s station. 

Virtual ward programme saves more than 2000 hospital bed days 

LCHS’s cardiology virtual ward works on a ‘step up, step down’ model, meaning patients can either be put on a virtual ward (‘stepped down’) from hospital, or they can be ‘stepped up’ to a virtual ward from a consultation or conversation with the team. The step-up programme allowed the team to treat patients in a personalised way, depending on the patient’s conditions and symptoms. In its first year, it had just under 500 admissions, saving more than 2000 hospital bed days. 

The first ever Lincolnshire NHS volunteer was successful on the Volunteer to Career Programme 

After volunteering at LCHS for four months, and joining the Volunteer to Career Programme, Elena Orlova secured a new role at LCHS as a Health Care Support Worker. The Volunteer to Career Programme is an initiative, designed by clinicians to inspire volunteers to take up NHS roles and equip them with the appropriate tools and knowledge to thrive. 

The NHS 75th birthday  

On the 5 July 1948 the National Health Service (NHS) was born, and healthcare became free and accessible to everyone. To celebrate, NHS staff in Lincolnshire opened the Yarbrough parkrun and held stalls for the runners and walkers as part of an NHS England campaign. Hundreds of people joined the event to run, jog, and walk, all dressed in blue. Lincolnshire NHS also held a schools birthday card competition in which the children designed a card to mark the NHS’ 75th milestone. 
Buildings across the county, including Lincoln Cathedral, the clock tower in Skegness and the Trinity Arts Centre in Gainsborough all lit up blue on the day of the birthday and senior leaders across LCHS visited teams to personally thank them for their hard work and commitment to the NHS. 

A 30-year dream became a reality for Lincolnshire nurse

Since she was 18, Nina Williamson had a dream of becoming a nurse. After 30 years in the NHS, she qualified through the apprentice registered nurse degree which is funded by LCHS and delivered through the University of Lincoln.   

LCHS celebrated the successful completion of its first-ever occupational therapy apprenticeship 

Nicola Cooper and Jeanette Collinson completed the Trust’s first-ever occupational therapy apprenticeship. Both Nicola and Jeanette have a combined 28 years of experience at LCHS, working in various roles and services. Over the years, LCHS has supported their career growth by providing opportunities to develop their skills and knowledge, the latest opportunity saw them qualify as occupational therapists.  
 
LCHS protected Lincolnshire residents with COVID-19 and flu vaccinations  

LCHS provided COVID-19 and flu vaccinations throughout the year with seasonal vaccination campaigns. The Trust also began the roll out of the national MMR vaccination programme.

Planned industrial action 

Industrial action continued to create challenges for LCHS and the Lincolnshire system throughout 2023/24. The Trust worked with system partners to prepare for industrial action which included delivering a joint communications response and ensuring that resource within the system was where the need was greater, often redeploying staff members.

New app was launched to help people suffering with post-COVID 

The Lincolnshire Post-COVID Rehabilitation Service launched its new app, called Living With – Covid Recovery. The app helps people recover from post-COVID and can be accessed without a medical referral. 

Lincolnshire NHS Charity

Lincolnshire NHS Charity is an independent and dedicated charity that plays a vital role in supporting both LCHS and Lincolnshire Partnership Foundation NHS Trust to make a difference to service user care. It supports innovative projects to enhance services and facilities that would not be funded by the NHS. The 2023/24 Lincolnshire NHS Charity highlights include:

• A new therapy dog named Bran joined the team at Welland Ward in Spalding to support patients receiving palliative care. Bran has had a positive impact on the palliative care patients supported every day by Johnson Community Hospital. 
• Eleven staff members from both LCHS and LPFT took part in London Landmarks Half Marathon and raised over £3,000 for the charity.
• Lincolnshire NHS charity was chosen by Springfields Outlet Shopping and Leisure as its charity of the year. This means that the charity benefited from funds raised from the outlet’s events, such as Bonfire Night and Christmas celebration events.
• The charity launched its new brand, including a new website, thanks to successfully securing the Charity Development Grant. 
• The charity purchased journals for young people who had family members receiving palliative care. The journals aimed to encourage young people to take time to recognise and record their feelings to help them process their experiences. 
• At Christmas, patients staying in hospital received a small gift thanks to the charity to enhance their experience and bring a little Christmas cheer right to their hospital bed. 
• The 2022-2023 Annual Report approved by Trustees on 9 January 2024, can be reviewed here, noting celebrations throughout the calendar year.

In April 2024, LCHS and United Lincolnshire Hospitals NHS Trust formed a Group, becoming Lincolnshire Community and Hospitals NHS Group. The Group strategic plan for 24/25 is below.

The Trust Board has assessed the Trust’s ability to continue for the foreseeable future in accordance with the Department of Health and Social Care (DHSC) Group Accounting Manual. Consequently, as in previous years, the Trust has prepared its 2023-24 Annual Accounts on a going concern basis.

In approving the trust's annual accounts, the Board of Directors has satisfied itself that the Trust has prepared the accounts on a going concern basis.

The Directors of the Trust have considered whether there are any local or national policy decisions that are likely to affect the continued funding and provision of services by the Trust. The Trust is a member of the Lincolnshire Integrated Care System (ICS). The Trust is one of 3 providers within the ICS and key to the delivery of the future healthcare provision for Lincolnshire. The Lincolnshire system has committed to and agreed a breakeven plan for 2024/25. The ICS has developed its Strategic Delivery Plan and NHS Long Term Plan this includes the continued provision of services by the Trust.

The move towards a group model progressed during 2023/24 with a new group name Lincolnshire Community and Hospitals NHS Group (LCHG) and a board in common agreed and commencing in April 2024. Both Trust's remain separate legal entities but have agreed to collaborate for the mutual benefit of the new group model and Lincolnshire system. As such we don't foresee any impact on the going concern assumption for 24/25.

There are no known factors or circumstances identified that would cause the Directors to doubt that Lincolnshire Community Health Services NHS Trust will continue to provide healthcare services into 2024-25.

For the 2023/24 financial year, the Trust delivered a system performance surplus of £1.38 million against a breakeven plan and ended the financial year with a £30.5m cash balance.

The Trust’s income is predominantly made up from commissioner contracts uplifted for inflation and growth. Income from our local Integrated Care board (ICB) \ Clinical Commissioning Groups was largely based on a block contract and this provided relative certainty regarding our income and cash flow. The Trust also received specific income for system developments and initiatives although this value was relatively minor in 2023/24.

The financial requirement for the year will be reducing the Trust’s underlying cost base and delivering efficiencies to achieve a balanced plan. This position includes a £7.0 million efficiency target with engagement from the ICS in looking to deliver efficiencies across the provision of healthcare across the system.

The Trust has prepared a 12 month rolling cash forecast, incorporating the planned breakeven position and full delivery of the £7.0 million efficiency, during the going concern period to 30 June 2024. The cash forecast shows sufficient operating liquidity for the Trust to continue to during 2024/25. The Trust will have access to working capital support and loans from NHS England should the need for this arise, however, there is no expectation of utilising this facility during 2024/25.

In conclusion, these factors, and the anticipated future provision of services in the public sector, support the Trust’s adoption of the going concern basis for the preparation of the accounts.

Safe staffing

Work throughout the year has progressed as we now consistently report and scrutinise our fill rates and care hours per patient day (CHPPD) on our community hospital wards. While there is no national benchmarking for CHPPD, LCHS has compared our data against other ward areas that offer a similar service to ours and therefore have been benchmarking against this. On the whole we have been above the benchmark, an area of focus for us moving forward is Welland Ward where we have seen our CHPPD below our benchmark due to Healthcare Support Worker fill rates. This is driven by unavailability rather than vacancy. The recruitment of internationally educated nurses has significantly improved our fill rates as they have transitioned from their induction to practicing clinicians.

As part of the wider work, we have seen a significant reduction in agency use and spend in community hospital and on the whole have been within target, there have been outside influences that have driven the increase in spend at Skegness Hospital due to the fire risk.

Community nursing has focused on their recruitment drive and transition from ward to community for our internationally educated nurses, all have had a positive impact on the service resulting in a trajectory of a zero registered nurse vacancy by December 2024.

The workforce reviews have continued with the Director of Nursing which has allowed building on workforce requirement including skills, roles and role descriptors within the service demonstrating clear career pathways. All community Nursing teams undertook a full census week from the community nursing safer staffing tool (CNSST) which captured demand, activity and workforce. The purpose of the CNSST is to;

• Support capacity and demand that recommends community nurse staffing levels sensitive to changing community workload.
• Support organisations in striving to meet Developing Workforce Safeguards (NHSI, 2018) by providing six-monthly Board reporting and annual staff resetting requirements.
• Determine best practice for community teams using an established service quality audit.
• To compare funded, actual, temporary, and recommended community nursing staffing.
• CNSST implementation is a key deliverable of the National Community Nursing Plan.
• NHSE has since put the tool on hold for three months meaning we are unable to use the data we have captured however what we have been able to use is the local learning per team and work with them on these findings to implement standardisation and different ways of working.

Medication errors

The rate and quality of medication error reporting remains high within the organisation. Multi-disciplinary team approach to medicines incident reporting helped engagement of frontline staff across professions and promoted sustained positive change. 

There is a consistent positive reporting culture which has supported staff to report and learn from incidents. This is evident in the number of medicines-related incidents reported per quarter during 2023/24 which have increased by approximately 30% when compared to last financial year’s figures.

This has been further strengthened by the appointment of an Associate Chief Pharmacist who will also lead on medicines safety for the organisation. He will be working closely with the Chief Pharmacist, the Quality team and divisions to support medicines management improvements locally.

The organisation has sustained the improvement made in the last financial year and continue to see increased recording of high-quality incident and risk data through the Trust’s incident reporting system (Datix); strengthened medicines management processes within Urgent Treatment Centres and Home Visiting teams; strengthened Controlled Drugs management, including for Patient’s Own Medicines, and closer working within the wider Lincolnshire system via continued attendance at the Controlled Drug Local Intelligence Network meetings; strengthened medicines security in clinical areas; embedding the Eight Rights of Administration across the organisation to support patient safety; supporting staff that administer medicines within community teams; supporting the Trust immunisation/vaccination teams to ensure safe patient vaccinations; ensuring access to medicines out of hours; and reviewing medicines related audits that provide assurance in relation to the safe and secure handling of medicines across all clinical sites.

Patient safety strategy

Patient Safety Incident Response Framework (PSIRF)

In August 2022 NHS England published the Patient Safety Incident Response Framework (PSIRF). This sets out the NHS’s approach to developing and maintaining effective systems and processes for responding to patient safety incidents for the purpose of learning and improving patient safety. PSIRF replaces the Serious Incident Response Framework (SIF) and will remove the ‘serious incident’ classification. PSIRF fundamentally shifts how the NHS responds to patient safety incidents for learning and improvement.

PSIRF will bring about a significant cultural shift in the way that patient safety incidents are managed. Unlike SIF, PSIRF does not prescribe what to investigate. This new approach will support greater focus on learning and improvement. Local implementation and transition plans supported the launch of PSIRF across the trust on 1 April 2024. The trust has worked closely with partners across the system to implement the framework change and develop a local Patient Safety Incident Response Plan with key priority areas for local learning and improvement.

This will continue to be a significant focus in 2024/2025 with key priority areas including patient safety learning and ‘just culture’.

Patient Safety Specialists

The Trust has appointed two Patient Safety Specialists to support the national Patient Safety Strategy delivery. These are significant posts for the organisation, leading implementation of all areas of the strategy and the wider patient safety agenda.

Patient Safety Partners

Working collaboratively across the system, the trust has developed the infrastructure to support and recruit patient safety partners. These patient partners will be directly involved in patient safety improvement project, working with organisation boards to consider how to improve safety. Posts have been advertised and recruitment is underway.

Learning from Patient Safety Events (LFPSE)

LFPSE has been a major upgrade to the existing National Reporting and Learning System (NRLS), creating a single national NHS system for recording patient safety events. Following a Datix upgrade, the Trust transitioned to LFPSE on 1 December 2023 enabling local risk management systems to record patient safety events on LFPSE.

Incident Reporting and Serious Incidents

The Trust reports all incidents of any type on the Datix incident management system – we report many incidents on behalf of other providers and partners too.

In 2023/24, a total of 10,059 incidents were recorded (an increase of 9% on 2022/23 figures), continuing to reflect our high reporting and positive safety culture, new LCHS services being established and our increased reporting on behalf of others for areas such as pressure damage and safety incidents observed under the care of other providers.

9,295 reported incidents were categorised as ‘’patient safety’’ with an associated severe harm/death rate of 0%.

Of the 9,295 incidents, 138 were moderate harm associated with pressure damage categories three and four.

In 2023/24 LCHS reported six serious incidents that were not pressure damage, which is a reduction of 4 from the previous year.

The serious incidents reported were categorised as follows: five falls, and one delay or failure to monitor.

Annual reporting of serious incidents demonstrated an overall reduction for the fourth consecutive year.

The themes of the serious incidents remain consistent with the reported focus areas of improvement – pressure damage.

Pressure ulcers are included in the Trust’s Patient Safety Incident Response Plan (PSIRP) for thematic review for learning outcomes. The learning outcomes will facilitate bespoke Community Nursing team safety and quality improvement plans to ensure involvement, improvement, and innovation. A review of our investigations into pressure damage indicates we need to improve our assessment and recognition in frailty and palliative patient status and be more proactive with care planning.

The Trust has established a Pressure Ulcer Working Group to develop an improvement plan and take forward the identified learning and improvement opportunities to deliver care differently.

No Never Events (serious incidents that are wholly preventable) have been recorded in 2023/24.

Patient Safety Alerts

In the financial year 2023/24, there have been 17 patient safety alerts issued and the Trust has acknowledged all the alerts within the 48-hour timescale.

​​​​​​​There remains one outstanding alert that has actions ongoing. A risk has been added to the corporate risk register to acknowledge that this alert remains open.

The remaining 16 alerts have had all required actions completed and have been closed.

​​​​​​​Safeguarding​​​​​​​

LCHS has remained fully compliant throughout the year in satisfying all contractual and legal safeguarding duties to keep patients, staff and those who use our services safe and free from abuse and neglect. The Director of Nursing, AHPs and Quality is the executive board lead for safeguarding.

The Safeguarding Team have taken 1,105 calls from staff members seeking advice and responded to 758 safeguarding incidents which included supporting 331 referrals to local authority safeguarding.

We have been a consistent and reliable system partner to the Lincolnshire Safeguarding Adult, Children and Domestic Abuse Partnerships and have contributed to the system priorities.

During 2023/24 the Safeguarding team has continued to lead on adult safeguarding enquiries which relate to a variety of care delivery issues. The safeguarding enquiries are robustly investigated and learning from these is shared via supervision, which is a cornerstone of embedding the learning and improving practice.

During this year, the Lincolnshire Safeguarding Children’s Partnership (LSCP) conducted the Section 11 audit, which seeks assurance that policies and procedures are robust and being appropriately used, and that safeguarding practice is being appropriately prioritised and led within the Trust. LCHS participated in the peer-review process, which confirmed LCHS was able to evidence full compliance within the audit and is expecting final approval from the LSCP.

Signed: Andrew Morgan                         Date Signed: 30/06/2024