Our performance in 2022/2023 - Maz Fosh, Chief Executive

When I think about community services, I imagine we’re the backbone of the NHS. Community services are not necessarily the first thing people have in mind when they think about health services. Still, we’re in the background and we are a vital link between primary care, the hospital, and healthcare support in your home. In 2022/23 we continued to focus on services that keep people well at home.

Our staff and volunteers have shown resilience and they continue adapting practices and services to ensure that our patients have continued to get the very best care and treatment. The commitment and dedication of all colleagues to making a difference in these challenging post-pandemic times are truly inspiring.

Partnerships remain a real priority for us at LCHS. Whether it’s working together with other NHS organisations in Lincolnshire or developing links with the voluntary, community and social enterprise sector partnerships and local educational providers.

We continued to support the county as the lead provider for two vaccination centres in partnership with NHS Lincolnshire Integrated Care Board and other partners and making excellent progress on COVID-19 vaccination boosters.

During these challenging times, our staff’s wellbeing has been at the front of the Trusts’ mind. Encouraging our teams to rest, exercise and enjoy the outdoors has been an important part of putting mental and physical health first. Our “Holistic Health” offer for staff includes training on menopause awareness and providing guidance to staff, we launched Champion Health – a new platform creating personalised health and wellbeing plans as well as an emphasis on financial wellbeing to reflect the pressures of the cost of living.

In LCHS, inequalities of any shape are against our values and fair treatment of our staff is directly linked to a better experience for our patients. One of the areas where we’ve been strengthening our support is staff networks which offer an invaluable support mechanism for colleagues who are members. We have allocated funding for a chair and vice-chair post, release time and overarching budget for these networks. Our Black, Asian, and Minority Ethnic (BAME) Network changed its name to CODE -Celebrating Our Diversity Every day to support The Commission on Race and Ethnic Disparities guidance that the term BAME should not be used by public bodies and companies anymore as it had become "unhelpful and redundant”. In the events and key dates section, you can read about many equality and inclusion-related celebrations that we held in 2022/23.

We welcome feedback from our staff, and we were pleased that our results continue to demonstrate that our staff engagement score remained in line with our corresponding benchmarking group and that staff morale also remained the same as the average score of other community trusts. Our response rate was 57%, which was the same as the average response rate for community trusts. It was also the second time that the survey was aligned with the themes of the NHS People Promise and LCHS’s highest scores were in the elements of ‘We are compassionate and inclusive’, ‘We each have a voice that counts’, ‘We are a team’.

I’d also like to thank our colleagues from primary care as the LCHS contract to provide these services has finished and the Trust made the difficult decision not to renew it. LCHS has decided to focus on working in partnership with GP surgery providers to develop services in local communities rather than as a provider of GP services. The Sidings Medical Practice in Boston moved to a new provider in August 2022. Patients from Spalding GP Surgery have been transferred to other local GP practices and colleagues working in the surgery were redeployed to other LCHS services from March 2023. I want to thank all staff from both practices for their work and dedication to patient care, especially during the very busy period during the COVID pandemic and when services were restored. The Sidings practice also played a significant role in the COVID-19 vaccination programme.

We recognise that we don’t deliver care in isolation and we must work together with our colleagues across the health and social care system. LCHS is a key system partner and through joint working we have developed many services in Lincolnshire including virtual wards, ‘winter’ and discharge initiatives and collectively we aim to provide workforce and apprenticeship solutions. All of these are described on the following pages of the Annual Report.

We have set out key highlights of the year across a number of service areas, awards, achievements and recognition. A few key points I’d like to draw your attention to include:

• developing our volunteering services with many local people coming forward to support our services. We have also secured specific funding (Volunteer to Career)
• a new clinical strategy setting out how we will work with patients, people, and partners to provide care closer to home and enable people to live their best lives in their communities
• continued role in providing COVID-19 vaccination services in the county
• developments in post-COVID-19 service, virtual wards, urgent community response and discharge to assess services
• investment in an improved environment for Scotter Ward in Gainsborough
• recruitment and retention developments.

We are also pleased to report that our year-end financial position met the required break-even expectations set by NHS England.

I would like to offer my sincere thanks to all our patients, staff, volunteers, and stakeholders for your continued support for community services. I continue to be extremely proud of our people and their achievements. I hope that you will enjoy reading about our work.

LCHS has a legal and moral obligation to manage the money it receives from the public purse each year and provide the best quality healthcare services possible. LCHS’s track record is strong in effectively managing its financial performance and delivering against our financial plan commitments. We have worked collaboratively with system partners to deliver service priorities, transform services, and ensure value for money.

Our year-end financial position met the required break-even expectations set by NHS England. The £4.8m efficiency target has been delivered (39% recurrently). Capital expenditure of £3.4m has been invested in clinical equipment, estates and information management and technology (IM&T). The Trust continues to manage and maintain a healthy cash balance.

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:

Service developments and initiatives

Volunteering services

During 2022/23, our volunteering service has become established within the Trust and has increased the amount of volunteering activity. We have recorded over 2,000 hours of volunteer and patient partner activity this year compared to just 216 hours in 2021/22. We have recruited 38 new volunteers, which brings our total to 54, working across 16 different services, sites, or departments. This includes roles in our community hospitals, rehabilitation groups, corporate services, and urgent treatment centres. Volunteers completed 787 shifts; 11 volunteers were issued the National Volunteer Centre award for “giving” 60 hours of their time while eight were recognised for “giving” 100 hours.

In 2023/24, the volunteering service aims to expand the number of services that involve volunteers. This includes areas such as transitional care and diabetes. We also aim to increase the number of volunteers in our community hospital wards and are working towards having volunteers on the wards daily.

Volunteer to Career

The Trust successfully secured £25,000 of funding from Health Education England to launch a new initiative encouraging volunteering in community hospitals in Lincolnshire. The Volunteer to Career initiative is designed by clinicians and aims to inspire volunteers to take up professional NHS roles and to equip them with the appropriate tools and knowledge to thrive. This scheme is run by Helpforce with a focus on encouraging and supporting volunteers who have an interest in pursuing a career in health and care.

LCHS has a focus on recruiting community hospital ward volunteers in Skegness and Spalding. Volunteers are vital to our wards to provide stimulation and company for our patients. Some of the tasks these volunteers help with include meeting and greeting visitors or doing activities with patients such as games, puzzles, and crafts. Volunteers keep patients’ company, by engaging conversation, and supporting them at mealtimes by serving meals or encouraging patients to eat and drink. As part of this work, we are excited to offer the fantastic opportunity for volunteers to complete qualifications, learn new skills, meet new people, be part of a team and potentially develop a career in the NHS.

In 2023/24, the Trust will roll out additional clinical and non-clinical volunteering roles in other locations across Lincolnshire.

Vaccination centres

The Trust is a lead provider for two vaccination centres in Lincolnshire. The centres are operated in partnership between Lincolnshire ICB, our community services, and the acute trust.

After more than a year of constant operation, Lincolnshire Showground Vaccination Centre shut its doors on 29 April 2022. Since it opened in early 2021, the centre played a major part in the county’s vaccination programme. What the teams at the Showground have achieved is truly phenomenal and we want to thank all those involved for making such a difference to the lives of so many people. The NHS in the county maintained its capacity to offer COVID-19 vaccinations both locally in Lincoln and around the county with fixed vaccination sites and by providing pop-up and outreach vaccination sessions at short notice and many of the team from the Showground supported these and other vaccination sites.

In 2022/23 our vaccination centres continued to offer first and second COVID-19 vaccination doses as well as boosters. In September, Lincolnshire started rolling out autumn boosters and a new vaccination centre opened in The Weighing Rooms in Lincoln. People came forward once again in significant numbers and it was exactly what we were hoping for. At the Weighing Rooms in Lincoln, they were regularly giving more than 500 vaccinations a day and at our other mass vaccination centre at Princess Royal Sports Arena, Boston, where the team routinely delivered over 1,000 vaccinations a day and, on some days, exceeded 2,000 vaccinations. This was supported by GP and community pharmacy-run vaccination sites.

The Lincoln site was visited in October by Public Health and Mental Health Minister Dr Caroline Johnson MP, and Karl McCartney MP who came to see the site and the vaccination team in action.

In December 2022, we celebrated the two-year anniversary of the launch of the COVID-19 vaccination programme in Lincolnshire. By 9 December 2022, the NHS across the Midlands had given over 27 million first, second, third and booster vaccinations, with Lincolnshire giving its two millionth vaccination on that day.

Achieving such a huge number of vaccinations was astonishing. Two years ago, the county went from not having any COVID-19 vaccination facilities to having a full-scale mass vaccination programme rolled out in a matter of weeks, something that had never been done before and that saved so many lives across Lincolnshire and the country. During this time, LCHS and other NHS partners including primary care set up new vaccination sites, gave the vaccines to children and adults, took vaccines into schools, care homes and our communities. We introduced new vaccines to counter new variants of COVID-19 and in partnership with our teams at vaccination centres, GP and community pharmacy-run sites across the county rolled up our sleeves and did what we needed to do to protect the people of Lincolnshire.

The vaccination programme continues into 2023/24 with spring booster jabs for people aged over 75 as well as individuals aged five years and over who have a weakened immune system.

Virtual wards

Virtual wards provide hospital-level care and remote monitoring for patients who would otherwise be in hospital, either by preventing admissions or allowing them to return home sooner to continue their treatment at home. This innovative approach delivers high quality care, safely and conveniently for people at home – where we’re told they would rather be.

In a virtual ward, support can include remote monitoring using apps, technology platforms and medical devices such as pulse oximeters. Support may also involve face-to-face care from multi-disciplinary teams based in the community, which is sometimes called Hospital at Home.

Virtual wards help relieve pressure on hospitals and urgent care services, by looking after people remotely and they promote working across organisations resulting in care being more joined up whether they're supported by community services, hospital staff or their GP.

We have LCHS staff working on several virtual wards that specialise in looking after patients with different conditions. We have virtual wards for heart failure, frailty, respiratory, all-age rapid response and same-day emergency care. They have a combined capacity of approximately 115 “beds” with further capacity being developed. Following the success of our involvement in these virtual wards, we are exploring how virtual wards could work for other conditions.

The Lincolnshire system has developed a virtual ward strategy, setting out the model of care and identifying additional specialities to support the development of virtual care. This strategy was supported by the Urgent Emergency Care Partnership Board and will be rolled out across the county. The strategy builds on the excellent collaborative work already undertaken across frailty, heart failure and all-age rapid response and will see expansion into palliative and end-of-life care, respiratory, and same-day emergency care bringing a holistic approach to the care people in Lincolnshire receive.

Clinical strategy

Our Board agreed in early 2022 that we would develop a new suite for 5-year strategies, including a new clinical strategy for 2023-28. It will help us reflect on the significant system and organisational developments in the past three years, including the COVID-19 response and new primary legislation that created the Lincolnshire ICS, and to bring it in line with the Integrated Care Strategy and NHS Integrated Care Board (ICB) Joint Forward Plan timeframes.

The clinical strategy had several key design principles:

• it is underpinned by Population Health Management (a way of working to help frontline teams understand current health and care needs and predict what local people will need in the future)
• people (patients, families, carers and the public) are central to everything that we do
• quality, safety, and effectiveness are embedded across everything we do
• it articulates the vision of services and a workforce which work together across health and care organisations to enable the best population outcomes
• it encompasses all our services and our ambitions for health across the lifespan.

It has a number of key areas of focus:

• links across national and local priorities
• a clear intent to co-produce and collaborate with the public and our partners
• Population Health Management, health inequalities, personalisation, and integration are golden threads across all areas
• clear links with our digital, data and people ambitions.

The three overarching themes of the new clinical strategy are:

1. work with health and care partners to deliver care closer to home. To ensure accessible, integrated, and responsive care
2. people are at the centre of all that we do. We will work with people to enable them to live their best lives from birth to the end-of-life
3. support people to live well in their communities for longer. We will work with people and health and care partners to build strong and supportive communities for the future.

Medical directorate developments

During 2022/23 LCHS employed its first head of medicines management pharmacist, who has worked closely with all divisions and the medicines management and quality teams to strengthen the medicines-related incident management process, ensuring that we learn lessons from incidents and embed them across the organisation. Also, medicines audits have been reviewed to ensure that they are fit for purpose and highlight areas of improvement and concern, in line with regulatory and legal medicines management standards.

Other areas of achievement include:

• renewal of the contract for the contracted pharmacy service
• success in bidding for external Health Education England funding to support the training of pre-registration pharmacy technicians to support succession planning and our ‘growing our own’ approach within the department, in conjunction with the Trust apprenticeship team
• success in recruiting a virtual wards pharmacy team
• supporting governance processes in relation to medicines administration within the new Discharge to Assess service
• initial work on introducing the ‘Discharge Medicines Service’ into clinical areas (work in progress) – to support enhanced communication with Community Pharmacies regarding medicines on discharge (supporting safe transfers of care)
• working with community nursing teams to strengthen inclusion and exclusion criteria in relation to medicines-related referrals
• introducing medicines quality visits in clinical areas to support the implementation of mitigating actions in relation to medicines standards thus demonstrating an improvement in compliance
• engagement with system-wide medicines and pharmacy initiatives through the Integrated Pharmacy and Medicines Optimisation Board
• influencing safe and cost-effective prescribing across the system by participating with the Lincolnshire Prescribing and Clinical Effectiveness Forum (PACEF) and through other workstreams.

Research

In 2022/23 there has been an increase in the number of participants in research studies across Lincolnshire Community Health Services NHS Trust and Lincolnshire GP practices. 2,896 people outside of the acute and mental health trusts were able to be involved in National Institute for Health and Care Research (NIHR) portfolio research.

This was broken down into 2,680 patients from 47 GP practices recruited into 19 different studies and 216 patients or staff from LCHS into 8 studies. In LCHS they covered clinical areas including stroke, autoimmune, irritable bowel syndrome (IBS) and MSK, as well as mindfulness in staff and surveillance of flu vaccine symptoms in school children. There were two studies completed in the Spalding GP Surgery under LCHS.

The second research conference was a success and plans for the third are well underway.

Poacher study

The Lincolnshire Poacher Study launched in 2021 and continued recruitment in 2022/23. The LCHS research team are looking for local people who are having new symptoms of IBS such as diarrhoea or other gut troubles to get involved. The study recruited from Lincolnshire GP practices and was sponsored by LCHS. It was led by Professor Jervoise Andreyev, Consultant in Gastroenterology at Lincoln County Hospital in collaboration with LCHS and supported by the University of Lincoln and the Hull Health Trials Unit. The aim of the research was to see if nurse-led clinics are more cost-effective for the management of IBS symptoms than the usual GP care. The nurse arm of the study followed an algorithm of tests and procedures that gave some patients a diagnosis of a condition and relief of their symptoms.

The study was focused on alleviating patient symptoms, enabling them to have a better quality of life and cost savings for the NHS. The Lincolnshire Poacher Study closed to recruitment in January 2023 having recruited 113 patients who will continue to be followed up until later in the year.

Developments in services treating people for post-COVID

The Lincolnshire Post-COVID Rehabilitation Service, hosted by LCHS, was established in December 2020 in response to the global pandemic. The service has supported over 1,732 patients since it began, with currently 414 receiving treatment. This includes men, women, and children.

As the needs of patients evolved, the team expanded to provide specialists in different areas. There are now 13 staff, including physiotherapists, occupational therapists, speech and language therapists, GPs, and a volunteer.

The service has received fantastic results and feedback. For example, patients said the service was wonderful, very helpful and informative and the staff were kind and highly skilled.

The service works by bringing together rehabilitation services from Lincolnshire as well as council and voluntary services. These multiple services meet virtually to discuss who is best placed to help patients with their recovery. Patients have a personalised care plan and receive regular contact from the team.

The service is largely virtual however patients may be seen face-to-face for treatment as required and there is now a specialist physiotherapist working in an outpatient clinic who regularly treats patients.

Developments this year have included virtual peer support groups, a self-management app, fatigue, and breathlessness (FAB) groups, brain fog groups and the creation of the Lincolnshire long COVID hub, working with NHS Charities Together. The peer support groups give patients the opportunity to talk to people going through similar issues and provide emotional and practical support. A patient said they answered a lot of their questions and helped them understand more about long COVID.

The FAB Group is specifically for patients suffering from fatigue and breathlessness and offers practical exercises and information to help them understand and alleviate symptoms. A member of the group said it was helpful to meet people with similar problems as it can be very frustrating and lonely. Handouts are given so patients can practice between sessions.

In addition, the service employed a research assistant from the University of Lincoln to complete an analysis of the new groups to ensure they are performing well and getting the best possible care for patients.

The Brain Fog Group is a one-off session to provide information on brain fog and cognitive issues related to COVID-19, and its management to help support the patient’s recovery.

Lincolnshire long COVID information hub launch

A new digital resource is now available for people suffering from the effects of long COVID and for their friends and families.

Working alongside local people with long COVID, many organisations in Lincolnshire have come together to develop the long COVID information hub, and LCHS was part of this together with Connect to Support Lincolnshire and voluntary sector organisations.

The hub provides guidance and information on long COVID and gives links, documents, and videos to help people with symptom management and signpost them to further help.

£3.5m work began an improved community ward in Gainsborough

Works started on a new and improved environment for the Scotter Ward in John Coupland Hospital in Gainsborough. The Scotter Ward at John Coupland Hospital is receiving significant upgrades to provide a modern and improved environment for patients and staff.

The hospital building, owned and managed by NHS Property Services, will undergo necessary improvements to enhance the care experience and futureproof the building. The £3.5 million project will create 3 new 4-bedded bedrooms, 4 single bedrooms and a larger palliative care suite. Most patients admitted to the Scotter Ward have mobility issues. The new inpatient accommodation and ensuite shower rooms will be fully accessible and include ceiling hoists to move patients around these areas more easily. The ward will also benefit from an improved day room which can be used for therapy or visiting, a larger medication and treatment room and improved storage areas. In addition, the ward team will have access to a larger staff room and separate changing rooms, an improved staff kitchen area and an additional office so that the whole nursing, medical, support and therapy team can work together from one site. These works demonstrate LCHS’s commitment to Gainsborough and providing care closer to home in our local community hospital.

Urgent community response

The service continues to make a measurable impact on local people. Urgent community response can be called and within two hours the team will assess and identify care and support services to enable patients to remain safe and well at home. In many cases, patients can avoid numerous and sometimes distressing trips to an accident and emergency department. Since this service started in October 2021, it has supported over 2,460 patients, with 285 (84%) of them being able to remain at home while under the care of the UCR service. Only 315 patients (11%) who were assessed and received a UCR needed to attend an acute hospital.

63% of UCR patients are over 80 years old and we know that older adults usually have better outcomes if they can receive care at home.

Future developments include a level one and two falls response service, in collaboration with LIVES (a charity providing emergency care in critical situations). We are currently training the UCR team to respond to falls, have purchased various lifting equipment and are working with the Lincolnshire ICB to have a streamlined falls pathway; ensuring patients receive the right response in the shortest time. We also have the advantage of our Clinical Assessment Service (CAS) receiving calls which would have ordinarily gone through to the ambulance service. We are looking to expand the list of calls we receive directly, to reduce the burden on the

ambulance service and boost referrals to the UCR service. Lastly, we are working on the integration of community services to see if Lincolnshire could have a 24/7 UCR service.

There is a video on the LCHS website where our clinicians talk about UCR and how it works.

Improving discharge process from hospitals

Discharge to assess service developments

This service launched in November 2021, working with partners across the Lincolnshire system to support discharges from hospital wards for patients who can return home with support from health and/or social care. It is important that hospital beds are available to those patients who really need them and to support patients to go back home if they’re able to do so. The discharge to assess service works with patients to maximise their independence and quality of life after a hospital stay. This includes improving their confidence, offering immediate support on discharge, supporting patients to be discharged sooner, preventing readmission, and assessing their long-term support needs. The service can look after up to 70 patients at any given time. And itis provided by two partners: LCHS and Libertas Reablement Service (LRS).

In 2022/23 the team accepted 608 rereferrals.

Integrated Discharge Hubs

Discharge to assess service works closely with the Integrated Discharge Hubs which launched in June 2022, in Lincoln County Hospital and Pilgrim Hospital in Boston.

In response to the national hospital discharge and community support guidance, and with the aim to provide a more timely way of discharging patients, the Lincolnshire system has re-aligned services to provide a more seamless way of referring, triaging and discharging patients. The Integrated Discharge Hubs operate as a coordination function, bringing together acute and community health partners; adult social care and reablement; and other partners including housing, neighbourhood teams and the voluntary sector to support the discharge of patients. Wherever possible, patients will be discharged to their homes, with care and support wrapped around them to maximise their independence and wellbeing. Other partners (including Age UK, St Barnabas, Palliative Care, Continuing Healthcare, and Neighbourhood Teams) are also virtual team members. We have seen very encouraging results and improved communication between partner organisations. With phase one well underway, the next steps are being considered to expand and create an acute and community hub.

The hubs continually review discharge processes to make sure they meet the needs of patients. The focus is on progressing discharges efficiently to allow patients to be discharged from hospital and continue to be cared for in a community setting or at home.

Occupational therapists and partners are exploring opportunities for closer collaboration between community occupational therapy services in LCHS and the Lincolnshire County Council. Working closely with colleagues in primary care and neighbourhood teams in the south of the county, initially, the project concentrated on preventing unnecessary duplication by ensuring patients see the right therapist at the right time, the first time. Hubs are also exploring joint decision-making at triage, joint training, and sharing documentation as well as myth-busting that challenges custom and practice.

MADE events

Several Multi Agency Discharge Events (MADE) have been facilitated in 2022/23 for community-based beds all acute hospital beds. During three MADE events that took place in August 2022, over 200 patients were discussed each day which contributed to the increased number of discharges and the feedback from everyone involved was very positive.

100-day challenge

Health and care partners across Lincolnshire joined forces to support the national 100-day discharge challenge in July 2022. The 100-day challenge was launched by NHS England and it involved the NHS, charities and the local council working together to improve the discharge of patients from hospital. Partners in the challenge included the Lincolnshire Integrated Care Board, Lincolnshire Community Health Services NHS Trust, United Lincolnshire Hospitals NHS Trust, Lincolnshire County Council, voluntary organisations, patients and their families.

By improving discharge systems and processes, the people of Lincolnshire are supported to have access to a hospital bed when they need it and patients are discharged as soon as they can be to continue their recovery and care in the comfort of their homes, with local support in place if they need it.

Breaking the Cycle Too

In November 2022, the United Lincolnshire Hospitals NHS Trust introduced the ‘Breaking the cycle’ initiative which demonstrated that it is possible to make changes to patient flow pathways that have a positive impact. To build on this, LCHS was involved in ‘Breaking the cycle Too’, which launched in December, and was led jointly by Lincolnshire’s health and social care teams to help us get as many people as possible safely home for Christmas.

The shared objectives were to improve the quality and safety of patient care by enabling safer discharge from our acute hospitals once patients were medically fit for discharge. The focus was on:

• reducing or eliminating patient’s waiting time for supported discharges by starting planning for it 24 hours earlier
• discharging patients earlier in the day (aiming for 33% before noon)
• planning tomorrow’s discharges today, to help make this all happen.

All these actions would help to maximise the existing capacity and start to realise the benefit of the additional capacity that was put in place for winter. We all have a role to play in ensuring that people are only in an acute hospital for the time that they need to be. We know that particularly frail people are adversely affected by unnecessarily prolonged stays.

Breaking the Cycle Too allowed to safely move more patients from acute hospitals to community hospital beds, which was another step closer to home for many of them. Our Discharge to assess service also played a vital part in this process.

Gifts for brave young patients

Staff members at Johnson Community Hospital in Spalding are giving brave young patients, who need to come into the hospital for blood appointments, personalised stickers, sweets, and fluffy toys to try and help ease their stress.

Many young patients can be quite nervous about attending appointments to have their bloods taken. This idea is to help them feel more comfortable, more at ease and they also get a little goodie for being brave. For very nervous children, our service can arrange a meet and greet with the nurse before their appointment. They can show them equipment that they use and explain what will happen on the day and make sure the child sees the same nurse to help minimise any anxieties.

These small goodies for the young patients in Spalding have been funded thanks to the Lincolnshire NHS Charity.

Getting to grips with technology

A partnership project between LCHS and the North Kesteven District Council provides residents with iPads that can be loaned out for up to six weeks along with one-to-one support provided by a specially trained Digital Coach. This project is aimed at people over 60 who have little or no experience with computers, smart phones, or other digital devices or who might just be a little rusty and need a reminder on how to use devices. After the six-week period residents are signposted and supported to buy their own device or directed to a partner organisation that can provide access to a free device. We’re pleased to provide the digital coaching from LCHS, as this supports the community to access health services online. This could be from using the nhs.uk website to look for information, to contact NHS 111 when needing medical advice or to access exercise videos given by a physiotherapist.

Trust became the main provider of apprenticeships in Lincolnshire

Stepping into the NHS became easier when LCHS became one of the only three trusts in the East Midlands that successfully achieved main provider status by the Education and Skills Funding Agency.

This means the team can now deliver apprenticeships outside of the Trust, making it much easier and more accessible for those wanting to start their career in the NHS. The centre can deliver a number of different qualifications for clinical and non-clinical apprenticeships at different levels.

For over 20 years, LCHS was an established NVQ Training Centre, and it became an employer provider in 2017 and for the past five years with a highly successful pass rate across all qualifications. In June 2021, the apprenticeship centre was rated ‘good’ by Ofsted.

Trust staff have built relationships and work with local schools, colleges, universities to help those who are interested in a career within healthcare to help them achieve their goals.

The Lincolnshire NHS Apprenticeship Centre is a huge benefit to our county. It means we can make it much easier to join the NHS for those who would like to pursue a career in healthcare but don’t necessarily have the relevant qualifications or experience.

Recruitment and retention developments

Growing our own

Nursing roles make up 40 percent of our staff who have a wide variety of jobs including, community nurses, district nurses, advanced nurse practitioners, Macmillan nurses, respiratory nurse specialists, sexual health nurses, student nurses and cardiac rehabilitation nurses to name a few.

LCHS is committed to growing our own workforce and supporting staff in such roles as healthcare support workers to complete qualifications to become registered nurses while working for our services. The Trust also supports clinical staff to achieve further qualifications such as master’s degrees. The Trust supports these staff whilst they complete their degrees, with time off for studying or attending the course and with Health Education England funding.

Case study: Chantel Bray and Chloe Whitehouse began their careers at Lincoln North Community Nursing team as part-time healthcare support workers in 2015. Their role was to support registered nurses by undertaking nursing tasks such as wound care and venepuncture (withdrawing blood). The team quickly realised the potential of both Chantel and Chloe and they soon progressed to senior health care support workers. They were enthusiastic to learn and took every opportunity to develop. Both continued to progress further with their new knowledge and skills and were promoted to assistant practitioners in 2018. More complex competencies were achieved, and Chloe and Chantel started an Open University Nursing degree. They completed their nursing training in LCHS as well as working as assistant practitioners. The course lasted four years.

International recruitment

With the system investment in LCHS services comes the challenge to recruit the staff needed to deliver them. LCHS already invests in apprenticeships and upskilling our existing workforce, however, long-term developments and recent service expansion can provide a more immediate challenge. We are currently developing an innovative partnership with Humber and North Yorkshire ICB, the Department of Health and Social Care (DHSC) and NHS England to develop an international recruitment framework that will enable us to work directly with the Kerala State Government in India to recruit directly into our system. Kerala has one of the

highest standards of health and care in India. It intentionally trains a surplus of health and care professionals including doctors, nurses, and other health care professionals, recognising that a significant number leave to work overseas. Developing the international recruitment framework in partnership with other organisations enables LCHS to gain experience and expertise in international recruitment at lower risk to us. In November 2022, four of our leaders travelled to India to interview prospective employees for both registered nurse and allied health professional (AHP) roles with the aim of appointing up to 40 staff to posts in LCHS services.

Supporting overseas workers to gain UK registration

LCHS is a partner in an initiative called the Lincolnshire Refugee Doctor Project which supports overseas doctors (who don’t necessarily need to be refugees) with courses to prepare them to be a doctor in the UK. We have developed the role of medical support worker for overseas doctors who are not registered in the UK. This role allows them to be fast-tracked into the health service and be supported to become registered NHS doctors while working under supervision. For example, one such doctor worked in Boston Urgent Treatment Centre seeing patients to give initial diagnosis and management plans and would discuss these with a GP before making the final decision on treatment. Patients ranged from newborn babies to elderly people. This colleague passed her exams in November 2022 and can now work as a doctor in the UK after completing the General Medical Council registration.

Events and key dates

NHS Staff Recognition programme – In April, all NHS organisations in the county launched Lincolnshire Recognition. It was a new tree-planting programme, created to reward and honour the Lincolnshire NHS team’s commitment, endurance, and skill throughout the COVID-19 pandemic. Lincolnshire's NHS staff have always shown great commitment to the people in their care, never more so than in recent times. Lincolnshire Recognition was a way of saying thank you for their service by offering staff the chance to plant a commemorative tree and tell their COVID-19 pandemic story.

International Nurses Day – as usual in May we celebrated the incredible work of our nurses across Lincolnshire and the difference our colleagues make to patients’ lives. Throughout the day were showcasing our amazing nurses and nursing staff across LCHS and why they became nurses. Our staff talked about their favourite thing about being a nurse and gave their best advice for anyone thinking of a career in nursing. A selection of case studies is available on the LCHS website.

National Staff Networks Day – It was the 6th year when we celebrated and recognised our staff networks and the impact, they have on staff wellbeing satisfaction and the tremendous role they have in supporting colleagues and allies. Our networks were a lifeline to many colleagues during the pandemic reducing loneliness and isolation for those who had to shield and work from home. Celebrations culminated with a lunch and chat virtual session on 11 May which included a special welcome from Cherron Inko-Tariah MBE, the author of “The Incredible Power of Staff Networks”.

Carers Week – Once again we were renewing our commitment to make carers visible during Carers Week (5-11 June) with Q&A sessions and webinars for staff who are carers, managers, and colleagues. Many people don’t immediately identify themselves as carers and they don’t seek support to help them in their caring role. LCHS is a member of the Employers for Carers Scheme and our colleagues who are carers have free access to many digital resources to support those looking after a loved one who is older, disabled or seriously ill. We also have a Carer Passport, this is a document completed by a staff member who is a carer and their manager to help to manage their work and caring responsibilities and it can be updated as circumstances change.

Volunteers Week – LCHS celebrated the contributions of our volunteers in June during the 37th annual Volunteers Week. The Trust hosted a virtual celebration event for all our volunteers on Microsoft Teams. Every one of our volunteers received a thank you card from the trust which was designed by a member of the public. The trust was also showcasing some of our fantastic volunteer’s stories and explaining how they help our teams via case studies on our social media.

Research Conference – This was the second year when we held this event in September in collaboration with the University of Lincoln Medical School. The theme was “Clinical research for all; it’s not rocket science!” This successful conference is set to become an annual event open to both clinical and non-clinical staff who are interested in research. In 2022, it included research focussed workshops, advice, and guidance on getting started in research as well as an insight into existing research projects within the trust. This action-packed day provided the perfect opportunity to network with colleagues in a research-focused environment.

Black History Month – October saw the trust celebrate the huge and often-overlooked contributions of Black people in the UK. The national theme for 2022 celebrations was 'Time for change: actions not words'. Our webinars this year concentrated on 'living legends'. Sessions included presentations from our colleagues and CODE Staff network as well as other inspirational speakers.

Fraud Awareness Month - NHS Trusts in Lincolnshire have made a commitment to tackle fraud against the National Health Service in the county by joining forces during Fraud Awareness Month in November. The aim was to raise awareness about how damaging fraud can be and highlight simple steps that can be taken to prevent it.

Disability History Month – a series of webinars and meetings were held in December in partnership with MAPLE (Mental and Physical Lived Experience) staff networks from LCHS, LPFT and ULHT focussing on the equality and inclusion of people living with disabilities and long-term health conditions. 2022 theme for the month was “Health and wellbeing” and our events offered a chance to talk to colleagues about anything and everything relating to disabilities, long term health conditions, and health and wellbeing in the workplace.

LGBTQ+ History Month – as usual in February Lincolnshire health and social care colleagues came together to host a range of virtual events celebrating lesbian, gay, bisexual, transgender, and non-binary history. This year, the event was supported by local drag artists, local charities, staff networks, NHS leaders and as usual students from the William Farr School.

Teams and colleagues recognised with awards and other accolades

Lincolnshire team shortlisted in the NHS Parliamentary Awards – the Children’s Rapid Response Respiratory Team, nominated by Karl McCartney MP, was selected as the Midlands champion for the prestigious NHS Parliamentary Awards in the Excellence in Healthcare category. They were shortlisted and went to represent our region in the national final. The team was recognised for the work they do with children and young adults who have significant complex physical disabilities and are at high risk of life-threatening chest infections.

Two Lincolnshire nurses receive Cavell Star Awards – the Cavell Star Awards is a national programme that celebrates the dedication of nurses, midwives, nursing associates and healthcare assistants and recognises the care they provide to patients, families, and colleagues. Two LCHS community nurses were awarded the Cavell Star. Kathryn Watson, Respiratory Nurse Specialist working for the Community Respiratory Team in County Hospital, Louth and covering East Coast, was nominated by her colleagues for delivering a high standard of care and going above and beyond especially during the COVID-19 pandemic. Amy Cheevers, a Parkinson’s Disease Nurse Specialist based in Grantham and covering South, South West and the East of Lincolnshire was the other Lincolnshire winner. Amy helped develop and expand the community team that looks after more than 700 people in the county who suffer from Parkinson’s disease. Amy is a supportive and inspirational manager and has trained new colleagues, mentored, and advised them in her capacity as an independent and supplementary prescriber.

Community NHS therapist shortlisted for a national digital award - Jon Rouston was shortlisted for the Chief Allied Health

Professions Officer Awards (CAHPO) 2022 in the digital practice category for leading the development of virtual wards in Lincolnshire and championing the role of Allied Health Professionals (AHPs). Jon is a Speech and Language Therapist who works as the Chief Clinical Digital Information Officer.

Palliative Single Point of Access (SPA) shortlisted in the Nursing Times Awards – This partnership project between LCHS, St Barnabas Hospice, Marie Curie and the East Midlands Ambulance Service NHS Trust was shortlisted for the HRH The Prince of Wales Award for Integrated Approaches to Care category. They simplified access to specialist palliative support for patients and families, available 24/7.

Lincolnshire nurse apprentice raises flag at House of Commons for Armed Forces Day - Dianne Smith, who works for LCHS is also a Royal Air Force (RAF) Reservist in her spare time. Dianne is currently working as a registered nurse apprentice in Sleaford and studying for a degree in nursing at the University of Lincoln. She is also known as Corporal Smith, Air and Space Operations Specialist (Flight Operations) in the RAF Reserves. To mark the start of celebrations for Armed Forces Week, Dianne was invited to attend a flag-raising ceremony led by the Rt Hon Sir Lindsay Hoyle MP, The Speaker of the House of Commons, on Monday, 20 June 2022 in New Palace Yard. A flag was raised by a representative from the British Army, the Royal Navy, and the RAF. Dianne was chosen to raise the flag for the RAF. The Armed Forces representatives participated in the flag-raising and then attended a reception at the speaker’s house.

LCHS staff recognised in Celebrating Success 2022 Staff and Volunteer Awards – each year LCHS recognises the dedication and commitment of our staff and volunteers to delivering outstanding community-based care. A record 187 entries were received for teams and individuals in 10 categories. This year the public, patients and carers have nominated in two categories: the People's Award and the Volunteer of the Year Award. Details of winners are available on our website.

Living the LCHS Way quarterly awards – each quarter our executive team and members of the Board judge our staff recognition awards. These awards recognise teams and individuals who go the extra mile to live the LCHS Way: improve services for patients, pull all the stops out to help deliver a great service, someone who improved the way they or their team works and go above and beyond.

Clinical practice educator recognised for supervision roll-out work – Ruth Cocks, one of the Trust’s clinical practice educators has been invited to the Foundation of Nursing Studies Celebration evening in recognition of her and the wider team’s work on introducing Resilience Based Clinical Supervision into the trust. Nearly 10% of the workforce access this support offer. LCHS has been recognised for the adaption of the supervision model and how the trust has used virtual methods and allowed all staff to access this.

Lincoln Urgent Treatment Centre (UTC) showcased in the national delivery plan - the Department of Health and Social Care (DHSC) and NHS England published their delivery plan for recovering urgent and emergency services. It includes a case study on the Lincoln UTC as a successful example of how a UTC that is co-located with an emergency department works. The strengths it identifies are LCHS’s focus on system working and building relationships which have delivered tangible benefits including an average time to see, treat, and discharge patients within 2.5 hours, and that 95% of patients had their initial assessment within 15 minutes.

NHS Charity

Lincolnshire NHS Charity is an independent and dedicated charity that plays a vital role in supporting both Lincolnshire Community Health Services NHS Trust 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 2022/23 NHS Charity

highlights include:

• Johnson Community Hospital’s 12th annual ball raising money for the hospital in Spalding.
• LCHS FC and Border Villarreal FC went head-to-head in a charity football match in Stamford, raising money for Lincolnshire
• NHS charity and MANUP. The game was raising awareness of openness among males about mental health issues.
• Big Tea Party which kickstarted a week of NHS 74 birthday celebrations. The family event in Boston was organised in partnership with United Lincolnshire Hospitals NHS Trust charity. It offered a range of activities including live music performances, a bouncy castle, and food and drink stalls. In total, the charity raised £1,510 during the event.
• A generous donation of £1000 from Maureen Davies a daughter of a couple who were cared for at Scarbrough Ward in Skegness Hospital. Maureen and her husband Peter made the donation in appreciation of the care and kindness of our staff.
• Scarbrough Ward staff embarked on a 12-hour silence disco dance-a-thon challenge to fundraise for a memory tree and special keepsake boxes for relatives who have lost loved ones. So far, the silent disco raised over £300.
• The outpatient department at Johnson Community in Spalding has received a brand-new drugs fridge. The fridge has been purchased with monies raised for Lincolnshire NHS Charity and will provide a valuable addition to ensure that all temperature-controlled drugs are stored at the correct temperatures.
• The new department piano at Archer Ward in Louth Hospital funded with charitable donations has been a huge hit with staff and patients. The idea for the digital piano came from one of the staff nurses who had sourced it online and used charitable funds to purchase it. The team have also said that the piano has provided excellent musical therapy for the patients being cared for on the ward, as well as added fun and laughter for all the patients as they love to reminisce over an old song.
• Following our successful Pumpkins for Parkinson’s fundraising campaign last year the community Parkinson's service has been able to purchase lots of fantastic equipment to enhance the care they deliver to their patients including a laser cane that lights up whenever it touches the ground.
• 11 runners from LCHS and LPFT laced up their running shoes and were training throughout winter months to represent our charity during the London Landmarks Half Marathon. The fundraising is still ongoing at the time or writing the report as the race takes place on 2 April 2023. We are keeping fingers crossed or our colleagues.
• The charity also supports staff wellbeing initiatives with funding for staff sports teams, crafts and singing groups.

The trust is managed through five organisational directorates:

• Chief Executive’s Office
• Finance and Business Intelligence Directorate
• Medical Directorate
• Nursing, Allied Health Professionals (AHPs) and Quality
• Operations Directorate
• 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, AHPs, Quality, Operations and Medical Directorates to ensure delivery of high quality, effective and efficient services.

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, complaints, concerns and compliments management, the Patient Advice and Liaison Service (PALS) for the Trust and the county of Lincolnshire, communications, engagement with the public and stakeholders and our volunteering service.

Finance and Business Intelligence Directorate

The directorate helps to ensure that LCHS delivers high quality, sustainable services by supporting financial sustainability, effective performance and positive organisational reputation ensuring continuous improvements in the delivery of services. Our mission is to drive great care close to home using our unique blend of skills, personalities, and experience through maintaining a focus on systems, processes, culture, and behaviours. Our functions include financial planning and management, contracting, performance and information to create business intelligence, as well as strategy and planning.

Medical Directorate

The Medical Directorate supports a substantive medical workforce to meet the developing needs of the trust. In addition, the trust also 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 includes medicines management, medical devices, and medical gases, learning from deaths, practitioner performance, research and development and clinical audit and quality guidance. During 2022-23 the Medical Directorate welcomed a new pharmacy team.

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: Safeguarding, Quality governance, Professional and effective practice and Infection Prevention and Control.

The Nursing, AHP and Quality team have a visible presence across LCHS providing support, expert guidance, and supervision to any team, supporting development and decision-making to influence great care.

Safeguarding - The Safeguarding team works trust-wide to develop and empower our staff to promote the welfare and wellbeing of children and adults as well as 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.

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 leads the development and growth of the clinical workforce.

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

Operations Directorate

Children, young people, and specialist services division

Many of LCHS’ services are 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 and physiotherapy, diabetes, heart failure, stroke, respiratory, pulmonary rehabilitation, Macmillan services, Tuberculosis, tissue viability, INR (international normalized ratio); continence, Lymphedema, Parkinson’s, post-COVID rehabilitation. We also provide countywide integrated sexual health and contraceptive health services through LISH (Lincolnshire Integrated Sexual Health). Children’s and young people services include immunisations and vaccinations, child health, children’s therapy and rapid response service and 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

Our community nursing service for adults are organised into community teams aligned to Primary Care Networks. Community nursing teams work closely with a range of services across 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: 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 timelimited rehabilitation and support for older people and adults with long term conditions.

Integrated urgent and emergency care division

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.

The service offer for LCHS urgent care is delivered as:

• Clinical Assessment Service - definitive clinical assessment by telephone
• Face-to-face patient consultation within Urgent Treatment Centres /GP Out of ours (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 Out of Hours 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.

In November 2022, the Trust’s operational business services became part of the Integrated Urgent and Emergency Care division. The trust operational business services include our operations centre and patient admin 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.

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.

Despite the progress in service developments and celebrations, we recognise that 2022/23 continued to provide challenges to healthcare in Lincolnshire. As a nation and an NHS, we continued to learn to live with COVID-19, learning new ways to live our lives and safely deliver our services. LCHS has proudly continued to support the vaccination programme throughout 2022 across Lincolnshire to help protect our staff and the public.

Lincolnshire, in common with the rest of the country, continued to experience delays in emergency care pathways and we continued to focus on improving our system quality and financial position. This year, once again, experienced unprecedented demand for our healthcare services across Lincolnshire, further compounded by the recent industrial action. Significant work has been done in collaboration with our partners across the region to focus on reducing waiting times and improving ambulance handovers. Since November, health and social care partners have been working on the ‘Breaking the cycle’ initiative which helped to create additional capacity in our workforce, beds, and care at home. Some of the actions providers took to enable safer discharge of patients who are medically fit for discharge (MFFD) included:

• starting discharge planning 24 hours earlier than usual
• discharging patients earlier in the day
• LCHS increased capacity in our community hospital beds and in our ‘Discharge to Assess’ service.

The war in Ukraine and the cost-of-living crisis also significantly affected our communities across Lincolnshire. LCHS has worked to put plans in place swiftly to support Lincolnshire residents as well as our staff at all opportunities and will continue to do so in 2023/24. LCHS, along with many other providers across the country, put in place new initiatives to help staff manage through this challenging period including keeping mileage rates under review, providing emotional support through our employee assistance programme, and offered practical support through an external financial wellbeing provider including free access to money advice to make sure staff receive the benefits they are entitled to and free financial education.

Looking forward, for 2023/24 NHS England has set out fewer, more focused national objectives to allow for priorities to be determined at a local level, where local leaders will make the best decisions for their local populations. The immediate priorities have focussed on the recovery of Lincolnshire’s core services and productivity. Secondly, continuing to make progress in delivering the key ambitions in the NHS Long Term Plan and thirdly in needing to continue transforming the NHS for the future. Recovering productivity and improving the whole system flow remain national priorities and we have clear plans in place to support the Lincolnshire ICS to achieve improvements in these areas. For community health services, national actions include increasing referrals into urgent community response (UCR) and expanding direct access and self-referral where GP involvement is not clinically necessary. We ensured that we worked with our partners to focus our planning on these priorities to maximise impact.

A central part of our recovery in Lincolnshire is tackling healthcare inequalities to protect those at the greatest risk of poor health outcomes. Studies show that deprivation increases the likelihood of having more than one long-term condition at the same time as well as having reduced access to care. In 2019, almost one in five neighbourhoods in Lincoln (18%) and one in six neighbourhoods in East Lindsey (16%) were among the most disadvantaged areas nationally. CORE20PLUS5 for adults and now children, is a new and national approach being deployed in Lincolnshire to inform action to reduce healthcare inequalities.

During this year, Lincolnshire entered and remained in Segment 4 of the NHS Oversight Framework and therefore continued to receive mandated intensive support through the Recovery Support Programme. Achieving a statutory break-even duty is a necessity and we were committed to playing an active role in supporting the wider Lincolnshire healthcare system in planning and focussing on quality and value for money as part of the system’s exit strategy from the NHS National Oversight Framework.

Decision following public consultation relating to four of Lincolnshire’s NHS services

In May 2022, the NHS Lincolnshire Clinical Commissioning Group (CCG) board reviewed the independent analysis of the public feedback received during the public consultation relating to four NHS services in the county.

This public feedback analysis sat alongside the other review processes which have occurred to inform decisions, including deliverability and financial viability of the proposals etc. As a result, the board made a decision about the service proposals for each

of the four services at their meeting, held on 25 May 2022.

The NHS Lincolnshire Clinical Commissioning Group (CCG) has decided the following:

• the establishment of a ‘centre of excellence’ in Lincolnshire for planned orthopaedic surgery at Grantham and District Hospital, and a dedicated daycare centre at County Hospital, Louth.
• the creation of a 24/7 walk-in Urgent Treatment Centre (UTC) at Grantham and District Hospital, in place of the current Accident and Emergency (A&E) department.
• the implementation of integrated community/acute medical beds at Grantham and District Hospital, in place of the current acute medical beds.
• the establishment of a ‘centre of excellence’ for hyper-acute and acute stroke services at Lincoln County Hospital, is supported by an increase in the capacity and capability of the community stroke rehabilitation service. Hyper-acute and acute stroke services will be consolidated at Lincoln County Hospital and no longer be provided from Pilgrim Hospital, Boston.

The next step in the process is to work up the detailed service model, including staffing, providers etc. Any updates regarding the progress of the agreed changes will be provided through the NHS Lincolnshire Integrated Care Board.

NHS Oversight Framework

The NHS oversight framework for 2022/23 replaces the NHS system oversight framework for 2021/22 which described NHS England and NHS Improvement’s approach to oversight of integrated care boards (ICBs) and trusts. A set of metrics is used, applicable to integrated care boards, NHS trusts and foundation trusts, is used to support in assessing their performance against five national themes of the NHS oversight Framework: quality of care, access, and outcomes; preventing ill health and reducing inequalities; people; finance and use of resources; and leadership and capability.

Lincolnshire ICB has been placed into segment 4, indicating very serious, complex issues manifesting as critical quality and/or finance concerns that require intensive support.

Looking back at our quality priorities 2022/2023

The quality account priorities for 2022/2023 were developed during some of the most challenging pressures the NHS has seen. The Trust has continued to drive quality improvement through winter pressures, industrial action, and the continued recovery from the COVID-19 pandemic. We are proud that we were able to continue to progress and learn from the Quality Account programmes.

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

Quality summary of performance

Safe staffing

The year has proven to be challenging, at both local and system level, in terms of ensuring we can evidence and meet safe staffing requirements. Our wards have continued to report on care hours per patient day and nurse shift fill rates. Work has continued to increase fill rates through support from bank and agency staff and particularly around block booking of agency where surge beds have been in use. Work has been undertaken to ensure increased staffing flexibility, but most importantly around standardisation and meeting the working time directive. This will support us to attract and retain staff by aligning shift offers with those offered by our partners.

Community nursing has also faced staffing challenges during 2022/23, particularly in terms of retention. However, teams have undertaken rapid learning and as a result, have implemented new ways of supporting and inducting new starters. There is a robust induction programme aligned to competencies and development. This is built on supernumerary time to allow individuals to receive the support and preparation needed to deliver care safely and effectively. The Trust has also worked proactively by enhancing apprenticeship opportunities.

The organisation has also committed to International Recruitment and has actively recruited in India.

Moving forward into 2023/24, we will implement the Community Nursing Safer Staffing Tool to provide an evidenced-based toolkit to assess the community nursing staffing establishment and skill mix, based on patient acuity and dependency and supporting effective workforce planning. This will inform the Trust safe staffing reviews, and provide assurance that staffing is safe, effective, and sustainable. Safe staffing continues to be reported via the quality governance structure from ward to Board.

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 2022/23, a total of 9232 incidents were recorded (an increase of 9% on 2021/22 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.

2806 reported Incidents were categorised as ‘’patient safety’’. with an associated severe harm / death rate of 0%.

Of the 2806 incidents, 142 were moderate harm associated with pressure damage categories 3 and 4 with 23 of them (15%) attributable to the organisation and the care provided.

In 2022/23 LCHS reported 10 serious incidents that were not pressure damage, which is a reduction of two from the previous year.

The serious incidents reported were categorised as follows: 4 falls, 2 clinical errors, 1 medication incident, 1 incorrect treatment, 1 treatment delay meeting serious incident criteria, and 1 diagnostic incident.

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

The themes of the serious incidents remain consistent with the reported focus areas of improvement – medicines administration and management, falls in community hospitals and delivery of care and treatment.

A review of our investigations into falls indicates we need to improve our assessment and planning related to those patients at risk of falls, think a little more adventurously as we work in controlled clinical environments, and consider wider personalisation in care planning to mitigate risk. The Trust has established a Falls Working Group to take develop and take forward the identified opportunities to deliver care differently. The work plan will also be in consideration of the wider frailty pathway and the increasing complexity of the patients received in community hospitals.

No never events (serious incidents that are entirely preventable) have been recorded in 2022/23.

Medication errors

The Trust has implemented a strengthened process in relation to medicines-related incident management this year by providing high levels of incident reporting and encouraging a positive learning culture, that ensures a proactive approach to learning and harm prevention across the organisation.

The number of medicines-related incidents reported per quarter during 2022/23 has increased which is consistent with a positive reporting culture.

This has been further strengthened by the appointment of a head of medicines management pharmacist who works closely with the quality team and divisions to support medicines management improvements locally.

This year’s improvements have included: the 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 alerts

In the year to date, there have been eleven patient safety alerts issued and the Trust has responded effectively to all of them, all responded to within the deadlines. All the alerts were acknowledged within the 48-hour timescale and of the eight alerts eight were not relevant to LCHS, two were for information only and one was completed, and all actions were closed.

Safeguarding

LCHS has remained fully compliant throughout the year in discharging 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 is the executive board lead for safeguarding.

The Safeguarding Team have taken almost 1,000 calls from staff members seeking advice and responded to almost 700 safeguarding incidents, including supporting 300 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 2022/23 we received 11 Adult Safeguarding enquiries, of which half related to pressure damage and the others to various aspects of care.

The concerns are robustly investigated and learning from these are shared via supervision, which is a cornerstone of embedding the learning and improving practice.

During this year, the Lincolnshire Safeguarding Adult Board conducted the LAAF 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 per-review process, which confirmed LCHS was able to evidence of full compliance within the audit.

Performance summary by CEO

I was delighted to present our Annual Report for 2022/23, which demonstrated a variety of work of all teams across the Trust. Our staff carry on providing high quality, compassionate care while working under challenging and demanding circumstances. Despite challenges, we have successfully restored our services providing a mix of face-to-face and virtual options where appropriate. We have learned a lot during the COVID-19 pandemic, and we have used this experience to innovate and improve our service delivery.

It is clear that a person’s own home is the best place to be once recovered from illness and in the last 12 months our focus was on strengthening services that support earlier discharges or keep people in their own homes in the first place so that they don’t need to go to an acute hospital.

Our staff are the bedrock of our service delivery and in the face of nationwide recruitment challenges of registered clinicians, we have focussed on growing and developing our own workforce supporting them with apprenticeships and obtaining university qualifications. We have also explored opportunities for international recruitment and soon we will welcome the first group of allied health professionals and registered nurses from India who will join #TeamLCHS.

As an organisation funded from the taxpayer’s money, we are mindful to offer the best value for money and use our resources efficiently.

I am pleased to have worked with all our partners over the last 12 months and look forward to continuing our joint working and creating new opportunities across Lincolnshire and neighbouring counties.

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

Accountable Officer: Maz Fosh, Chief Executive, Lincolnshire Community Health Services NHS Trust

Signature:

Date: 22/06/2023