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Home Epley manoeuvre to treat BPPV (right ear) - patient information

Description: This factsheet explains what benign paroxysmal positional vertigo (BPPV) is, what the Epley manoeuvre treatment method is and how to perform it safely at home.
Url: /Media/UHS-website-2019/Patientinformation/Audiology/Home-Epley-manoeuvre-to-treat-BPPV-right-ear-2783-PIL.pdf

Home Epley manoeuvre to treat BPPV (left ear) - patient information

Description: This factsheet explains what benign paroxysmal positional vertigo (BPPV) is, what the Epley manoeuvre treatment method is and how to perform it safely at home.
Url: /Media/UHS-website-2019/Patientinformation/Audiology/Home-Epley-manoeuvre-to-treat-BPPV-left-ear-2782-PIL.pdf

Recipe book - For babies who need to make the most of every mouthful

Description: RECIPE BOOK For babies who need to get the most out of every mouthful Contents 04 06 11 14 15 16 18 20 22 Acknowledgements & introduction Getting started... and useful tips Weaning advice (chart) Simple feeding plan for the first month (chart) Simple week meal planner (chart) Some general advice Shopping list Recipes: Contents Recipes: Veggies � Sweet potato & cashew butter � Peas, potatoes & mint � Butternut squash, peanut butter & cinnamon � Peas & carrots Recipes: Fruit � Prunes, apricots & ground almonds � Peaches, sultanas & baby rice � Mango & almond butter � Raspberry, banana & almonds Recipes: Colours of the rainbow � PURPLE: Plum, aubergine & blueberry � RED: Beetroot, apple, red pepper & cashew butter � ORANGE: Sweet potato, butternut, carrot & cinnamon � YELLOW: Mango, yellow courgette, sweet corn & turmeric � GREEN: Pea, kale, pear & avocado � WHITE: Apple, cauliflower & celeriac Recipes: Growing up � Pollock, carrots, kale, butternut squash & potato � Avocado, apple, lentil, broccoli, courgette & mint � Beef & prunes with mashed potato � Aromatic chicken & rice � Mauritian lamb with lentils & rice Recipes: Family favourites � Fish fingers & sweet potato chips � Bobotie � Pasta bolognaise � 1st Birthday cake 24 26 32 36 enjoy... 02 Acknowledgements This book has been written by Dr Luise Marino (RD, PhD) Clinical Academic Paediatric Dietitian at Southampton Children's Hospital. This book is part of independent research arising from a (Dr Luise Marino, Health Education England/NIHR Clinical Lectureship (ICA-CL-2016-02-001) supported by the National Institute for Health Research. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, Health Education England or the Department of Health. The following people have provided generous help and feedback: � Parents of babies who need to make the most of every mouthful � thank you for your time and feedback, without which this book not be possible � Paediatric Dietitians � Catherine Kidd, Natalie Davies, Sian Phillips, Carol Fudge, Jennifer Hoare � for your expertise and invaluable comments � Paediatric Speech and Language Therapists � Lowri Daniel, Julia Robinson, Lucy Cuthbertson � for your guidance and practical instruction � Dr Rosan Meyer � for being so giving of her expertise and generously allowing us to adapt her weaning advice table � Specialist Paediatric Cardiac Liaison Nurses � Gill Harte, Colette Cochran, Cate Anson and Dr Tara Bharucha Consultant Paediatric Cardiologist � for your unfailing support and advice � Southampton Children's Hospital Charity and the publishers � Michelle Wheeler, Judith Stephens, Amy McBrayne, Alanna Lee for making it all possible � Angela Award Brown � for giving her time and photography for this book (http://www.feastsshootsandleaves.co.uk) and WhitSpaces, Arlseford for allowing us to use their incredible space � Heather Pierpoint (headfudgedesign.co.uk) � Graphic designer for bringing the publication to life Dedication For all the families and their precious babies who we are privileged to meet � your stories and journeys inspire us to do better. RECIPE BOOK For babies who need to get the most out of every mouthful From around 6 months � 12 months of age Who is this book intended for? Some babies are born with conditions which mean they need to get the most out of everything they drink and eat. These babies include those with congenital heart disease (CHD), cystic fibrosis (CF) and some babies who are born too early. For lots of different reasons weight gain and feeding problems are common amongst these babies and as a result some do not gain weight well. We have heard from parents that much of the advice available on parenting and baby websites does not give enough information to help with weight gain and moving babies onto food, which is why we have decided to write this book. This recipe book is the first of a series where we hope to provide practical advice as to how to get the most of our every mouthful. The recipes and advice within this booklet will not be suitable for infants with inherited metabolic disorders, kidney problems and for those with food allergies. If your baby has a food allergy or there is a history of food allergies in the family discuss food introduction with your paediatric dietitian. If you are unsure, please check with your dietitian/speech and language therapist or health care team about any of the information contained in this book. This book is not meant to replace medical advice and you should seek advice from your local health care professional if your baby is not gaining weight well or is having feeding difficulties. The information in this recipe book does not replace individualised dietetic or speech and language advice that has been adjusted for a child's oral motor skills. The information is correct at the time of publishing, and undergoes periodic reviews to ensure up-to-date evidence is used. Dr Luise Marino (RD, PhD) Clinical Academic Paediatric Dietitian HEE/NIHR ICA Clinical Lectureship Endorsement "As a new mum who is just about to start her baby's first weaning process it's so important that parents and carers get access to good dietary information, particularly if your child needs to get the most of every mouthful. This book has been created not only to support families through this process but with every penny raised going directly to the children's hospital to fundraise for valuable services to improve the life of children across the region" � Shelina Permalloo � Southampton children's hospital charity ambassador and winner of MasterChef winner 2012, restaurateur Lakaz Maman, Bedford Place, Southampton thank you 05 Getting started... What to expect in the beginning... Weaning your baby can be both an exciting and daunting process. Starting solids is a huge event for your little one. Up until now, they have only had the tastes of milk and medicine. But all of sudden there's a whole new world of tastes and textures to explore. Babies are not born knowing how to eat so don't be surprised if your little one isn't quite sure what to do, or if food is spat back out to begin with. As with drinking milk some babies find weaning easier than others, so try not to compare your little one to other babies or indeed other siblings. They will still be getting most of the nutrients they need from milk, so how much your baby eats is less important than getting them used to the idea of trying new flavours and textures. Ages and stages All babies are different � some babies take longer to move from the different texture stages, this is quite normal. Below is a general guide based on baby foods available in the supermarket. It also gives an idea of what home made foods should look like. � Stage 1: Smooth purees are best made with a blender and can be either - Thin puree runs easily off a spoon - Standard puree drops easily off a spoon - Thick puree can be eaten with a spoon � Stage 2: Thicker puree with tiny very soft lumps � Stage 3: Mashed foods usually blended - Thick puree with less sauce and small moist soft lumps around � the size of a 5p piece � Stage 4: Fork mashed and chopped are soft foods mashed down with a fork - Thick with small moist soft lumps around the size of a 5p � 10p piece Complementary food can be introduced from 17 weeks of age and by 6 months of age, depending on your little one's feeding readiness and oral skills To help you and your little one get started, here are some useful hints and tips for those first feeds � Always sit with your little one when they are eating � never leave them alone with food � Choose a time when both you and your little one are relaxed and there is not too much going on � usually mid-morning or lunchtime � After the first week or so you can introduce a new taste every few days to help expand the variety of foods they eat. Think of a rainbow and introduce a range of different coloured foods � Sit your baby in a supportive chair, or if able to sit, in their high chair. Use a small soft-flat weaning spoon and offer a very small amount When introducing something new... � Change only one thing at a time e.g. making a familiar flavoured pur�e slightly thicker or lumpier, or keep a familiar texture when you introduce a new food � Encourage your baby with smiles and sounds. It's important for them to know they're doing well � If possible have something to eat at the same time so they can see you are enjoying food too � Make gradual changes to texture sometimes just by adding a � a 5p piece amount of slightly lumpier food aid course which provides advice on what to do if your baby chokes on food � Remember all of the senses are involved in eating and drinking; smell, touch, sounds, sight and smells; - We eat food with our eyes, so it is important to make food look good - Touching food is as important as eating, so let you little one get messy - Smells of delicious food can encourage babies to eat 2 Offer your little one a variety of foods � think of a rainbow and all the different colours of food you could offer them to eat Before you start the exciting journey of introducing food It is important to consider whether your little one is ready � talk to your little one's health care team. As a general guide some signs of readiness are: � Your baby can hold their head up and has good head and neck control � Sits with support � You'll find your baby's mouth closes around the spoon and food stays in their mouth � You'll find your baby watches you eat and reaches for food � You'll find your baby leans forward and forward and opens their mouth when food approaches How do I know when my baby has had enough to eat? � Take your baby's lead to see when they've had enough � They'll start batting the spoon or bottle away, shut their mouth or turn their head away when they are finished � stop at this point � Your baby will also eat different amounts each day e.g. sometimes they may eat five teaspoons at one meal and very little at the next � it's all normal. You may even find your little one only eats well once every couple of days � All foods can be a choking hazard, so always sit with your baby whilst they are eating � it is a good idea to go on a first Babies should get messy when they eat � Let them get some food around their mouths, try not to wipe their mouth, hands and face clean after every mouthful e.g. with the spoon or wet wipe � Don't worry if your little one makes a face or even spits food out. Remember it can take 15 � 20 times of trying something before your little one will like it � so don't give up if they pull a face when you given them broccoli! 06 07 What foods should I give at this stage? The best food to begin with is often something like baby rice � it is very smooth and usually contains lots of extra vitamins and minerals, helping to support your baby's growth. Begin feeding your little one with a very small amount � for example 1 teaspoon. Then slowly increase the amount up to 1�3 measured tablespoons over a number of days or weeks. You'll also find that pureed vegetables such as carrots, parsnips, swede and potatoes are great first foods, as are unsweetened pureed fruits like apples and pears. Other good foods to include are; � Well-cooked red meat, chicken and fish, finely pureed with rice or vegetables � Smoothly pureed lentils, dhal or beans served with vegetables or rice � Eggs, soya and milk are also good sources of nutrients � The latest advice on peanuts encourages you to give your baby nuts � ensure nuts are finely ground to avoid choking or try nutritious smooth nut butters instead. Ready-made infant meals can be enriched using the ideas below. For home-made purees, there are some recipes included in this weaning guide � feel free to `swap' ingredients to make new combinations. To make the puree the right consistency for your little one, use your baby's usual milk instead of water. � Following a meal offer a fruit or full cream yogurt based dessert or custard or rice pudding or mashed avocado � For older babies e.g. > 10 months a teaspoon of grated cheese/cream cheese can be added to mashed potato or meat dishes, instead of a nut butter We do not recommend the addition of extra oil or cream to food � if you have had a heavy rich meal it can make you feel sick, babies have the same feeling. Instead try to use a teaspoon of smooth nut butters, coconut cream or smooth plain cream cheese or a small pinch of grated cheese. 4 From 7�8 months of age � offer textures and finger foods as well as pureed food at mealtimes When should I start adding texture? Amazingly, your baby doesn't need teeth to chew! Once your little one has become used to smooth textures and mild tastes, now is the time to gradually move them on to finely mashed foods. It'll encourage chewing which is important for developing muscles, and, believe it or not, speech. To begin with, if you are using pouches or a jar, take � � 1 teaspoon of stage 2 food and add it to the stage 1 food, mixing well. You may find your little one doesn't notice or gags a little bit, this is normal. Once they have got used to this texture add 2 � 3 teaspoons in until you have completely moved over. If you are using home made food, before it is a very fine puree take � � 1 teaspoon of a slightly coarser texture out and follow the same process. teach your baby simple tastes, e.g. green and orange vegetables and offer finger foods of these vegetables at the same time so they can learn what family foods look and feel like � Move onto textures that suit their age and stage. If your little one has had reflux or a nasogastric tube they may find it difficult to move onto food which has lumps and they may stay on one stage a little longer � don't worry too much if at 10 months of age they are still on smooth purees, your therapist will be able to provide advice � Change over to more textured food slowly making small changes every 2 � 3 days � Offer a mix of puree and finger foods at the same meal, so your little one can pick up items and self-feed. It may take a while for them to get the hang of it � All babies develop differently and they may only want to feed themselves when they are much older. So don't worry if they are not interested yet � Let your little one play with their food and get messy! It all helps them learn to accept lots of different foods � Babies and toddlers learn from watching you eat. So if they see you enjoying fruit and vegetables with your meal, they'll learn to love them too � Ideally your baby will sit in a high chair at the table and eat at the same time as the rest of the family Finger food for little fingers from around 7 months of age At first most of the food that is offered will go on the floor, but don't worry! Remember, we eat with all of our senses, so let them enjoy this journey of discovery. The easiest type of finger foods are those that dissolve � these make good first finger foods: � Puffs, baby biscuits The following finger foods are quick to prepare, packed with goodness and let your little one practice their picking up skills � the aim for these is to get your little one used to seeing what family foods look like � so don't worry if they are not eaten: � Soft-cooked vegetable batons like carrots, swede, sweet potato broccoli, avocado � Strips of meat are not usually offered until 10 months � Peeled soft fruit batons/thin slices such as melon sticks, banana, pear, peach slices � Baby biscuits like rusks that dissolve without crumbling How can I make meals energy-nutrient dense? As babies have small tummies (about the size of their fist) it is tricky to fit a lot in without either making them feel or be sick. You can use the nutrient dense recipes provided in this book or add the following examples to your little one's meals; Breakfast: � Add � � 1 teaspoon of smooth nut butter (almond, cashew, peanut) to warm baby porridge or � Add 1 tablespoon smooth fruit puree � To make the puree to the right consistency for your little one use your baby's usual milk instead of water Lunch and supper: � Offer protein at both main meals such as meat, fish, chicken or beans/lentils with a starch (rice/potatoes/pasta) and vegetables � add � � 1 teaspoon of a smooth nut butter � As you baby gets older e.g. over 9 months of age and their portion size increases, increase the amount of nut butter to 1 � 2 teaspoon per meal 3 How long will my baby need energy-nutrient dense feeds for? Your little one's dietitian or health care team will be able to provide advice Should I use shop bought or home-made food? Most families like to mix and match between puree meals they have made at home and ready to use infant food. Shop bought baby food is made to very high standards, so for busy families it is often a good alternative to home-made meals. What about finger foods? � Below are some tips on how to use a `mix and match' approach to weaning � at mealtimes � Offer individual tastes of puree foods to 08 09 Weaning advice: For babies needing to make the most of each meal Once your little one reaches 7 or 8 months, they may have a firmer grip � sometimes this develops a little later in babies who have had a number of operations. At this stage they may be able to use a finger and thumb to pick up smaller foods which helps them keep hold of foods like broccoli and develop their hand-to-eye co-ordination. Getting to grips with food is a great way for your baby to learn about exciting new tastes and textures. As all little ones learn new things at a different pace some will take a bit longer to learn to hold smaller bits of food. It is good to carry on offering pieces of food that are long enough to grip with the palm of the hand so they can bring it up to their mouth. HELP! � my baby is gagging during a meal It is normal for babies to gag when food is being introduced. The most important thing to remember is this is all new to your baby � some babies take longer than others to get the hang of it. If you are finding any aspect of introducing food difficult or your little one is showing signs of not wanting to eat at all � don't suffer in silence � we are here to help. Talk to you little one's health care team and speech and language therapist about how you and your baby can be supported. Food and feeding advice Stage 1: Around 6 months Introduce dairy, eggs, ground nuts meat, chicken, fish, wheat and soy Stage 2: Around 8 �10 months Encourage finger foods Stage 3 & 4: Around 10 months Encourage family foods and self feeding � Continue on breast milk or nutrient energy dense feed (16�18oz) � Continue with vegetables and fruit � place 1 or 2 food pieces on the highchair table � Continue with yoghurt/cheese � Main meals should include protein e.g. chicken, fish, beans, lentils, meat along with veggies and start e.g. potato, rice, pasta � If you are using ready to use baby food, add 1 teaspoon of smooth nut butter to each meal including porridge at breakfast Type of food to offer If you are making food at home, try some of our recipes in this booklet. � Continue on breast milk, usual formula milk or a nutrient energy dense feed formula (20 �22oz per day) � Offer 1 new fruit, vegetable or starchy food per day � First, offer baby rice, baby cereal (these have extra vitamins and minerals), cooked fruits or vegetables � Move on to foods such as milk, egg, nuts, chicken, turkey, lamb, beef, fish, wheat and pulses � After a few weeks every meal can have a carbohydrate, veg/fruit and a protein portion � If you are using ready-made baby meals add ��1 teaspoons of smooth nut butter to each meal including porridge at breakfast � Start with 1�2 ice cube amounts of food per meal. � Offer 1 meal per day then over 1 � 2 weeks increase to 3 meals per day. � At this stage of weaning, new tastes are more important than the portion size � Know when your little one has had enough e.g. turning his/her head away, closing his/her mouth � From around 7 months give soft lumps and finger foods put out on highchair table at same time as other food � Mealtimes should last for up to 15 minutes � When your baby can sit, introduce a high chair and make sure they are well supported in the highchair � Provide a spoon to play with and encourage playing with food � getting as messy as possible! � Continue on breast milk or nutrient energy dense feed formula (18�20oz) � Main meals should include protein e.g. chicken, fish, beans, lentils, meat along with veggies and start e.g. potato, rice, pasta � If you are using readymade baby meals add 1 � 2 teaspoons of smooth nut butter to each meal including porridge at breakfast � Try some of our recipe ideas from page 20 Portions � Soft lumpy meals (bigger lumps) � Know when your little one has had enough e.g. turning his/ her head away, closing his/ her mouth � Mealtimes should last for up to 15 minutes � Small pieces and bigger lumps � Promote finger foods � Know when your little one has had enough e.g. turning his/ her head away, closing his/her mouth � Mealtimes should last for up to 20 minutes Mealtimes � Should sit in a high chair � Provide a spoon to play with � Let your little one touch or play with food � Should sit in a high chair � Let your little one touch or play with food � Encourage self feeding * Suggested feeding times: 8-9 am, 11-1 pm, 4-5pm with milk in between (this is just a guideline) 10 11 Weaning advice: For babies needing to make the most of each meal Stages 1 Weaning advice: For babies needing to make the most of each meal Texture � Your little one's therapist may suggest a particular thickness of pur�e � Smooth pur�e can be either: - Thin pur�e runs easily off a spoon - Standard pur�e drops easily off a spoon - Thick pur�e can be eaten with a spoon � The thickness of a pur�e is changed by heat e.g. as food cools it can become thicker � Other foods such as cereals may need extra liquid or extra time for the milk to soak in � At this stage the lumps should be small and soft � When you are moving onto this texture there should only be a small amount of lumps � Blend the food stopping just before it is a smooth pur�e � take out a teaspoon of very well mashed food and put to one side� carry on blending then add the coarser texture back in � If your little one still finds this texture difficult � try half a teaspoon next time � Gradually increase the texture every 2 � 3 days unless your therapist advises otherwise � Fork mash needs some preparation in the mouth before swallowing � Avoid offering foods that have a mix of textures e.g. lumps floating in liquid such as cereal in milk What does it look like � Foods in this stage are very smooth and have no lumps � This is usually the first stage of foods that are tried � These foods need to blended or sieved for a very smooth texture Feeding skills � Smooth pur�es can be swallowed easily � No chewing is needed � Pur�e can be managed by sucking and swallowing � A standard pur�e that drops easily off a spoon is the easiest for little ones starting out to eat Stages Finger foods What does it look like � From around 7 months start to offer finger foods put a variety of different foods out on highchair table at same time as other puree foods � To begin with most food will end up on the floor � To begin with, the best types of foods to start off with are ones that dissolve easily e.g. sweetcorn puffs � Dissolving foods melt evenly in the mouth without leaving lumps e.g. carrot puffs � These types of food help with chewing skills as your little one needs enough skill to be able to hold the food in the mouth until it melts � Other good finger foods to then move onto are steamed, such as well cooked carrots sticks, banana, avocado, soft pear, soft flaky fish, toast finger, pasta shells � Some types of food are a choking hazard and should be avoided in babies and young children � This list may not included everything � so it is important that you sit with your little one at each meal & snack time � Young children should be encouraged to sit down and eat rather than run around Feeding skills � Always try the food yourself to check it dissolves easily before giving it to your little one � Foods that dissolve should initially be placed at the side of the mouth where their back teeth will come to encourage tongue movement � With practice your little one may be able to bite pieces off (bite-anddissolve) Texture � Always sit with your little one when they are eating any food � If able offer bite and dissolve foods e.g. vegetable flavoured puffs between meals � Move on to soft cooked vegetables, small pasta shells and soft fruit. � It is sometimes useful to offer these foods as in between meals snacks, so you are your little one can enjoy them exploring new foods and textures together 2 � When your little one is ready to move onto stage 2 foods, start by offering a thicker smooth stage 1 pur�e � Foods in this stage are still blended but to a coarse pur�e with a thick sauce � There will also be small moist, soft lumps and � the size of a 5p piece � In this stage flavour combinations are more complex and have a slightly stronger taste, e.g. cottage pie � In this stage your little one will be developing their feeding skills further learning to use their lips and tongues more for eating � Some little ones take a while to adapt to a change in texture � this is normal as not every baby develops at the same pace � Try to make very small changes of one thing at a time � Some foods may still need to be smooth pur�e and others mashed e.g. vegetables can be a thick mash, but meat may still need to be a smooth pur�e � Lumps should be moist and soft � Lumps should not be bigger than a 5p piece and they should be soft Choking hazards 3 � Foods in this stage can be well fork mashed and have less sauce � Babies often enjoy quite stronger tastes e.g. mild lamb curry and new combinations e.g. sweet and savoury chicken � Foods are forked mashed with some bite size pieces that older babies can pick up as finger foods � Raw vegetables are often hard � so offer soft cooked sticks e.g. carrot, courgette and celery � Hard pieces of raw fruit such as apple and pear should not be given � Avoid slippery foods such as pieces of canned fruit � cut them up into small pieces or mashed e.g. sweet corn kernels; � All finger foods should be cut in short thin sticks e.g. lengthways rather than then being round in shape, as this reduces the risk of choking - Mini sausages/mini scotch egg balls - Cut whole grapes, berries, cherries, melon balls, cherry/plum tomatoes lengthways into quarters - Cut orange/satsuma segments into quarters � take the pips out and remove any pith - Chunks of fish flaked should be checked for bones 4 � Foods at this stage can have tender pieces: soft cooked pieces e.g. 10p piece size in thick sauce � Sometimes when little ones are not well, they go back a couple of stages in terms of textures and feeding � this is normal so try not worry * Suggested feeding times: 8-9 am, 11-1 pm, 4-5pm with milk in between (this is just a guideline) * Suggested feeding times: 8-9 am, 11-1 pm, 4-5pm with milk in between (this is just a guideline) 12 13 Simple feeding plan for the first month: From around 6 months of age Stages NOTE: Simple week meal planner: From around 6 months of age Day MONDAY How much and when? All babies are different � some babies eat more than others at meal times, this is quite normal Examples � Purees should be very smooth Waking Baby's usual milk Breakfast Baby cereal with milk & � teaspoon smooth nut butter Baby cereal with milk & � teaspoon smooth nut butter Baby cereal with milk & � teaspoon smooth nut butter Baby cereal with milk & � teaspoon smooth nut butter Baby cereal with milk & � teaspoon smooth nut butter Baby cereal with milk & � teaspoon smooth nut butter Baby cereal with milk & � teaspoon smooth nut butter Mid morning Baby's usual milk Lunch Purple meal* Or Baby's usual milk Purple meal* Or Baby's usual milk Purple meal* Or Baby's usual milk Purple meal* Or Baby's usual milk Purple meal* Or Baby's usual milk Purple meal* Or Baby's usual milk Purple meal* Or Baby's usual milk Evening meal Meat, chicken or fish based ready prepared baby food & � � 1 teaspoon smooth nut butter Fruit pot Meat, chicken or fish based ready prepared baby food & � � 1 teaspoon smooth nut butter Yogurt Meat, chicken or fish based ready prepared baby food & � � 1 teaspoon smooth nut butter Oat based pudding Meat, chicken or fish based ready prepared baby food & � � 1 teaspoon smooth nut butter Fruit pot Meat, chicken or fish based ready prepared baby food & � � 1 teaspoon smooth nut butter Yogurt Meat, chicken or fish based ready prepared baby food & � � 1 teaspoon smooth nut butter Oat based pudding Meat, chicken or fish based ready prepared baby food & � � 1 teaspoon smooth nut butter Custard Evening milk Baby's usual milk TUESDAY WEEK 1 � Usual milk feeds plus small but increasing amounts of solids � Days 1 & 2 � In the middle of or after one milk feed, offer 1 small teaspoonful of solids � Days 3 & 4 � In the middle of or after one milk feed, offer 1 � 2 teaspoons of solids � Days 5 & 6 � After one milk feed, offer 2 � 4 teaspoons of solids � Day 7 � After one feed offer 2 � 5 teaspoons of solids � Usual milk feeds plus solids at one or two feeds a day � Breakfast � baby's usual milk plus 2 � 5 teaspoons of solids � Lunch or evening meal � baby's usual milk plus 2 � 5 teaspoons of solids � Usual milk feeds plus solids at two feeds a day � Breakfast � baby's usual milk plus 2 � 3 tablespoons of solids � Lunch or evening meal � baby's usual milk 2 � 3 tablespoons of solids � � � � Usual milk feeds plus solids at two or three feeds a day Breakfast � baby's usual milk plus 2 � 3 tablespoons of solids Lunch � baby's usual milk 2 � 3 tablespoons of solids Evening meal � baby's usual milk plus 2 � 3 tablespoons of solids � Baby first rice cereal � Baby first rice cereal with puree apple � Baby first rice cereal with puree carrots WEDNESDAY Baby's usual milk Baby's usual milk Baby's usual milk Baby's usual milk Baby's usual milk Baby's usual milk WEEK 2 � Baby first rice cereal with � teaspoon of smooth nut butter � Sweet potato & almond butter or peas, potato and mint THURSDAY Baby's usual milk Baby's usual milk Baby's usual milk FRIDAY WEEK 3 � Baby first rice cereal with � teaspoon of smooth nut butter � Peas and Carrots or Prunes, apricots and ground almonds as a butter � Baby first rice cereal with � teaspoon of smooth nut butter � Peas and Carrots or Prunes, apricots and ground almonds � Butternut and smooth peanut butter or peaches, sultanas and baby rice Baby's usual milk Baby's usual milk Baby's usual milk SATURDAY WEEK 4 Baby's usual milk Baby's usual milk Baby's usual milk SUNDAY Baby's usual milk Baby's usual milk Baby's usual milk * Suggested feeding times: 8-9 am, 11-1 pm, 4-5pm with milk in between (this is just a guideline) NOTES: 1. As your little one gets bigger rainbow meals can be used as side dishes. * for rainbow meals see recipes on page 28 2. Rainbow, growing up or ready prepared baby meals can be offered at lunch and evening meal * Suggested feeding times: 8-9 am, 11-1 pm, 4-5pm with milk in between (this is just a guideline) 14 15 Some general advice Recipes, foods to avoid, textures, safety and hygiene, storing, reheating, do's and don'ts Recipes The recipes below make 100g portions � Colours of the rainbow, fruit & veggies recipes make 100g portions of food, to begin with your little one may only manage 2 � 5 teaspoons at a meal, but as they get bigger they may eat 100g portions � Growing up recipes are between 200 � 260g servings and can be used for lunch and supper or as a single meal as your little one gets bigger � All of the recipes can be: - made in bigger batches, just scale up the amounts accordingly Textures All of the recipes can be adapted to the texture that suits your baby such as: � Stage 1 � 2 : Smooth purees are best made with a blender and can be either - Thin puree runs easily off a spoon - Standard puree drops easily off a spoon - Thick puree can be eaten with a spoon � Stage 3: Mashed foods usually blended - Thick puree with less sauce and small moist soft lumps around � the size of a 5p piece � Stage 4: Fork mashed are soft foods mashed down with a fork - Thick with small moist soft lumps around the size of a 5p � 10p piece Cool food as quickly as possible (ideally within 1 � 2 hours) and put it in the fridge or freezer. Food in the fridge should be eaten within 1 � 2 days. Frozen food should be thoroughly defrosted before reheating. The safest way to do this is to put frozen food in the fridge overnight or using the defrost setting on the microwave. Reheat food so it is really hot, but remember to let it cool down before you offer it to your baby. To cool food quickly, put it in an airtight container and hold it under a running cold tap, stopping to stir the contents from time to time, so it is cool all of the way through. DO'S Always wash your hands before preparing foods. Wash your baby's hands before feeding Wash all bowls, spoons and other utensils in hot soapy water or put on a hot wash in the dishwasher. Keep chopping boards and other utensils clean DON'TS Don't save and reuse food that your child has half eaten Avoid raw eggs � this includes uncooked cake mixture, homemade ice creams, mayonnaise or desserts that contain uncooked raw eggs. Always cook eggs until the yolks and whites are firm Avoid any shark, swordfish or marlin � this is because the levels of mercury in these fish can affect your baby's growing nervous system. You should also avoid giving raw shellfish to babies to reduce their risk of getting food poisoning Foods to avoid: � Salt � unless advised by your health care professional salt should not be added to your little one's food � Sugar � your little one doesn't need sugar added to any food � Honey � very occasionally honey contains a bacteria that produces toxins in your little one's intestines causing a serious illness called infant botulism. It is best not to give honey until your little one is over 1 year of age Keep utensils, chopping boards and surfaces clean. Keep any pets away from food or surfaces where food is prepared When reheating food from frozen, make sure it is hot all of the way through. If you are using a microwave, ensure you always stir it and check the temperature before feeding it to your baby. Cook all food thoroughly and cool it to a lukewarm temperature before giving it to your baby Keep cooked and raw meats away from each other in the fridge. Always wash your hands after touching raw meant Wash and peel fruit and vegetables, such as apples and carrots Safety & hygiene As a baby's immune system is still developing, bacteria in food can cause food poisoning. If you follow a few simple guidelines this will help protect your baby from germs. Don't give children food or drink whilst sitting on the potty Don't reheat cooked food more than once, as this increases the risk of food poisoning 16 17 Shopping list For the recipes you can buy fresh, frozen or tinned fruit and vegetables. All of these ingredients are available in budget as well as other supermarkets. Fr ui t & Ve gg ies � Frozen pe as ixe d pe pp ers � Frozen /f re sh m rn � Frozen swee t co rrot s � Frozen /f re sh ca sh � Bu tter nu t sq ua to � Swee t po ta � Ka le � Co urge tte � Swede � Pa rs ni ps Nut bu tters (n o adde d suga r va rie tie s) � Smoo th pe an ut bu tter � Smoo th ca sh ew bu tter � Smoo th almon d bu tter Pu ls es & grai ns � Ch ic kp ea, be an or gram flo ur � Ti nned ch ic kp ea s � Le nt ils � gree n an d re d � Grou nd almon ds � Ba by rice /c er ea l (s tage 1) � (n ot orga nic) � Q ui no a Oi ls � Co co nu t crea m � Ol ive oi l Fi sh & meat � Whi te or oi ly fish � Lam b � Be ef � Ch ic ke n � Po tato � Ba na na � Av oc ado spbe rr ies � Frozen /f re sh ra ue be rr ies � Frozen /f re sh bl ango � Frozen /f re sh m in ju ice � Ti nned pe ache s ju ice � Ti nned pr unes in ric ot s � Re ad y to eat ap � Su lta na s He rb s & sp ice s in t � Frozen /f re sh m ri an de r � Frozen /f re sh co nger � Frozen /f re sh gi ic � Grou nd tu rmer on � Grou nd cin nam 18 19 RECIPES Veggies � Sweet potato & cashew butter � Peas, potatoes & mint � Butternut squash, peanut butter & cinnamon � Peas & carrots Fruits � Prunes, apricots & ground almonds � Peaches, sultanas & baby rice � Mango & almond butter � Raspberry, banana & almonds Colours of the rainbow � Purple � Plum, aubergine & blueberry � Red � Beetroot, apple, red pepper & cashew butter � Orange � Sweet potato, butternut, carrot & cinnamon � Yellow � Mango, yellow courgette, sweet corn & turmeric � Green � Pea, kale, pear & avocado � White � Apple, cauliflower & celeriac Growing up � Pollock, carrots, kale, butternut squash & potato � Avocado, apple, lentil, broccoli, courgette & mint � Beef & prunes with mashed potato � Aromatic chicken & rice � Mauritian lamb with lentils & rice Family favourites � Fish fingers & sweet potato chips � Bobotie � Pasta bolognaise � 1st Birthday cake 20 21 VEGGIES: Sweet potato & cashew butter Ingredients � 90g sweet potato � 10g smooth cashew butter (or other smooth nut butter) Peas, potatoes & mint Ingredients � � � � 20g frozen garden peas 70g potato 10ml (2 teaspoons coconut cream) 2 � 3 mint leaves or 1 teaspoon frozen chopped mint Butternut squash, peanut butter & cinnamon Ingredients � 85g frozen or fresh butternut squash � 10g (2 level tablespoon) smooth peanut butter � 5ml (1 teaspoon) coconut cream � pinch of ground cinnamon Peas & carrots Ingredients � 30g frozen or fresh peas � 60g frozen or fresh carrots � 5g (1 teaspoon) smooth peanut butter Method � Peel the sweet potato and place in pan of unsalted cold water � Bring to the boil and cook until tender � Using a stick blender puree until smooth � Add in 20g or 2 tablespoons of smooth cashew butter � Using the stick blender to mix well � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays Method � Place the carrots in a pan of boiling hot water, bring to the boil and cook until tender � Drain the carrots and place in a bowl � Cook peas in hot water for 2 minutes, drain and mash the peas through a sieve to get rid of the skins � Add the peas, carrots and smooth peanut butter together � Using a stick blender puree until smooth � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays Method � Peel the potatoes and place in pan of unsalted cold water � Bring to the boil and cook until tender � Drain the potatoes and leave to one side � Cook peas in hot water for 2 minutes, drain and mash the peas through a sieve to get rid of the skins � Add the pea pulp to the potatoes and using a stick blender puree until smooth � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays Method � Place the chopped butternut and a pinch of cinnamon in a pan of boiling hot water, bring to the boil and take off the heat � Using a stick blender puree until smooth � Add in 10g of ground almonds or 1 level tablespoon of smooth peanut or other nut butter along with 1 teaspoon of coconut cream � Use the stick blender and mix well � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays Nutrition content per 100g 164 kcal / 3.7g protein / 5.5g fat / 26.2g carbohydrate / 9% protein energy ratio Nutrition content per 100g 104 kcal / 3g protein / 3.8g fat / 15g carbohydrate / 11.5% protein energy ratio Nutrition content per 100g 105 kcal / 3.3g protein / 7g fat / 8g carbohydrate / 12.5% protein energy ratio Nutrition content per 100g 105 kcal / 3.3g protein / 7g fat / 8g carbohydrate / 12.5% protein energy ratio 22 23 FRUIT: Prunes, apricots & ground almonds Ingredients � 75g tinned prunes in juice � 15g ready to eat apricots � 10g ground almonds Peaches, sultanas & baby rice Ingredients � 75g tinned peaches in juice � 15g sultanas � 20g baby rice Mango & almond butter Ingredients � 85g fresh mango � 15g (3 levels teaspoons) almond butter Raspberry, banana & almonds Ingredients � 40g fresh or frozen raspberries � 45g banana � 15g ground almonds Method � Place the tinned prunes and ready to eat apricots (approximately 4) with the prune juice in a pan and simmer on a low heat for 5 minutes or until the fruit it soft � Add in 10g or 1 tablespoon of ground almonds � Using a stick blender puree until smooth � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays Method � Place the tinned peaches and sultanas with the juice in a pan and simmer on a low heat for 5 minutes � Add in 20g or 4 tablespoons of baby rice � Using a stick blender puree until smooth � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays Method � Peel and chop the fresh mango into chunks � Place in a bowl along with 15g smooth almond butter (3 level teaspoons) � Using a stick blender puree until smooth � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays Method � Place the raspberries in a pan, adding 20 ml of water � bring to a boil and then simmer for 2 � 3 minutes until cooked � Pour the raspberries into a bowl along with the banana and ground almonds � Using a stick blender puree until smooth � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays 1 � 2 cubes can be added to your little one's usual breakfast cereal Nutrition content per 100g 132 kcal / 3g protein / 6g fat / 13g carbohydrate / 9% protein energy ratio Nutrition content per 100g 190 kcal / 4.1g protein / 1.5g fat / 42.6g carbohydrate / 8.6% protein energy ratio Nutrition content per 100g 120 kcal / 3.4g protein / 7g fat / 10g carbohydrate / 11% protein energy ratio Nutrition content per 100g 146 kcal / 4.2g protein / 8g fat / 13g carbohydrate / 11.5% protein energy ratio 24 25 COLOURS OF THE RAINBOW COLOURS OF THE RAINBOW: PURPLE RED ORANGE Plum, aubergine & blueberry Ingredients � � � � 40g plums canned in syrup 30g aubergine pulp (without the skin) 10g blueberries 20g chickpea flour or baby cereal Beetroot, apple, red pepper & cashew butter Ingredients � � � � � 30g beetroot 30g apple 25g red bell pepper 15g (3 teaspoons) cashew butter 20ml water Sweet potato, butternut, carrot & cinnamon Ingredients � � � � � � 30g sweet potato 30g butternut squash 25g carrots 15g (3 teaspoons) peanut butter pinch of cinnamon water Method � Peel and chop the aubergine into chunks, sprinkle with salt and leave for 10 minutes, before washing thoroughly under cold running water � Place aubergine chunks, plums and syrup, blueberries and chickpea flour in a pan � Simmer on a low heat until the aubergine is soft � add your little one's usual infant formula or breast milk as required � Using a stick blender puree until smooth � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays Method � Peel and chop the beetroot into chunks � Dice the red pepper and peeled apple � Place all the beetroot, apple and red bell pepper into a pan, add in 50ml of water � Simmer on a low heat until the mixture is soft, drain off any excess water � Add in the cashew butter � Using a stick blender puree until smooth � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays Method � Place all the sweet potato, butternut, carrot and a pinch of cinnamon into a pan cover with cold water and bring to the boil � Simmer on a low heat until the mixture is soft, drain off the excess water � Add in the peanut butter � Using a stick blender puree until smooth � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays Nutrition content per 100g 94 kcal / 4.4g protein / 1.2g fat / 17.5g carbohydrate / 18.7% protein energy ratio Nutrition content per 100g 128 kcal / 4.3g protein / 9g fat / 9g carbohydrate / 13% protein energy ratio Nutrition content per 100g 143 kcal / 4.3g protein / 9g fat / 13g carbohydrate / 12% protein energy ratio 28 COLOURS OF THE RAINBOW: YELLOW GREEN WHITE Mango, yellow courgette, sweet corn & turmeric Ingredients � � � � � � 30g mango 25g yellow courgette (or green with no skin) 35g sweet corn 10g chickpea flour or baby cereal pinch of turmeric water � 50ml Pea, kale, pear & avocado Ingredients � � � � � 30g frozen garden peas 20g pear 20g kale 30g avocado water � 50ml Apple, cauliflower & celeriac Ingredients � � � � � � 25g apple 20g cauliflower 20g celeriac 20g chickpeas 5ml olive oil water � 50ml Method � Peel and chop the pear � Chop the kale into ribbons � Add the kale and pear into a pan with 50ml water � Simmer on a low heat until the mixture is soft, add in the peas and cook for a further 2 � 3 minutes � Take off the heat and add in the mashed avocado � Using a stick blender puree until smooth � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays Method � Peel and chop the apple and celeriac � Break the cauliflower into florets � Add all of the ingredients, including the olive oil into a pan with 50ml water � Simmer on a low heat until the mixture is soft � Using a stick blender puree until smooth � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays Method � Peel and chop the mango � Chop the yellow courgette or peeled green courgette if yellow are not available � Add all of the vegetables, chickpea flour, pinch of turmeric and 50ml water into a pan � Simmer on a low heat until the mixture is soft, drain off the excess water � Using a stick blender puree until smooth � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays Nutrition content per 100g 107 kcal / 3.8g protein / 1.8g fat / 18.9g carbohydrate / 19% protein energy ratio Nutrition content per 100g 93 kcal / 3g protein / 6.6g fat / 5.6g carbohydrate / 13% protein energy ratio Nutrition content per 100g 89 kcal / 2.4g protein / 6g fat / 7g carbohydrate / 10.7% protein energy ratio 30 GROWING UP: Pollock, carrots, kale, butternut squash & potato Ingredients � � � � � � 15g white fish* 30g carrots 60g kale 35g butternut squash 60g potato 1 teaspoon coriander Avocado, apple, lentil, broccoli, courgette & mint Ingredients � � � � � 50g avocado 30g apple 20g red lentils (cooked) 30g broccoli 25g courgette � 25g rice (makes 100g cooked rice) � 50ml water � lemon juice � few sprigs of mint Method � Chop the carrots, kale and fish � Add the carrots, butternut squash, potato, fish, olive oil and coriander into a pan � Simmer on a low heat until the mixture is soft, add in the kale and cook for a further 2 � 3 minutes � Before mashing the mixture take out a couple of pieces of carrot and fish to be used as finger foods during the meal � Using a stick blender or fork mash the rest until soft lumps remain � If the meal is a little thick add a small amount of your little one's usual infant formula or breast milk Method � Cook the rice and lentils in unsalted water until tender � Cut the courgette and broccoli into small pieces, steam over the cooking rice � In the meantime grate the apples and cube the avocado, sprinkle with a little lemon juice to stop the mixture going brown � Wash the mint leaves and finely chop � Keep some grains of rice, lentils, vegetable and fruit mixture to one side � Mash the rest of the rice and lentils with a fork, then add in the courgette, broccoli, grated apple and avocado until soft lumps remain � If the meal is a little thick add a small amount of your little one's usual infant formula or breast milk From around 7 months of age introduce finger foods, take a few pieces of carrot and fish from the mixture before you puree it. Offer as finger foods at the same time as serving the meal. This way your little one gets used to see what different food looks like. Nutrition content per 100g 135 kcal / 5.8g protein / 6.1g fat / 15g carbohydrate / 17% protein energy ratio Nutrition content per 100g 278 kcal / 6.8g protein / 11.4g fat / 40g carbohydrate / 9.7% protein energy ratio 32 *For fish always check for bones. 33 GROWING UP: Beef & prunes with mashed potato Ingredients � � � � � 20g mince beef 10g onions 80g butternut 35g carrots 20g prunes (2) � � � � � 100g potato 100ml water 5ml olive oil pinch of ginger pinch of turmeric Aromatic chicken & rice Ingredients � � � � � � 20g chicken breast 10g onion 30g mango 80g sweet potato 30g spinach 15g rice (60g when cooked) � � � � � � 100ml water 5ml olive oil 10ml coconut cream pinch of coriander pinch of ginger pinch of turmeric Mauritian lamb with lentils & rice Ingredients � � � � � 20g lamb mince 10g apricots (2) 10g green lentils 80g carrots 30g kale � 75g macaroni or small shaped pasta � 100ml water � 10ml coconut cream � pinch of cinnamon � pinch of turmeric Method � Braise the mince beef and onions in the oil, add in the pinch of turmeric and ginger and cook on a low heat until the onions are soft � Chop the butternut squash, carrots and prunes into small cubes, then add to the beef mixture with an additional 100ml of water cook on a low heat until all of the ingredients are soft and the liquid is reduced � In a separate
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Hospital trust hails lockdown as our 'lifeline' in taking back control of coronavirus spread in the community

Description: Chief medical officer at University Hospital Southampton Derek Sandeman is urging the public to adhere to newly-imposed lockdown restrictions, describing it as a 'lifeline' for the community.
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Caring for your urinary catheter - patient information

Description: Guide to caring for your urinary catheter
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Procedure for height of children over 2

Description: NIHR Southampton Biomedical Research Centre The NIHR Southampton Biomedical Research Centre (BRC) has a tight quality assurance system for the writing, reviewing and updating of Standard Operating Procedures. As such, version-controlled and QA authorised Standard Operating Procedures are internal to the BRC. The Standard Operating Procedure from which information in this document has been extracted, is a version controlled document, managed within a Quality Management System. However, extracts that document the technical aspects can be made more widely available. Standard Operating Procedures are more than a set of detailed instructions; they also provide a necessary record of their origination, amendment and usage within the setting in which they are used. They are an important component of any Quality Assurance Framework, but in themselves are insufficient and need to be used and interpreted with care. Alongside the extracts from our Standard Operating Procedures, we have also made available here an example Standard Operating Procedure and a word version of a Standard Operating Procedure template. Using the example and the Standard Operating Procedure template, institutions can generate their own Standard Operating Procedures and customise them, in line with their own institutions. Simply offering a list of instructions to follow does not assure that the user is able to generate a value that is either accurate or precise so here in the BRC we require that Standard Operating Procedures are accompanied by face-to-face training. This is provided by someone with a qualification in the area or by someone with extensive experience in making the measurements. Training is followed by a short competency assessment and performance is monitored and maintained using annual refresher sessions. If you require any extra information, clarification or are interested in attending a training session, please contact Dr Kesta Durkin (k.l.durkin@soton.ac.uk). This document has been prepared from Version 4 of the BRC Standard Operating Procedure for measuring height of children over 2. It was last reviewed in June 2015 and the next review date is set for June 2017. The version number only changes if any amendments are made when the document is reviewed. Page 1 of 4 NIHR Southampton Biomedical Research Centre NIHR Southampton Biomedical Research Centre Procedure for Measuring HEIGHT OF CHILDREN OVER 2 BACKGROUND Accurate length/height measurement of infants and children is essential as an indicator for physical growth. Length and height measurements can be plotted on percentile charts and compared to the general population. Height measurement can be affected by posture, footwear, feet and head positioning. It is necessary therefore to have a technique to measure height that can be replicated by other measurers; over time; and in the same subject. For the purposes of both longitudinal follow-up studies of individuals or populations, and cross-sectional group studies, accurate and reproducible measurements of height are essential. PURPOSE To ensure correct and uniform measurement of child height. SCOPE This procedure applies to all individuals measuring child height within the BRC. It is for use on children over two years of age who are able to stand stably and unaided. Any individuals over this age who are too unstable or unable to stand unaided should be length measured instead, in the supine position on a measuring board (i.e. Kiddimeter). RESPONSIBILITIES It is the responsibility of staff to read and use this procedure when measuring child height. It is the responsibility of the Principal Investigator to ensure that staff members who are working on specific studies have adequate experience and training to do so. Page 2 of 4 NIHR Southampton Biomedical Research Centre PROCEDURE Stadiometers: http://www.marsden-weighing.co.uk/index.php/marsden-hm250p.html Stadiometers are devices specifically designed for the accurate measurement of height and when used with care yield data of the highest quality. There are a few different stadiometer models in the BRC. The Leicester Height Measure is very "user friendly" but all the stadiometer models in the BRC can yield equally accurate and precise results if the measurer adheres strictly to the outlined procedure. The `Leicester Height Measure' is lightweight and portable and allows measurement accuracy of height to the nearest 1mm. The range is from 0 ? 2.07m, in 1mm gradations. It comes in the form of a plastic measuring rod, in four sections which slot together. There are unique codes at each end of each rod (i.e. star shape, square, circle etc.) which line up with each other to ensure that sections are slotted together properly. It has a base plate for the individual to stand on, two stabilising side arms that make contact with the wall and a head plate with arrows indicating the point at which the measurement should be read. Each rod is marked in metric (centimetres and millimetres) and imperial (feet and inches) units. You will require two practitioners, one holding the child's head in the Frankfort Plane, the other maintaining the child in the correct standing position, pulling down the head plate and reading the value. 1. 2. 3. 4. 5. Ensure the stadiometer has been checked and validated using metal rods of known height. Ensure that the stadiometer is wiped clean before use. Wash your hands and explain the procedure to the child and/or their parent or guardian. Explain you will want them to stand as tall and straight as possible and that you will be making 3 measurements of their height. Measure wearing light clothing. Ensure that heavy outer clothing and shoes are removed. Roll up trousers and jeans in order to check the position of the heels and to make sure the child is not standing on tip-toes. Undo or adjust hairstyles and remove hair accessories that interfere with measurement. If the child has a hairstyle that can not be adjusted (e.g. braids/dreadlocks), an implement of a known length (such as a short metal rod) can be placed on the crown of the head between the braids/dreadlocks when the head is in the Frankfort plane. The total height of child plus rod can then be measured and the length of the rod can be subtracted from the result in order to obtain a height measurement. You may ask ladies wearing headscarves if they would mind removing them. If they are unhappy to do this, you can ask to feel the top of their head/ask them how many layers of material are on top of the head and how their hair is arranged beneath the scarf. Make a note in the participant's medical notes if you have had to do any of these. Page 3 of 4 NIHR Southampton Biomedical Research Centre 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. Ask the child to stand on the stadiometer, facing forwards as tall and straight as possible with their arms hanging loosely at their sides. Their feet should be flat on the base plate of the stadiometer and positioned slightly apart, in line with their hips, to aid balance. There is an outline of feet on the base plate but it is not necessary for the child to stand on the feet marks. Their buttocks and shoulders should touch the stadiometer. The practitioner working from the side should ensure that the feet are flat and to the back of the footplate and that gentle pressure is applied to the knees to keep the legs at straight as possible. Ensure the child's head is in the "Frankfort plane". This position is an imaginary line from the centre of the ear hole to the lower boarder of the eye socket. This is a midline position. If will be necessary for the practitioner working from the front to manipulate the child's head in their hands by placing the heels of their palms either side of the face and the fingers of each hand on the back of the skull above the neck. Your fingers should come to rest on the mastoid process behind the ears. Firmly but gently, apply upward pressure lifting their head to the maximum height. Avoid jerky movements and perform the procedure smoothly, taking care not to tilt the head at an angle. Ask the child to take a deep breath and hold. The assisting measurer standing at the side should then bring the head plate down onto the head, ensuring it rests on the crown of the head, i.e. the top back half. The measurer working from the side should then read the measurement. The measurer's eyes should be level with counter/pointer and the measurement needs to be read to the nearest 1mm (this may require a stool/small ladder). Record the measurement. The child should be able to step off the stadiometer without ducking their head. Make three measurements of height, asking the child to stand off the stadiometer between each measurement. The three measurements should all fall within 2mm of one another. If the first three measurements do not fall within this 2mm limit then you must perform measurements of height until the 3 most recent results are within 2mm of one another. Cherry-picking the best 3 results from a choice of more than 3 measurements is not permitted. Record the three most recent results and calculate the mean by adding the three values together and dividing by 3. Should you be making repeated measurements on the same individual on different days, it is advisable to measure at the same time of day if possible. During the day our height decreases due to compression of the spine. Page 4 of 4
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Procedure for adult circumference measurements

Description: NIHR Southampton Biomedical Research Centre The NIHR Southampton Biomedical Research Centre (BRC) has a tight quality assurance system for the writing, reviewing and updating of Standard Operating Procedures. As such, version-controlled and QA authorised Standard Operating Procedures are internal to the BRC. The Standard Operating Procedure from which information in this document has been extracted, is a version controlled document, managed within a Quality Management System. However, extracts that document the technical aspects can be made more widely available. Standard Operating Procedures are more than a set of detailed instructions; they also provide a necessary record of their origination, amendment and usage within the setting in which they are used. They are an important component of any Quality Assurance Framework, but in themselves are insufficient and need to be used and interpreted with care. Alongside the extracts from our Standard Operating Procedures, we have also made available here an example Standard Operating Procedure and a word version of a Standard Operating Procedure template. Using the example and the Standard Operating Procedure template, institutions can generate their own Standard Operating Procedures and customise them, in line with their own institutions. Simply offering a list of instructions to follow does not assure that the user is able to generate a value that is either accurate or precise so here in the BRC we require that Standard Operating Procedures are accompanied by face-to-face training. This is provided by someone with a qualification in the area or by someone with extensive experience in making the measurements. Training is followed by a short competency assessment and performance is monitored and maintained using annual refresher sessions. If you require any extra information, clarification or are interested in attending a training session, please contact Dr Kesta Durkin (k.l.durkin@soton.ac.uk). This document has been prepared from Version 3 of the BRC Standard Operating Procedure for making circumference measurements of adults. It was last reviewed in October 2015 and the next review date is set for October 2017. The version number only changes if any amendments are made when the document is reviewed. Page 1 of 5 NIHR Southampton Biomedical Research Centre NIHR Southampton Biomedical Research Centre Procedure for Measuring ADULT CIRCUMFERENCES BACKGROUND This procedure is to be used for making circumference measurements of adults. PURPOSE To ensure correct and uniform measurements of adult circumferences. SCOPE This procedure applies to any study that requires taking circumference measurements of adults, within the BRC. RESPONSIBILITIES It is the responsibility of the measurer to use this procedure when making circumference measurements of adults. It is the responsibility of the study Principal Investigator to ensure that staff members who are working on specific studies have adequate experience to do so. PROCEDURE Metal tapes are the best to use for making anthropometric circumference measurements. Adult Maximal Calf Circumference 1. Where possible, make measurements on the non-dominant side. 2. Perform this measurement in the same way for both males and females. 3. Wash your hands and explain the procedure to the participant. 4. It is always preferable for circumference measurements to be made on bare skin. However, if this is not possible, it can be measured over a thin layer of Page 2 of 5 NIHR Southampton Biomedical Research Centre clothing such as tights, leggings or thin trousers. If trousers can be rolled up, this should be done, as long as it does not compress the area where you measure. The measurement must not be made over jeans. 5. Ask the volunteer to stand with his/her feet about 25cm apart in a relaxed position, with their weight evenly distributed on both feet. 6. Place the tape around the calf at the widest part and ensure that the tape is horizontal around the calf. The tape should rest on the skin but not indent it. 7. Move the tape up and down to locate the maximum circumference. 8. Make 3 measurements of calf circumference. 9. Measure to the nearest 0.1cm and beware of digit preference. 10. Record all three measurements and the mean, by adding the values together and dividing by three. Adult Mid Thigh Circumference 1. Where possible, make measurements on the non-dominant side. 2. Perform this measurement in the same way for both males and females. 3. It is always preferable for circumference measurements to be made on bare skin. However, if this is not possible, it can be measured over a thin layer of clothing such as tights, leggings or thin trousers. The measurement must not be made over jeans. 4. Wash your hands and explain the procedure to the volunteer. 5. Ask the participant to stand in a relaxed position with their weight evenly distributed on both feet. 6. Begin by identifying and recording the length of the femur: a. Palpate for the anterior superior iliac spine (ASIS) and mark with a pen. b. Palpate for the lateral superior margin of the patella (LSMP) and mark with a pen. 7. Using a tape measure, find and record the mid-point between the ASIS and LSMP and mark with a pen. 8. Ensure the tape is horizontal around the thigh. It should rest on the skin but not indent it. 9. Make 3 measurements of thigh circumference at this mid-point mark. 10. Measure to the nearest 0.1cm and beware of digit preference. 11. Record all three measurements and the mean, by adding the values together and dividing by three. Adult Hip Circumference 1. Perform this measurement in the same way for both males and females. 2. Wash your hands and explain the procedure to the volunteer. 3. Ask them to stand with their legs together. Page 3 of 5 NIHR Southampton Biomedical Research Centre 4. Apply the blank tape at the widest part, usually between the greater trochanter (top of the thigh bone) and the lower buttock level, with the volunteer's legs together. 5. Ensure tape is horizontal around the hips. It should rest on the skin but not indent it. 6. Make 3 measurements of hip circumference. 7. Measure to the nearest 0.1cm and beware of digit preference. 8. Record all three measurements and the mean, by adding the values together and dividing by three. Adult Waist Circumference 1. Perform this measurement in the same way for both males and females. 2. Wash your hands and explain the procedure to the volunteer. 3. Stand behind the patient and palpate the iliac crest (the large curving pelvic bone, just below the waist). Palpate and mark the skin on both sides with a horizontal line at its highest point. 4. Palpate the lower rib margin on and mark skin with a horizontal line at the lowest point. Palpate and mark the skin on both sides. 5. Using the tape measure, make a mark (on both left and right side) identifying the mid-point between those made at the iliac crest and the lower rib margin. Apply the tape at the mid-point marks. Ensure the tape is level with the mid-point marks around the waist. The tape should rest on the skin but not indent it. 6. Ask the volunteer to relax, i.e. not to deliberately hold him/herself in or out, and to look straight ahead with arms relaxed at his/her sides. 7. Be prepared to make the measurement and then ask the volunteer to breathe in and then out. As the waist circumference will change the tape so that it sits on the skin all the way round. Make the measurement and read the tape during the pause at the end of expiration. 8. Make 3 measurements of waist circumference 9. Measure to the nearest 0.1cm and beware of digit preference. 10. Record all three measurements and the mean, by adding the values together and dividing by three. Adult Mid Upper Arm Circumference 1. Where possible, make measurements on the non-dominant side 2. Perform this measurement in the same way for both males and females. 3. Wash your hands and explain procedure to the volunteer. 4. Ask the volunteer to stand with his/her back to the measurer, with their arms hanging by their sides. 5. Palpate the tip of the acromion (the point of the shoulder) on the nondominant side and mark with a cross. Page 4 of 5 NIHR Southampton Biomedical Research Centre 6. Ask the volunteer to flex their arm to 90 degrees. Palpate the olecranon (tip of the elbow) and mark it with a cross. 7. Put the tape measure on the mark made at the shoulder and drop it down to the tip of the elbow by the side of the arm. 8. Read the exact distance as if you had drawn an imaginary horizontal line from the bottom most point of the elbow to your tape measure. 9. Mark a point on the arm halfway between the acromion and olecranon. This marks the vertical level at which the circumference will be measured. It is important that this measurement is made with the arm flexed, otherwise the tape takes an oblique course across the upper arm, and the mid-point is too high up. 10. The subject is then asked to relax, with the arm hanging by her side. This is important as a very different reading may be obtained if the arm is not fully relaxed. 11. Place the tape around the upper arm with the tape's upper border on the mark. Ensure tape is horizontal around the arm. Make sure the tape is not pulled too tight. It should rest on the skin, but not indent it. 12. Read the tape to the nearest 0.1cm and beware of digit preference. 13. Make three measurements of mid upper arm circumference. 14. Record all three measurements and the mean, by adding the values together and dividing by three. Adult Mid Forearm Circumference 1. Where possible, make measurements on the non-dominant side 2. Perform this measurement in the same way for both males and females. 3. Wash your hands and explain procedure to the volunteer. 4. Ask the participant to stand straight facing you. 5. Palpate for the olecranon and make a mark with a pen. Palpate for the styloid process (the prominent bone of the wrist) and mark the most prominent point with a pen. 6. Using a tape measure, measure the distance between the marks at the olecranon and styloid process and mark the mid-point with a line. 7. Measure forearm circumference by placing the tape around the arm with the upper border of the tape at the mid-point line. 8. Read the tape to the nearest 0.1cm and beware of digit preference. 9. Make three measurements of mid forearm circumference. 10. Record all three measurements and the mean, by adding the values together and dividing by three. N.B. You may make the measurements using either pre-marked anthropometric measuring tape or blank tapes. Blank tapes provide a permanent record and reduce observer bias. This way, the circumference is marked with pen on a blank tape and subsequently converted to length by measuring against a validated fixed ruler. Page 5 of 5
Url: /Media/Southampton-Clinical-Research/Procedures/BRCProcedures/Procedure-for-adult-circumference-measurements.pdf

Papers Trust Board - 30 January 2020

Description: Date Time Location Chair Apologies Agenda Trust Board – Open Session 30/01/2020 9:00 - 11:45 Conference Room, Heartbeat Education Centre, F Level, North Wing, SGH Peter Hollins David Bennett 1 Chair’s Welcome, Apologies and Declarations of Interest 9:00 To note apologies for absence, and to hear any declarations of interest relating to any item on the Agenda. 2 Minutes of Previous Meeting held on 9 January 2020 3 Matters Arising and Summary of Agreed Actions To discuss any matters arising from the Minutes, and to agree on the status of any actions assigned at the previous meeting. 4 QUALITY, PERFORMANCE and FINANCE Quality includes: clinical effectiveness, patient safety, and patient experience 4.1 Staff Story 9:15 To receive feedback from patients, carers, or other stakeholders about their experience of the Trust's services. 4.2 Briefing from Chair of Quality Committee for review (Oral) 9:30 Tim Peachey, Non-Executive Director 4.3 Briefing from Chair of Audit and Risk Committee for review (Oral) 9:35 Simon Porter, SID/Non-Executive Director 4.4 Briefing from Chair of Strategy & Finance Committee for review (Oral) 9:40 Jane Bailey, Non-Executive Director 4.5 Integrated Performance Report for Month 9 review 9:45 To review the Trust's performance as reported in the Integrated Performance Report and the Quarterly Patient Safety Report. Sponsor: Jane Hayward, Director of Transformation & Improvement 4.6 Finance Report for Month 9 for review 10:30 Sponsor: David French, Chief Financial Officer 5 STRATEGY and BUSINESS PLANNING 5.1 Change Champions for decision 10:40 Sponsor: Gail Byrne, Director of Nursing & Organisational Development Attendees: Tristan Chapman, Director of Improvement & Partnerships, David Young, Head of Leadership Development and Change Champions 6 CORPORATE GOVERNANCE, RISK and INTERNAL CONTROL 6.1 Feedback from Council of Governors' meeting 23 January 2020 (Oral) 11:00 Sponsor: Peter Hollins, Trust Chair 6.2 Register of Seals, and Chair's Actions for ratification 11:05 In compliance with the Trust Standing Orders, Financial Instructions, and the Scheme of Delegation. Sponsor: Peter Hollins, Trust Chair 6.3 Board Assurance Framework 2019-20 Quarter 3 Report and Next Steps for 11:10 review To receive the Quarter 3 report on the Board Assurance Framework and update on Risk Appetite and Principal Risks for 2020/21 Sponsor: Paula Head, Chief Executive Attendee: Audley Charles, Interim Company Secretary 6.4 Board Committee Terms of Reference - Current Position for review (Oral) 11:30 Sponsor: Peter Hollins, Trust Chair Attendee: Audley Charles, Interim Company Secretary 7 Any other Business 11:40 To raise any relevant or urgent matters that are not on the agenda 8 To note the date of the next meeting: 26 March 2020, in the Conference Room, Heartbeat Education Centre, F Level, North Wing, SGH 9 Exclusion of press, public, and others The public and representatives of the press may attend all meetings of the Trust, but shall be required to withdraw upon the Board of Directors resolving as follows “that representatives of the press, and other members of the public, be excluded from the remainder of this meeting as publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted.” 10 Items circulated to the Board for reading 31 December 2019 Press Release: Liver expert says alcohol withdrawal symptoms ‘to blame’ for workplace anxiety 17 January 2020 Press Release: Senior doctor says perfect school attendance for children with chronic conditions “unfair and unrealistic” Page 2 10.1 11 11:45 12 12:00 13 13:15 20 January 2020 Press Release: Southampton surgeons showcase state-of-the-art surgical robot 22 January 2020 Press Release: Researchers find drug used widely to treat eye condition has “no benefit” Guardian of Safe Working Hours Quarter Report Sponsor: Derek Sandeman, Medical Director Follow-up discussion with governors Clinical Visit Lunch Page 3 2 Minutes of Previous Meeting held on 9 January 2020 1 Trust Board Minutes Open Session 9 January 2020 Date Time Location Chair Present Attendees Apologies Minutes Minutes Trust Board – Open Session 09/01/2020 9:00 - 10:54 Conference Room, Heartbeat Education Centre, F Level, North Wing, SGH Peter Hollins (PTH) Jane Bailey (JB) Non-Executive Director (NED) Gail Byrne (GB) Director of Nursing & Organisational Development Cyrus Cooper (CC) NED Jenni Douglas-Todd (JD-T) Senior Independent Director/NED Keith Evans (KE) NED Designate Simon Porter (SP) /NED Paula Head (PH) Chief Executive David French (DAF) Chief Financial Officer Jane Hayward (JH) Director of Transformation & Improvement Joe Teape (JT) Chief Operating Officer *Steve Harris (SH) Director of Human Resources *Audley Charles (AC) Interim Company Secretary & Associate Director of Corporate Affairs *Duncan Linning-Karp (DL-K) Divisional Director of Operations 3 Governors 2 Members of staff *Denotes non-voting member/attendee David Bennett, NED Derek Sandeman, Medical Director Tracey Burt, PA to Trust Chair and CEO 1 Chair’s Welcome, Apologies and Declarations of Interest The Chair welcomed members and attendees, including Keith Evans, NED Designate. He noted that that was the first Trust Board JD-T had attended as Deputy Chair/SID. There were no interests declared in relation to items on the agenda. 2 Minutes of Previous Meeting held on 28 November 2019 The minutes were confirmed as an accurate record subject to the following updates/amendments:- • DL-K and JMcA to be denoted as non-voting attendees. • PTH advised that as the Trust Board minutes for 28.11.2019 had only just been re-issued, any subsequent observations would be accepted by email. RESOLVED: The minutes were approved as an accurate recored subject to the changes indicated. 3 Matters Arising and Summary of Agreed Actions The Action log was reviewed and updated as follows: • Annual Litigation & Insurance Review – Action 116. An update would be taken to the March Quality Committee and to Board on the 26th March 2020. • Patient Mis-identification – Action 117. This would be taken to the April Quality Committee and an update provided to the Board on the 30th April 2020. • Research and Development Strategy – Action 118. A tentative date had been scheduled for this to be discussed at a Board Study Session. • Shared Research and Development Mission – Action 119. A meeting between the Vice Chancellor and Chair of Council of the University of Southampton, PTH and PH had been arranged for the 14th February. • Staff suffering violence – Action 127. SH advised that he had met the staff (and their managers) who had presented at the Trust Board. On reflection he felt that whilst there was a range of relevant policies/procedures in the organisation, they did not link together well. The issue would be reviewed at the People Committee which was due to operate from February 2020 under the chairmanship of JD-T. An update would be given at the April Board. ACTION: SH/GB to update the April Board. • Patient experience and waiting times – Action 130. JH advised that information on cancer waiting times would be provided to the Board on the 30th January. ACTION: JH to update Board on the 30th January. 4 QUALITY, PERFORMANCE and FINANCE 4.1 Patient Story A patient and her husband shared their experience of the Trust’s services following her diagnosis with ovarian cancer in March 2019. They praised the nursing staff but expressed disappointment about communication and the service provided by the physios. They also mentioned expensive car parking, poor food, the lack of empathy/support provided by stoma nurses and being given the wrong medication. PTH thanked them for attending and sharing their experience. Page 2 ACTION: GB to advise the couple of actions taken in relation to their observations. 4.2 Briefing from Chair of Strategy & Finance Committee for review Jane Bailey, Non-Executive Director, summarised the items discussed at the Strategy & Finance Committee held on the 6th January and highlighted the following:- • whole system updates had been discussed and the impacts they would have on the Trust’s future capacity and resourcing. • the current financial position and the Cost Improvement Programme had been considered. It had been a challenging month but the papers and issues were clear and there was nothing specifically that needed to be flagged to the Board. • the forecast outturn had been considered and would be discussed during the Closed Board. 4.3 Integrated Performance Report for Month 8 for review JH, Director of Transformation and Improvemnt, introduced the report. Improving patient journeys • JD-T asked whether anything had been done differently to support administrative staff who had to contact patients regarding the cancellation of operations. PH advised that matrons had been providing support to admin teams and patients having their operations cancelled on the day of surgery were being contacted/seen by senior staff. • PTH noted that it had been a difficult period for delayed transfers of care and asked whether the Trust could encourage other organisations to do more. PH advised that this was a national issue and whilst additional funding had been provided by government, it was not sufficient to match demand. Local councils had been trying different things but lack of staffing was a key issue for many care providers. JT advised that there had been between 80 and 100 delayed transfers of care during the period and whilst some issues were within the gift of UHS, there were also capacity and external factors and all aspects of the process needed to be speeded up. ACTION: JH advised that delayed transfers of care would be discussed at a Quality Committee. • PTH asked what was driving referral to treatment time performance and where the Trust would be if demand had not increased in the way it had. JH advised that there had been some quite successful programmes to reduce demand this year but the greatest difference had been the Trust’s inability to deliver additional outpatient clinics and theatre lists. Page 3 She noted that West Hants CCG had been doing work on intial triage to reduce demand. Key Performance Indicators (KPI) report PTH suggested that the icons were removed as they were not adding value. This was agreed. (IPJ1-L) Non elective LOS - it was noted that the line was very flat and that this was one of the Trust’s most important metrics. (IPJ16-N) %Patients on an open 18 week pathway - the impact this wait had on patients was a concern. (HL1-N) Cumulative Clostridium difficile - the increase in numbers was noted. GB advised that this was due to increased testing because of the norovirus outbreak, rather than higher levels of C. difficule being present. (HL12) Crude Mortality Rate – PTH noted the sharp increase and asked whether this should be a matter of concern.. TP advised that this metric was particularly sensitive to coding issues. (HL14-L) Maternity FFT negative score – the score was noted and GB suggested that there was some fatigue with the collection of data. The Trust would be working with a new survey supplier. (HL15-L) Staff Sickness Absence - it was noted that this was increasing and that other workforce metrics were not being met. (LE7-L) NIHR CRF/BRC publications year on year growth – JB noted the decline and the impact this might have on the Trust obtaining the next BRC research grant. CC advised that an advisory panel would be coming to the Trust on January 22nd and would provide an indication of the likely bid success. Estates – DAF noted the drop off in these graphs and advised that a new Head of Maintenance had recently started work at the Trust. KE asked which were the most important KPIs and this was debated briefly. RESOLVED: The Board noted the report. 4.4 Staff Strategy 6-month Progress Report for review The report was presented by SH, Director of Human Resources and the following points were highlighted:- • in Spring 2018 the Trust had agreed a five-year Staff Strategy which now needed to be refreshed to align with new UHS goals, the clinical strategy and to meet the requirements of the National NHSI People Plan. Page 4 • the staff sickness absence rate was still below the National average but had increased and was an indication of the pressure staff were under. • appraisal rates had dropped but the Trust was working to improve the quality of appraisals. • there had been significant strides made in the recruitment of overseas nurses which had helped to reduce agency spend. Following national advice from the BMA regarding pensions, UHS had written to all consultants providing contractual assurance. PH suggested a pragmatic approach as staff reviewed their work/life balance and advised that other solutions to demand/capacity issues would be needed. GB advised that because of demand/capacity issues and the opening of more areas, registered nurses had been moved around the Trust. They were now spread more thinly which may result in the need for extended agency use. She also advised that the running of a kindness and civility campaign across the Trust was being considered. There was also to be a calendar of events to celebrate nursing. JD-T advised that the new People Committee would meet for the first time in February. Terms of Reference would be signed off and the Committee name confirmed. JB asked whether any themes relating to low staff morale had been picked up through the staff survey. SH advised that the HR Business Partners had run some sessions with staff in areas identified and the Change Champions had also picked up on hot spots. CC noted the growing strain on medical train and suggested that this should be monitored. RESOLVED: The Board noted the report. 4.5 Finance Report for Month 8 for review The Finance Report for Month 8 (November) was presented by DAF, Chief Financial Officer. It had been expected that the month would be profitable as winter pressures had not set in and most staff were at work but a surplus of £0.6m was delivered against a planned surplus of £3.1m. This was largely due to the impact of norovirus which meant that significant elective capacity was lost, as beds were occupied by nonelective patients. The Trust was also unable to admit new patients to empty beds due to infection being present in bays. The other significant factor was CIP delivery which was £3.1m against a plan of £3.7m. The CIP plan had required length of stay reductions which would have enabled cost savings through bed closures. The engagement of PwC to support the Trust’s ‘Always Improving - Inpatients’ programme would help with length of stay improvements during the coming months. Page 5 Year to date the Trust had a £4.4m surplus excluding PSF and a £7m surplus including PSF which was within £0.1m of Plan. DAF was confident that the Trust would achieve the Q3 surplus plan which would trigger Q3 PSF of £3.8m. It was unlikely, however, to achieve the Q4 plan which would require an £11m surplus. The forecast year end surplus was £2-5m which represented a £12-15m downside. The four key factors affecting the Trust’s financial out-turn for the year were:- • the length of the norovirus outbreak and the impact of flu. • the impact of high non-elective activity off-setting profitable elective capacity. • CIP, in particular, length of stay reductions. • the outcome of negotiations with CCGs who were challenging coding and counting. RESOLVED: The Board noted the report. 5 CORPORATE GOVERNANCE, RISK and INTERNAL CONTROL 5.1 Amendments to the Trust's Constitution for approval The paper was presented by PTH. Board members were advised that there was an error on page 3, section 1.1 which should state that were 6 voting Executive Directors, including the CEO. Change to Section 4.2: Composition of the Board of Directors Following discussion the Remuneration and Appointment Committee had approved the appointment of a new Executive Director. A Director of People, who would be a voting member of the Board, would be appointed and the recruitment process was underway. It was therefore proposed that the Trust’s Constitution be amended to read that the Board of Directors would comprise:- 4.2 The Trust’s Board of Directors is to comprise; 4.2.1 A non-executive chair 4.2.2 Not less than five or more than seven each of executive and nonexecutive directors 4.2.3 The numbers of executive and non-executives shall be equal 4.2.4. The Chairman has a casting vote in the event of a tie Change to Sections 13.1 and 13.6: Arrangements for the appointment of the Lead Governor and Deputy Lead Governor The Constitution did not state how those appointments should be made and the arrangement outlined on page 3 of the paper was proposed for adoption. Page 6 RESOLVED: The Board approved the proposed amendments to the Trust’s Constitution. 5.2 Register of Seals, and Chair's Actions for ratification DAF suggested that the fee agreed with PricewaterhouseCoopers be removed from the Trust’s records, so that it was not subject to FoI requests as it was commercially sensitive. RESOLVED: The Board approved the removal. 6 Any other Business Thanks • Steve Erskine, Chair, Hampshire Hospitals had spent Christmas Day at UHS with his mother and had thanked staff for the “terrific treatment” she had received. • PTH noted that that was the last formal Board meeting that SP would attend as a NED. He thanked him for all his work on the Board and for his contributions to the Strategy and Finance Commmittee and the Audit Committee. Register of Interests • JD-T asked for an amendment to be made to the register. 7 To note the date of the next meeting: 30 January 2020, in the Conference Room, Heartbeat Education Centre, F Level, North Wing, SGH There being no further business the meeting was closed at 10.54 hrs Page 7 3 Matters Arising and Summary of Agreed Actions 1 List of Action Items List of action items Agenda item Assigned to Deadline Status Trust Board – Open Session 31/10/2019 4.3 Briefing from Chair of Audit and Risk Committee for review (Oral) 116. Annual Litigation & Insurance Review Charles, Audley Peachey, Tim 26/03/2020 Pending Explanation action item TP to ensure nature of claims against the Trust is picked up through the Quality Committee and provide a periodic summary to Board. Acknowledged at the November Board and the Interim Company Secretary to discuss with Tim Peachey a Formal Report to be presented to the March Quality Committee, after which the Chair will update the Board in his briefing. An update will be brought to the March Board after the Annual Business Cycle for the Quality Committee has been approved. Trust Board – Open Session 31/10/2019 4.5 Integrated Performance Report for Month 6 for review 117. Patient Mis-identification Byrne, Gail Peachey, Tim 30/04/2020 Pending Explanation action item The Quality Committee to review progress on eliminating the possibility of patient mis-identification in 6 months' time and feed back to the Board. This to be incorporated into the Quality Committee agenda for 27/04/19, with an update to Board. Trust Board – Open Session 31/10/2019 4.5 Integrated Performance Report for Month 6 for review 118. Research and Development Strategy Hollins, Peter Sandeman, Derek Explanation action item Identify an opportunity to discuss R&D strategy during a Board Study Session. Item tentatively scheduled for the April Board Study Session. 07/04/2020 Pending Page 1 of 3 Trust Board – Open Session 31/10/2019 4.5 Integrated Performance Report for Month 6 for review 119. Shared Research and Development Mission Head, Paula Explanation action item Arrange a joint meeting of the UHS and UOS Boards. Meeting arranged for 14 February 2020. 30/01/2020 Pending Trust Board – Open Session 28/11/2019 3 Matters Arising and Summary of Agreed Actions 127. Staff Stories - Staff members suffering violence Byrne, Gail Harris, Steve 30/04/2020 Pending Explanation action item SH to consider the need for a specific procedure as part of his review until resolved and GB to inform staff members involved of the outcome. This issue would be reviewed at the People Committee which was due to operate from February 2020 under the chairmanship of JD-T. An update would be given at the April Board. Explanation Harris, Steve SH has now met with the staff members, and also held a separate meeting with the line manager and the matron from the area. The meetings were productive. In summary it is concluded that there need to be revision to existing policy and practice, and an increase in the existing support provided to staff, particularly when injured at work through violence. The areas identified were: • Ensuring compassionate and fair application of trust policy (particularly sickness) when colleagues are injured in the line of duty • Increasing the levels of support and deploying these rapidly for those who are physically injured, and ensuring metal injury is prevented or supported if this occurs • Increasing support and awareness of PTSD • Formalising a fast tacking programme to ensure staff can receive clinical treatment at UHS, and potentially other NHS organisations, in a timely way to help support them back to work sooner. • Rapid application of temporary injury allowances where appropriate. Page 2 of 3 Trust Board – Open Session 28/11/2019 4.5 Integrated Performance Report for Month 7 for review 130. Patient Experience and Waiting Times Hayward, Jane 30/01/2020 Pending Explanation action item The Board requested that positive assurance in relation to patient experience and waiting times be provided in the opening narrative of the next reports. JH advised that information on cancer waitiing times would be provided to the Board on 30th January 2020. Trust Board – Open Session 09/01/2020 4.1 Patient Story 145. Patient Story Byrne, Gail Explanation action item GB to advise the couple of actions taken in relation to their observations. 30/01/2020 Pending Trust Board – Open Session 09/01/2020 4.3 Integrated Performance Report for Month 8 for review 146. Improving Patient Journeys Hayward, Jane 30/01/2020 Explanation action item JH advised that delayed transfers of care would be discussed at the Quality Committee. Update: The Complex Discharge Quarter Report will be reviewed at the Quality Committee on 27 January 2020. Pending Page 3 of 3 Report to the Trust Board of Directors dated Thursday, 30 January 2020 Title: Integrated Performance Report 2019/20 Month 9 Category Quality, Performance, and Finance Agenda item 4.5 Sponsor Director of Transformation and Improvement Author Trust Performance Manager Provenance Classification The Integrated Performance Report is reviewed monthly by the Board of directors This Report is unclassified. Purpose and The paper is presented for REVIEW. recommendation Relevant strategic  Goal 1: Improving goals patient journeys.  Goal 4: Building an expert and inclusive workforce.  Goal 2: Delivering value-based health and care.  Goal 5: Being agile in meeting people’s needs.  Goal 3: Supporting healthy lives.  Goal 6: Creating leading-edge research, education, and innovation. Assurance framework links • BAF01 – Inability to develop partnerships and redesign services innovatively renders the Trust unable to meet the expectations of the NHS long term plan, our strategic plan, and sustainable elective and nonelective pathways • BAF02 – Failure to deliver regulatory requirements causes the Trust to breach the terms of its Provider Licence leading to a loss of local leadership due to an enforced change in Board and Executive composition, impacting on Goals 1 to 6 • BAF03 – Failure to achieve financial targets results in a shortfall in cash required to deliver the capital programme • BAF04 – Reduced access to resources compromises the quality of services • BAF05 – Capacity and capability gaps in the workforce lead to an inability to provide safe and timely care • BAF06 – Lack of capacity and agility renders the Trust unable to respond to the changing operating environment, causing a failure to provide contracted services • BAF07 – Poor staff wellbeing and engagement leads to an inability to deliver safe and timely care • BAF08 – Lack of inclusion and diversity results in the failure to get the best from every individual • BAF09 – Failure to respond with the necessary organisational changes in design and operation renders the Trust unable to remain a competent NHS Provider • BAF10 – Inability to offer translational research renders the Trust unable to maintain its cutting-edge teaching hospital status Impact n/a assessments Other standards n/a affected Integrated KPI Board Report Digest Improving patient Journeys December was a challenging month for UHS across both the elective and non-elective pathways. While the norovirus outbreak from November largely abated, we continued to spend a significant number of days on Black Alert and a high number of elective cancellations. Non elective length of stay increased slightly from 6.38 in November to 6.41 in December. This is the second month in a row we have had an increase following a reducing trend for the previous 38 months. Delayed transfers of care increased in December to 7.3% against a target of 3.5% which is the highest figure since definition changes made in August 2018. Although we are not achieving the percentage target year to date we have delivered 1067 more complex discharges when compared to last year reflecting the additional complexity and volume of patients we are treating. We have continued to work closely with system partners and we are working together to ensure we have additional capacity in the winter months. The wider system has put in 15 additional beds, as well as a home care service, and UHS opened the first tranche of winter beds at Princess Anne (a 26 bedded medical ward, a net increase of 14 beds). The COO team have stated to work with the Integrated Discharge Bureau to improve the escalation framework for DTOCs, and are also convening a summit with the system to look at what more can be done, including how risk is more appropriately spread across the system at times of heightened pressure. Adult bed occupancy has been consistently higher this autumn compared to last autumn at around 94%. Adult bed occupancy last year was 86.4%, this year it was 93.2% in December. We have had a 7.8% growth in emergency attendances and a 3.4% increase in non-elective spells (year to date) accounting for the additional inpatients this summer. The Always Improving Inpatients project started in late November with a plan to reduce LOS by 12% by March 2020. Teams have been engaging in the project well. This is being rolled out in phases so will not deliver a 12% reduction overall in LOS but will be focused on key areas. While early anecdotal reports have been positive, we are not expecting data showing any improvements until February. ED performance improved in December from the low of November. For the month, type 1 performance in December was 76.3% and we ranked 3rd of 8 Major Trauma Centre peers (8th being worst). Local delivery system performance was at 86.6% in December against a local target of 90.0%. The key issues remain the same, poor bed flow (particularly for medicine and medicine for older people) and internal processing and capacity within the Emergency Department. A new clinically led action plan is being developed with the department and will be ready by the end of January. While performance obviously remains important, the current overcrowding within the department, patient experience and outcomes are the driving factor in our improvements. The key improvements focus on: • Internal processing and standardisation within the Emergency Department • Pull from receiving specialties (including developing new pathways, e.g. for #NOF) • The potential to expand SDEC • A longer term strategy on the future of the Emergency Department, including the estates (and the Emergency Village) • What more the system can do to reduce attendances and improve discharges • Mental Health • GP streaming As part of the budget setting process we are also looking at what additional investment the Emergency Department needs and how this will support both performance and safety. The percentage of patients on an open Referral to treatment pathway (waiting list) who have waited less than 18 weeks in December is at 79.5%. Patients waiting over 18 weeks increased by 337. The overall waiting list increased in size by 87 patients over December. Capacity in OPs and theatres was reduced due to December bank holidays. Neurology, Ophthalmology and ENT all had increased volume of > 18 week waits in the referral category, these are patients who have not yet been seen. Ophthalmology, dermatology and colorectal all had increased numbers of patients in the still on pathway category (these patients have been seen but not yet had a definitive treatment) and gynaecology, urology and ENT all increased their number of > 18 week patients waiting for surgery. 52 week breaches • In December 22 patients had not received a definitive treatment within 52 weeks. • The main areas of concern remain ENT, benign urology and paediatric orthopaedics. There are specific plans in place for these specialties whilst other care groups with lower volumes are carefully tracking all long waiting patients. Work is ongoing to improve pathways across all RTT areas and a range of plans are in development as part of our plans for 2020-21. Some examples of these include:- Neurology. • In January the team commenced a 200 day rapid improvement project with the aim of reducing patients requiring Outpatient appointment by up to 28% per annum. • If achieved, assuming referrals do not increase, this would balance demand and capacity it would not however reduce the backlog, further plans would need to be developed for this. Ophthalmology • There is additional capacity via an insourcing model at Lymington hospital from February 2020, delivering 1,400 additional outpatient appointments. • There will be a new consultant in eye casualty from March 2020 adding additional 219 clinic slots per annum and 252 cataract operating slots. ENT • We are planning to operate on 75 long waiting patients by the end of March either in the private sector or by the use of an insourcing company. This would remove the long waiting benign work which is displaced due to the high ENT cancer demand. • There are ongoing discussions with CCGs about stopping some referrals to UHS for benign ENT work which would then take place at alternative locations. Urology • In January the team are undertaking benign long waiting kidney stone work in the private sector; It is expected to remove 14 longer waiting benign patients from the waiting list. • There is space in the newly developed urology day unit, with the appointment of an Associate specialist for kidney stone work this should treat an additional 32 patients from the waiting list by the end of March. The ENT & Ophthalmology operating work streams are being supported by additional NHSI funding which was secured in December. Gynaecology • The gynaecology theatres have been refurbished this winter, the re-opening has been delayed due to validation of the air handling system. The service will continue to use theatre K in the meantime and will maintain access to theatre k when gynaecology are back and operating in their own footprint. • UHSFT has access to one theatre at Southampton treatment centre, the service has been asked to review their use of the STC and are due to report back with actions against all of their 52 week breach risk in light of this additional capacity being made available. Paediatric Orthopaedics. • All patients at risk of not being treated within 52 weeks now have dates for surgery. • A sustainable plan for paediatric trauma is required and will form part of the overall discussion around theatre capacity. Diagnostics 6 week diagnostic performance did not achieve the target at 2.51% against a target of 80%). Of those found to have moderate or high alcohol dependence 86% were given relevant advice or a referral to specialist services in December, this performance is stable not achieving the target 90% (last achieved December 2018). Of those found to smoke who were given advice or offered medication performance in December was 96%, above the target 90%. Building an expert and inclusive workforce This month staffing remains amber overall because some key targets have been missed for staff turnover and appraisals. A small increase in CHPPD can be attributed to a decrease in patient numbers due to the Christmas period and the amount of nursing hours remaining stable. Rolling sickness absence rates are continuing to increase and are now over 0.16% over the target of 3.4% a, underpinned by a higher rate of sickness absence during the summer compared to 2018. Reporting of sickness will transition to statistical control process from February. UHS has seen improvements in rates of employment for BAME Band 7+ to 9%. Additionally, the position for the following is stable: statutory and mandatory training compliance (with 7 of 12 measures meeting target). In UHS ward-based areas, total nursing staff vacancies have increased by 0.69% since last month Registered nurse vacancies in ward-based areas have again decreased this month (by -0.63% since last month) and is below the target of 15%. These changes are due to 24 Overseas nurses having acquired their PINs and promotion of RNs, however there have also been staff lost due to relocation of staff and reduction in contracted hours mainly following return from maternity leave, . The total CHPPD rate in the Southampton General has increased from last month to RN 5.7 (previously 5.6), HCA 3.5 (previously 3.4) overall 9.2 (previously 9.0).The CHPPD for ward based areas (excluding Critical care units) in in the Trust has increased from last month to RN 4.2 (previously 4.1) HCA 3.5 (previously 3.5) overall 7.7 (previously 7.6). Being agile in meeting people’s needs Estates helpdesk requests completed on time did not achieve target in December (10th month in a row), currently at 77.2%. Unresolved help desk requests remain below target, in December we had 838 against a target 85% in November at 92.8%. Since introducing eQuest requesting in theatres in SGH we have seen a surge in histo requests being placed directly. In total the number of specimens being acknowledged is increasing. UHS patient logins to My Medical Record dropped significantly in December. Cumulative patient registrations is at 21,727. The plan is to increase to 100,000 registrations by the end of this year. At the current rate of increase this will not be achieved. Mr Dave Berry, Chair of the MyMR steering group, will review this and a new MyMR strategy is being developed. Leading edge research, education and innovation In Q3 2019/20 UHS was ranked 9th for non-weighted and 6th for weighted CRN recruitment against a target of being in the top 10 and top 5 respectively. Whilst we are still meeting target for non-weighted recruitment in terms of ranking our performance against our NIHR CRN target is significantly down, largely due to one large musculoskeletal study (5k participants) unlikely to hit target but also impacted by capacity constraints within clinical trials pharmacy. Our weighted recruitment is currently not meeting target, and again is also down against our NIHR CRN target which reflects in part that many of our more complex interventional clinical trials have been impacted by the capacity constraints within clinical trials pharmacy (see below for how these have been addressed) In Q3 UHS are currently ranked 13th for contract commercial study recruitment, which whilst an improvement against previous recent performance (up from 16th), is still not meeting our target of being in the top 10, so we will continue our specific focus on improving our commercial performance. Comparative CRN recruitment performance by specialty was on target in Q3 2019/20 with 52% specialties ranking as predicted (in the top 5 or top 10 based on prior performance). Proportion of commercial studies closing in 18/19 FY on time and to recruitment target ended the year below the 80% target at 71%, however this was an improvement on the 17/18 performance of 57%. In Q3 2019/20 this metric is currently at 65%, and we anticipate a further improvement by year end, with an ambition that we will meet the 80% target. Proportion of non-commercial studies closing on time and to recruitment target in Q3 is currently at 65% and again we anticipate that this will improve significantly by year end, such that Wessex will meet its 80% target. Clinical study set up and recruitment (in particular for the commercial portfolio) has been impacted by capacity constraints across the research infrastructure and by pressures within the clinical services, in particular with regards to pharmacy capacity to set up and deliver clinical trials. Capacity constraints within clinical trials pharmacy have been addressed in the longer term by a business case to double staffing levels, which was approved by TIG in November 2020 and the initial round of recruitment has recruited additional pharmacy staff due to start in the new year. In the shorter term the clinical trials pharmacy team have been working closely with the R&D office to streamline processes, and work together against a prioritised pipeline of studies in set up. The year to date NIHR CRF & BRC publications in 2019/2020 is 329 currently (14.5% less than same time last year), related to a loss of clinical academic staff. This is a major concern for our next BRC and CRF applications and actions are currently in progress that will require Trust support in due course. Integrated KPI Board Report covering up to Dec 2019 Executive Sponsor - Jane Hayward, Director of Transformation Jane.Hayward@uhs.nhs.uk Chart Type Cumulative Column Example Cumulative Column Year on Year Line Benchmarked Line Percentiles Control Chart Variance from Target Report Guide Explanation A cumulative column chart is used to represent a total count of the variable and shows how the total count increases over time. This example shows quarterly updates. A cumulative year on year column chart is used to represent a total count of the variable throughout the year. The variable value is reset to zero at the start of the year because the target for the metric is yearly. The line benchmarked chart shows our performance compared to the average performance of a peer group. The number at the bottom of the chart shows where we are ranked in the group (1 would mean ranked 1st that month). A line percentiles chart is used to represent the distribution of a variable. The 50th percentile shows the median value, we also show the 5th, 25th (lower quartile), 75th (upper quartile) and 95th centiles. A control chart shows movement of a variable in relation to it's control limits (the 3 lines = Upper control limit, Mean and Lower control limit). When the value shows special variation (not expected) then it is highlighted green (leading to a good outcome) or red (leading to a bad outcome). Values are considered to show special variation if they -Go outside control limits -Have 6 points in a row above or below the mean, -Trend for 6 points, -Have 2 out of 3 points past 2/3 of the control limit, -Show a significant movement (greater than the average moving range). Variance from target charts are used to show how far away a variable is from it's target each month. Green bars represent the value the metric is achieving better than target and the red bars represent the distance a metric is away from achieving it's target. 2 December 2019 Improve Patient Journeys IPJ1-L Non Elective LOS Rolling 12 months IPJ2-N Delayed transfers of care (CQC Calculation) Oct Nov Dec Jan Feb Mar Apr May Jun Jul 7.5 6.70 6.0 8.96% 7.1% 5.26% Aug Sep Oct Nov Dec Monthly Target 6.41 =21days) 231.62 204.36 177.10 162 77.44 IPJ4 Outliers weekday (am) census average 50.48 22 23.51 196 IPJ10-N UHS Total (includes SGH all types and lymington until Jul 19) Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec QTD 88.8% 90% 80% 76.3% 77.3% 695% 3 3 5 9 7 9 7 7 6 6 5 4 72.4% 53 91.29% 83.4% 75.48% 90.7% 90.7% 78.3% 78.94% IPJ11- Local Delivery System L/N . 94.33% 88.2% 82.14% 92.9% 86.6% 86.87% Q Target 95% 95% L = 90% N = 95% IPJ12 Same Day Emergency Care (SDEC) 70 IPJ13-N Time to initial assessment 95th Centile UHS Total - 55 40 Awaiting national data definition - - 42 IPJ14-N Time to treatment Percentiles UHS Total IPJ15-N Total time spent in ED Total Percentiles UHS Mean, 1:34 50th, 1:21 Mean, 2:44 50th, 2:41 90th, 3:24 =92% 79.51% 34605 30633 - 0.5 5 9 10 8 9 10 6 8 3 6 5 7 8 6 IPJ21 The national average for this metric in November was 79.36% with UHS ranked 106th out of 155 organisations. IPJ22NL 62 day cancer wait performance 88.0% 76.5% 72.6% N=> 76.2% 90% L=> N = 23 L= 1 of 74% 77% 170.5 1 of 13 tumour sites achieved 62 day target in July. IPJ23NL 31 day cancer wait performance 97.1% 93.3% 89.5% N=> 96% N=70 88.05% L=> L=58 of 879 88% 95% IPJ24-N Urgent GP referrals seen in 2 weeks 96.8% 91.2% 85.6% 83.0% 97.5% => 93% 0 of 1544 97% 12 of 13 tumour sites achieved 2 week target in July. IPJ25 Snapshot of waits > 104 days 72 29 28 46 28 37 28 26 33 38 41 55 52 41 - - - 100% IPJ26 28 Day Faster Diagnosis 79% => 95% 231 of 1484 78% 70% IPJ26 - this KPI is being shadow monitored by UHS in preparation for national submissions beginning April 2020. There is no update this month 6 December 2019 1.30 Value Based Health and Care MMoonntthhllyy Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Target YTD YTD Target VB4-L Complaints per 1000 units 0.22 0.00 - 0.29 100% VB5-L % Complaints closed within 35 days 20% VB6 Urgent cancer referrals and Breast Symptoms referrals VB7 Number of first cancer treatments (i.e. 31 day activity) VB8 Total ED Attendances 40% 2,000 1,300 500 200 12,000 9,000 1704 1658 388 373 11967 10868 86% 70% Month QTD -46 +79 YTD +233 -2.7% +2.3% +1.7% +15 +9 +32 +4.0% +1.2% +1.1% +1099 +2505 +7371 +10.1% +7.9% +7.8% VB8: Lymington MIU removed. VB9 Non-elective Spells 6,700 6660 +273 +335 +1916 (incl. CDU) 5,000 6387 +4.3% +1.7% +3.4% 7 December 2019 VB10 Face to Face OPA Value Based Health and Care Monthly 65,000 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Target YTD YTD Target 51669 -4142 +3410 - 45,000 47527 -8.0% +0.9% - VB10/VB11: This currently excludes mymedical record contacts. VB11 8,500 Non-Face to Face OPA 5,000 7513 +347 +3225 +3225 7166 +4.8% +6.9% +6.9% 9.5 Total nursing staff all inpatient 9.1 VB12 areas - Care hours per patient day (CHPPD) 8.0 9.2 - The total CHPPD rate in the Southampton General has increased from last month to RN 5.7 (previously 5.6), HCA 3.5 (previously 3.4) overall 9.2 (previously 9.0).The CHPPD for ward based areas (excluding Critical care units) in in the Trust has increased from last month to RN 4.2 (previously 4.1) HCA 3.5 (previously 3.5) overall 7.7 (previously 7.6) 100 62 VB13 Red Flag staffing incidents 50 28 - 0 8 December 2019 Supporting Healthy Lives Monthly Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Target YTD YTD Target HL1-N Cumulative Clostridium difficile HL2 Number of pressure ulcers causing 2 moderate/severe harm 0 HL2 KPI commenced in April 2019, no historic data available HL3-N Medication Errors (severe/Moderate) 1 HL4 Serious Incidents Requiring Investigation (SIRI) 4 HL5-L Number of overdue SIRIs 6 30 6 49 49 =35% 100% HL7-N Neonatal admission temperature within range rate 40% HL8-N Bronchopulmonary Displasia (BPD) rate 100% 57% 80% 0% > =80% =20% =20% 80% > 90% > 90% 11 December 2019 EW1-L Staff - Turnover - Rolling 12-months An Expert and Inclusive Workforce Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Monthly Target 13.83% 13.22% 12.60% 13.0% 13.6% 92% =76% 30% 9.0% - 12 December 2019 Being Agile in Meeting People's Needs Estates Monthly Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Target 2500 1771 1724 - R-3M - BA1-L Number of Help desk requests and percentage completed on time 1000 100% 85% 81.0% 77.2% > 85% 77.3% 50% 1500 Reactive Maintenance BA2-L Unresolved help desk requests 1000 750 838 85% 82.5% - - 222 > 95% 98.2% 97.3% 13 December 2019 BA6 Monthly average unavailable toilets (%) Oct 1% Being Agile in Meeting People's Needs Monthly YTD Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Target Target 0.53% 0.47% 0.51% 0.32% 0.80% 1.00% 0.49% 0% BA6 - This KPI is intended to be a proxy of the impact of maintenance work that is not completed on patients and staff. 9,000 BA7 Number of computers 8,000 7,000 4.0 7899 7971 8144 8181 BA8 Average age of computers (years) 3.5 3.9 3.9 3.0 95% BA9-L Percentage specimens requested through eQUEST - rolling 3M 89.3% 3.9 3.8 4.0 > =95% - 85% 95% BA10L Percentage specimens available for acknowledgment through eQUEST - rolling 3M 85% 200,000 BA11 digiRounds patient records accessed 100,000 0 91.4% 47,681 > =95% - 151,538 14 December 2019 Being Agile in Meeting People's Needs Monthly Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Target eQuest Results Alerts Sent 20,000 BA12 Decision support notifications (email alerts) 10,000 0 20000 8693 BA13 Medxnote 10000 BA14 InfoQlik (Daily) Activity BA15 Sap BI (Daily) Activity 0 50 23.2 0 50 31.8 8430 29.8 27.4 0 44,800 BA16 My Medical Record - Cumulative UHS patient registrations 22,400 0 10,000 BA17 My Medical Record - UHS patient logins 0 1,697 718 21,727 2,447 15 December 2019 Leading Edge Research, Education and Innovation Comparative CRN Recruitment Performance Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec LE1-L Non-weighted 8 7 7 10 9 YTD YTD Target - Top 10 LE2-L Weighted 2 2 3 - Top 5 5 6 LE3-L Contract commercial 12 13 - Top 10 13 16 15 LE4-L Comparative CRN Recruitment performance by clinical specialty 42% 50% 58% 44% 52% 52% 50% Proportion of studies closing in FY on 75% 71% 59% 68% 65% LE5-L time and to recruitment target - 65% 80.00% commercial Proportion of studies closing in FY on LE6-L time and to recruitment target - 50% 46% 56% 65% 65% 65% 80.00% non-commercial 16 December 2019 Leading Edge Research, Education and Innovation Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec LE7-L NIHR CRF & BRC publications Year on year growth 581 385 246 137 Quality of practice experience for LE8-N doctors in training (annual report with quarterly qualitative updates) Minor Risk 100 78 LE9 Number of Apprenticeship Starts 0 Minor Risk 30 Minor Risk 12 Minor Risk 28 Minor Risk YTD Target No risk - 17 Quarterly Patient Safety Report Sep 19 – Nov 19 • The NHS Patient Safety Strategy. Safer culture, safer systems, safer patients was released in July 2019. Link to document: NHS safety strategy. UHS is developing our own UHS patient safety strategy planned launch April 2020. A safety culture workshop was held in early December. • One Never Event was reported in this quarter. Discussions are ongoing with NHSE regarding the categorisation of a miss placed NG tube in a paediatric patient. • There were 12 new SIRI cases and 1 Never event reported to SISG and 1 infection prevention SIRI During this period we report 1 new ophthalmology SIRI • The trust has meet the 95% target for VTE assessments since October 2019 • Work is continues to develop guidance to standardise the definition of harm for patients on RTT or cancer pathways who are waiting for treatment outside of agreed national standards, a paper has gone to Quality committee to approve process. • RCA’s completed for 12 hour trolley breeches in ED (these are predominately mental health patients) are now being clinically reviewed to ensure there are no clinical, patient safety or safeguarding concerns and that learning is identified where relevant. • In relation to lying and standing blood pressure (BP) – Safetrack has been further support completion based on staff feedback by enforcing an antisocial hours logic and providing a 3 minute capture option. Reports available at local level for clinical leaders to monitor compliance. Education ongoing for lying and standing BPs including Health care assistant competencies. • The pharmacy team have redesigned how they measure medicines reconciliation to ensure it captures all eligible patients and matches the updated national definition. The focused review of areas where rates are significantly lower than target has identified three key areas (child health, oncology and women’s health). An action plan is being developed to resolve the shortfall in these areas. • Southampton City CCG have funded a Acute Kidney Injury (AKI) nurse led follow up clinic as one of their 2019/2020 QUIPP. This is already supporting a reduction in readmissions and improve safety netting for those with AKI stage 2 and 3. Work is ongoing to make this service business as usual and widen out to include West Hampshire CCG patients. • Incident report rates have continued to remain greater than the 35 per 100 bed days. Which is line with a positive reporting culture. • Full time Falls lead in post until April 2020 Current focuses are QI development for the CQUIN and falls policy, review of the falls policy, especially head injury guidance and management, and Trust wide education development. • In the first week of October UHS took part in a national NHSI audit to check the skin of every adult and child inpatient over 3 days. Results have been submitted to NHSI. • UHS held a workshop to review the concept of adopting the principle of a patient safety zone in November. Patient safety zone • Year to date we have had 4 deaths following high harm falls (1 Div A, 2 div B and 1 Div D) • An in depth review of the increased incidence of pressure damage in CICU has demonstrated that this is reflective of the co-morbidities and acuity of the patients and not poor practice. • 4 cases ar
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Trust-governance-and-corporate-docs/2020/Papers-Trust-Board-30-January-2020.pdf

Infective conjunctivitis - patient information

Description: We have given you this factsheet because your child has been diagnosed with infective conjunctivitis. It includes what infective conjunctivitis is, how it is treated and how you can reduce the spread of infection.
Url: /Media/UHS-website-2019/Patientinformation/Eyes/Infective-conjunctivitis-2361-PIL.PDF

Annual-report-24-25-final

Description: 2024/25 Incorporating the quality account University Hospital Southampton NHS Foundation Trust Annual Report and Accounts 2024/25 Presented to Parliament pursuant to Schedule 7, paragraph 25(4)(a) of the National Health Service Act 2006 © 2025 University Hospital Southampton NHS Foundation Trust Contents Welcome from our Chair and Chief Executive 7 Performance report 9 Introduction from the Chief Executive 10 Overview 11 Principal risks to our strategy and objectives 16 Performance overview 17 Performance analysis 22 Quality priorities 29 Financial performance 33 Sustainability 33 Social, community, anti-bribery and human rights issues 34 Events since the end of the financial year 35 Overseas operations 35 Equality in service delivery 35 Going concern 41 Accountability report 42 Directors’ report 43 Remuneration report 69 Staff report 82 Counter fraud 98 Code of governance for NHS provider trusts 98 NHS System Oversight Framework 99 Statement of the chief executive officer’s responsibilities as the accounting officer of UHS 100 Annual Governance Statement 102 Scope of responsibility 102 The purpose of the system of internal control 102 Risk management and control within the Trust 102 Review of economy, efficiency and effectiveness of the use of resources 116 Quality account 119 Part 1: Statement on quality from the Chief Executive 120 Part 2: Priorities for improvement and statements of assurance from the Board 122 Part 3: Other information 194 5 Annual accounts 241 Statement from the Chief Financial Officer 242 Auditor’s report including certificate 244 Foreword to the accounts 251 Statement of Comprehensive Income 252 Statement of Financial Position 253 Statement of Changes in Taxpayers’ Equity 254 Statement of Cash Flows 256 Notes to the accounts 257 6 Welcome from the Chair and Chief Executive Officer University Hospital Southampton NHS Foundation Trust (‘UHS’ or the ‘Trust’) has experienced another challenging year, with increased demand for the Trust’s services, a more restrictive financial environment, and changes in terms of the organisation of the NHS in England. Despite the challenges faced by the Trust during 2024/25, we can feel incredibly proud of the achievements of our 13,000 staff, who went above and beyond to deliver for our patients and the communities we serve. Particular highlights include: • In the top 15 in the country against government targets for elective recovery performance with 127% of activity compared with 2019/20. • Top-quartile performance against most performance metrics compared to similar sized teaching hospitals, including long-waiting patients on referral to treatment pathways, diagnostics and cancer performance. • Delivery of £85.3m of savings through our cost improvement programme – the highest ever amount by the Trust. We continue to be one of the best performing trusts in England in many areas. The Trust’s elective recovery performance places it as one of the best performing trusts in England. As a result, we have seen the number of long-waiting patients fall to one patient waiting over 78 weeks and to 21 patients waiting over 65 weeks – in many instances these delays were due to a national lack of corneal transplant tissue. This is despite an increase in the number of patients being referred to the Trust for treatment. Our performance against key cancer metrics has seen an improvement in commencing treatment of cancer within 62 days to 81% by March 2025, against the NHS England average for 2024/25 of 70.5%. Similarly, the Trust performed in the range of 88%-96% during the year against the target of patients commencing treatment within 31 days of diagnosis. There has been significant demand for non-elective care throughout the year, which has placed significant demands on the Trust’s emergency department. There were frequently more than 400 attendances per day and the Trust saw an average of 13,100 patients per month (2023/24: 12,700). As a result of this increased demand, coupled with issues with flow through the hospital and a high incidence of seasonal illnesses during the winter, UHS’s performance against the four-hour emergency department target has steadily declined over the course of 2024/25. The Trust also recorded a lower than expected death rate via the Summary Hospital-level Mortality Indicator (SHMI) and was one of 12 trusts in England out of 119 with lower than expected death outcomes. The Trust reported a deficit of £7m at year-end, which represents a significant achievement given the financial pressures we have experienced, such as significant demand for services above block contract levels, pay award pressures, and inflation. The Trust also saw its productivity improve during the year and delivered its highest ever performance under its cost improvement programme. 7 Despite the introduction of strict controls in early 2024, the Trust exceeded its target for workforce numbers during 2024/25 by 373 whole-time-equivalents. However, a significant proportion of this number was due to assumed reductions in the number of staff required to manage patients with no clinical criteria to reside in the hospital and patients with a primary mental health need not materialising. Instead, the number of both categories of patient continued to rise during the year, placing additional strain on the Trust’s capacity and reducing flow through the hospital as patients are unable to move in a timely way from the emergency department, to wards and then to discharge due to lack of capacity. Higher levels of staff absence during the winter months coupled with high levels of seasonal illness and consequent demand on the emergency department also necessitated the opening and staffing of surge capacity. Indeed, demand on the emergency department was so great during the year that surge capacity was required even outside of the typically busier winter period. Our people remain our greatest asset. Without our staff, the Trust would not be able to deliver for the communities we serve. We were pleased to see the results from the 2024 Staff Survey, which placed UHS above the benchmarking group across all the key people themes. In particular, there have been improvements in relation to satisfaction with immediate managers, flexible working opportunities, and staff recommending UHS as a place to work. UHS has also continued with its staff room refurbishment programme and made significant improvements to the prayer facilities for Muslim staff, patients, students and community members in our chapel, all funded by Southampton Hospitals Charity. We expect 2025/26 to be even more challenging than 2024/25. The Trust has already had to take some difficult decisions in terms of its workforce numbers, prioritisation for capital expenditure, and services. We will be expected to continue to maintain quality of patient care and experience and to deliver the required levels of performance whilst at the same time having to make significant reductions in its expenditure to deliver a balanced budget. Many of the challenges faced by the Trust – in common with other providers – can only be addressed by working in partnership with wider local partners, such as other healthcare providers, local authorities and charities to deliver system-wide solutions. At the same time, we recognise that there is more that we can do internally to ensure that our internal processes deliver in the most effective and efficient manner. We would like to express our heartfelt thanks to our amazing staff, who have gone and continue to go above and beyond to put our patients first and deliver world class care. Jenni Douglas-Todd Chair David French Chief Executive Officer 8 PERFORMANCE REPORT OVERVIEW AND PERFORMANCE Performance report Introduction from the Chief Executive Officer This was another challenging year for the Trust, continuing the trend seen in previous years of increasing demand which must be balanced with the need to deliver quality patient care whilst maintaining a sustainable financial position. The Trust saw even higher demand for non-elective care than in recent years with attendances at the emergency department being as high as 400 per day and the Trust having to open and staff surge capacity for a significant proportion of the year, including outside of the typically more strained winter period. The trend of increasing numbers of patients having no clinical criteria to reside in hospital, but unable to be discharged due to a lack of funded care in a more appropriate venue, continued, as did the increasing number of patients presenting with a primary mental health need. This placed significant pressure on the Trust’s resources due to the impact on flow through the hospital and the need to engage additional members of staff to manage these patients – in some instances this requires as many as four members of staff, usually via a specialist agency, for each patient as well as, potentially, additional security resource. Despite the challenges, the Trust continued to perform well when compared to other comparable organisations, achieving some of the best elective recovery performance in England at 127% compared to 2019/20 levels. The Trust implemented spending and recruitment controls in early 2024, which it continued to operate under during 2024/25, in order to manage its difficult financial position. However, the Trust ended the year above its plan in terms of workforce numbers, although a significant proportion of this amount was due to the increasing number of patients having no criteria to reside and mental health patients. The Trust achieved its highest ever delivery on its cost improvement programme with £85.3m of savings, and achieved an overall end of year deficit of £7m. 10 OVERVIEW AND PERFORMANCE Overview About the Trust Our services University Hospital Southampton NHS Foundation Trust is one of the largest acute teaching trusts in England with a turnover of £1.5 billion in 2024/25. It is based on the coast in southeast England and provides services to people living in Southampton and south Hampshire and specialist services, including neurosciences, respiratory medicine, cancer care, cardiovascular, obstetrics and specialist children’s services, to nearly four million people in central southern England and the Channel Islands. The Trust is also a designated major trauma centre, one of only two places in the south of England to offer adults and children full major trauma care provision. As a leading centre for teaching and research, the Trust has close working relationships with the University of Southampton, the Medical Research Council, National Institute for Health and Care Research (NIHR), Wellcome Trust and Cancer Research UK. The Trust is consistently one of the UK’s highest recruiting trusts of patients to clinical trials and one of the top nationally for research study volumes as ranked by the NIHR Clinical Research Network. Every year the Trust: treats around 166,000 inpatients and day patients, including about 75,000 emergency admissions sees over 770,000 people at outpatient appointments deals with around 155,000 cases in its emergency department The Trust provides most of its services from the following locations: • Southampton General Hospital – the Trust’s largest location, where a great number of specialist services are based alongside emergency and critical care, and which includes Southampton Children’s Hospital. • Princess Anne Hospital – located across the road from Southampton General Hospital and providing maternity care and specialist care for women with medical problems during pregnancy and babies who need extra care around birth. • Royal South Hants Hospital – although the Trust does not operate this site near the centre of Southampton, it provides a smaller number of services from this location. • New Forest Birth Centre – located at Ashurst on the edge of the New Forest and run by experienced midwives and support staff, it acts as a community midwifery hub. • Lymington New Forest Hospital – a community hospital located in Lymington managed by Hampshire and Isle of Wight Healthcare NHS Foundation Trust. UHS manages surgical services at the hospital. The services provided by the Trust are commissioned and paid for by the Hampshire and Isle of Wight Integrated Care System (ICS) and, in the case of more specialised services (such as treatments for rare conditions), by NHS England. 11 OVERVIEW AND PERFORMANCE Trust services are supported by clinical income, of which 53% is paid for by NHS England and 44% by integrated care boards, predominantly the Hampshire and Isle of Wight Integrated Care Board (ICB). These are provided under a standard NHS contract, which incorporates ongoing monitoring of the Trust and the quality of the services provided. Our structure UHS gained foundation trust status on 1 October 2011. A foundation trust is a public benefit corporation providing NHS services in line with the core NHS principles: that care should be universal, comprehensive and free at the point of need. The Trust is licensed as a foundation trust to provide these services by NHS England and the healthcare services we provide are regulated by the Care Quality Commission. Since 1 July 2022, the Trust has been part of the Hampshire and Isle of Wight Integrated Care System when this was established through the Health and Social Care Act 2022. Each ICS has two statutory elements: an integrated care partnership (ICP) and an integrated care board. The ICP is a statutory committee jointly formed between the NHS integrated care board and all upper-tier local authorities that fall within the ICS area. The ICP brings together a broad alliance of partners concerned with improving the care, health, and wellbeing of the population, with membership determined locally. The ICP is responsible for producing an integrated care strategy on how to meet the health and wellbeing needs of the population in the ICS area. The ICB is a statutory NHS organisation responsible for developing a plan for meeting the health needs of the population, managing the NHS budget and arranging for the provision of health services in the ICS area. The Trust has been a university teaching hospital since 1971. The diagram below provides an overview of the overall organisational structure of the Trust. Public and foundation trust members Council of Governors Board of Directors Executive Directors Division A Surgery Critical Care Ophthalmology Theatres and Anaesthetics Division B Cancer Care Emergency Medicine Helicopter Emergency Medical Services Medicine and Medicine for Older People Pathology Specialist Medicine Division C Women and Newborn Maternity Child Health Clinical Support 12 Division D Cardiovascular and Thoracic Neurosciences Trauma and Orthopaedics Radiology Trust headquarters division OVERVIEW AND PERFORMANCE Our values The Trust’s values describe how things are done at UHS and act as a guide to all staff working with colleagues to deliver high quality patient care and a great patient experience every day. These values are: Patients, their families and carers are at the heart of what we do. Their experience of our services will be our measure of success. Partnership between clinicians, patients and carers is critical to achieving our vision, both within hospital teams and extending across organisational boundaries in the NHS, social care and the third sector. We will ensure we are always improving services for patients through research, education, clinical effectiveness and quality improvement. We will continue to incorporate new ideas, technologies and create greater efficiencies in the services we provide. 13 OVERVIEW AND PERFORMANCE Our strategy 2021-25 The Trust’s strategy was updated during 2020/21 to take account of everything its staff had experienced during the COVID-19 pandemic and what had been learnt from this. The vision for UHS is to become an organisation of world class people delivering world class care. The Trust’s strategy is organised around five themes and for each of these it describes a number of ambitions UHS aims to achieve by 2025. Theme Ambitions Outstanding patient outcomes, • experience and safety By 2025 we will strengthen our national reputation for outstanding • patient outcomes, experience and safety, providing high quality care • and treatment across an extensive range of services from foetal medicine, through all life stages and conditions, to end-of-life care. Pioneering research and • innovation We will continue to be a leading • teaching hospital with a growing, reputable and innovative research • and development portfolio that attracts the best staff and efficiently delivers the best possible treatments and care for our patients. World class people • Supporting and nurturing our people through a culture that values • diversity and builds knowledge and skills to ensure everyone reaches their full potential. We must provide • rewarding career paths within empowered, compassionate, and motivated teams. Integrated networks and • collaboration We will deliver our services with • partners through clinical networks, collaboration and integration across geographical and organisational • boundaries. • We will monitor clinical outcomes, safety and experience of our patients regularly to ensure they are amongst the best in the UK and the world. We will reduce harm, learning from all incidents through our proactive patient safety culture. We will ensure all patients and relatives have a positive experience of our care, as a result of the environment created by our people and our facilities. We will recruit and enable people to deliver pioneering research in Southampton. We will optimise access to clinical research studies for our patients. We will enable innovation in everything we do, and ensure that ‘cutting edge’ investigations and treatments are delivered in Southampton. We will recruit and develop enough people with the right knowledge and skills to meet the needs of our patients. We will provide satisfying and fulfilling roles, growing our talent through development and opportunity for progression. We will empower our people, embracing diversity and embedding compassion, inclusion and equity of opportunity. We will work in partnership with key stakeholders across the Hampshire and Isle of Wight integrated Care System. We will strengthen our acute clinical networks across the region, centralising when necessary and supporting local care when appropriate. We will foster local integration with primary and community care as well as mental health and social care services for seamless delivery across boundaries. We will build on our successful partnership with University of Southampton (UoS), growing our reputation as a national leading university teaching hospital. 14 OVERVIEW AND PERFORMANCE Foundations for the future • We will deliver best value to the taxpayer as a financially Making our enabling infrastructure efficient and sustainable organisation. (finance, digital, estate) fit for • We will support patient self-management and seamless the future to support a leading care across organisational boundaries through our university teaching hospital in the ambitious digital programme, including real time data 21st century and recognising our reporting, to inform our care. responsibility as a major employer • We will expand and improve our estate, increasing in the community of Southampton capacity where needed and providing modern facilities and our role in broader for our patients and our people. environmental sustainability. • We will strengthen our role in the community as an employer of choice, a partner in delivery of services to our population and by leading the Greener NHS agenda locally. During each year of the strategy the Trust sets out a more detailed series of objectives to achieve and progress towards the delivery of its ambitions. In 2024/25 these objectives included: Outstanding patient Establishing an integrated approach to quality management. outcomes, experience Treating patients according to need but aiming to meet the target of zero and safety 65-week waiters by the end of September 2024, and continued reduction of longer waiters. Reducing length of stay across elective and non-elective pathways. Improving patient experience and outcomes through continued implementation of the Fundamentals of Care programme. Pioneering research and innovation Delivering year four of the research and innovation investment plan. Delivering year two of the five-year research and development strategy implementation plan for research for impact. World class people Delivering a workforce plan for the Trust for 2024/25 which is safe, sustainable and affordable. Delivering targeted improvements in staff experience, engagement and culture. Sustaining turnover at less than 13% and maintaining sickness absence at under 4%. Integrated networks In partnership with acute trusts working directly with priority areas to and collaboration progress joint network strategies. Working with the local delivery system on vertical integration to reduce the number of patients without criteria to reside. Foundations for the future Delivering a stretching financial plan for 2024/25, including identifying what needs to be true to recover a sustainable financial position and exit the Recovery Support Programme. Engaging the organisation in the challenge to manage demand so that capacity and demand are in equilibrium. Delivering the aims of the 2024/25 transformation programmes and always improving strategic priorities. Delivering the prioritised 2024/25 capital programme and setting a prioritised capital programme for 2025/26. Completing year two of the Public Sector Decarbonisation Scheme. 15 OVERVIEW AND PERFORMANCE Performance against these objectives was monitored and reported to the Trust’s Board on a quarterly basis. At the end of 2024/25, the Trust had met the objectives set as follows: Corporate Ambition Number of Green Amber Red objectives Outstanding patient outcomes, 4 3 1 0 safety and experience Pioneering research and innovation 2 2 0 0 World class people 3 2 0 0 Integrated networks and collaboration 2 0 2 0 Foundations for the future 5 2 2 1 Totals 16 8 6 2 Note: Green: achieved in full Amber: partially achieved Red: not achieved Particular areas to highlight where the Trust has achieved strong delivery during the year include: • Reduction in the number of patients waiting over 65 weeks, with only 21 waiting over 65 weeks. • Reduction in the length of stay by 5.25% through successful delivery of the inpatient flow transformation programme. • Implementation of the Fundamentals of Care programme. • Successful delivery of year four of the research and innovation investment plan. • Reducing staff turnover to 10.1% at year end and achieving a staff absence rate below 4%. • Progress in developing the identified priority clinical networks. • Successful delivery of the Trust’s 2024/25 capital programme. Principal risks to our strategy and objectives The Board has identified and manages the principal risks to the delivery of its strategy and objectives through its board assurance framework. The principal risks to the delivery of its strategy and objectives identified by the Trust during 2024/25 were that: • There would be a lack of capacity to appropriately respond to emergency demand, manage the increasing waiting lists for elective demand, and provide timely diagnostics, that results in avoidable harm to patients. • Due to the current challenges, the Trust fails to provide patients and their families or carers with a high-quality experience of care and positive patient outcomes. • The Trust would not effectively plan for and implement infection prevention and control measures that reduce the number of hospital-acquired infections and limit the number of nosocomial outbreaks of infection. • The Trust does not take full advantage of its position as a leading university teaching hospital with a growing, reputable and innovative research and development portfolio, attracting the best 16 OVERVIEW AND PERFORMANCE staff and efficiently delivering the best possible treatments and care for its patients. • The Trust is unable to meet current and planned service requirements due to unavailability of staff to fulfil key roles. • The Trust fails to develop a diverse, compassionate and inclusive workforce, providing a more positive experience for all staff. • The Trust fails to create a sustainable and innovative education and development response to meet the current and future workforce needs identified in the Trust’s longer-term workforce plan. • The Trust does not implement effective models to deliver integrated and networked care, resulting in sub-optimal patient experience and outcomes, increased numbers of admissions and increases in patients’ length of stay. • The Trust is unable to deliver a financial breakeven position, resulting in: inability to move out of the NHS England Recovery Support Programme; NHS England imposing additional controls/ undertakings; and a reducing cash balance, impacting the Trust’s ability to invest in line with its capital plan, estates and digital strategies and in transformation initiatives. • The Trust does not adequately maintain, improve and develop its estate to deliver its clinical services and increase capacity. • The Trust fails to introduce and implement new technology and expand the use of existing technology to transform its delivery of care through the funding and delivery of the digital strategy. • The Trust fails to prioritise green initiatives to deliver a trajectory that will reduce its direct and indirect carbon footprint by 80% by 2028-2032 (compared with a 1990 baseline) and reach net zero direct carbon emissions by 2040 and net zero indirect carbon emissions by 2045. As in previous years, demand for services continued to increase, especially for emergency (nonelective) care. The winter months in particular saw both high levels of demand and above average levels of staff absence due to seasonal illnesses. The Trust consistently experienced high numbers of patients having no clinical criteria to reside in hospital, but who could not be discharged due to a lack of appropriate care packages. This results in a lack of flow through the hospital and also requires additional staff to be engaged due to the need to open surge capacity. In addition, the Trust continued to experience significant challenges from patients with a primary mental health care need for whom there were insufficient spaces available in a more suitable alternative setting. Performance overview The Trust monitors a broad range of key performance indicators within its departments, divisions, directorates and through Trust executive committees. On a monthly basis, the Board and executive committee receives a performance report containing a variety of indicators intended to provide assurance in respect of the Trust’s strategy and that the care provided is safe, caring, effective, responsive, and well-led. This report also includes the Trust’s performance against the national targets set by NHS England. The performance reports include a ‘spotlight’ section, which provides more detailed analysis of a particular area. Typically, this is one of either the national targets or the Trust’s performance against the expectations set out in the NHS Constitution. 17 OVERVIEW AND PERFORMANCE The monthly performance report is also published on the Trust’s website. The Chief Executive Officer provides a regular report on performance to the Council of Governors, which includes a range of non-financial and financial performance information. Capacity The Trust experienced high demand for its services, continuing the trend from previous years. Demand in the emergency department in particular was significant, with attendances growing by 3.2% compared to 2023/24. This situation has resulted in a gradual decline in the Trust’s performance against the target of 95% patients spending less than four hours in the main emergency department. The number of patients having no clinical criteria to reside continued to impact flow within the hospital. The number of patients having no clinical criteria to reside was frequently above 250 at any one time during the year. The Trust experienced an increase in the number of referrals with the number of patients on a waiting list under the 18-week referral to treatment pathway rising from approximately 59,000 to 62,000 by the end of the year. Quality and compliance The Trust’s elective recovery performance was one of the best in England at 127% compared to 2019/20. The Trust continued to monitor the quality of care delivered throughout 2024/25 through a number of established quality assurance programmes. Clinical leaders monitored key quality, safety and patient experience indicators such as falls, pressure ulcers and venous thromboembolisms. The roll out of the Trust’s Fundamentals of Care initiative continued. High-quality peer reviews were consistently conducted, with a key focus on weekly matron-led quality walkabouts – both during and outside of standard hours – centred around the five CQC domains: safe, effective, responsive, caring, and well-led. Additionally, focused matron walkabouts were introduced to address specific themes related to patient safety and Fundamentals of Care standards, such as medication safety and infection prevention. These initiatives have been instrumental in identifying areas for improvement and promoting the sharing of best practices across teams. The Trust’s clinical accreditation scheme (CAS) builds on this intelligence, with clinical areas completing self-assessments of performance and review teams completing on-site visits. The clinical areas were supported by the CAS team from an initial contact meeting and walkabout through to outcome panel. Patient representatives were included in these review teams. CAS paperwork was reviewed to reflect the learning points from themed Matron’s walkabouts, aligning it to the CQC single assessment framework and the UHS Fundamentals of Care programme to ensure a robust ward accreditation. Learning was shared at the clinical leaders’ group and via reports. 18 OVERVIEW AND PERFORMANCE A framework was developed to govern Mortality and Morbidity meetings at the Trust, setting expectations for the content and format of these meetings. In addition, further work was carried out to ensure that the output from these meetings was shared more widely and that there is a clear escalation process. The Trust opened a patient and family support hub, repurposing the Macmillan Centre into a generic non-disease specific facility. The Trust worked with system partners to develop a unified and standardised approach to volunteer recruitment using a passporting system. The Trust commenced its implementation of the National Safety Standards for Invasive Procedures 2 (NatSSIPs 2). Violence, abuse and aggression against staff continued to rise. The Trust took action over the course of the year to support its teams, including through roll out of de-escalation training. This has had a positive impact and has reduced the requirement for physical restraint and has reduced the number of incidences of physical violence against staff. However, the level of violence and aggression directed at staff by patients and other members of the public continues to be an area of concern for the Trust. The Trust continued to build its always improving culture and drive on quality improvement by training over 1,000 staff, remaining 3% above the NHS average for all improvement focussed staff survey questions and winning an award for patient involvement in improvement and safety. This enabled improvements across theatre, inpatient flow and outpatient programmes. In 2024/25, average length of stay was reduced by 5.25%, an additional 1,230 patients were treated in theatres, and 7% of patients were placed onto patient initiated follow up (PIFU) outpatient pathways. Partnerships Further information can be found in the quality account. The Trust works within the Hampshire and Isle of Wight Integrated Care System and is an active member of a number of partner groups including the Acute Provider Collaborative Board and the Health and Wellbeing Board. The Trust develops and agrees its annual financial plans with the Integrated Care Board. The Trust is a member of a number of specific partnership groups for particular services, including the Central and South Genomics Medicine Service, the Children’s Hospital Alliance and the Southern Counties Pathology Network. The Trust works actively as a partner with other provider organisations around clinical networks, particularly with acute Trusts within the Integrated Care System and others closely located geographically. The Trust also links closely with the University of Southampton on a number of topics including research, commercial development and education and has a developed meeting structure to oversee this. 19 OVERVIEW AND PERFORMANCE Workforce The Trust’s key area of focus during 2024/25 was to maintain a flat workforce level in order to meet the Trust’s 2024/25 workforce plan. In addition, the Trust sought to reduce reliance on bank and agency staff. The Trust ended the year above its workforce plan by 373 whole-timeequivalents. A significant proportion of the expected reduction in staff numbers had been linked to expected delivery of reductions in the number of patients having no criteria to reside and mental health patients through system-wide transformation programmes. However, these reductions did not materialise. In addition, due to the significant demand on the Trust’s services, it was necessary to open and staff surge capacity. This was exacerbated by high levels of staff absence due to illness during the winter months. The Trust was successful in reducing staff turnover to 10.1%, achieving the local target of 75% of staff in each area has received training, including neonatal medical team. • Trolley dashes. • Train the trainer. Progress metrics Audit of compliance: • Has it been undertaken for the appropriate babies? • Was the frequency of observation undertaken correctly? • Was the score accurately calculated? • Did escalation take place if required? • Was the response to escalation appropriate? 157 QUALITY ACCOUNT Quality Improvement Priority Four: Implementation of the National Safety Standards for Invasive Procedures (NatSSIPs) 2 at UHS Core dimension Patient safety Rationale of selection The new National Safety Standards for Invasive Procedures (NatSSIPs 2) represent the progression of the original NatSSIPs. The key aim to standardise, harmonise and educate (SHE) across organisations and procedural teams remains central to the NatSSIPs purpose. Critical changes include bolstered organisational standards and proportionate checks that recognise different levels of risk during major and minor invasive procedures, and the adaptions to processes that may be necessary in lifethreatening situations. This standardisation, harmonisation and education goals are set out in the table below. Standardise Harmonise Educate Organisational Sequential (‘The NatSSIPs Eight’) Safety behaviours, processs, policies, insight, involvement and performance measures across organisations and specialities. Expected behaviour, safety standards, checklists and format across invasive specialities. Across groups of hospitals. Across IT systems. Reduce variation across specialities. Commit to safety education, human factors expertise and systems thinking. Create a safety infrastructure, leadership understanding and training in cultural change. Teach and train in team behaviours, human factors, systems thinking learning / co-production with patients. Investigations into the increase of never events in 2023 and 2024 has identified that the majority of these had contributing factors related to stop points for safety. The key learning identified: Thematic analysis of never events Surgical mark not visible/clear Not listening to patient concerns Change in surgical plan and lack of documentaion Lack of time out if concerns are raised Lack of triangulated checks Ability to speak up concerns Swab, sharp and instrument count process Implant checks not triangulating patent details Inexperienced staff with lack of familiarity of processs Lack of induction training in stop points Distractions during stop point checks 158 QUALITY ACCOUNT All these factors will be addressed through NatSSIPs2 implementation. Safer invasive procedures is to be included as a local quality indicator by the ICB within the 2025/26 national contract. Key aims • Establish a NatSSIPs oversight committee. • Set up an invasive procedures committee. • Establish the following workstreams: o Audit of stops point for safety in theatres and for minor procedures in outpatient and ward areas o Multi-disciplinary safety walkabouts o VLE and induction workstream • Education: recruitment of medical education led to set up simulation-based MDT training. • Patient involvement. • NatSSIPs eight and communications. • Stop points for safety staff resources. Progress metrics • Increase in the completion of VLE stop points training. • Develop and implement a programme to deliver non-technical skills to the MDT. • All areas with a never event in the last two years have an up to date audit and action plan for compliance with NatSSIPs2. 159 QUALITY ACCOUNT Quality Improvement Priority Five: Fundamentals of Care Core dimension Patient safety Rationale of selection The term Fundamentals of Care (FoC) describes the eight standards that staff across the Trust have committed to in collaboration with the patient, to support the physical and emotional needs of patients’, relatives, and carers. This is not a new concept, it underpins the core values of what it means to be a healthcare professional, to truly ‘care’ and will build upon our achievements in year one. Operational challenges have led the workforce to become more task-focused and less personfocused, taking away from that personalised care experience but we are committed to changing that culture, following our Trust value, patients first. The FoC exemplifies how the interdisciplinary team connects and builds relationships with our patients, getting to know them and what matters to them as a person, not just as a patient, supporting and encouraging independence and rehabilitation from the beginning of their hospital stay. These activities are the essentials of our daily living such as personal hygiene, skin care, oral hygiene, toileting, eating and drinking, and mobilising. Communication is also essential and includes both listening and hearing patients, understanding what is important to them using communication tools they need, coming to shared decisions with patients about their care and recognising the diversity of our population, embracing accessibility for those with people with learning disabilities, sight/hearing loss or other disabilities, or if English may not be their primary language. In addition, the FoC encourages us as healthcare professionals to consider the whole person, support cultural, spiritual, mental health, emotional wellbeing and dignity needs of people we care for and those that matter to them. We know here at UHS that not everyone experiences this level of care, but we acknowledge the need to change the rhetoric from ‘we are busy’ to ‘we are never too busy to care’ empowering and educating our staff at all levels to challenge the ‘we have not got time’ rhetoric and ensure fundamental care is at the heart of what we do at UHS. Thus improving, patient care and experience. Key aims We will grow the multi-disciplinary engagement and involvement in workstreams that embrace the FoC and encourage person centred to care. We will continue to pursue the digitalisation of the Friends and Family Test (FFT), using this data and the national inpatient and urgent and emergency care survey as a baseline, while linking with involved patients where required with to encourage feedback on the FoC. We will listen to the voice of our patients, their relatives, and carers to make sure their stories and experiences are heard by our workforce to encourage the organisation wide change. We will ensure the FoC will has clear and measurable improvement metrics as part of a live clinical quality dashboard that will afford ward managers and senior leaders, the opportunity to monitor, review and report on to FoC in their areas. 160 QUALITY ACCOUNT We will embed the FoC into the matron walkabout and CAS processes, supported by consistent evaluation metrics that ask the patients about their experiences and encourage clinical areas to continually assess and evaluate the FoC in their areas through a self-assessment tool. We will enhance the availability of existing resources on our virtual learning environment (VLE) in collaboration with our patient partners for all staff groups and embed the FoC into training across the organisation, to improve the knowledge, skills and awareness ensuring the delivery of quality care. We will continue to test and evaluate the What Matters To Me project, growing our volunteer role to support staff in finding out what is important to the patient and using their personalised board to remind staff of the ‘person’ they are caring for. We will continue to establish project links in child health, maternity and outpatients to ensure a bespoke, but collaborative roll out of FoC, considering how these different care environments may impact care. Progress metrics • Patient hygiene: we will see an improvement in the number of patients who report having their personal care needs met, particularly within their first 24 hours coming through emergency admission routes. • Skin integrity: we will support the reduction in incidences of avoidable pressure ulcers across the organisation. • Communication: we see an increase in the number of people accessing our interpreting services and a reduction in complaints related to interpretation. • Pain: we will see an improvement in patients reporting that their pain was well controlled when coming through the emergency department. • Mouthcare: we will see a positive uptake in the implementation of the new mouthcare assessment tool and an improvement in patients reporting that their oral hygiene needs have been met. • Nutrition and hydration: we will see an increase in patients reporting they are being offered adequate food and drink provisions throughout their hospital stay, including access to equipment for those with conditions or disabilities that impact their ability to do so independently. • Bowel and bladder care: we will see improved assessment of bowel and bladder habits through increased documentation using the Inpatient Noting system. • Enhancing safe movement: we will support a reduction in the incidence of high harm falls and high harm falls that have preventable causes. • Infection prevention: we will see a reduction in nosocomial infections through increased hand hygiene standards and more effective cleaning of equipment. 161 QUALITY ACCOUNT Quality Improvement Priority Six: Develop the Trusts’ approach to reducing the impact of health inequalities (HIs) (year two) Core dimension Clinical effectiveness Rationale of selection Tackling health inequalities is a key priority for the NHS. At UHS we have been working to have an impact on health inequalities for several years. In 2024/25 we formalised these efforts with a governing board, chaired by our chief medical officer and with a clear programme of improvement based on recognised priorities. This formed the basis of our quality priority in 2024/25. This year’s quality priority is a continuation of the work that started in 2024/25. We intend to continue to grow our understanding and actions as an organisation, improving the equity of access, outcomes and experience of our services across our community. Key aims We are continuing our health inequalities board, with focus on five priorities: enabling our organisation, data and measurement, clinical service priorities, communication and engagement and strategy and approach. Each of these priorities have aligned directors to oversee improvement and a detailed delivery plan. Key priorities and expected outcomes from each of these are listed below: Enabling the organisation • Developing supporting structures: set up governance so that teams who identify health inequality related issues know where they can go for help, so that we can understand frequently arising challenges and notice when a problem raised might be affecting other of the hospital too. This will aid improvement, learning from issues identified and escalation of issues that cannot be resolved locally • Capability building: develop training for our staff to understand health inequalities, identify them within services and access tools to make improvement. • Delivery of the health inequalities officer role: grow knowledge of the health inequalities officer role across the organisation and utilise this role to share knowledge, training and support improvements. Data and measurement • Continue to develop our understanding of inequalities in access across outpatients and diagnostics, inpatients, theatres and the emergency department. • Enable the measurement of improvement in areas recognised as clinical priorities. • Enable completion of national reporting. Clinical priorities • Improve services and support for patients and staff with obesity (children and adults). • Improve identification and control of hypertension. • Improve services and support for patients and staff who smoke. 162 QUALITY ACCOUNT Communication and engagement • Adopt health inequalities into leadership and decision making. • Learning from our communities and our staff. • Communicating improvements internally and externally. • Staff support campaign. Strategy and approach • Overseeing and agreeing UHS approach and strategy for HIs. • Overseeing annual delivery against priorities. • Aligning programme resource. • Maintaining collaborative working with public health and Integrated care board teams and other local healthcare providers. • Keeping up to date with national recommendations and expectations, sharing this knowledge with our organisation. • Overseeing trust-wide improvement and health inequalities maturity. Progress metrics • Increasing numbers of staff trained. • Numbers of health inequalities issues reported (expected to increase through understanding before reducing due to improvement work). • Case studies shared of successful improvement projects. • Increased involvement and collaboration with patients and public on improvement. • Increased use of QEIA templates in decision making. • Demonstration of improved access to care for obesity, tobacco dependency and hypertension. 163 QUALITY ACCOUNT 2.3 Statements of assurance from the Board This section includes mandatory statements about the quality of services that we provide relating to the financial year 2024/25. This information is common to all quality accounts and can be used to compare our performance with that of other organisations. The statements are designed to provide assurance that the board of directors has reviewed and engaged in crosscutting initiatives which link strongly to quality improvement. 2.3.1 Review of services During 2024/25 UHS provided and/or sub-contracted 118 relevant health services (from total Trust activity by specialty cumulative 2024/25 contractual report). UHS has reviewed all the data available to them on the quality of care in all these relevant health services. The income generated by the relevant health services reviewed in 2024/25 represents 100% of the total income generated from the provision of relevant health services by UHS for 2024/25. 2.3.2 Participation in national clinical audits and confidential enquiries The UHS clinical audit programme was developed in support of the Trust’s vision by putting patients first, working together and always improving. This leads on to a specific strategy for clinical outcomes, to ensure robust and measurable processes are in place to plan locally and participate strategically. Healthcare Quality Improvement Partnership (HQIP) produces a National Clinical Audit & Enquiries Directory which identifies those national audits which are included in the NHS England Quality Account List 2024/25, those audits which are part of National Clinical Audit and Patient Outcomes Programme (NCAPOP). NCAPOP audits are commissioned and managed on behalf of NHS England by HQIP. These collect and analyse data supplied by local clinicians to provide a national picture of care standards for that specific condition. On a local level, NCAPOP audits provide local trusts with individual benchmarked reports on their compliance and performance, feeding back comparative findings to help participants identify necessary improvements for patients. The audits listed on the NCAPOP are ‘must-do’ national audits. The quality accounts national clinical audit list includes audits which we regard as ‘best practice’ to participate in (in addition to those from the NCAPOP) and for that reason we always include these in our corporate audit plans as a priority where they are relevant to our Trust. UHS has a strong history for completing clinical audits. The clinical effectiveness team has a robust approach to governing and supporting the completion. We’ve opened discussions with senior clinical leadership within Hampshire and Isle of Wight Integrated Care Board regarding the current challenges with contributing to and using the outputs of national audits. Benchmarked data resulting from national audits provides strong guidance on areas of excellence and improvement, however completion can be challenging in its compl
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