From Board to Ward – November 2024

Our staff are working extremely hard, with incredible purpose and resolve to improve timely access to care for patients. We are making progress on urgent and emergency care and we’re in the middle of a rapid sprint to try to speed up the rate of progress. Our Board leaders also heard about our Secret Garden, why it’s award-winning and the profound difference fresh air and this beautiful space makes for patients and families. In November’s Board to Ward we share three key highlights to demonstrate key progress, decisions made and share in an open and transparent way some developments and learning:

• How much our patients and their families value the Secret Garden
• Improving timely access to care for patients
• Building more space to care – the new Dartmoor Building

Secret Garden

“I felt honoured and privileged to be able to take a critically ill baby down to the garden and it was one of the proudest moments in my career. I have never felt such a feeling of accomplishment and it was quite surreal having such a sick baby and all our medical equipment outside in the sunshine (this was the first time we as a unit had done this). I still remember parents and staff becoming emotional when we made it outside. It was a beautiful afternoon and one I will never forget”– Staff Member

A multi-disciplinary team of doctors, senior nurses, neonatal nurse consultants and therapists (Kate Tantam, Jude Fewings, Dr. Mel Philipps and Diane Keeling) told our Board leaders the story of our Secret Garden and garden room today. The garden, which is in a lightwell in the middle of Derriford Hospital, first opened on Christmas Eve in 2018. As Kate Tantam described, everything about this project has come from what patients and their families told us they wanted and the project has been co-designed with patients every step of the way.

It was inspired by one patient in particular who had been with us for a long period of time and who loved dogs and the outdoors. For a number of reasons we couldn’t bring his dog into the Intensive Care Unit (ICU) but he longed to be outdoors, so the ICU team used to take him outside so that his dog could come and visit him. With this particular patient and others, the team soon saw the value of giving patients the opportunity to be normal, to feel fresh air, to feel rain, to feel wind and how natural light helped patients reconnect with their natural sleep-wake cycles and so the idea for the garden was born.

Derriford Hospital was the first hospital in the UK to take patients outside during a pandemic for care. It became only the second hospital in the country to have a secret garden room when, with the support of charitable funds, a space was opened in 2022 as part of the garden with piped oxygen, power, skylights, glass walls and the feeling of bringing the outside in.

Kate and the team talked about the impact for patients – the joy for one woman of being able to celebrate her birthday in the garden, achieving her wish of being able to hold her baby grandson on her 70th birthday.? Dr. Mel Philipps and Diane Keeling described, for the families of neonatal babies who are receiving palliative care, the importance of being able to make memories together as a family in the garden. The team made the point repeatedly that the little things – feeling the fresh air and sun on their face - are really the big things for patients and their families.

Kate is now undertaking a PhD research and has written guidance around transferring critically ill patients to the outdoors and one of the reasons the Secret Garden work has won two national awards is because our team are now supporting other hospitals to create gardens for their patients.

Improving timely access to care for patients

We are on a sprint to accelerate the action of our One Plan to improve Urgent and Emergency Care. The 4-week sprint is accelerating work on the three key pillars of the One Plan to improve Urgent and Emergency Care: Admission avoidance, Dynamic Flow and Timely Discharge. Since mid-September we have seen a rise in admissions. This is related to a 10% increase in the number of patients attending as emergencies.

We have opened a Community Frailty Virtual Ward with Livewell Southwest this month. The aim of the Community Frailty Virtual Ward is to provide holistic, integrated and proactive care for frail individuals through a virtual ward, specifically for those who are at risk of imminent deterioration that would result in admission to hospital. Additionally, it aims to provide an alternative for early supportive step down from hospital for patients to continue their recovery at home. We will be able to care for 21 patients on this community virtual ward by December.

We have now introduced an x-ray car to attend patients who have fallen at home or in the community. The mobile x-ray team, staffed by Radiographers and Imaging Support Assistants, has helped to prevent 10 patient referrals so far from needing an ambulance to convey them to the emergency department for a scan. The pathway has received overwhelmingly positive feedback from patients and families who were very grateful to avoid long delays, and a very busy emergency department. All patients have been followed up with an appropriate care plan for their injury and have received excellent support from community teams who have been pivotal in making this pathway a success. Once operating at full capacity, it is expected this service will help to keep over 1000 patients a year out of hospital and cared for in the comfort of their own home, releasing 12,000 bed days per annum.

Patients being seen more quickly

More patients (consistently >65%) arriving in our urgent and emergency areas are being seen, treated and admitted or discharged within 4 hours. But in October we narrowly missed our target of 67% achieving 66.5% of patients being seen, treated and admitted or discharged within 4 hours.

Here are some other updates on our performance for patients:

• We are reducing long waits for patients needing operations. We have zero patients waiting 104 weeks. We are aiming for zero patients waiting over 78 weeks by the end of December but are currently forecasting 35 (20 x Neurology, 9 x Orthopaedics, 5 x Cardiac Surgery and 1 x Urology). Of these 35, 15 involve delays due to patient choice.
• The Trust has achieved the Cancer Faster Diagnosis Standard (FDS) for the 6th consecutive month ensuring delivery of a diagnosis within 28-days of referral for the majority of our suspected cancer patients. We also are exceeding the national average for providing treatment within 62-days of referral.
• Ambulance Handover Delays: after 2 months of improved ambulance handover performance, we reported an increase in ambulance delays in Oct 24 with 5,917 hrs lost against a plan of 3,588. This compares with 3,777 hrs lost in Sep 24 but remains a significant improvement on the same time last year (Oct 23 = 8,906).
• % of beds taken by patients who are medically well to leave: We have reported 5 consecutive months above plan for patients with No Criteria to Reside with 10.6% of bed capacity used by patients who are well enough to leave in Oct 24 against a plan of 9.0%. This is the equivalent of 91 patients with no criteria to reside occupying our beds each day throughout October.

Urgent Treatment Centre at Derriford Hospital taking shape fast

The Dartmoor Building is a significant new 3-storey building currently being constructed at the edge of the Derriford Hospital campus. The ground floor of this new building will be used for a new Urgent Treatment centre (UTC) and also as a new home for the Fracture Clinic.

The Dartmoor Building will directly support Urgent and Emergency Care improvements, in particular reducing ambulance handover delays and reducing waits in the Emergency Department. Providing an alternative ‘walk-in’ front door for urgent and emergency care, creating additional capacity and decompressing the existing Emergency Department.

The new purpose-designed Fracture Clinic will provide improved accommodation that will benefit staff and patients. It is a key enabler for the new Urgent and Emergency Care Building, funded under the government’s New Hospital Programme. The old Fracture Clinic will be used to relocate the paediatric emergency department whilst the new Urgent and Emergency Care Building is being constructed.

The upper floors of the Dartmoor Building will be used to relocate our outpatient department from the Derriford Hospital building which will provide modern, patient centred facilities on the first floor, which will improve patient experience dramatically. The second floor has been designed to include sound proofed pods to facilitate virtual wards and telephone or video consultations. The relocation of outpatients from the hospital will allow the space to be repurposed to provide additional Same Day Emergency Care facilities.

The Dartmoor Building is being constructed at rapid pace with the ground works, steel frame and floors all complete and the cladding is being erected. The building will be complete in two phases, with the UTC opening first, followed by the remainder of the building in Spring 2025.

Every month our Board leaders meet in public.

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