Our Performance in 2021-22 - Maz Fosh, Chief Executive

Last time when I was writing an overview of the year I said that it’s been one of the most exceptional years we have ever faced. However, looking back at 2021/22 I can equally say that the last 12 months have been unprecedented, and they were dominated by the response to, and recovery from, the COVID-19 pandemic. Throughout that time our teams, yet again, have gone above and beyond to ensure our core services continued to provide care and as the year has progressed, we were also able to move on to restore and recover many of our services to be able to deliver more care close to home.

Our staff and volunteers have shown resilience and they were innovative in adapting practices and services to ensure that our patients have continued to get the very best care and treatment. The commitment and dedication of all colleagues to making a difference in these challenging times is truly inspiring. We have seen new care pathways being developed and services being remodelled and redesigned to offer a mix of face to face and virtual assessments and therapy groups. These improvements and changes have been supported by best practice guidance and research evidence.

We carried on with embracing new ways of working offering more services digitally to suit patient’s needs, but the bulk of our services and treatments continue to be delivered face to face. We also continued our partnership with the Lincolnshire Clinical Commissioning Group and United Lincolnshire Hospitals NHS Trust to provide the county’s two vaccination centres in Lincoln and Boston enabling hundreds of thousands of people to receive their COVID-19 vaccine. LCHS is committed to supporting the vaccination and booster programme in 2022/23 as it is rolled out to more age groups. We’re also proud of the role the Sidings Medical Practice played as a vaccination hub within its local Primary Care Network. Our county has made significant progress to date and we have performed well in comparison to other systems.

We recognise that our staff are our most valuable asset. Their collective, collaborative work both within LCHS and with our key health and social care partners, has enabled us to sustain delivering quality care. Supporting our staff wellbeing through these challenging times remained our focus in the last 12 months. We have strengthened and expanded our “Holistic Health” offer including training more colleagues as Mental Health First Aiders and we continued to offer emotional wellbeing support through Lincolnshire Staff Wellbeing Hub. I recognise that it has not been the easiest time for those joining our organisation during the COVID-19 pandemic, so in 2021 LCHS launched a new employee support group where staff can meet new faces, discuss new experiences, and reflect on their first month or two with us. We also continue to strengthen our staff networks and staff groups.

We regularly ask for feedback from our colleagues via the National Quarterly Pulse Surveys (which replaced Staff Friends and Family Test) which measure how engaged our staff feel in the trust. Evidence clearly shows that good staff experience is directly linked to better patient experience and outcomes. Our response rate to the NHS staff survey 2021 was 62% which is higher than average for other community trusts and our results are comparable or above with the national results from our benchmarking group. We know that last year has been difficult for many colleagues due to the challenges of COVID-19 pandemic and increased demand on many services and staff feedback reflects this. I was reassured by the positive responses on patient care, with high scores from staff agreeing that their role makes a difference and that patient care is our top priority. We will spend some time with our leaders and staff to look at their feedback and target our focus for future improvements.

In 2021, amidst our ongoing response and recovery from COVID19, our trust entered its tenth anniversary of being established as an independent NHS trust to provide general and specialist community healthcare services within local communities. We celebrated it with blogs, Feature Focus articles and case studies from our staff.

In 2021-22 the Care Quality Commission (CQC) visited two GP practices that are run by LCHS. Spalding GP surgery has been rated as ‘requires improvement’ following inspection in November 2021. When we took on the Spalding GP Surgery as a caretaker in 2018, it was rated ‘inadequate’ and placed in special measures. Since then, we have focused on improving the services offered to the local population. The latest CQC report identifies these improvements and the inspectors recognised that the practice had put a lot of effort into addressing previous safe care and treatment issues. We recognise that there are still areas we need to work on, and we have used the CQC feedback to guide us to make further improvements. Sidings Medical Practice in Boston was also visited by the CQC in January 2022 and the inspectors rated it ‘good’ for having effective, caring responsive and well-led services. We wanted to thank colleagues in both practices for their support in the run up to and during the CQC visits.

Our staff have risen to the challenge during an intensive period of crossover between safely managing to provide essential services despite the ongoing pandemic and restoring and recovering our services to pre-COVID levels where possible. Please do take a look at our highlights of the year of our performance and achievements over the last 12 months. A few key points I’d like to draw your attention to include:

• Improvements and developments in urgent care services, including brand new UTC facilities in Lincoln.
• We said farewell to our colleagues in Peterborough UTC as the service moved to the new provider.
• We implemented a new Urgent Community Response service supporting adults who have urgent care needs and who otherwise may need to go to hospital. This service has made a real, measurable impact on the people of Lincolnshire in its first six months.
• We continued our work with COVID-19, frailty and cardiac virtual wards collaborating with other partners to enable patients to continue their supported recovery at home
• LCHS remained the lead provider for the two Lincolnshire vaccination centres and the programme made excellent progress in vaccinating the population across the county

From 1 April 2021 Lincolnshire became an Integrated Care System (ICS) enabling us to progress with our ambitions of reducing health inequalities and improving outcomes for our patients. Better Lives Lincolnshire is the name of the ICS for our county bringing together hospital, community and mental health trusts, GPs and other primary care services with local authorities and other care providers. Better Lives Lincolnshire exists to improve the health of all residents, better support people living with multiple and long-term conditions, preventing illness, tackling variation in care and delivering seamless services while getting maximum impact for every pound.

While 2021/22 was not the COVID-free year that we were all hoping for, our learning as a result of the pandemic helps us to give a new dimension to Lincolnshire community services. Digital solutions, redesigned pathways and effective, safe and timely referral and discharge processes will be continued and will help us shape the possibilities of the future community health care provision in Lincolnshire.

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

Our year-end financial position met the required break-even expectations set by NHS England. The £3.2m has efficiency target has been delivered (55% recurrently). Capital expenditure of £2.3m has been invested in clinical equipment, estates, and information management and technology (IM&T). The trust continues to manage and maintain a healthy cash balance.

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

Service developments and initiatives

Urgent Treatment Centres

Spalding’s Minor Injury Unit was upgraded to an Urgent Treatment Centre (UTC) with extended opening hours from 8am to 8pm. This change underlines LCHS’s commitment to provide a consistent level of urgent care services across Lincolnshire and to safeguard the county’s busy A&E services for those who really need them. We have also introduced bookable appointments available via the NHS111 service in all of our UTCs, which gives our patients the opportunity to get the care they need at a time that suits them.

As part of the transformation of emergency care at Lincoln County Hospital, patients needing urgent care are now being treated in a new £3.5 million purpose-built centre. The new state-of-the-art Urgent Treatment Centre provides a bright and welcoming entrance for the whole of the emergency department, including a new reception and waiting area that follows the latest social distancing guidance, as well as 10 treatment rooms, a new X-ray and dedicated triage areas. The centre has been built next to the A&E department, allowing patients to be booked in at reception, assessed and treated in the right place for their needs.

Following a joint delivery with ULHT of temporary Urgent Treatment Centre in Grantham Hospital as part of response to COVID-19, the service has reverted back to an A&E (between 8am to 6.30pm) run by the acute hospitals trust from 30 June 2021. LCHS continues to provide GP out of hours service with an enhanced walk-in service in the evenings.

In June 2021 we also said farewell to our colleagues from Peterborough UTC as the service moved to a new provider. We would like to thank all staff who worked in the service, especially as urgent treatment centres played a crucial role in supporting acute hospitals and primary care during the COVID-19 pandemic.

Urgent Community Response

Urgent Community Response is a new service in Lincolnshire that only launched in October 2021 but has already made a measurable impact on local people. At LCHS, we believe that people are recovering better when they are at home or their place of residence. Staying at home allows them to be more independent and live healthy lives for as long as possible. However, sometimes patients may need urgent support to continue to stay at home and avoid going to hospital. This is where urgent community response service plays its part in supporting patients with urgent care needs who otherwise may need to go to hospital. The service covers the whole county – there's no variation in service offered throughout Lincolnshire. On receiving a referral, the team will assess the patient's needs and offer support within 2 hours. Between October 2021 and March 2022, the service supported 570 patients, with 424 (74%) of them being able to remain at home while under the care of the UCR service. These patients avoided distressing trips to A&E. Only 72 patients (12%) who were assessed and received an urgent community response needed to attend an acute hospital.

Typical patients who would require support from this service are older adults, people whose health deteriorated because of long-term conditions, people who had a fall without injury and people with increased confusion, dementia or frailty.

Virtual wards

To help with releasing capacity in acute hospitals and continue providing care closer to home, LCHS together with other partners has developed three virtual wards: cardiac, COVID-19 and frailty. The virtual ward involves teams from across the health and social care services in the county. This collaboration involves everyone from community healthcare services, GP services, local council, hospital and also other clinicians.

The virtual ward enables a safe discharge of identified patients out of hospitals into their own homes as well as early identification and intervention for those people who may be at risk of hospital admission. Patients from the COVID-19 virtual ward receive an oximeter to monitor their oxygen saturation levels three times per day and their recovery is supported by daily clinical review phone calls. Some patients are at significantly higher risk of deterioration following COVID infection and this enhanced monitoring and treatment gives confidence to discharging clinicians and patients that they will be safely ‘cared for’ virtually following discharge from the acute setting.

The frailty virtual ward offers both 'step up' (admission avoidance) and 'step down' (early assisted discharge) services, with some patients having the opportunity to remain at home or return from hospital sooner, with access to the full support of a multi-disciplinary team. Patients who need some further care or monitoring and are well enough to leave hospital are assessed to see if they are suitable for the virtual ward. If suitable the virtual ward team creates a personalised plan for them.

The cardiology virtual ward has cared for an increasing number of people who have been able to remain in their own home. This has been possible though increased virtual and face to face surveillance of patients, putting in place plans of care to avoid hospitalisation, management of worsening symptoms in a timely way (including weekends and bank holidays), prompt recognition and management of abnormal blood results and increased opportunity for patient initiated follow up. Early assisted discharge from hospital has been facilitated for some patients following an acute phase of their heart failure or cardiac condition. This has also included being able to care for patients before surgery, where the patient would normally have spent their pre-surgery period in hospital, in some cases, patients were able to stay at home.

All patients who are being taken care of by any of the virtual wards have their condition overseen by a multidisciplinary team (MDT) of health professionals who meet daily. Patients are also be contacted by a member of the team at least once per day; during this contact their condition and observations will be monitored and any concerns addressed. A home visit can also be arranged if needed.

Further enhancements in this service are planned for 2022-23.

Lincolnshire vaccination centres

The trust is the lead provider for Lincolnshire’s two vaccination centres based at the Lincolnshire Showground and the Princess Royal Sports Arena in Boston. The vaccination centres have progressed as a new partnership between commissioners, community services and the acute trust. The vaccination centres operate under LCHS’ CQC registration, governance oversight and overarching leadership. Lincolnshire NHS Clinical Commissioning Group has undertaken the lead for employment and operational delivery of the vaccination programme and any 'out of hours' issues while ULHT has headed up the provision of pharmaceutical provision, storage and logistical aspects.

The strong local partnership approach within the NHS and with colleagues in local government, the care sector, and the voluntary sector is an impressive hallmark of the vaccination programme and was only made possible by the continued dedication and hard work of NHS staff, volunteers and partners across the county.

In Lincolnshire, as of 1 March 2022, the vaccination programme has administered 1,684,003 vaccines, that includes 616,670 first doses, 584,143 second doses and 483,190 booster doses. Of the most vulnerable population, currently 94.8% of all those eligible (3 months from 2nd dose) over 80s have been vaccinated with a first, second and booster dose, as have 97.9% of 75–79-year-olds, 98% of 70–74-year-olds and 98% of all Clinically Extremely Vulnerable (CEV) people aged 16-69. We are proud to report that the Lincolnshire vaccination programme met the accelerated booster campaign target to offer all eligible aged 18 and over a booster vaccine by 1 January 2022. The overall Lincolnshire position for booster vaccination uptake compares favourably with the national average and Lincolnshire has achieved the third highest uptake within the Midlands region. There has also been good progress with vaccinations of young people (5-11 and 12-15-year-olds) via the school service and vaccination centres.

The COVID-19 vaccination programme in the county has been a significant success to date and Lincolnshire has performed well in comparison to other systems. It has been an amazing effort and we are grateful for the continued hard work and support from all our staff, partners, and volunteers for their contribution.

Women’s physiotherapy pilot

A woman's body goes through incredible physical and hormonal changes before and after delivery of a baby. Sometimes even simple the day-to-day activities can become uncomfortable. For years, discomfort associated with pregnancy has been accepted as a normal part of the pregnancy process, but often something can be done about it. That’s why we launched a pilot physiotherapy service specifically for mums-to-be. Initially the service started in June 2021 in Skegness and following a successful launch additional clinics were established in Mablethorpe and Horncastle in March 2022. The service accepts referrals from healthcare professionals as well as self-referrals.

HomeFirst Partnership

The enhancement of the HomeFirst Partnership in Lincolnshire was a real success in 2021-22. Senior advanced clinical practitioners from LCHS, working in Lincoln County Hospital A&E saw, treated, and discharged primarily respiratory patients. In doing this they provided a holistic approach to care to ensure the patient can be well supported in the community and apply Discharge to Assess and HomeFirst Principles. The wider aspects of this work also included initiatives such as:

• Use of neighbourhood team integrated resources to support discharge to assess and admissions avoidance activity including all community and primary care resources.
• Implementing digitised discharge care plans via the Care Portal platform, to improve acute flow processes and create a visible record of acute and community professionals in contributing to Care Plans. Developed using the acute spa discharge forms, this system reduces paper records, reduces errors and reduces issues in manually locating records. It also supports wider personalisation agenda and improves patient outcomes.
• Development of a Single Point of Access (SPA) for clinicians to refer patients appropriately into palliative and end of life care.
• In partnership, the development of a SPA in ULHT for all discharge support referrals which are then shared with relevant system partners as appropriate.

New websites supporting patients and families

In 2022 our services launched two new websites to support self-care and wellbeing of our patients. A new physiotherapy website offers support for Lincolnshire patients struggling with muscle and joint conditions. With the launch of the brand new Musculoskeletal Physiotherapy Service website, we provide a central point of information regarding some of the most common musculoskeletal conditions, promoting self-care and supporting the general public to remain as active and independent as possible. The website has dedicated sections offering advice and self-help information for managing specific conditions which commonly affect areas of the body. There is also additional information on the wider aspects of health including getting fitter, caring for your mental health and longstanding pain.

Lincolnshire parents and families looking for support with their children’s development can now access a new Children’s Therapy Services website. It is a perfect starting point for parents who are looking for professional advice and specialist support when it comes to improving their child’s development. The website gives parents professional advice about the steps they can take to support their children with being healthy and well. It includes information on what typical development looks like for specific age groups and describes some common neurodevelopmental difficulties and how to manage their impact on daily life. There is also a referral form which can be completed by health professionals, parents and older children who can self-refer into the service.

Furthermore, we have been improving accessibility of the trust’s website to ensure that people with disabilities or who are using assistive technologies to access the internet, can easily and effectively access the online information we provide. As of March 2022 LCHS website has a score of 87 out of 100 in the Silktide Web Accessibility Index. This is reported as 29th in England. Although, there are number of NHS trusts with the same score, so in real terms, LCHS is ranked 9th in England. We are also reported as the top NHS organisation in Lincolnshire for website accessibility by Silktide. Most of the work necessary to make the trust’s website accessible was undertaken in-house.

Discharge to assess service

The Pathway 1, a term used to describe patients who are able to return home with support from health and/or social care, discharge to assess service launched at the end of November 2021 working with partners across the Lincolnshire health and care system, to support discharges from hospital wards. The service offers short-term packages of rehabilitation, reablement and recovery support with the aim of improving independence levels for patients who leave hospital with ongoing care needs. The service has now provided therapeutic support to over 350 individuals.

The service ensures that there is seamless transfer of care between health and care services, with support from the new ‘integrated discharge hub’. It supports patients to be discharged sooner, with the most appropriate packages of therapy and care support in place. Whilst this hub is in its infancy, it has highlighted the benefits of working together collaboratively and discussing all opportunities for personalised, patient support. Both the discharge hub and the LCHS Pathway 1 discharge to assess service continue to expand to support patients across the county.

C-Card Scheme

Young people aged 16-19 (or 25 for those with learning disabilities), across Lincolnshire are now able to register online for Lincolnshire Sexual Health’s C-Card Scheme. The scheme provides free condoms, lube and sexual health information. Previously, registration was only possible via specific C-Card provider locations but now the online portal makes it easier to place an order and have it discreetly delivered.

We are delighted to offer a confidential and easy way for young people across Lincolnshire to sign up for our C-Card Scheme. It makes it more convenient for those who may be unable to access our clinics, their local pharmacy or other registration points.

Pulmonary rehabilitation face to face groups

Patients with chronic respiratory problems which cause breathlessness and fatigue again benefit from face-to-face pulmonary rehabilitation as the groups came back to village halls and community centres around the county. At the start of the lockdown, the service paused face-to-face groups as most patients were asked to shield due to their health. The team introduced virtual sessions, which proved very successful for some; however, not all patients had the technology to attend the meetings. Some honestly admitted that they struggled to engage with and adhere to the routine of virtual classes.

It was clear for us that our patients were missing out because they couldn’t attend physical classes, so the service worked hard to restore face to face classes in a safe way.

Post-COVID service celebrated its first birthday

LCHS host the Lincolnshire Post-COVID Rehabilitation Service, which has developed considerably over the last year. New posts this year have included specialist physiotherapists, specialist occupational therapists, specialist cardiac nurse, a GP, an assistant practitioner alongside therapy assistants and admin staff.

The service has expanded to include more support from specialist services, voluntary groups and charities, to help patients with the numerous symptoms of post-COVID. Developments also include a new fatigue and breathlessness group, after feedback from patients, appointing a volunteer and assistant practitioner to help with peer support groups and an increased involvement with research and development. The team is working alongside the University of Lincoln to employ a research assistant to carry out research and service evaluation.

We have received around 800 referrals and in December 2021 the service celebrated its first birthday.

Quality improvements in the Lincolnshire stroke service

The work included the introduction of neuropsychologist post into community stroke service and embedding Stroke Association into community teams with shared delivery of virtual groups. It has reduced the length of stay for patients in acute hospitals by an average of 4.5 days. Thanks to the expansion, the support is now available to all patients who require this vital service and can be delivered closer to or in their homes. It is estimated that over 2% of Lincolnshire population suffered a stroke and need this care. Our stroke service is a great example of the Lincolnshire healthcare system working in partnership.

Podiatry service developments

Podiatry team is the central point of access for foot complications in Lincolnshire. The team completes triage for ULHT Multidisciplinary Diabetic Foot Team (MDFT) consultant clinics. Developments include enhanced collaboration with leg ulcer nurses, district nursing and diabetes nursing. This has ensured patients are seen by the right person at the right time in the right place. The service also now planning to develop a lower limb Community Multidisciplinary Diabetic Foot Team.

New medical roles in the trust

We now have eight medical support workers at LCHS. These are qualified overseas doctors who need healthcare experience in the UK before they can become registered. They play a valuable role, in the multi-disciplinary professional team, providing high quality care for patients. They undertake a range of essential routine clinical tasks under supervision. Our medical support workers are currently working in our Urgent Treatment Centres, on an inpatient ward or in primary care.

Most of our medical support workers are refugee doctors and by providing them with employment we are also helping them and their families settle into life in the UK.

Volunteering services

We know that volunteers can bring valuable lived experience to our services and support our patients with the ongoing recovery. A new volunteering service has been set up in the trust and the team has worked collaboratively with other support services to develop robust processes and resources to support the recruitment, selection, onboarding, training and management of volunteers. This has included working with clinical teams to identify and develop new volunteer roles and raising awareness of volunteering throughout the organisation.

Eight new volunteer roles and three patient partner roles have been developed:

• Communication Support Volunteer - Children’s Therapy
• Volunteer Group Supporter – Pulmonary Rehab and Cardiac Rehab
• Virtual Volunteer Group Supporter – Post-COVID Service
• Hospital Ward Volunteer – Gainsborough and Skegness
• Urgent Treatment Centre Volunteer
• Hospital to Community Support Volunteer - Stroke Service
• Digital Communication Volunteer
• Administration Volunteer – Operations Service Centre
• Patient Partner – 15 Steps Challenge
• Patient Innovation Group member
• Patient Partner Recruitment

We plan to embed impactful volunteer roles consistently. LCHS currently has 46 volunteers, five of whom undertake a patient partner role. Existing volunteers have been involved in the shaping of our volunteering services and this will continue in 2022/23 through focus groups and feedback.

There have been several new studies opening in the trust in 2021/22. These have been in stroke rehabilitation, physiotherapy post fracture next of femur and stammering in children through the speech and language team. These studies have enabled our patients the opportunity to be involved in research studies as part of their care. The Lincolnshire Poacher study is also recruiting after initial delays due to COVID-19. The study, which LCHS sponsors, is recruiting patients with new symptoms of irritable bowel syndrome who attend their GP practice. The patients are randomised into either, usual care following NICE guidance under the GP, or, nurse led care under the two Poacher research nurses. The study currently has 30 Lincolnshire GP practices enrolled and 136 referrals. To date 54 patients have been consented onto the study.

SWANS Study from BAME Network

Staff Wellness and Networks support (SWANS) is a qualitative research study that sought to explore barriers as well as enablers of access and uptake of staff wellbeing services and/or staff support networks. It was looking at NHS staff identified as having an elevated risk of COVID-19 infections due to having a pre-existing health condition or being from a Black, Asian or Minority Ethnic (BAME) background. The study was sponsored by the Sir Captain Tom Moore COVID relief funds via the NHS Lincolnshire Charity and was approved and vetted by the University of Lincoln Research Ethics Committee. The study was proposed and carried out in response to the increased burden on the health and wellbeing of the identified NHS staff groups to establish barriers and enablers. The study was therefore aimed at equipping local NHS provider trusts with qualitative data that aids their response to the support needs of the identified clinically vulnerable staff groups during the Covid-19 pandemic. The report and findings are available on our website .

Events and key dates

Research Conference - In collaboration with the University of Lincoln, LCHS held our first research conference for AHPs in November 2021. This was a virtual event which had very positive feedback. We are hoping this will become an annual event and will be open to all LCHS staff.

Provider Collaborative Event – as we move to the Integrated Care system and new ways of working Provider Collaboratives are playing an increasingly important role in transforming and creating sustainable NHS services. This online event was for those who wanted to be part of the conversation on and 139 people from more than 35 organisations joined us on the day.

Black History Month – October saw the trust celebrate Proud to Be Black History Month 2021 with our partners through a series of virtual events. The aim was to celebrate the culture and histories of black communities as well as educate and recognise the challenges often faced daily by people of colour and the impact this has on their lives. Sessions included live dramatisation of Rosa Parks story, national speakers and a lunch hour facilitated by LCHS Black, Asian and Minority Ethnic Staff Network with inspirational readings, poetry and personal stories.

Disability History Month – to mark the month we held a series of webinars for Lincolnshire NHS staff with guest speakers addressing a range of disability-related topics. In particular this year we were concentrating on themes of hidden disabilities and disability sex and relationships.

Celebrating Success 2021 – In November we held our staff awards virtual ceremony which was covering both 2020 and 2021 as we weren’t able to hold it before due to the pandemic. It was great to come together (albeit virtually) and celebrate some of the incredible achievements of our dedicated staff who embodied our values in their work every day. Details of the shortlist and winners are available on our website.

LGBT+ History Month – it is now an annual tradition for Lincolnshire health and social care colleagues to come together every year in February and host an event marking the month. This year due to COVID the celebrations moved online with a number of workshops and informative sessions.

Teams and colleagues recognised with awards and other accolades

Boston nurse wins silver award for her work during the pandemic - A lead general practice nurse working in our Sidings Medical Practice in Boston received the prestigious Chief Nursing Officer Silver Award. Sarah Hyde was awarded this honour for her work throughout the COVID-19 pandemic. Sarah took a lead role in the vaccination hub in Boston coordinating nursing teams from different practices to ensure the most vulnerable patients could be vaccinated safely and close to home. Her colleagues say she is an exceptional nurse who not only inspires but provides support to the whole team and always goes that extra mile. The Chief Nursing Officer awards were introduced to recognise significant and outstanding contributions made by nurses and midwives in England. The awards are for individuals and teams who have excelled in their performance. Silver Award acknowledges major contributions to patients and the profession.

Lincolnshire NHS Apprentice Centre rated Good by Ofsted - The apprentice centre run by LCHS was inspected in the summer of 2021 making it only the second NHS organisation nationally to receive a full Ofsted inspection in 2021 and the first community trust. The report rated our centre ‘Good’ and commented on how well the trust prepares its apprentices for their career in the NHS and how proud they are to contribute to the trust and patient care. The centre was established in 2017 to support the development of LCHS staff and since then it has supported 81 apprentices to successfully complete their apprenticeships. These range from non-clinical apprenticeships of Level 3 Business Administration to Level 6 Chartered Manager Degree Apprenticeships to Clinical Level 2 Healthcare Support Worker to Level 6 Nurse Degree Apprenticeships. The centre is supporting a further 90 apprentices and we are planning to recruit more.

LCHS podiatrist wins award from national body for service during COVID-19 pandemic - Sharon Laughton, a podiatrist at LCHS, received the Ernest Runting Award from the Royal College of Podiatry. She attended the House of Lords for the presentation. The award was for distinguished service, to honour the podiatrists who put themselves at risk to deliver healthcare services and supported the national effort during the COVID-19 crisis. Sharon who is normally based at Newland Health Clinic in Lincoln, volunteered for redeployment in March 2020 and was placed with Lincoln South Integrated Community Nursing Team based in North Hykeham.

Lincolnshire NHS Stroke Service crowned national winners - The Lincolnshire Stroke Service has been crowned winners of a national award which recognises quality improvements in how services are delivered to patients. The team scooped the accolade in the Chief Allied Health Professions Officer (CAHPO) Awards 2021 in the Innovation and Delivery of Systems category where they were commended by judges for their determination to come together across health organisations to improve patient care and their experiences when accessing the service.

LCHS community nurse awarded Queen’s nurse title - A community Macmillan clinical nurse specialist based in Deeping and Bourne has been given the prestigious title of Queen’s Nurse, by community nursing charity The Queen’s Nursing Institute (QNI). Gwen Eldred who works for LCHS received the title after over 30 years of service to nursing, with the last 20 years in Lincolnshire. Gwen has worked hard to develop her knowledge undertaking educational courses, alongside increasing her vocational experience, to improve the care she is able to give her patients. However, the title is not an award for past service but indicates a commitment to high standards of patient care, learning and leadership. Nurses who hold the title benefit from developmental workshops, bursaries, networking opportunities, and a shared professional identity.

Cardiac Rehabilitation Team shortlisted in Medilink Awards - Team’s work on digitally supported cardiac rehabilitation services with Dynamic Health Systems Services Ltd has been shortlisted for Medilink North of England Healthcare Business Awards 2021 in the category Partnership with the NHS: Advances in Digital Healthcare. The competition was tough. While our team wasn’t one of the winners on this occasion, it is still a great achievement to make it to the final with other regional health sector pioneers who improve patient care through technology.

Cardiac rehab digital programme featured in BACPR Connect - Our digital programme supporting patients who undergo rehabilitation following a cardiac event has been showcased in August 2021 issue of BACPR Connect magazine. The magazine is produced by the British Association for Cardiovascular Prevention and Rehabilitation. The programme called V Heart Health was built using VitruCare platform. It includes educational content, mental health support, pre-recorded exercise sessions, pre and post exercise questionnaires and biomedical trackers. Our Digital Health team supported the project with the remodelling of a room to suit the needs of the rehab service; kitted out with sound-proof boards, a ceiling hung microphone, an 86-inch television screen and a state of the art 360° camera, becoming one of the first digital suites to be created to support digital delivery in the trust. V heart health programme is now on cohorts 9 and 10. Thanks to using a digital platform the service was still able to care for patients while reducing face to face contact in order to control the spread of coronavirus.

Children’s Rapid Response Respiratory Service shortlisted in HSJ Value Awards 2021 - The team was finalist in the Paediatric Care Initiative of the Year. It is a fantastic achievement to reach the final and be one of a handful of projects recognised nationally.

‘Pathway zero’ featured in NHS England’s case study - NHS England and NHS Improvement published a case study on the work we did during the COVID-19 response to support the discharge of patients to their own home who did not need a specific care package to support them (known as ‘pathway zero’). The case study features LCHS and Age UK Lincoln and South Lincolnshire. Our solution of 24 hours post-discharge phone calls and creating wrap-around community care for patients showed how we can improve the discharge process by working as a system with other local organisations.

LCHS Continence service presents at an international event – The service co-presented at the European Value-Based Procurement Conference MedTech Europe showcasing patient outcome improvements on incontinence care based on trials of holistic prescribing of containment products.

NHS Charity

Lincolnshire NHS Charity is an independent and dedicated charity that plays a vital role in supporting both Lincolnshire Community Health Services NHS Trust and Lincolnshire Partnership Foundation NHS Trust to make a difference to service user care. It supports innovative projects to enhance services and facilities that would not be funded by the NHS. The 2021/22 NHS Charity highlights include:

• Skegness nurses fundraising for training and long-term care for their new four-legged staff member called Rammie. The charity supported staff at Scarborough Ward in Skegness Hospital to raise funds to pay for their new therapy dog’s training and long-term care on the ward. The activities included a sponsored skydive, 18 mile walk from Skegness to Chapel St. Leonards, raffle, 24-hour bikeathon and ‘in the stocks day’ which involved throwing wet sponges at clinical team leads.
• Pumpkins for Parkinson’s carving competition to raise funds for Parkinson’s Team
• NHS community services in Grantham received a charitable donation of £500 from the Grantham Freemasons. This donation will go towards revamping the staff area in LCHS Grantham base. It will benefit staff members who work in community nursing, Macmillan service, diabetes and therapy services.
• Pupils at Spalding Grammar School participated in a virtual trek from Lands End to John O’Groats in 2021 raising over £2,000 for the charity. The team at Spalding decided that this money would be best spent on new physiotherapy equipment for our younger patients as the funds were raised by young people. Equipment purchased so far includes walking bars and balance boards.
• Ian Tomblin ran the London Marathon in October 2021 in memory of his late mother. She was cared for by the Tulip Suite at Spalding Johnson Hospital so Ian wanted to give back to the ward for the excellent care they delivered. He managed to raise an incredible £2,850.
• Spalding based Pennygate Patient Link donated specialist equipment worth more than £33,500 to Johnson Community Hospital. The Visual Fields machine is used to measure a person’s entire visual field including blind spots and peripheral vision.

Our charity continues to benefit from the funding received from NHS Charities Together following an outstanding fundraising effort by Captain Sir Tom Moore. The grant supported staff wellbeing projects such as a staff kitchen upgrade at John Coupland Hospital, water boilers being installed on our wards and outdoor furniture being able to be purchased for staff to enjoy during well-deserved breaks. We have also purchased iPads for our wards which patients have been able to use to stay in touch with their loved ones.

Next year's plans include further improvements to staff rooms and a major project supporting staff who are carers and who juggle caring duties with their work. We're also looking to support patients suffering from post-COVID syndrome to get back to full fitness quicker.

The trust is managed through five organisational directorates:

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

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

Chief Executive's Office

This directorate manages the corporate business services of LCHS. Functions include the corporate secretariat and governance of the trust Board and trust Board Committees, including Trust Board development, logistics and support, corporate assurance and governance, administration of freedom of information requests, compliance and legal services, registrations and membership with regulating bodies, complaints, concerns and compliments management, the Patient Advice and Liaison Service (PALS) for the trust and for the county of Lincolnshire, communications, engagement with the public and stakeholders and our new volunteering services.

Finance and Business Intelligence Directorate

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

Medical Directorate

The Medical Directorate supports a substantive medical workforce to meet the developing needs of the trust. In addition, the trust also has a fully contracted bank medical workforce to support at times of surge and increased demand. In addition to the medical workforce, the Medical Directorate includes medicines management, medical devices and medical gases, learning from deaths, practitioner performance, research and development and clinical audit and quality guidance.

Nursing, AHP and Operations Directorate

In 2021/22 we restructured the directorate to reflect the vision and aims of our clinical strategy and focus on integration, linking with system partners and the ICS; focus on patient pathways and population health management; simplicity, adaptability and agility; system and professional leadership and career pathways. We now have three divisions:

Children, young people and specialist services division

Many of LCHS services are led by allied health professionals who use a holistic approach to assess, treat, diagnose and manage a range of conditions in adults and children across community settings. The focus is on prevention and improvement of health and wellbeing to maximise the potential for individuals to live full and active lives.

Our services include: speech and language therapy, musculoskeletal and physio, diabetes, heart failure, stroke, respiratory, pulmonary rehab, Macmillan, Tuberculosis, tissue viability, INR; continence, Lymphedema, Parkinson’s, post-COVID rehabilitation. We also provide countywide integrated sexual health and contraceptive health services through LISH (Lincolnshire Integrated Sexual Health). Children’s and young people services include immunisations and vaccinations, child health, children’s therapy and rapid response service and children in care.

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

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

Collaborative community care division

Our community nursing service for adults are organised into community teams aligned to Primary Care Networks. Community nursing teams work closely with a range of services across LCHS including allied health professionals and specialist services, to provide support to people with long term conditions, people who are frail, and those at the end of life. Community nurses also work closely with a range of professionals from other agencies including Primary Care as part of Neighbourhood Teams to provide integrated care for patients designed to meet local needs.

LCHS has four community hospitals: County Hospital, Louth, John Coupland Hospital in Gainsborough, Johnson Community Hospital in Spalding and Skegness Hospital. We also deliver care within the Butterfly Hospice in Boston.

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

Integrated urgent and emergency care division

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

The service offer for LCHS urgent care is delivered as:

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

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

An underpinning operations centre and operational business services

The trust operational business services includes primary care, our operations centre and patient admin services.

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

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

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

People and Innovation Directorate

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

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

We are naturally proud of our achievements however we recognise that Lincolnshire has its healthcare challenges The immediate and future impact of COVID-19 is creating further challenges the healthcare system must address including increased waiting lists for elective care and post-COVID care still being required. We are clear that we have plans in place to address these challenges; while the national focus is on dealing with the elective care backlog which the Lincolnshire system is working hard to resolve, community service waiting lists are also a national priority. To this end, LCHS has established a project that is already starting to impact on driving down our waiting lists, taking account of factors that affect health inequalities and supporting people to wait well where they are waiting for services.

In addition to the elective backlog and community waiting lists, some of the main challenges facing Lincolnshire healthcare are:

• Improving performance against cancer waiting times
• Reducing pressure on urgent and emergency care
• Improving access to mental health services
• Ensuring effective and equitable use of resources
• Improving workforce stability and reducing reliance on agency
• Reducing the system finance deficit
• Delivering the national ambition on integrated care, the dissolution of the CCG, and the creation of the ICS infrastructure.

In 2021 Lincolnshire health system became a part of the NHS England and NHS Improvement new Recovery Support Programme which replaced the previous Special Measures regime. The announcement that the Lincolnshire system was in segment 4 of the new System Oversight Framework (SOF) was anticipated as it reflected both financial pressures we face as a system and issues with some of the quality of care provided at times. However, we are not satisfied with this. Our ambition is to exit the regime as soon as possible for the benefit of our population and we have plans in place as a system to do this in 2022. Lincolnshire NHS Chief Executives are clear that we do not want to be in the Recovery Support Programme longer than 12 months and have committed to work together to deliver the very best, sustainable services for our local community. To do this we need to:

1. Achieve our system financial plan for 2021/22
2. Build an effective system plan for the next three years, (the System Delivery Plan) and
3. Support United Lincolnshire Hospitals NHS Trust out of Care Quality Commission (CQC) special measures. (It was announced in March 2022 that following a recent CQC inspection ULHT would be taken out of special measures with immediate effect).

While as a provider organisation LCHS’ governance and finances this year remained in segment 1 of the SOF, we were committed to playing an active role in supporting the wider Lincolnshire healthcare system in planning and focussing on quality and value for money as part of the system’s exit strategy.

Public consultation relating to four Lincolnshire’s NHS services

NHS Lincolnshire Clinical Commissioning Group has put forward proposals for changes to the four NHS services. Public consultation took place over a 12-week period started from 30 September 2021 until 23 December 2021. The four NHS services consulted on were:

• orthopaedic surgery
• urgent and emergency care at Grantham and District Hospital
• acute medical beds at Grantham and District Hospital
• stroke services

Public consultation promotes accountability and assists decision making; public bodies give an account of their plans or proposals and listen to feedback. The consultation was widely promoted via stakeholder organisations, leaflet deliveries commissioned to 370,000 households across Lincolnshire, posters and leaflets in GP practices and public locations, online and traditional media coverage and advertisement.

During the consultation period, stakeholders were invited to provide feedback through:

• A consultation questionnaire for all residents, stakeholders and organisations: the questionnaire was available online (hosted by Opinion Research Services ORS) and paper questionnaires were widely circulated and available on request. An easy read version and translated documents were also available.
  • Independently facilitated engagement designed and conducted by ORS:
  • A telephone residents survey; and
  • Independently facilitated online focus groups and 1:1 in-depth interviews with members of the public (delivered by ORS);
• Engagement activities undertaken by NHS Lincolnshire CCG, including
  • Face-to-face and online public events, and a ‘virtual’ 24/7 event
  • Meetings with NHS staff members, stakeholders and services users
  • 'Pop-up’ engagement activities at market days across Lincolnshire
  • Written or email submissions from residents, stakeholders and organisations
  • Petitions (organised by two local campaign groups and submitted to ORS)

LCHS has supported the public consultation advertising the routes to feedback via our social media channels and staff communication. We have also supported face-to-face and virtual events through the presence from LCHS ‘topic experts’, clinicians and senior leaders.

The responses to the consultation have been analysed and presented to the Lincolnshire CCG in a public Board meeting that took place outside of the reporting period included in this Annual Report. On 25 May 2022, the CCG Board approved the following changes to Lincolnshire NHS services:

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

Single Oversight Framework

The Single Oversight Framework (SOF) outlines the approach NHS England takes to overseeing the performance of NHS trusts and identifying where commissioners and providers may need support. Metrics are identified for assessing CCG, trusts and ICSs.

Each trust receives an overall rating of one (highest) to four (lowest) based on data monitoring and NHSE/I’s judgement of providers’ circumstances across the five themes of quality, access and outcomes, preventing ill health and reducing inequalities, leadership and capability, people, finance and use of resources.

Quality Account Performance

The Quality Account priorities for 2021/22 were discussed with stakeholders including staff groups and patients and were then agreed with the LCHS Quality and Risk Committee and trust Board.

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

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

Quality summary of performance

Safe staffing

The ability to maintain safe staffing in an escalating and changing environment continues to be a fundamental safety priority for both staff and patients alongside infection prevention and control, safeguarding, risk management, policies and procedure controls and clinical incident management.

The organisation’s governance framework has continued to focus on key patient and staff measures and includes continued scrutiny and assurance of key patient safety areas including safe staffing.

In 2021 an internal audit on safe staffing was undertaken and provided an opinion that significant assurance was evidenced with some suggested areas of improvement. The report noted that the processes and controls along with management actions and governance provided significant assurance.

The trust completed the safe staffing Business Assurance Framework initial assessment and shared with the trust Board. No control gaps have been identified and a number of ‘in progress’ improvements were recognised as appropriate.

There are a number of key workforce development programmes and pipelines in the trust which continue to positively impact on safe staffing:

• Community placement expansion programmes – offering more opportunities for student placements in the community services to encourage careers in community services.
• Advanced clinical practice integrated pathways – working with United Lincolnshire Hospitals NHS Trust to develop a standardised and integrated model for ACPs in Lincolnshire across nursing and AHP professionals and to support rotational opportunities.
• Apprenticeship expansion – funded by additional system allocation to support expanded placement numbers and wider medical roles.
• Zero healthcare support workers programme – to maintain zero vacancies and pipeline of healthcare support worker roles.
• Recruitment programmes – cohort recruitment opportunities and refreshed approach to attraction.
• Supporting advanced clinical practice, allied health professionals and nursing fellowships
• Continued drive for additional apprentice associate nurse, associate nurses developing to become registered nurses and commitment to the District Nurse Specialist Qualification.

Incident reporting and serious incidents

The trust reports all incidents of any type on Datix and in 2021/22 a total of 8454 incidents were recorded. The trust has continued its record of being a consistently high reporter of incidents reflective of our positive safety culture recording 2806 incidents categorised as patient safety with an associated severe harm/death rate of 0%.

In 2021/22 LCHS reported 12 serious incidents, this is a reduction of 8 from the previous year. The serious incidents reported were categorised as follows: six serious incidents were falls – two falls resulted in a fracture, one with no harm, three head injuries; two medication incidents; one unexpected death; one treatment delay and failure to recognise/refer to safeguarding, one diagnostic incident.

Pressure ulcers that are recognised as a deep wound that reaches the deeper layers of the skin – a category 3 pressure ulcer – or a very deep wound that may reach the muscle and bone – a category 4 pressure ulcer - are reported as serious incidents. The number of category 3 and category 4 pressure ulcers reported as serious incidents has decreased significantly from 292 for the previous year compared with 176 in 2021/22. Our Tissue Viability Nurse Specialists have been working with the community teams to ensure more consistent recognition of the correct categorisation of pressure damage.

The community teams have been working hard to support different patients. In the early months of the pandemic, families and carers began working with us to deliver shared care, access to some community settings and homes was restricted and technology became vital to maintaining communication.

As part of our quality improvements plans, we will continue to work with patients through personalised care planning, work with health and social care colleagues in partnership to reduce harm for all patients and work to refresh our clinical skills an competencies in all of our services.

Medication errors

LCHS continues to report medication incidents and has been assessed by our internal auditors as providing significant assurance regarding the safe storage and handling of medicines within service areas.

The trust delivers a high number of injectable medicines to patients within our community and immunisation services and have maintained a low medication error rate.

There has been a continued reduction of the omission error rate within the community nursing services following a change in the scheduling process and the introduction of the “call-back” system.

Safety thermometer

The safety thermometer is a national point prevalence tool which allows the trust on one day each month to measure and monitor the number of our patients who may have suffered certain types of harm whilst in our care. The tool looks at four harms: pressure ulcers, falls, blood clots and urine infections for those patients who have a urinary catheter in place. Due to COVID-19 the collection of safety thermometer data was suspended in March 2020 and there are no plans currently to restart the recordings.

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

Patient safety alerts

There have been twelve patient safety alerts issued and the trust has responded effectively to all of them. All the alerts were acknowledged within the 48-hour timescale and of the eight alerts three were not relevant to LCHS, three were for information only and six were completed and all actions closed.

Safeguarding

LCHS has remained compliant throughout the year in discharging all contractual and legal safeguarding duties. We have been a consistent and reliable partner to the Lincolnshire Safeguarding Partnerships and have worked closely with all services to ensure that safeguarding is considered as part of normal business.

The consistent reporting, and quality assurance processes evidences that our staff discharge their duty of care to our patients and service users, with many examples of appropriate multiagency challenge and excellent patient advocacy to enable our patients to live free from harm and abuse.

Performance summary

From working together in new and different ways to caring for COVID-positive patients, our staff have worked alongside our system partners, as a key player in the local NHS to ensure continuity of service as well as to restore and recover our services. Our staff have been nothing short of phenomenal and we are grateful for this.

With the move to an Integrated Care System, we are working closer than ever before with other providers, local authority and voluntary sector to deliver great care close to home.

The continued impacts of the pandemic turned both professional and personal worlds upside down. But this made us all step up and have a proactive approach to wellbeing to look after each other and we will continue to invest in health and wellbeing of our people.

The trust also continues to have a robust, values-based approach to recruitment and retention and developing talent to ensure we have the right skills, in the right place.

In summary, the trust and its staff and volunteers have faced yet another unusual and challenging year, but our staff, volunteers and their services have also experienced many successes. As we come to an end of the financial year, we are confident that the foundations we have begun to lay over the past year will bring benefits to our patients, their carers and our staff and volunteers for many years to come.

I’d like to end by thanking our staff, volunteers, Board members and partners. Everyone, as always, has pulled together and yet again proven what a fabulous institution the NHS is and how privileged we are to have it, and to work in it.

Accountable officer:

Maz Fosh, Chief Executive
Lincolnshire Community Health Services NHS Trust

Date: 16 June 2022