Annual Report Structure - Table of Contents

The following table details the outline structure for the Quality Account/Report 2014/15

Received

Confirmed as in progress

Not received

Section / Accountable Person
PART 1: Statement on Quality from the chief executive of the NHS Foundation Trust
Statement on quality by the Chief Executive and introduction / Naomi Blackwell/Jennie Hall
Dashboard - our priorities from last year / Naomi Blackwell
PART 2: Priorities for improvement and statements of assurance from the board
Priorities for improvement in 2015/2016 / Naomi Blackwell (Draft)
Our 10 year strategy / Naomi Blackwell
Staff FFT / Liz Woods
Developing the Quality Account / Naomi Blackwell
London Quality Standards / Simon McKenzie
Learning from other organisations / Jennie Hall
Review of services / Directors
Research / Dan Forton
Participation in clinical audits / Kate Hutt
Use of CQUIN payment framework / Imran Hussain
Statement from CQC / Sal Maughan
Data Quality / Tom Dewar
Information governance toolkit attainment levels / Lech
Clinical coding error rate / Tom Dewar
Statements of assurance from the board / Jennie Hall
Part 3: Improving Patient Safety
Medication errors / Chris Evans
Patient safety incidents / Maria Prete
Patient falls / Yvonne Connolly
Patient Safety thermometer / Yvonne Connolly
Offender healthcare / Alison Ludlam
Summary hospital-level mortality indicator / Kate Hutt
% patient deaths with palliative care coded at either diagnosis or specialty level / Kate Hutt
Risk assessed for venous thromboembolism / Imran Hussain
C.difficile / Matt Laundy [NB1]
Patient safety incidents reported / Yvonne Connolly
Part 4: Improving Patient Experience
Community learning disability referrals / Alison Ludlham
Complaints / Sarah Duncan
Responding to Patients Needs / Imran Hussain/Tom McGill
End of Life Care (new for 2015/2016) / [NB2]David Flood/ AnnelieseWeichart
Part 4: Improving patient outcomes
Sexual health in secondary schools / Alison Ludlham
Clinical outcome measures in community services / Alison Ludlham
Patent Reported Outcomes Measures (PROMS)
Groin hernia surgery / Kate Hutt
Varicose vein surgery / Kate Hutt
Hip replacement surgery / Kate Hutt
Knee replacement surgery during the reporting period. / Kate Hutt
Clinical Records (new for 2015/2016) / Jennie Hall/Evon Wheeler
28 days readmission / Imran Hussain
Part 5: Performance
Maximum time of 18 weeks from point of referral to treatment in aggregate - admitted C) / Martin Wilson
Maximum time of 18 weeks from point of referral to treatment in aggregate - non-admitted C) / Martin Wilson
Maximum time of 18 weeks from point of referral to treatment in aggregate - patient on an incomplete pathway C) / Martin Wilson
A&E: maximum waiting time of four hours form arrival to admission/transfer/discharge (D) / Martin Wilson
All cancers: 62-day wait for first treatment (E) from:
Urgent GP referral for suspected cancer / Imran Hussain
NHS Cancer Screening Service referral / Imran Hussain
All cancers: 31-day wait for second or subsequent treatment (F), comprising: / Imran Hussain
Radiotherapy / Imran Hussain
Anti-cancer drug treatments / Imran Hussain
Surgery / Imran Hussain
PART 6 - Annex 1: Statements from commissioners, local Healthwatch organisations and Overview and Scrutiny Committees
Wandsworth CCG (on behalf of local CCGs) / Sandra Iksander
Wandsworth Council (OSC) Richard Wiles / Richard Wiles
Healthwatch Wandsworth / Healthwatch
Healthwatch Merton / Healthwatch
Healthwatch Lambeth / Healthwatch
Statement to confirm stakeholders engaged with and internal assurance processes achieved / Naomi Blackwell
PART 6 - AnnexA : Clinical Audits
Participation in clinical audits / Kate Hutt
National clinical audits undertaken / Kate Hutt
Local clinical audits undertaken / Kate Hutt
PART 6 - AnnexB : Assessment of compliance against London Quality Standards / Simon Mackenzie

[NB1]Should MRSA be included?

[NB2]Need clarity from Jennie as to what exactly this indicator should report on