Quality Account – Clinical effectiveness category

Hip fracture is a major health issue in an ageing population. About 70,000 to 75,000 hip fractures occur each year and the annual cost (including medical and social care) for all UK hip fracture cases is about £2 billion. About 10% of people with a hip fracture die within 1 month and about one-third within 12 months. Most of the deaths are due to associated conditions and not to the fracture itself, reflecting the high prevalence of comorbidity.

The Trust is currently a national outlier for death rates following hip fractures, latest figures from the National Hip Fracture database Q2 2025 shows that 6.3% of patients die within 30 days of surgery (this is based on case-mix adjusted mortality) against a national average of 6%. Pressure ulcers in hip fracture patients are also significantly increasing.

The National Audit of Care at the End of Life (NACEL) is a national comparative audit of the quality and outcomes of care experienced by the dying person and those important to them during the last admission leading to death in acute hospitals. It is a mandatory requirement for East Sussex NHS Healthcare Trust (ESHT) to review case notes of patients who are at the end of their life in hospital to review the quality of care provided to the patient and carers.

NACEL highlights the importance of recognising when a patient is at the end of life and this being reflected in the case note review. It has been noted from NACEL data (2024) that dying is recognized (and/or acknowledged) significantly later in ESHT hospitals compared to the national average.

This is a current priority option for 25/26 Quality Account – low compliance evidenced with live auditing standards

The use of the WHO Surgical Safety Checklist has been implemented to enhance patient safety and reduce the risks of clinical incidents. The completion of the checklist as part of a quality monitoring system provides assurance to the organisation that patients are being safely prepared and cared for during operative/invasive procedures.

The standard is that all spot check audits must be 100% compliant i.e. each section of the checklist is fully completed and if not, action is taken at a local level to address this and an exception report is produced to explain why, and steps taken to reduce it happening again.

There was concern over time that the above audit could be become a tick box exercise. To this end areas are encouraged to undertake a live observational study of the WHO Checklist process.

34 areas still require a live audit for the current year, reasons cited included lack of staff / resource. Staff have not been available to go to other departments to conduct live audits due to high sickness levels, vacancies, Industrial action by Doctors and Specialist weeks like the “Perfect week”.

High risk medicines including opioids, insulin, and anticoagulants account for a disproportionate share of severe and moderate harm incidents across the Trust.

In addition, discharge related medication errors (incorrect doses, omitted medicines, transcription errors, or incomplete communication) contribute to avoidable deterioration, readmission, and patient safety incidents.

Following a self-assessment of the ESHT Acute oncology service in line with Surrey and Sussex Cancer Alliance guidelines, compliance with the Neutropenic sepsis Door to Needle Time standard was found to be 11%.

Best practice NICE guidelines NG12 guidelines state that ALL patients with suspected Neutropenic sepsis on Chemotherapy should receive IV antibiotics as part of the sepsis 6 protocol within 60 minutes of arrival to an emergency service.

This has been flagged as a significant risk with an action plan and improvement expected.

Nutrition related incidents frequently highlight gaps in:

• Initial and ongoing nutritional assessment
• Timely dietetic referral and review
• Documentation of intake, weight monitoring, and hydration
• Communication of nutritional needs during transfers of care
• Provision of support for patients with dysphagia, dementia, delirium, or high frailty

Given the scale of impact and the cross-cutting nature of nutrition in patient safety, this area has been identified as a priority for improvement.

Speech and Language Therapy (SLT) is a nationally recognized core part of Hyperacute, acute and long-term Stroke Rehabilitation. The quality and quantity of acute SLT input is monitored via the SSNAP (Sentinel Stroke National Audit Programme) audit. The audit monitors the length of time it takes for SLT input to occur following admission, and how often and for how long, subsequent input lasts.

Over the 2025 period the SSNAP scores for several SLT related domains have fallen below national standards:

• % of applicable pts given a formal swallow screen within 24 hrs of clock start – 29% vs 84.60% nationally
• % of applicable pts who were assessed by SALT within 72 hrs of clock start – 37.5% vs 85.40% nationally

VTE harm is typically driven by reliability failures in key safety processes, for example:

• VTE risk assessment not completed, completed late, or not updated when a patient’s condition changes
• Inappropriate prophylaxis decisions (omitted when indicated, prescribed when contraindicated, incorrect dosing/weight adjustment, renal adjustment, or duration)
• Delays in administration of prophylaxis (especially first doses)
• Poor documentation and communication of prophylaxis plans during internal transfers and at discharge
• Missed opportunities for patient education about symptoms and post-discharge risk

VTE prevention is highly dependent on consistent, system-wide implementation, and improving reliability in this area directly reduces avoidable harm, readmissions, and mortality.