Derbyshire Health
United
Quality
Account
2014/15
Contents
Index
Page Number
Introduction and CEO Message
2
Section 1
Message from Our Chairman
3
Section 1
Who we are
4
Section 1
Our Objectives 2014/15
5
Section 2
Our Services
6
Section 3
Our People
25
Section 4
Our Quality Assurance
28
Section 5
Our Patient Experience
33
Section 6
Our Innovation working in partnership
40
Section 7
Our DHU Objectives 2015/2016
47
Section 8
Statement of Director Responsibilities
48
Section 9
Statement from Commissioners
49
Section 10
Statement from HealthWatch
51
Section 11
Glossary
52
1
Derbyshire Health United Ltd. Quality Account 2014/2015
Introduction & CEO Message
Introduction to the Derbyshire Health United Quality Account 2014/15 from Stephen Bateman, CEO
This Quality Account for Derbyshire Health
United Ltd (DHU) has been produced in line with
national requirements. It is intended to provide a
realistic assessment of the quality of care
provided by DHU during 2014/15.
The content and format of this Account is laid
down in the NHS (Quality Accounts) Regulations
2010 which came into force on 1 April 2010. As a
provider of healthcare, we are required to
present certain information which has been
nationally determined, in the form of statements.
These mandatory statements are specified in the
above regulations.
We encourage our staff, patients, public and
healthcare partners to look at this Quality
Account to understand what we are doing well
and where improvements in services are
required. This Account outlines our priorities for
improvement in the coming year (2015/16) and
we welcome comment on, and involvement in,
determining future priorities for improvement.
Our Quality Account provides the opportunity for
us to report on the progress we have made in the
last year and our plans for improvement this year.
We made significant progress over the last 12
months and we continue on our journey of
continuous quality improvement.
Many of the improvements we have made so far
have been widely recognised. The Care Quality
Commission
(CQC)
recognised
these
improvements following inspections of our Out of
Hours service in early 2014. This has been
followed up by further inspections in our Prisons
Services (October/November 2014) and NHS111
services in March 2015. The inspectors said that
we were delivering safe and effective care to
patients through a well-led organisation, as we
were chosen as one of the first organisations to
undergo their more in depth, new-style
inspections of Out of Hours and NHS111 services.
an organisation which listens to our patients and
uses their feedback to improve the quality of care
we provide. Our Board meetings always now start
with a patient story, and these have proved to be
enormously beneficial to us by really bringing to
life what it’s like to be cared for by DHU.
Along with taking on new services in 2014/15 to
support the Derbyshire healthcare system as
detailed in this Quality Account, we have been
focused on delivering the services we provide for
our Out of Hours and NHS111 patients from the
contracts that were implemented in 2013/14.
Throughout 2014/15 we have seen a significant
There has been significant changes at Board level increase in patients demand and expectations
over the last year, however the focus remains with over 1.2m patient contacts taking place in
very clearly on the quality of care and compassion these services over that period.
we demonstrate, along side a transparent culture
I am grateful to those who have contributed to
aimed at reducing incidents of avoidable harm to
the content of this year’s Quality Account and to
patients and ensuring learning and outcomes are
those who have worked with us to ensure that
acted upon to improve patient safety.
they accurately reflect the work that we have
We are not complacent and we know from the undertaken this year. As Chief Executive, I am
challenges in 2014/15 that there is still significant pleased to confirm that the information
improvements to be instigated to improve contained in this Quality Account is to the best of
safety, quality, and the overall patient experience. my knowledge, accurate.
We are absolutely committed across the
organisation in taking an active approach to
provide quality healthcare. From reading this
Quality Account, you will get a sense that we are
Stephen Bateman CEO
Derbyshire Health United Ltd. Quality Account 2014/2015
2
Section 1 Message from our Chairman
Message from our Chairman David Whitney
It is a privilege to say a few words of introduction to this
annual report as the newly appointed Chair on behalf of the
recently constituted DHU Board.
I have already had the opportunity to witness the excellence
of DHU services at first hand and the skill and dedication of
staff throughout the organisation; our CEO has reflected this
in more detail in his summary of the important achievements
of 2014/15.
The new Board is totally committed and determined to build
upon the substantial progress of last year as we face the
challenges of 2015/16.
The primary focus of DHU will remain the provision of high
quality, innovative and safe patient care whilst ensuring that
we meet national targets within the finite resources available
We look forward to working closely with patients, staff and our partners as we move forward
together in the year ahead.
David Whitney
DHU Chairman
3
Derbyshire Health United Ltd. Quality Account 2014/2015
Section 1 Who we are
Who we are
Derbyshire Health United Board of Executive and Non-Executive Directors (March 2015)
Derbyshire Health United (DHU) is a 'not-for-profit' social enterprise
organisation and is the provider for NHS Out-of-Hours services on behalf
the North Derbyshire, South Derbyshire, Hardwick and Erewash Clinical
Commissioning Groups.
DHU are the provider for the NHS111 Services for Derbyshire,
Nottinghamshire, Northamptonshire, Leicestershire, Leicester and
Rutland and are the provider of Offender Health and Justice services for
HMP Sudbury and Foston Hall prisons. DHU believe that patients
deserve good quality treatment in a caring and safe environment.
As a team DHU are committed to doing the right thing, in the right way,
at the right time, in the right place and with the right results - improving
the lives of patients 24 hours a day, 365 days a year. DHU's quality
account is intended to provide assurance of the quality of our service
using information generated both internally and from external
organisations.
Top Row— Left to Right
Bottom Row—Left to Right
Jenny Tilson—Director of Nursing and Quality
Pauline Davis—Non-Executive Director
Dr Aqib Bhatti—Clinical Director
Keith Nurcombe—Non-Executive Director
Dave Walsh—Director of Human Resources and Organisational Design
Margaret Amos—Non-Executive Director
Stephen Bateman—Chief Executive Officer
David Whitney—Chairman
Pauline Hand—NHS 111 Programme and Operations Director
Christine Bain—Non-Executive Director
Dr John Blissett—Clinical Director
Dr Phillip Cox—Deputy Chairman, Non-Executive Director
Peter Quinn—Director of Finance, Performance & IT
Carly Gray—Company secretary (in Attendee)
Jenny Doxey—Deputy Clinical Director (Attendee)
Dr Tony Gould—Medical Director (Not in the image above), Non-Executive Director
Derbyshire Health United Ltd. Quality Account 2014/2015
4
Section 1 Our Objectives 2014/2015
We continued in 2014/15 to improve the quality of our services, to ensure they are safe, effective, caring , responsive and
well led. Within this Quality Account we will highlight where we have achieved our objectives.
Objective 1
Objective 2
Objective 3
Placing patients at the heart of our
organization
Integration and partnership within the
health community in delivering services to
patients
Innovation and creation of opportunities
and benefits for the company and patients
Section 1,2,3,4,5,6,7,8
Section 6
Section 6
Objective 4
Objective 5
Objective 6
Involvement of public and patients in the
development of our services
Delivering an quality, safe and caring
service for patients at the time that they
need it
Providing a stable and positive working
environment for our staff
Section 5
Section 2, 4, 5
Section 3
5
Patient Comment; “Caller rang to say he wanted to pass on his compliments to our staff at DHU—excellent service from start to finish”
Derbyshire Health United Ltd. Quality Account 2014/2015
Section 2 Our Services
DHU delivers Out-of-Hours Primary Care Service to
over a million people in Derbyshire
Derbyshire Health United (DHU) provides Out of Hours
primary care services across the county of Derbyshire
from a total of 13 locations. These services operate when
your local GP surgery is closed between the hours of
6:30pm & 8am Monday to Friday with services being
available 24 hours a day weekends & bank holidays. DHU
Out of Hours primary care services form part of an
integrated healthcare provision working alongside the
NHS 111 service and the evening / overnight District
Nursing service for Derbyshire. Integration of the three
services has allowed DHU to improve the patient journey
encompassing a multidisciplinary approach to ensure
referral to the appropriate healthcare professional.

North High Peak Urgent Care Centre (Walk in
Service)

Swadlincote Urgent Care Centre (Walk in Service)
The above services are open 7 days a week during the
Out-of-Hours period, with Ashgate Manor, Derby Urgent
Care Centre and Ilkeston Community Hospital also
having services available overnight. The following
additional facilities are open at the weekend & also on
Bank Holidays:

DHU operate primary care centres at the following 
locations:

Ashbourne Urgent Care Centre – St Oswald’s
Hospital
Bolsover Hospital
Clay Cross Hospital

Ashgate Manor – Chesterfield

Ripley Hospital

Buxton Hospital

Whitworth Hospital

Chesterfield Royal Hospital

Derby Urgent Care Centre

Ilkeston Community Hospital

Long Eaton Health Centre
DHU’s newest Primary Care Centre, Ashgate Manor in
Chesterfield houses one of the NHS 111 call centres and
6 consulting rooms in a ‘state of the art’ Primary Care
and training
Centre. The staff and patients are
delighted with their new environment.
Derbyshire Health United Ltd. Quality Account 2014/2015
6
Section 2 Our Services
The delivery of our Out of Hours Primary Care Service
All of DHU’s services are available to the residents of
Derbyshire and can be accessed by contacting the NHS 111
Service. Following a thorough and detailed assessment of a
patients healthcare requirements, a NHS 111 Advisor can
recommend each patient the most appropriate course of
action:

General Practitioners (GP’s)

Emergency Care Practitioners (ECP’s)

Advanced Nurse Practitioners (ANP’s)

Minor Conditions Nurses (MCN’s)

Self-care advice

District Nurses (DN’s)

Contact a local pharmacy

Nurse Advisors (NA’s)

Contact a local dentist

Mental Health Specialist Nurses

Contact own GP during daytime opening hours

Healthcare Assistants (HCA’s)

Arrange an appointment with a GP or Nurse 
Practitioner Out of Hours

Receptionists

Arrange an advisory telephone call from DHU’s 
Clinical Team if Out of Hours
Support Staff

Advise attendance at an Emergency Department

Arrange an Emergency Ambulance for a Life

Threatening Emergency
Drivers

Dental Nurses

Phlebotomists
If a patient requires an appointment DHU’s local service is 
supported by a vast group of healthcare professionals
working together to deliver a comprehensive service to
patients across the county.
Pharmacist
Pharmacy Technicians
This service comprises of a number of health care
professionals :
7
Patient Comment “Very happy with the service,
dealt with very quickly and professionally”
Patient Comment; “many thanks to the OOH GP who she was in contact with yesterday, was very pleased with the level of care.”
Derbyshire Health United Ltd. Quality Account 2014/2015
Section 2 Our Services
The delivery of our Out of Hours Primary Care Service
During 2014/2015 DHU have experienced a significant increase in the number of patients accessing
services. In order to facilitate this increase in patients contacting DHU, we have been continually
working to improve the services that we provide.
When patients attend an appointment in one of our Primary Care Centres and have been assessed,
they will be treated by one of DHU’s many GP’s, Advanced Nurse Practitioner (ANP) and Minor
Conditions Nurses (MCN).
Over the last year we have increased the availability of the clinical service that we provide at many of
our sites across the county. Increased opening times, additional appointments available at local
centres and an increase in the number of clinicians at many of our centres have increased the local
accessibility for many patients.
Patients living in the following areas: Ashbourne, Clay Cross, Ilkeston, Long Eaton, New Mills and
Swadlincote now have increased access to appointments locally with either a GP or ANP. In addition to
these services our main centres in Derby and Chesterfield are always open whenever the GP surgeries
are closed.
We continually review all of our primary care services to improve the availability of appointments, the
access to these appointments and the services that we are able to provide at all of our Primary Care
Centres.
In addition to the above Primary Care Centres DHU have a fleet of vehicles to undertake urgent and
routine home visits to the elderly, terminally ill or housebound patients that require a face-to-face
assessment and are unable to travel to one of our centres.
“I would like to thank you for the
excellent service I received at the weekend. I
received an appointment promptly and the Nurse
Practitioner I saw was really helpful”
Patient Comment
Derbyshire Health United Ltd. Quality Account 2014/2015
8
Section 2 Our Services
The delivery of our Out of Hours Primary Care Service
During 2014/15 DHU were able to fully achieve the majority of the 12 National Quality Standards for Out of Hours primary care services and
additional local key performance indicators. DHU are continually reviewing our clinical services and internal processes to improve the delivery of
services we provide. This is to ensure appropriate clinical staffing provision to meet the needs of the significant increase in patients accessing
DHU’s services. During the last year over 100,000 patients have attended an appointment in our primary care centres and have been assessed and
treated by one of DHU’s many GP’s, ANP’s and MCN’s.
In addition to patients attending our Primary Care Centres, our clinicians have also visited over 20,000 patients in their own homes, Nursing,
Residential Homes or Community Hospital across the county. Our GP’s and ANP’s have also undertaken over 35,000 consultations over the
telephone. National Quality Standard 10, Face to Face Clinician assessment for Urgent Walk in Patients and Routine Walk-In Patients seen has
been consistently met. DHU achieved above the target of 95% compliance every month throughout 2014/15. DHU clinicians were able to see and
treat 96.7% of all urgent Walk-In Patients within 1 hour of arrival and 100% of routine Walk-In Patients within 2 hours of arrival.
National Quality Standard 12 has been the area of challenge for DHU during 2014/15 and 2 parts to this 8 part standard need improvement.
Although achieving the ‘emergency and routine’ home visit and face to face appointment targets a project group has been formed specifically to
focus on the improvement required to achieve the ‘urgent face to face appointment’ and ‘urgent home visit’ standard within 2 hours of
assessment. Within Quarter 4 of 2015 our response has been timelier, as we progress into Quarter 1 of 2015 we are implementing a strategy to
further improve our response times for patients that require urgent access to our services within 2 hours.
Quality and Innovation (CQUIN) Schedule for Out of Hours Service
For 2014 to 2015 financial year, DHU strived to achieve targets initiated by six CQUINS which were issued by the CCG at the beginning of the year.
Four of the six CQUINS involved our medication prescribing particularly in relation to antibiotic prescribing, which is a key factor in the increase in
Clostridium Difficile infections and also the increase in antibiotic resistance. We completed many audits and were proactive in reminding clinicians
about correct prescribing. This was a challenging task and at the end of the year we achieved an amber rating.
An additional CQUIN was for clinicians to access patient’s summary care records when available and with patient consent. This target was again
difficult for us but we did improve greatly over the year. We again achieved amber in this CQUIN. The final CQUIN was to work with patient and
professional groups to promote the understanding of the NHS 111 and the Out of Hours Service. Our relationship manager and others carried out
a varied programme of interactions over the whole county during the year and we achieved a green status for this final CQUIN. DHU have
improved practice and learned from our CQUIN challenge in 2014/15 and look forward to the CQUIN Challenges during 2015/16.
9
Derbyshire Health United Ltd. Quality Account 2014/2015
Section 2 Our Services
The delivery of our Out of Hours Primary Care Service
RightCare©
A RightCare© plan is an active care plan for patients that have more complex healthcare
requirements. Currently Derbyshire has 11495 active Rightcare plans. The plan facilitates an
increased knowledge and awareness in relation to each patients individual healthcare needs,
supporting any intervention from healthcare professionals that may be required when the patient’s
own GP surgery is closed/not available. A RightCare© plan is a streamlined care pathway for an out
of hour’s clinician to access and incorporate into an episode of care within the Out of Hours period.
RightCare© plans are completed by the patients own GP Practice/Primary Care team. Rightcare© is
fully integrated with NHS 111 service and can be viewed by other healthcare agencies such as
secondary care providers and ambulance services.
By having a RightCare© plan those patients are reassured that other clinicians dealing with their
health have access to and can follow a care plan that has been developed by their GP and in line with
their wishes, this avoids unnecessary or inappropriate admissions to hospital. For those patients who
are requiring palliative care or end of life care the RightCare© plan provides an up to date record for
clinicians to incorporate into any care that is required or delivered during the Out of Hours period.
Patient Transport Service
During 2014/15 DHU piloted a Patient Transport Service. Patients that were unable to attend a
Primary Care Centre were transferred to one of our centres by a member of the DHU transport team
in one of our response vehicles. The initiative was introduced to improve the patient journey and
improve utilisation of clinician time by reducing the number of Home Visits required. Unfortunately,
after piloting, full review, and discussion with Commissioners, this initiative was withdrawn at the
beginning of 2015 due to lack of demand for this service from our patients.
Introduction of Minor Conditions Nurse
To further improve and develop our Nursing workforce across the county the introduction of a Minor
Conditions Nurse training programme has been implemented. Five experienced DHU NHS 111 Nurse
Advisors have completed the first stage of their training successfully and our now working within our
Primary Care Centres supporting our GP’s & ANP’s. The programme has been extremely successful
and will continue to support the development and capability of our nursing team. DHU’s education
team are working closely with Universities across the East Midlands to further support this
development.
Participation in Initiatives
The DHU Out of Hours team are also actively working with our local Clinical Commissioning Group’s (CCG’s) to provide further support to
‘in-hours’ primary care services. In hours services are provided between the hours of 8am-6.30pm. DHU are working collaboratively with
Derbyshire Community Health Services, Chesterfield Royal Hospital, North & South Derbyshire CCG’s, Hardwick CCG and Erewash CCG to
provide access to additional services:

Additional Home Visiting Service provision to support local GP practices in Hardwick

Additional GP & ANP appointments at Ilkeston Hospital and Long Eaton Health Centre as part of the Prime Minister’s National Challenge
Fund initiative.

Emergency Department GP primary care streaming service at Chesterfield Royal Hospital

DHU Clinicians are also supporting local GP practices daytime services
Derbyshire Health United Ltd. Quality Account 2014/2015
10
Section 2 Our Services
The delivery of our Out of Hours Primary Care Service
Summary Care Record (SCR)
DHU Out of Hours services have access to Summary Care Records. This is a secure electronic summary of key health
information available to authorised healthcare staff providing care to patients in an emergency or Out of Hours.
A Summary Care Record will hold limited essential information such as details of any medicines the patient is taking
and any allergies or adverse reactions to medicines they have had. Additional information will also be added to a
patient’s Summary Care Record with explicit consent from the patient. .
As the Summary Care Record is an electronic record it provides faster, easier access to essential information about a
patient to safely support their treatment and care during a consultation and in a emergency situation.
Who has access?
Healthcare staff involved in supporting or providing a patient’s care in an emergency can access a patient’s Summary
Care Record.
To access a patient’s Summary Care Record healthcare staff will:

need to ask permission every time they need to look at a patient’s Summary Care Record.

need to be directly involved in caring for the patient;

need to have a Smartcard with a chip and passcode (like a bank card and PIN);

will only see the information they need to provide care for the patient and will have their details recorded;
and
If a patient cannot be asked, for example if they are unconscious, it is possible to look at a patient’s record without
asking them. In this instance, a note will be made on the patient’s Summary Care Record that permission to view was
not gained.
11
Patient Carer Comment “There is no other word to describe the quality of her end of life care than outstanding”
Derbyshire Health United Ltd. Quality Account 2014/2015
Section 2 Our Services
Our NHS111 Service
NHS England introduced NHS111 to make it easier for patients to access local NHS healthcare services in England. Patients dial
111 when they need medical help fast when it is not a 999 emergency. The NHS111 service makes it easier for patients to get the
right care 24 hours a day 365 days a year.
Derbyshire Health United (DHU) is commissioned to provide the NHS 111 service for Derbyshire, Nottinghamshire,
Northamptonshire, Leicestershire, Leicester and Rutland. In order to provide the NHS111 service, DHU employ fully trained
NHS111 Call Advisors and Nurse Advisors, along with Dental Nurses and Paramedics to ensure we provide an efficient, effective
and quality service to our patients. DHU pride ourselves in the skill mix we employ to ensure we deliver the appropriate outcomes
for patients. DHU focus on the patient journey, ensuring that our Advisors are fully trained in all aspects of the NHS 111 service to
ensure patients are directed to the local service that is right for them. Although DHU provide the NHS 111 service for Derbyshire,
Nottinghamshire, Northamptonshire, Leicestershire, Leicester and Rutland, in Derbyshire it is quite different. In Derbyshire DHU
is the provider for the Out-Of-Hours (OOH) GP Service which enables the NHS111 service to provide integrated care for patients.
What does this mean?
The integrated NHS111 and Out-Of-Hours service in Derbyshire delivers a streamlined approach to patient care. DHU staff are
able to directly book appointments into 13 primary care centres or allocate a home visit across Derbyshire from the patient’s first
point of contact with the service. DHU are able to track and trace the patient’s journey from the start to finish
If the patient re-contacts the NHS 111 service with a query on their Out of Hours contact in Derbyshire, then the Call Advisor or
Nurse Advisor will have visibility of the OOH system to advise the patient on their query e.g. to inform them how long it will be
for their telephone call back from a nurse or clinician.
When you call NHS111 for Derbyshire, Nottinghamshire, Northamptonshire, Leicester, Leicestershire and Rutland you will be
answered by a member of our team based in one of our call centres.
Where are the staff based?
DHU’s NHS111 Services operates from 2 call centres in Derbyshire and 1 call centre in Leicestershire providing local knowledge’s
in the areas we provide the NHS111 service.
Derbyshire Health United Ltd. Quality Account 2014/2015
12
Section 2 Our Services
These graphs indicate the increase in call volumes year on year from 2012 and the projected call volumes for 2015/16 for the NHS
111 contracts currently held by DHU in Derbyshire, Leicestershire, Leicester, Rutland, Northamptonshire and
Nottinghamshire. Where there is no bar on the chart in 2012/13 the service in that area had not yet commenced.
Patient demand increased from 2013/14 to 2015/16 by 234,83 calls. Last year DHU answered 956,707 patient calls through the
NHS 111 service. In 2015/16 we forecast that we will answer the telephone to over a million patients, approximately 1.1 million.
13
Patients comment. “everyone she has spoken to from the (111) service has been brilliant' and she is very happy with the help she has received”
Derbyshire Health United Ltd. Quality Account 2014/2015
Section 2 Our Services
NHS111 Performance
There are numerous Key Performance Indicators (KPI) that have to be achieved by an NHS 111 Nurse recruitment is currently a national problem. DHU have developed a recruitment strategy
provider. These include achieving less than 0.05% of calls engaged, less than 5% abandoned calls, focusing on the recruitment and retention of Nurse Advisors, Dental Nurses and Paramedics.
answering 95% of calls within 60 seconds and less than 10% calls transferred to 999 ambulance.
The target of Nurse Advisor call backs is currently being reviewed nationally in line with the new
Reports on these KPIs are sent to commissioners daily and weekly telephone conferences take place NHS111 specification and DHU are in discussion with our commissioners in terms of agreeing a locally
with commissioners to discuss weekly performance. DHU also provide monthly reports which are agreed target.
submitted to commissioners of the service and to the NHS 111 National Team. This enables
DHU have one of the lowest referral rates to 999 ambulance from an NHS 111 service in the Country
commissioners and NHS England to be able to make comparisons against other NHS 111 providers.
at approximately 8% of calls. This is 3% lower than the National average of 11%.
A monthly meeting focusing on adherence to the performance standards and quality of the service is
The graph highlights the percentage of final dispositions that result in an emergency ambulance being
held between DHU and our commissioners.
dispatched on total triaged calls.
This meeting is in addition to the monthly Clinical Governance Meetings held jointly with
commissioners and other stakeholders that have a connection to the NHS 111 service, such as East
Midlands Ambulance Service, A&E representatives, Out of Hours Representatives from all Counties,
District Nursing Services, Patient and Public Involvement Representatives.
DHU have struggled to maintain the standard of answering all calls in 60 seconds, just falling slightly
below the target. However, the average length of time it has taken DHU to answer all calls is 6
seconds, which is an excellent achievement.
Our emphasis during 2015/16 is to improve upon this target and to ensure all patients are answered
with line with national KPI’s. DHU have increased our staffing in order to meet the rising demand and
are actively scrutinising all aspects of our service to aim to consistently achieve this national target.
A further national KPI measured within the NHS111 service is time for Nurse Advisors to call patients
back following transfer to our nurse triage queue. We have found this target to be challenging due to
increasing patient demand and the difficulties in recruiting Nurse Advisors .
To ensure that our service is safe for patients we have employed the assistance of Agency Nurses who
are clinically trained in NHS111 Pathways. Furthermore due to the integrated NHS111/OOH service in
Derbyshire we have been able to provide our NHS111 service with additional GP support.
Excellent national performance achieved on
this NHS111 KPI
Patient Comment “ received excellent service from 111 service and the doctor was extremely helpful and pleasant”
Derbyshire Health United Ltd. Quality Account 2014/2015
14
Section 2 Our Services
NHS111 Key Achievement 2014/15 - UXL
In 2014/15, DHU have successfully
implemented the UXL program, an
innovative internal learning and
development program targeted to
support front line employees.
“I spent an hour listening to my calls and discussing
emergency and ED dispositions and the process of
validation.
This has improved the quality of my calls in that I can
now assess more appropriately and effectively for the
safe care of individuals who call the service.
I am better able to validate what people calling the
service are telling me and this improves patient care in
UXL is delivered by a team of highly qualified and terms of time and what to advise people.
experienced trainers both clinical and non-clinical, which
sets out to improve individual and collective I am also better able to access calls that need emergency
or GP care, this means that people are directed to the
performance against clinical and operational targets.
right place for them.
DHU takes an active approach in order to improve the
patient’s safety, journey, experience and the quality of Overall, the process of UXL, I feel has improved the
our service delivered. UXL enables this by providing quality of care that I give to patients calling our service”
methods of support which include one to one coaching, Carol Dysart, DHU NHS111 Nurse Advisor
training sessions and frequent feedback to our NHS111
“UXL was an excellent project. NHS 111 is about
employees.
signposting patients to the right place at the right time.
During 2014/15, 152 Call Advisors and 80 Nurse Advisors
had embarked on the DHU UXL program. Since UXL has I had a lot of positive feedback from team members
I also noticed an
been developed we have seen a reduction in regarding this following UXL.
improvement
in
the
quality
of
care
given to patients
referrals to 999 and the Emergency Department and an
increase in self-care and referrals to see own GP within 3 following this project”
working days.
Sally Cave, DHU NHS111 Clinical Shift Manager
These statistics prove that the DHU UXL program is valid
and that it improves not only the patient experience, but
the employee’s ability to take patients through NHS
Pathways assessments and direct them to the most
appropriate care depending on their symptoms.
15
Derbyshire Health United Ltd. Quality Account 2014/2015
Nurse Advice and Paramedic Advice Lines
Another key development was the introduction of the Nurse Advice and Paramedic
Advice lines. If a Call Advisor needs assistance they can ring through to a Nurse Advisor
who is always available to take queries. This provides clinical support to aid the decision
making of Call Advisors. In addition over the winter period we also had a Paramedic in
the Call Centre working with the NHS 111 staff ensuring the appropriate use of the
ambulance resource. This support included asking patients when appropriate to make
their own way to ED when the ambulance service was under pressure.
NHS 111 Internal Update
In order to ensure all NHS 111 staff are continually informed of new developments,
training initiatives and any learning from incidents and complaints we have introduced a
NHS 111 Update specifically for this task which is sent out to staff on a fortnightly basis
(more often if required). This has been a very successful communication tool which has
been welcomed by staff.
Section 2 Our Services
Patient Comment; “I would like to pass my compliments
to the 111 service, I have used this service before in the
past and have found it very efficient. I had to call again
this morning and explained that you have always been
very helpful”
Derbyshire Health United Ltd. Quality Account 2014/2015
16
Section 2 Our Services
Additional Patient Services to support demand during Winter
Over the past few years NHS England and formerly the Department of Health
recognised that the demand for a large majority of health services increased

significantly over the winter period, usually October/November to March/April.
The increase in demand is and has been particularly noticeable within the out
of hours services (NHS111), primary care services (GPs) and accident &
emergency (A&E) departments.
As a consequence of this increased demand each year, additional funding is
awarded to the clinical commissioning groups in order that they can secure
additional services to support patients during those winter periods to gain
access to health services when most needed.

support patients with dental problems out of hours
Provision of a Primary Care Service within the ED department at
Chesterfield Royal Hospital to support patients with minor ailments/
injuries which releases much needed capacity for patients with major
problems to be seen more timely in A&E
Home visiting service during the working week which supports the GP
practices in Hardwick to see more patients within surgery hours and
supports the truly housebound patients to receive a medical service at
home.
During the winter of 2014/15 Derbyshire Health United (DHU) had been All of the above services have operated within the Derbyshire boundary in
awarded a proportion of that additional funding to deliver the following order to support our patients and ensure that patients receive the right service
at the right time and in the right place. Many of the above services have
services:
prevented patients from being admitted to hospital when not appropriate, and
have ensured patients have received a more timely service.

An additional GP and vehicle to support more home visits at weekends
for patients who are truly housebound by their condition

A crisis night sitting service to support patients at home in times of
crisis either for the patient or their carers. This service has also helped
to prevent inappropriate admissions to the local acute hospital

Supporting additional GPs and nurse practitioners during out of hours
periods (8.00pm to 8.00am next day) to give more patients clinical
advice over the telephone

Providing specialist dental nurse advisors in the NHS111 service to help
17
Derbyshire Health United Ltd. Quality Account 2014/2015
Section 2 Our Services
Derby Walk-In Centre
The Derby Walk-in Centre is a Nurse led service
employing a variety of healthcare professionals
offering a wide range of services to patients who can
attend without an appointment. The opening times
are 8am to 8pm, 7 days a week. This facility allows
patients access to a clinical assessment and treatment
or advice relating to minor injury and minor illness.
The experienced and highly skilled Nurse
Practitioners and Health Care Assistants are able to
provide assessment and treatment for the following
Minor illnesses and Injuries:

Minor
eye
conditions/infections
–
conjunctivitis, removal of superficial foreign
bodies

Acute wound treatment

Insect and animal bites and stings

Allergies i.e. hay fever

High temperature

Headaches and dizziness
Patient Satisfaction

Coughs, colds and flu-like symptoms

Blood tests

Minor skin conditions or infections

Emergency contraception

Rashes, sunburn, head lice, scabies,

At the Walk-in Centre we always aim to deliver a high standard of patient care and
satisfaction within all aspects of the service, we monitor this through patient feedback,
friends and family surveys and audits of our activity / performance data.
Minor head injuries

Minor allergic reactions

Minor scalds and burns

Abdominal pain


Breathing problems e.g. asthma
Muscle and joint injuries e.g. strains and
sprains, back pain, tendonitis

Chest infections

Stomach complaints such as indigestion,
constipation, vomiting and diarrhoea

Back pain

Suture removal

Urinary tract infections

Dressings

Ear and throat infections
Patient Comment; “I attended the Derby Walk in Centre on Osmaston
Road this morning. The nurse who checked me was very caring, kind and
put me at ease. I cannot remember her name but should she read this, a
big thank you for your help”
Patient Comment; “I had need to use the Derby walk in centre on Sunday
08 March 2015 and although the centre was very busy and I was quickly
seen and treated by extremely kind and cheerful staff in particular the
health care assistant”
Derbyshire Health United Ltd. Quality Account 2014/2015
18
Section 2 Our Services
Key Achievements for Derby Walk in Centre 2014/2015
Derby NHS Walk-in-Centre were able to assure that they were compliant with CQC to be registered as a
Health Care Provider 2014.
Clinical Audit
The Walk in Centre undertakes a quarterly Antimicrobial Audit. The audit looks at 3 areas Clinical
Justification for prescribing, Formulary based choice and Rationale if prescribing is outside of guidelines. The
objective was to ensure Practitioners are prescribing within the Derbyshire Joint Area Prescribing Committee
Antimicrobial Treatment guidelines (DJAPCAT Guidelines) results were positive.
Complaints
The Walk In Centre were able to demonstrate that in relation to the patient attendance figures their
number of complaints was extremely low.
Medicines Management
Walk In Centre Audit Forward plan included undertaking x2 Antimicrobial Medicine audits. The WIC met the
required target of achieving 85% compliance and improved on this target by 1.5% at the end of March
2015.
Mandatory Training
98% of all staff completed their Mandatory training up to the end of March 2015.
Patient & Public Engagement
Derby Forum undertook a patient Survey in September 2014. Feedback was overall excellent. Results
included: The reception was welcoming 40% advised that it was welcoming 32 % good and 27% satisfactory.
Patient Privacy and Dignity was preserved 33% excellent, 39% good and 27% satisfactory.
Contract Responsibility
DHU responsibility for this contract ended on the 31st March 2015.
Patients comment. “30 minutes wait – that’s fine, good, efficient service pleasantly provided”.
19
Derbyshire Health United Ltd. Quality Account 2014/2015
Section 2 Our Services
District Nursing Service
The District Nursing Service at Derbyshire Health United
(DHU) operates from 6pm-8am 7 days a week. We employ
District Nursing Sisters, Community Staff Nurses and
trained Health Care Assistants. We have a number of sites
across the county where we are based. The nurses always
travel in fully equipped company vehicles. Our minimum
requirement is that each vehicle is manned by at least 1
Registered Community Nurse and 1 trained Health Care
Assistant. The out of hours Community Nursing service
provides skilled, flexible nursing care to meet the needs of
individuals and carers in the community. The service is
delivered in a caring and non-judgmental manner in
agreement with the individual and carer, taking into
account their physical, social, psychological, cultural and
ethnic requirements.
The out of hours service will provide both planned and
unplanned care to patients in their own homes in
partnership with the day time Community Teams and
evidence based interventions may include but not be
restricted to:

Bowel Management

Catheter Management

End of Life – Terminal Care / Palliative Care

Leg Ulcer Management

Medicine Administration

Syringe Driver Management

Wound Care/Tissue Viability including complex
wound management
Our aim is to provide high quality nursing care, in the most
appropriate setting to reduce hospital admissions,
promote quality of life, facilitate early discharges and
coordinate complex packages of care. The service
operates 7 days a week.
DHU have 1 District Nursing team based in Matlock, and
1 District Nursing team based in Buxton each evening
6pm-midnight.
DHU have 3 District Nursing teams based at Ashgate
Manor in Chesterfield each evening 6pm-midnight and 1
team covering the overnight period until 8am
DHU have 2 District Nursing teams based at Mallard
House in Derby during the evening 6pm-midnight and 1
District Nursing Team covering the overnight period until
8am.
Patient quote: “I was visited by 2 District Nurses. They were fantastic, with the right mixture of compassion and professionalism, under-scored by a
wonderful sense of humour. They were brilliant, thank you so much.”
Derbyshire Health United Ltd. Quality Account 2014/2015
20
Section 2 Our Services
Participation in Initiatives
seamless transition between the in hours and out of hours service.
We aim to do this in a number of ways:
Members of the District Nursing (DN) team at DHU are actively

involved in the following initiatives:
Bi-monthly operational meetings between DHU and DCHS
team leaders.

DHU Patient Participation and Involvement Group.


DHU Communication and Engagement Forum.
Sharing of incidents and issues promptly between
organisations when they arise.

The Care and Compassion Agenda (Care-makers) NHS 
England.
Automatically sending a record of all patient contacts to
the GP practice following a visit (if consent is gained).

Signing up as Dignity Champions.


Becoming Dementia friends.
Referring patients back to their own day team the following
day, if required.

Following the care plan as agreed by the day DN team and
the patient.
By being involved in these initiatives, members of the DN team at
DHU are hoping to enhance the care received by, and the service
delivered to, the patients of Derbyshire.

The District Nursing Service in Derbyshire offers a 24/7 service to
patients requiring nursing care within their own home.

Participation in Initiatives
The daytime service is delivered by Derbyshire Community Health
Services (DCHS) 8am-6pm and the out of hours service is delivered
by Derbyshire Health United 6pm-8am. The daytime service can
refer patients for planned care in the out of hours period, if
appropriate.
Use of Rightcare plans to view important patient
information relating to long term conditions and end of life
care.
Liaising with care agencies, care co-ordinators and DN
teams regarding ongoing care.
On average, the DHU District Nursing team carries out 1699 visits
per month across Derbyshire.
This is a 27% increase in activity since DHU commenced the out of
hours District Nursing Service in 2011. We aim to visit those with a
high priority within 4 hours, or sooner wherever possible. We have
achieved this target in 99% of cases.
We therefore work collaboratively with DCHS in order to provide a
Patient quote: “I would like to compliment the District Nursing team for the excellent care and attention that has been given this morning.” 2015
21
Derbyshire Health United Ltd. Quality Account 2014/2015
Section 2 Our Services
Training and Development
The DHU District Nursing (DN) team undertake a range of training
and development activities. They are required to undertake
mandatory training as part of their role, which includes basic life
support, information governance, health and safety, safeguarding
and infection control. In addition to this, the DN team also attends
a patient handling study session. Other training available has been
verification of death, catheter management, percutaneous
endoscopic gastrostomy management and domestic abuse
training. There has been training specifically aimed at our Health
Care Assistants including second checking and clinical skills.
End of life and Syringe Drivers
Incidents
Every month the DN team carries out an average of 80 visits where
the patient has, or requires a syringe driver. Syringe drivers are
essential pieces of equipment used in end of life care and the
District Nursing team at DHU carries a syringe driver in every
vehicle. The District Nursing team at DHU is very experienced in
caring for patients at the end of life and participate in ongoing
training and development provided by the Derbyshire Macmillan
End of Life Care Development team. DHU also has representation
on the North Derbyshire End of Life Forum, the North Derbyshire
End of Life Project, the DCHS End of Life Care Group and the
Derbyshire wide End of Life group. By being engaged with our
partner organisations in these groups we aim to be actively
involved in service development which hopes to improve End of
Life care across Derbyshire.
59 incidents were reported and investigated by the DN team in
2014/2015. On average there are 5 incidents logged per month
that have been allocated to the DHU DN team. In 2014/2015 the
largest number of reported incidents related to pressure ulcers,
numbering 16 (27%). In July 2014 DHU adjusted it’s reporting
procedures following the publication of guidance from NICE and
NHS England. The second largest group of incidents related to
communication issues which totalled 12 (20%). As a result of this
the DN team leaders have been working more closely with their
colleagues within DCHS to ensure better communication between
the in hours and out of hours services.
Quote from a letter of thanks:
Quote from a letter of thanks:
“Just a note to say a really big thank you
to the evening nurses and the night
nurses for the care given to our Mum for
the last few nights of her life. Your
kindness and patience was much
appreciated by the family.”
“We wanted to thank the out of hours
team of nurses who we frequently had to
call on. They are not only efficient looking
after Mum and making her comfortable,
but still have some energy to be so kind
and supportive to us.”
April 2014
May 2014
Derbyshire Health United Ltd. Quality Account 2014/2015
22
Section 2 Our Services
DHU Offender Health &
Justice Services
The Offender Health & Justice Division is responsible for
delivering high quality care to prison establishments across the
Derbyshire
County. A wide range of service are delivered
including:

Primary Mental Health

Clinical Substance Misuse

Long Term Conditions Management

Urgent Care

GP Services

Sexual Health & Contraception

Immunisation & Vaccinations

Medicines Management
The purpose of the service is to ensure individuals residing within
the prison establishment receive a high quality of care that is
equitable with healthcare services available to the general
population within the community.
23
HMP Foston Hall
HMP Sudbury
HMP Foston Hall is a closed female establishment that has the
capacity to hold up to 381 prisoners over the age of 18.
HMP Sudbury is a Category D (Open) Prison that has the capacity
to hold up to 584 male prisoners, over the age of 21.
HMP Foston Hall also has a dedicated unit to support patients
with a confirmed personality disorder.
HMP Sudbury is a resettlement prison designed to support the
reintegration of longer serving prisoners back into the
community.
The healthcare service operates on a 24/7 basis and is delivered
by a multi-disciplinary team.
Comments received from patients at Foston Hall over the past
year include:
“The infection disease awareness meeting was ten out of ten for
information, guidance, inspiration and empowerment.”
“Thanks for all the help and support I have been given. Also for all
the positivity you all gave to me. It really helped me get through
my detox. It meant a lot.”
A member of staff also received commendation from NHE
England stating “Following recent correspondence, excellent
feedback has been received from a client you cared for.
The client’s letter was outstanding and shows you are someone
who went beyond expectations in the delivery of person centric
care.
The client took the time to write to the Governor and explained
the impact your kindness had, this shows what excellent care
should look like. – Director of Nursing & Quality (NHS England)
Derbyshire Health United Ltd. Quality Account 2014/2015
The Healthcare service operates 7 days a week between 07:30
and 17:00.
Comments received from patients at HMP Sudbury over the past
year include:
“I would really like to thank the Healthcare Team, especially the
Nurses and the receptionist who are professionals at their work,
thanks so much”
“Just a word of gratitude to all the staff at HC Sudbury, you are
appreciated for all of the sterling work and help you provide to all
at this establishment, it is appreciated by most of us here so
thanks. You provide an excellent service in times of cuts and
shortages to the HC system so again thank you.”
Section 2 Our Services
Patient Engagement
Independent Body Findings
Patient engagement remains a key priority to delivering
healthcare services to the prison population, many of which
include traditionally ‘hard to reach’ groups. In order to address
this challenge the healthcare team delivers regular health and
wellbeing activities to ensure key messages are delivered.
In October 2014 the service at HMP Foston Hall underwent an
unannounced Care Quality Commission (CQC) visit and Her
Majesties Inspectorate of Prisons (HMIP) Inspection, with a follow
up inspection taking place at HMP Sudbury in November 2014.
Inspectors were very impressed with the services offered and
deemed the service fully complaint across all expectation
outcomes (safe, effective, caring, responsive, and well-lead). A
sample of findings from both establishments include:
Health promotional activity is specifically aimed at the health
needs of the population and includes a range of topics including
cervical cancer, testicular cancer, smoking less, alcohol
awareness, hand hygiene and sexual health.
Incidents
A total of 52 incidents were reported between the period April
2014 – March 2015. Although the number of incidents remained
low during the first two quarters, trend analysis identified
medicine administration errors remained the highest type of
incident reported.
In order to address this ongoing trend a new medicines
management team were launched to take ownership of medicine
administration. Data analysis from Quarter 3 highlighted how this
change had significantly reduced the number of medicines
administration errors by over 30% of incidents reported and also
contributed to a drop in the number of incidents reported, a
pattern that has continued into Quarter 4.
CQC:
“Staff worked as part of a team and enjoyed working in the
service. This showed the provider promoted high
standards of care by creating an environment where
clinical excellence can do well.”
“As part of the quality assurance process any action was
taken to improve highlighted areas if required. This
meant peoples complaints were fully investigated and
resolved where possible to their satisfaction.”
HMIP:
“Clinical and serious incidents were regularly reported, and
causes addresses exceptionally well.”
“The availability of nurse practitioners enabled women to
have faster access to clinical care and a range of
medication.”
“The new health care representatives’ meeting was a
positive development; it promoted cooperation
between women and health care staff and was run in a
flexible but structured way.”
Derbyshire Health United Ltd. Quality Account 2014/2015
24
Section 3 Our People
Derbyshire Health United (DHU) has a dedicated and highly
motivated workforce with a strong history of attracting and
retaining loyal and committed staff.
Introduction
Many of our staff have backgrounds in other parts of the health 
community and many of them retain their skills and knowledge by
also working with us.
Involvement of public and patients in the development of
our services

Our people understand that we exist;
Providing a stable and positive working environment for
our staff
To provide healthcare services for the benefit of the local 
community in which we live and work
Developing skills and talents for the mutual benefits of
staff member, organisation and patients
As a not for profit organisation, we provide for patients

appropriate outcomes and health gain through their contact with
our service
Delivering an efficient and effective service for patients at
the time that they need it
Our people believe in:

Placing patients at the heart of our organisation

Integration and partnership within the wider health
community in delivering services to patients

Innovation and creation of opportunities and benefits for
the patients, the health community and the company
25
Kayley Barnett - Call Advisor “I really enjoy working for DHU, everyone is
really friendly and supportive”
Derbyshire Health United Ltd. Quality Account 2014/2015
Staff Development
Within the staff appraisal process, individual objectives and targets
are set which are related to the Company’s corporate objectives. The
overall aim of this scheme is to maximise individual employee
effectiveness and potential
Our substantial Education and Training Division encompasses all
mandatory training within the company which includes Safeguarding
Children and Vulnerable Adults, Information Governance, Basic Life
Support, Moving and Handling, Infection Control and Health and
Safety. We also offer our sessional GPs supported training days, a
system of alerts on clinical issues accessed via a login-protected area
of our website and other professional support services.
Section 3 Our People
Performance & Development
Our Culture and Values
We invest in our people and strive to provide the 
highest possible standards of care and the very best 
patient and staff experience.
What we do

Quality

Innovative

Professional

Value for money

Dedication

Cost effective

Accountability

Passion for service

Patient focussed / understanding needs
Commitment
Mutual respect
We have a long standing annual Performance and Development
review process which takes place at least once per year. Managers
and staff will discuss and record the following:

Comment on objectives set in the last review, and
summarise evidence gathered to support a rating.

Summarise and expand on what has been done well as
well as summarising and expanding on aspects/areas of
performance where there could be improvement,

Discuss and record training and development needs and
possible outcomes

Flexibility

Reward and recognition

Value people

Loyalty

Developing people

Agree and set objectives for the coming year

Progressing career paths

Agree career aspirations and record any succession
planning implications
How we do it

Honesty / integrity / trust

Teamwork

Our culture and values:
Vicky Brown—Resourcing and Development Manager “It is the people that make working for DHU
a wonderful place ”
Derbyshire Health United Ltd. Quality Account 2014/2015
26
Section 3 Our People
Communication & Engagement
The benefits of working for Derbyshire Health United
DHU has set up a Communication &
Engagement Forum (CEF) in 2014 and this
consists of employee representatives
from across the entire organisation.
Salaries and grading comparable with NHS agenda for change
terms and conditions of employment, DHU provide;
DHU believe employees will be able to
perform at their best when they know
and understand their duties, obligations,
rights and have the opportunity to make
their views known to the management
team on issues that affect them.
DHU has made improvements in 2014/15 to internal and external
communications and engagement. This has enabled DHU to have the
ability to exchange views, issues, receive instructions and discuss new
ideas.
Employee Recognition Scheme
Working with our Communication and Engagement Forum we have
developed the employee recognition ‘The Limelight award’.
This is an intense illumination of employee effort, on a monthly basis we
reward someone placed in the “Limelight”, centred on their exceptional
contribution to DHU in providing not only quality patient care but care
and compassion for their colleagues too.
Winners of the Limelight Award are given a pin
badge to wear with pride, so that everyone
knows that the employee has been recognised
for their commitment, care and compassion to
our patients and our staff.
27

Generous holidays

Westfield Health cover

NHS Pension Scheme
Achievements 2014/15
Human Resources (HR), the Payroll department and the communications and engagement, providing staff newsletters,
Communications department have been working on several improving external communication and
conducting an
issues during 2014/15
employee survey and revising the DHU Intranet / Internet.
In order to improve employee engagement and retention we
have introduced assessment centres for all our recruitment in
OoH, Prisons, WIC, 111 & Corporate divisions. This is to ensure
we attract and retain the right calibre of candidates, and this
initiative has led to the successful recruitment of 180 people in
last 6 months. Once recruited they attend our improved and
re-launched corporate induction process.
HR has also been pivotal in helping line managers to improve
attendance by running absence management training
workshops for line managers and conducting absence
management surgery sessions.
The Payroll team have worked on the Payroll system and have
also administered changes to the NHS Pension scheme,
launched the NEST Pension Scheme and administered Pension
Human Resources function has been instrumental in auto enrolment.
restructuring our new DHU Board and recruited a new Chair,
On top of this the team provided an employee relations service
Director of Finance and four new Non-Executive Directors
which includes revising policies, advising on disciplinary,
The Human Resources and Payroll department have also grievance issues and managing TUPE transfers.
implemented an integrated IT system to improve the
functionality of the departments to benefit our employees.
The internal recruitment of a Communications Manager has
also helped the team to launch an employee communication &
engagement group which is aimed at improving
Derbyshire Health United Ltd. Quality Account 2014/2015
Section 4 Our Quality Assurance
Care Quality Commission Out Of Hours Report May 2014
The Care Quality Commission (CQC) regulates all health and adult social To understand the patients’ experience of care CQC asked the following 5
care services in England through inspections and monitoring. It aims to questions:
ensure essential quality standards are met by all care providers. All of Are services safe? 
our services are registered with the CQC.
CQC; “We found that the provider had in place robust and rigorous
On the 26th and 27th February 2014 CQC visited our Out-of-Hours systems to ensure that people seeking to work at DHU were appropriately
services at Ashgate Manor and Chesterfield Royal Hospital. The recruited and vetted to ensure their eligibility and suitability”
inspection team was led by a CQC Lead Inspector and a GP. The team
included an additional CQC inspector, a GP, Practice Manager, a nurse
and an expert by experience who helped to capture the experiences of
patients who used the service.
Jenny Tilson, Director of Nursing and Quality;
“We are committed to the delivery of excellent
care, making sure our patients are at the heart
of everything we do. We are passionate about
listening to patients, and strive to ensure that
they receive safe, effective and compassionate
care.”
Are services effective? 
CQC; “We found that the service was providing effective care to a wide
range of patient groups with differing levels of need often with limited
information available to clinicians”
Before visiting, CQC reviewed a range of information about the Are services caring? 
Out-of-Hours service and asked other organisations to share what they
CQC “Patients, their relatives and carers were all positive about their
knew about the service.
experience and said they found the staff friendly, caring and responded to
their needs. We observed examples of good interaction between patients
Information was also reviewed that had been provided at the request of
and staff and noted that staff treated patients with respect and kindness
the inspection team. The CQC team visited DHU over two days and and protected their dignity and confidentiality.”
spoke with members of staff including Doctors, Nurse Practitioners,
Are services responsive to people’s needs? 
Receptionists, Call Advisors, Nurse Advisors, Directors and the members
CQC; “We found that the provider had an effective system to ensure that,
of the DHU board.
where needed, clinicians could provide a consultation in patients’ homes.”
Patients and carers who used the service were also spoken to by the
Are services well-led? 
inspection team.
CQC; “Members of staff we spoke with talked positively about the
management of the service and said there was a desire from above for
staff to continually learn and improve.”
Access to the full report can be found on the CQC website.
http://www.cqc.org.uk/location/1-1192461912
“CQC - well-led and managed by an enthusiastic and knowledgeable senior management team and board of directors, and their values and behaviours were shared by staff”
Derbyshire Health United Ltd. Quality Account 2014/2015
28
Section 4 Our Quality Assurance
Derbyshire Health United (DHU) is committed to
safeguarding and promoting the welfare of
children and vulnerable adults.
Prevent lead to effectively disseminate the Prevent
agenda.

DHU continued to work with partner agencies across
all the counties including NHS Trusts, East Midlands
Ambulance Service, Social Services and other agencies
to ensure that safeguarding issues are dealt with both
in and out-of-hours. Closer links with commissioners
were developed in the form of themed call reviews
specifically around safeguarding

Commissioners undertook quality assurance reviews
in 2014/15 for both Adult and Children’s safeguarding
and found DHU to be a high performing organisation
in its commitment and response to safeguarding.
As a health provider organisation we ensure that our
employees and board members are knowledgeable about
safeguarding and confident and competent in carrying out
their responsibilities.
Key achievements in 2014 / 15

DHU Lead Nurse for Vulnerable Adults and Named
Nurse for Safeguarding Children worked closely
together to develop and update the policies and
training programmes in line with the latest national
guidance.


The safeguarding team expanded to provide a more
comprehensive service and increased training and
availability for the support and supervision of staff
across the service.

The DHU safeguarding strategies were updated to
include “Prevent” and Mental Capacity/ Deprivation
of Liberty training. The clinical training team
recruited specifically for a team member to deliver
training in this area.

The Adult safeguarding lead was supported to
complete the Certificate in Continuing Professional
Development: Preventing Terrorism: Understanding
Radicalisation, Vulnerability and Improving Practice.
This action ensured that DHU has a competent
29

DHU recognises the importance of the treating people
with Dignity and respect. There are over 50 Dignity
champions throughout the service inclusive of
Directors, clinicians, corporate staff and staff
providing day to day delivery of patient care.
DHU was awarded the Bronze Award for Dignity in
Care within Derbyshire in 2013. This year we have
continued to work towards compliance for the silver
award and hope to successfully achieve that award in
the very near future. This demonstrates DHU’s
continuing commitment to Dignity in Care and shows
that the staff members uphold the main ethos behind
the initiative.
Derbyshire Health United Ltd. Quality Account 2014/2015
Image
Section 4 Our Quality Assurance
Our commitment to lifelong learning
and development for all groups of staff.
understanding of the difficulties some of our patients
are facing.

Our DHU commitment to life long learning is provided by a
team of clinical and non-clinical trainers in addition to
facilitating staff with access to external courses at Universities
and other providers.
Key achievements in 2014 / 15



The DHU clinical training team have developed a Minor
Conditions Nurse course specifically designed to meet 
the needs of the Out of Hours service. This leads to an
apprenticeship as an Associate Nurse Practitioner with
DHU. This initiative is in response to the national drive
for addressing the recognised shortage of advanced
clinicians, and to improve our recruitment and
retention of our Nurse Advisor Team.
Successful completion of the first module of this course
by a number of our nurses this year has enhanced the 
service provision in our Primary Care Centres and
Urgent Care Centres across Derbyshire.
In 2014/15 DHU have delivered a variety of bespoke
training programmes and education events for different
staff groups at all levels. There has been a series of
education sessions on increasing awareness and
understanding of people with a disability or mental 
health problems and recognising the impact of issues
such as domestic abuse or suicide. In doing this we
have enabled our staff to develop a broader
Additional modules have been developed and included
in the initial “pathways” training for the NHS 111 staff
in DHU. These have included dealing with emergency/
resuscitation
situations
on
the
telephone,
understanding the unwell child and dealing with
challenging callers. This has given our call centre staff
enhanced skills in providing safe and effective quality
care over the telephone.
Training programmes have been delivered to our
HealthCare / Receptionists. This is to ensure the need
for healthcare support workers to have adequate
training and supervision as highlighted by the
Cavendish Report. As a result of this the support to
clinicians in our Primary Care Centres has been
improved providing extra care and safety for patients in
the waiting areas.
There has been a comprehensive training programme
and dedicated training team for the provision of
Dementia Awareness training. DHU were successfully
commissioned by Health Education East Midlands
(HEEM) to provide dementia awareness training to
primary care providers, dental and pharmacy services
across the whole of the East Midlands.
Customer care training was delivered to receptionists
and other non clinical staff across DHU in 2014/15.
There was a focus on care and compassion
throughout all training delivered in this year.
Derbyshire Health United Ltd. Quality Account 2014/2015
30
Section 4 Our Quality Assurance
Clinical Audit
In DHU, audits are one of the methods used to inform and shape training and
improve the quality and delivery of our services. These audits also provide
assurances to our commissioners on the quality of our services across the
Out-of-Hours and NHS111 services.
Key achievements in 2014 / 15


Established in March 2014, the clinical audit committee meets
quarterly to promote a standardised high quality audit culture across
the organisation. Its membership includes both clinical and non clinical
staff from all areas of the organisation.
The committee has supported DHU staff to develop and participate in
audit. As a result 2014/15 has seen an increased number of audits
undertaken in the organisation and this has improved standards in our
practice and environment.

Audits in 2014/15 have included; Health & Safety, Infection Control,
Clinical Records, Rightcare© Service, Safeguarding service and
Medicines use and safety.

Results of an audit on participants learning from mandatory training
led to the development of a telephone Basic Life Support (BLS) session
being added to the NHS 111 staff initial training. This is in addition to
the standard BLS training delivered across the organisation.

31
This year there have been individual audits specifically around
paediatric consultations including an audit on the use of Feverish
Illness guidelines and a Paediatric Observational Priority Score (POPS)
which has improved the clinical care delivered to children accessing
the service.
Derbyshire Health United Ltd. Quality Account 2014/2015
Medicines Management
As part of the clinical care provided to our patients, DHU are committed to
ensuring that patients have access to the required medicines out of hours.
This means that we work closely with the local pharmacies, NHS England local
area teams, and the medicines management team at the CCG to ensure we
provide a safe and effective service. All our Clinicians are able to prescribe or
supply medicines when the patient’s condition requires them in the out of
hours period.
Key achievements in 2014 / 15

We have established a new medicines management committee to
bring together the expertise from different branches of the service to
review and improve practice.

Medicine errors have been reduced in the last year by focussing on
extra education and articles in clinical newsletters for all clinicians.

Our Patient Group Directions (PGD’s) were updated in line with new
NICE guidelines in order for patients to receive the treatment they
require in an effective manner. The PGD group incorporates the
experienced clinical staff and pharmacists.

Regular audits of medicine use and prescribing practice highlighted
specific areas for change. In line with national guidance DHU have
reduced the unnecessary use of antibiotics, this has involved educating
both staff and patients.
Section 4 Our Quality Assurance
Health & Safety

Health & Safety within Derbyshire Health United (DHU) is a primary
function that requires specific focus to enhance the provision of
service in order to maintain the levels of protection offered to all of
our staff, patients and visitors. While all of our staff hold health and 
safety at the heart of everything that they do there is always room

for improvement.
the Health & Safety Agenda.
Training for all levels of staff.
Completion of a formal site audit programme to highlight 
fundamental changes that are required to ensure the
Health & Safety of staff, patients and visitors.
Introduced a Self-Assessment process around display
screen equipment (DSE).

Risk assessments of service provision for key contracts.
Maintained full adherence to Health & Safety Legislation
requirements.
Implementation of Key Health & Safety related policies and 
procedures in line with HSE Legislation.
Maintained high safety levels for all service users across all
of DHU operational sites.
Throughout 2014/15 the key focuses on Health & Safety have
Key achievements in 2014/15 we have;

culminated in a safer, robust and more proactive culture around

Seen a significant decrease in the number of health and
the provision for the whole Health & Safety agenda.
safety incidents being reported through our Datix Incident
The key focuses of this period 2014/15 were;
Reporting system.

Introduction of a robust Health & Safety Management

Structure including a Health & Safety Committee to oversee
Improved on an existing quality Health & Safety culture and
made this part of our core values as a Healthcare
Organisation.
Improved the provision of Mandatory Health & Safety
Infection, Prevention and Control
are carried out at all sites to ensure quality and patient safety.
Derbyshire Health United ensures infection prevention and control Key achievements in 2014/15 were;
(IP&C) remains a core underlying element in its healthcare

To include the reviewing and updating of all IP&C related
delivery.
policies to reflect current best practice.
To achieve this, all staff members are required to undertake IP&C
To develop new policies relating to venous access devices,
training both on appointment and at regular intervals. This 
catheterisation and personal protective equipment in
training is reviewed on a regular basis to ensure it reflects best
response to updated NICE guidance.
practice.
The organisation also recognises that effective hand hygiene is 
one of the main methods of preventing healthcare associated
infection and actively encourages good hand hygiene practices
amongst all staff members. In addition to this, annual IP&C audits
To put in place robust procedures in response to the
recent Ebola crisis, with all DHU sites equipped to manage
a potential case, should one occur.
Derbyshire Health United Ltd. Quality Account 2014/2015
32
Section 5 Our patient experience
As an organisation, we welcome patient
feedback which is valuable in order for us to
improve the patient experience.
Patient Feedback
All complaints, concerns and patient feedback is
dealt with by our experienced team of staff within
the Integrated Governance Department. Formal
complaints are handled in line with the 2009 NHS
complaints and social care regulations.
Governance team. Learning outcomes are fed
back to our managers and employees within team
meetings, one to ones and within our internal
communications. When necessary changes in
policy and procedures within the organisation
takes place to ensure that learning is embedded.
DHU received 312 complaints excluding informal
DHU will monitor that learning outcomes are
prison complaints received in 2014/15 compared
established through a continual audit process.
with 350 complaints excluding informal prison
complaints received in 2013/14.
During 2014/15 four complaints were passed
onto the Parliamentary and Health Service
100% of complaints were acknowledged within
Ombudsman, 3 of these were not upheld and one
three working days. All complaints are thoroughly
is still under investigation.
investigated and trends are identified. The top
three complaint themes in this period included
staff attitude, communication and diagnosis &
treatment.
Complaints involving staff attitude are all fed back
to the individuals concerned in order for our
employees to reflect on their behaviour.
Every complaint is investigated by our Integrated
33
Derbyshire Health United Ltd. Quality Account 2014/2015
NHS 111
Complaints: 01
April 2014 – 31
March 2015
Number of
patients who
made contact
with our
service
Number of
complaints
received
% of complaints
from total
patient contacts
Total
956,707
228
0.024%
Section 5 Our patient experience
Incidents
Derbyshire Health United actively encourages its
staff to report any worries or concerns they might
encounter in practice, through our electronic
incident management system (Datix).
These concerns are then assessed and reviewed
with the Integrated Governance team taking the
lead. Concerns may be varied and can relate to
any aspect of patient care or service provision.
Each case will be investigated and finding of any
investigation will be fed back to the person who
raised the concern initially.
Serious Incidents
Any learning from investigations may be used as
part of an organisational action plan with the
overall aim being to improve practice, ensure
safety is maintained and to improve patient
satisfaction. In 2014/15 we reviewed our incident
reporting process, we provided education and
learning sessions for our employees in order to
ensure staff felt confident in the reporting
mechanisms and also to ensure clarity in what
constitutes an incident.
DHU have often been praised for our open and
honest approach to reporting Serious Incidents.
During 2014/15 we reported 23 Serious Incidents
across all of our contracts. All Serious Incidents
are reported to our Commissioners within 2
working days, in line with the Serious Incident
policy.
DHU has processes in place to respond to Serious
Incidents and ensure a robust investigation is
carried out. This results in DHU learning from the
incident and minimising the risk of the incident
happening again and thereby protecting our
patient from future harm.
Themes are reviewed and learning from these
incidents is shared across the organisation both
on an individual basis and group learning via our
Weekly NHS111 Newsletters and monthly Clinical
Updates to prevent them from reoccurring. We
report all Serious Incidents onto STEIS (Strategic
Executive Information System) which is the
National Serious Incident Reporting system, this
ensures that learning is shared both regionally
and nationally. As DHU are the provider for the
NHS111 Service across 4 contract areas i.e.
Derbyshire, Nottinghamshire, Northamptonshire
and Leicester, Leicestershire & Rutland (LLR)
learning is shared across the 4 counties.
All Serious Incidents are fully investigated.
Duty of Candour
The Duty of Candour was recommended by the are offered a copy of the investigation reports.
Francis report to promote openness and
Some families choose not to receive this level of
transparency and ensures that patients harmed
detail. DHU welcome meetings with families to
by a healthcare service are informed.
discuss events face to face.
DHU have developed a ‘Being Open’ policy to
guide staff and improve communication with
patients when something goes wrong.
DHU have developed processes to inform
patient’s families of Serious Incidents and they
Derbyshire Health United Ltd. Quality Account 2014/2015
34
Section 5 Our patient experience
Derbyshire is a multicultural and
multi-ethnic society and DHU recognises
the importance of respecting the array of
different cultures and languages. DHU
has produced it's promotional literature
in several languages to provide relevant
information about it's services to as
many people as possible. The resources
will continue to be adapted to meet the
needs of the people of Derbyshire and
DHU will continue to recognise that
cultural differences are an ongoing
process within our diverse society.
Julie Tomlinson - Safeguarding Lead Nurse
35
Derbyshire Health United Ltd. Quality Account 2014/2015
Section 5 Our patient experience
Patient Experience
During 2014/15 we have worked hard to better understand and 
learn from our patient’s experience when they access our services.
We have improved the way we collect and manage feedback from

patients in order to maximise patient safety and improve
experience.
We have in 2014/15;

Established the Friends and Family Test at all our Primary
Care Centres where we see patients face to face.
Continued to receive a source of feedback from an
independent organisation called Client Focused Evaluation
Programme (CFEP), and engaged fully with Healthwatch.
Took opportunity to delve deeper into this patient feedback
both positive and negative and from this individual
managers now are more proactive in managing staff
performance and service change.

Reviewed and rewritten our DHU Patient and Public
Involvement Strategy.

Engaged a patient forum who appraise our patient
information, newsletter and who are actively involved in In 2014/15 we engaged with our patients in over 46 patient
service developments.
meetings/events and 12 GP patient participation groups.

Involved our staff from all divisions engaging them in regular
meetings to progress patient experience initiatives in DHU.
This monthly meeting is chaired by the Director of Nursing
and Quality which reports its outcomes to the Integrated
Governance Committee. The Board receives assurance that
all patient and public strategic objectives are being met
through quarterly reports presented by the Director of
Nursing and Quality.


We recognised the need to gain representation from hard to reach
groups, young adults, different ethnicities, mental health and are
actively looking at ways to do this, e.g. social media etc. We have
successfully established new links with various groups including the
Chesterfield Locality PPG Network, Sanctuary, Housing 21, North
Derbyshire Pensioners Association, Chesterfield Care Group,
Learning Disabilities for Derby City & Derbyshire, Midland
Association for Amputees and Friends, Derby City and South Derby
Mental Health Carers Forum and have recently established a link
Appraised our previous methods of collecting patient
with the Ladies Group in Chesterfield and will continue to build on
feedback and enabled more opportunities for patients to
this during 2015-16.
feedback on their experience.
We maintain our links with the Royal Derby Hospital (for Care
Reviewed our patient complaints leaflet and made
Coordinators) as well as the Derby Health Forum and North
amendments ensuring that we have this available in Derbyshire CCG Lay Reference Group. We already have dates in the
different languages.
calendar for 2015-16 to further engage with patient groups.
Derbyshire Health United Ltd. Quality Account 2014/2015
36
Section 5 Our patient experience
Our Patient Experience
Coordinator commented:
“DHU respond to patient
feedback received through a
number of different channels
as well as comments
received by Healthwatch.
Wherever possible DHU
make
improvements in
response to comments”
YOU SAID Example:
"I rang at 2pm and I got an appointment
at 5pm. The waiting area is clean and
bright with many toys for toddlers but no
toys for babies. I was only waiting 15
minutes to be seen. The nurse spoke to me
very nicely and handled my baby son very
gently. I was given a diagnosis and
advice."
WE DID Example:
Books and toys suitable for
purchased
babies
YOU SAID Example:
“when I attended my appointment, the
signage in your primary care centre was
not clear, and I had difficulty locating your
services, consequently I was late for my
appointment”
WE DID Example:
Our sites and Services Manager carried
out an extensive review of signage across
all of our sites, including our corporate
buildings to ensure patients have a more
positive experience.
37
Derbyshire Health United Ltd. Quality Account 2014/2015
Section 5 Our patient experience
Friends and
Family Test
DHU carry out a
friends and family test
every month across all
our Out of Hour’s
Primary Care Centres
The Friends and Family Test is an important opportunity
for patients to provide feedback on the care and
treatment they receive. The Friends and Family Test is
a simple way to identify both good and bad
performance and encourage organisations to make
improvements.
Introduced in 2013 the test asks patients whether they
would recommend health services to their friends and
family if they needed similar care or treatment. This
test enables patients to give feedback on the quality of
the care they receive, giving service managers and
employees a better understanding of the needs of their
patients to enable improvements. The test asks the
standard question, “How likely would you
recommend Derbyshire Health United to friends and
family if they needed similar care or treatment?” for further clarification.
Derbyshire Health United have been performing this
Patients will use a descriptive five-point response scale
test since January 2014. Below is a chart that shows
to answer the question with the following response
the average result for each Primary Care Centre from
categories:
April 2014-March 2015. We are extremely pleased with
• Extremely likely
our results throughout the year overall 86% of patients
• Likely
agreed they would recommend the service they have
• Neither likely or unlikely
received to friends and family. The test also gives
• Unlikely
patients the opportunity to comment on our service,
• Extremely unlikely
and we have taken an active approach to respond to
these comments.
Both the positive and negative answers are analysed
using a given formula which results in a score (Net We have also used the scores for each Primary Care
Promoter). Only the Extremely Likely response is used Centre to help us understand issues and problems at
as part of the calculation, please refer to the ‘NHS particular sites.
Friends and Family Test’ publication guidance 2013.
Derbyshire Health United Ltd. Quality Account 2014/2015
38
Section 5 Our Patient Experience
Patient Story - Ashbourne Sports
Lecturer praises Walk-in-Centre
A sports lecturer from Ashbourne who became ill at the
weekend has praised the treatment she received at
Ashbourne Walk in Centre, based in St Oswald’s
Hospital.
fantastic,” says Kathryn. “The Doctor said I was quite
poorly and treated my illness with steroids and
antibiotics. So within 20 minutes of leaving home I was
seen and treated.
Katherine Bates is a Lecturer in Sport at Derby College
on the sports therapy programme which helps to
manage sporting injuries. Katherine woke up on the
Sunday feeling ill and was concerned about her
condition worsening.
“I am extremely happy with the care I received and the
service was highly efficient. The Doctor was excellent
and I didn’t have to wait at all to see him. People are
very quick to make a complaint about the NHS but slow
to praise the good work that is being done by health
professionals day in day out.”
“When I am run down I am prone to developing a
chest infection which can leave me feeling very ill Ashbourne Walk-in Centre, run by Derbyshire Health
indeed,” said Katherine.
United, provides health advice and treatment for minor
injuries and ailments without an appointment. The
opening times are being extended from 31 January to
Katherine felt that she couldn’t wait until her GP 8am – 4pm each Saturday, Sunday and Bank Holiday.
surgery opened on a Monday and went straight to the
The service is available to anyone, whether registered
Ashbourne Walk in Centre.
with a GP or not.
“I was seen by a GP within 10 minutes which was
39
Derbyshire Health United Ltd. Quality Account 2014/2015
Section 6 Our Innovation working in partnership
Stephen Bateman, CEO “ We are committed
to working with commissioners and key
partners to transform services in line with
the joined up care strategies across
Derbyshire”
Derbyshire Health United Ltd. Quality Account 2014/2015
40
Section 6 Our Innovation working in partnership
Erewash HUB
During 2014/15, DHU have been working with Erewash CCG as the Lead Provider in partnership with the Erewash GP Provider Group and Derbyshire
Community Health Services to pilot two Primary Care Hubs, one in Long Eaton and one in Ilkeston. These Primary Care Hubs operate Monday to Friday
evenings as an extension to daytime GP primary care services and from 9am to 5pm at weekends and Bank Holidays. Appointments within the two
Primary Care Hubs can be booked via the patients own GP Practice receptionist, via the NHS 111 service or the local Minor Injuries Unit following an
assessment.
This extension of available primary care access gives patients local access and support to your GP practice, reducing the need to attend your nearest
Emergency Department, Urgent GP Out Of Hours services or Minor Injuries Unit.
The overall aim of the service is to provide extended access to primary care via the two locality hubs. Broader aims and objectives are to:

Allow Local NHS providers and commissioners to use resources effectively within the health economy.

Provide extended capacity to primary care via two locality hubs.

Improve local access to primary care in the evenings and weekends.

Improve the patient access experience to local GP services.

Reduce A&E attendances particularly children under 5 years.

Facilitate integration of services to provide the right care, right place at the right time.

Work to establish links with Out of Hours GP services, Minor Injury Units and community teams to ensure patients receive the right services at
the right location.

Improve urgent care pathways amongst GP practices, Minor Injury Units the NHS 111 & Out of Hours GP services.

Have a shared appointment system across all surgeries.
41
Derbyshire Health United Ltd. Quality Account 2014/2015
Section 6 Our Innovation working in partnership
Crisis Night Sitting Service
DHU are providing a crisis night sitting service for patients in South Derbyshire funded by the Derbyshire Winter
Resilience Funding. This service is to help prevent admissions to hospital and to help carers in crisis.
If clinicians visiting patients in the middle of the night feel that a patient may be able to be managed in a
different setting such as in a rehabilitation unit, or a respite bed rather than acute admission we can action by
providing a night sitter from within our service.
Patient safety is maintained and by avoiding admissions to acute hospitals ensures clinical effectiveness for the
patients and for the overall wider health services within the county.
Night sitters are trained Health Care Assistants, who will sit with the patient to keep them safe until the next
morning when they can be referred to an alternative health or social care service.
This service has been found to be ideal for tired patient carers, who need a nights rest in order to be able to
carry on the next day delivering their caring duties. This service recognises there is a need to not only look after
the patient, but to support those who often deliver the patient care 24 hours a day.
Patient Comment; “I want to thank you for the
excellent service I have received from you on Saturday”
Derbyshire Health United Ltd. Quality Account 2014/2015
42
Section 6 Our Innovation working in partnership
Chesterfield Royal Co-Location
DHU work closely with Chesterfield Royal Hospital NHS Foundation Trust
to provide a Primary Care service in the Emergency Department (ED).
Streamed Weekend Total
This co-location service was put in place back in November 2012 to
strategically target those patients who present to the ED but actually can
be assessed and treated by Primary Care Medical Practitioners or
Advanced Nurse Practitioners.
Having the Primary Care Centre co-located within the Acute Trust has
enabled enhanced patient care as there is direct access to speciality
services on-site.
On a patient’s arrival at the ED main entrance, a DHU advanced nurse
practitioner will rapidly clinically assess the patient and appropriately
transfer (stream) them to either ED or the Primary Care Centre to see a
clinician.
Patients who attend with primary care conditions and meeting an agreed
criteria can be streamed into our Primary Care Centre to see either a GP or
an advanced nurse practitioner .
This service has been found to relieve patient flow pressures within the ED
at Chesterfield Royal Hospital NHS Foundation Trust.
The service continues to evolve and further development of the streaming
service is being discussed as there is a potential for DHU to see more
patients with minor injuries. The average outcomes over a weekend are as
in the chart opposite.
Patient Comments “Fast and friendly”, “Wonderful nurse put my son at ease”, “Great”, “Excellent, quick, friendly”
43
Derbyshire Health United Ltd. Quality Account 2014/2015
Section 6 Our Innovation working in partnership
“The main benefit I see of this service is the
quality of patient care in particular for the
housebound who are able to access primary
care in their own home in a timely manner”
Kirsty Osborn—Senior Nurse Practitioner
Hardwick Acute Home
Visiting Service
Our work to improve services
for patients requiring urgent
care
DHU have been working in partnership with Hardwick CCG to provide an Acute Visits Service to GP practices since March 31st 2014. During this time
we have delivered 691 visits on behalf of 16 practices to patients requiring an urgent home visit.
The pilot was set up due to the profile of emergency admissions for Hardwick CCG showing a high proportion (20%) with a primary diagnosis of
‘signs and symptoms’ that have a zero day length of stay. The main clinical risk area for GP’s and patient’s is around those patients requesting
urgent visits for chest pain, dyspnoea, abdominal pain and other conditions that, whilst not automatically requiring a 999 call, require urgent
attention. The pilot aims to reduce unnecessary hospital admissions and to increase capacity in GP Surgeries, by providing a specific in hours home
visiting service focused at this group of patients for all 16 surgeries in Hardwick CCG. The home visits are carried out by DHU Nurse Practitioners
who attend within two hours of clinical triage.
This home visiting service has been hugely successful and beneficial to patients who would otherwise have had to wait until surgery is finished to be
seen or go to hospital unnecessarily. The current pilot has been extended for a further three months to enable a full analysis of the benefits and
outcomes to enable us to take this project forward.
Patient Comments “Impressed and thankful for this service” “very impressed with this service, well done” “hope they keep this service going”
Derbyshire Health United Ltd. Quality Account 2014/2015
44
Section 6 Our Innovation working in partnership
Mental Health Nurses in Call Centre
DHU have worked in partnership with Derbyshire Healthcare
Foundation Trust to develop mental health support within
the NHS111 call centre and for Out of Hours clinicians.
Members of the mental health team are trained to work
alongside the NHS111 Call Advisors and Nurse Advisors. They
are available by telephone for all our staff within the
Derbyshire county to provide support when required.
Patient safety is enhanced as the Mental Health Nurses are
able to access the care plan and past consultation notes
which will ensure standardised appropriate care for the
individual patients needs.
This service within the NHS111 Call centre ensures the
patient get the right care in the right place in the right time.
This enhanced service reduces unnecessary referral to the
emergency department, out of hours home visits and 999
calls ensuring a more clinically effective service.
A recent patient satisfaction survey sent to patients who had
come into contact with a Mental Health Nurse from this
initiative have fed back that their experience was better than
when they previously contacted NHS111. It was also stated
that at that the time of calling NHS111 the service helped to
meet an effective outcome for the patient, e.g. health, social
care or self-care.
45
Derbyshire Health United Ltd. Quality Account 2014/2015
Section 6 Our Innovation working in partnership
Dental Nursing Out of Hours—Call Centre
As an ongoing approach to improve the quality of our service, DHU have now introduced dental nurses within the NHS 111
service. This provides a wider skill mix to meet the needs of our patients in recognition of the limited urgent dental
services available out of hours.
Our registered dental nurses are fully trained and qualified in the use of NHS Pathways software and are able to triage all
calls coming into the NHS 111 service. Patients with dental symptoms make up a large proportion of the NHS 111 contacts
from the public.
We have spent considerable time reviewing the analysis of when patients have contacted the NHS 111 service, thus
enabling DHU to rota our dental nurses for when they are needed the most.
Currently patients contacting the NHS 111 service with dental concerns are passed through NHS Pathways, however DHU
are working to put plans in place for these patients to be directly answered by a dental nurse.
Dental nurses have the expertise and knowledge to help the patient and direct them to the appropriate dental service for
their needs. The patient experience has been much improved for those suffering from dental problems.
“Working for Derbyshire health United, it has become very evident to me over recent
weeks that there Is high demand for dental services and/or advice nationally . I am
delighted to say that Derbyshire health united are striving towards providing a full dental
nurse advising team which will not only enhance the excellent service already in place, but
also contribute to providing excellent patient quality care”
Brenda Wilbourn: DHU Dental Nurse Advisor
Derbyshire Health United Ltd. Quality Account 2014/2015
46
Section 7 Our DHU Objectives 2015/2016
We will continue in 2015/16 to improve the quality of our services, to ensure they are safe, effective, caring , responsive
and well led.
Objective 1
Objective 2
Patient Safety
Integration through partnerships
We will provide a high quality effective and safe
service to all our patients. Placing patients at
the heart of safe, compassionate and
competent care.
We will develop new models of integrated care
through embedding key partnership working
which commenced in 2014/15. This will Include
the redesign of Emergency and Urgent care
pathways.
Objective 5
Good Governance
Objective 3
We will be a well led, financially viable
organisation, balancing effective decision
making with innovation and transforming
services.
Objective 4
Supporting our workforce
Focus on prevention and self-care
We will aim to attract, recruit, retain and
develop all our staff to be part of delivering
good quality healthcare services.
We will use our experience and expertise to
work with patients, families and our local
communities to develop resilience and capacity
in preventative services and self care.
47
Derbyshire Health United Ltd. Quality Account 2014/2015
Section 8 Statement of Director Responsibilities
The directors are required under the Health Act 2009 to prepare a Quality Account for each financial year. The Department of Health has
issued guidance on the form and content of annual Quality Accounts (which incorporates the legal requirements in the Health Act 2009
and the National Health Service (Quality Accounts) Regulations 2010 (as amended by the National Health Service (Quality Accounts)
Amendment Regulations 2011).
In preparing the Quality Account, directors are required to take steps to satisfy themselves that:

The Quality Accounts presents a balanced picture of the organisations performance over 2014/15.

The performance information reported in the Quality Account is reliable and accurate.

There are proper internal controls over the collection and reporting of the measures of performance included in the Quality
Account, and these controls are subject to review to confirm that they are working effectively in practice.

The data underpinning the measures of performance reported in the Quality Account is robust and reliable.

Conforms to specified data quality standards and prescribed definitions, and is subject to appropriate scrutiny and review.

The Quality Account has been prepared in accordance with Department of Health guidance.
The directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the Quality
Account.
By order of the Board
5th May 2015 ….......................................................................... Chairman of the Board
5th May 2015 ….......................................................................... Chief Executive Officer
Derbyshire Health United Ltd. Quality Account 2014/2015
48
Section 9 Statement from Commissioners
Commissioner Statement
patients and the company, involvement of public and patients in service development,
delivering a quality, safe and caring service for patients, and provision of a positive working
NHS North Derbyshire Clinical Commissioning Group (NDCCG) is responsible for providing
environment for staff
the commissioner statement on the quality account provided by Derbyshire Health United
(DHU). This is the first Quality Account published by DHU and has been shared with It is clear that the commitment of DHU to these areas has led to significant achievements
Hardwick, Erewash and Southern Derbyshire CCGs as associate commissioners. This Quality and developments which have enhanced patient care. It is noted from the Quality Account
Account is very comprehensive and considerable focus has been given to the achievements that DHU intends to continue to work to sustain and enhance these improvements over the
made by DHU. The commissioner would encourage DHU to provide detail regarding the next year, with specific targets relating to safer staffing, staff education and engagement
with national initiatives such as the Dignity Champion and Dementia Friends programmes.
CQUIN schedule achievements and the Out of Hours KPIs in next year’s Quality Account.
General Comments
Careful consideration has been given to the content and accuracy in line with the national
guidance. NDCCG can confirm that DHU has produced a Quality Account that meets the
required criteria and that the information provided appears to be accurate and
representative of the information available to NDCCG through contract monitoring and
quality assurance processes during the year.
The Care Quality Commission visited DHU Out of Hours Service during February 2014 and,
the inspection was part of a programme to test the CQC approach to monitoring Out of
Hours Care. DHU were assessed against the following five criteria, are services safe,
effective, caring, responsive to patients needs and well led. Positive feedback from the CQC
was received in all areas
Measuring and Improving Performance
In relation to patient safety Commissioners continue to receive all serious incident reports.
Improvements have been noted in the timeliness of these reports DHU continue to work
with the commissioners to continually improve the Serious Incident reporting process, this
includes analysis and quality sign off of investigation reports. The number of patient
complaints in relation to the number of contact made by patients to services provided by
DHU received remains extremely low
The Quality Account describes the quality of services provided this year by DHU measured
against national, regional and local standards as detailed within the NHS contract and also
within the local quality schedule and quality incentive scheme (CQUIN). DHU has performed
exceptionally well in respect of the percentage of triaged 111 calls being transferred for an
emergency service (999) response. Other national 111 key performance indicators have
proved challenging and DHU have emphasised that they intend to focus on the other KPIs
during the next year.
DHU have identified six objectives that identify areas for service and quality improvement,
these include placing patients at the heart of the organisation, integration and partnership
within the health community, innovation and creation of opportunities and benefits for
49
Derbyshire Health United Ltd. Quality Account 2014/2015
Continue to page 50
Section 9 Statement from Commissioners
The Quality Account is an annual report to the public that aims to demonstrate that the DHU
is assessing quality across the healthcare services provided. The Quality Account provides
patients and their families with an accurate, honest and reflective account of the progress
that DHU has made throughout this year and its future plans to further enhance service
provision.
NHS North Derbyshire Clinical Commissioning Group and associate commissioners look
forward to continuing to work with and support DHU to commission and deliver high quality
patient care.
Jayne Stringfellow
Chief Nurse and Quality Officer
On behalf of NHS North Derbyshire Clinical Commissioning Group
13 May 2015
Derbyshire Health United Ltd. Quality Account 2014/2015
50
Section 10 Statement from Healthwatch
Healthwatch Derbyshire
Healthwatch Derbyshire collects real people’s experiences of health and social care
services, as told by patients, their families and carers. These experiences, as reported to
Healthwatch, will form the basis of this response.
Healthwatch Derbyshire has passed this patient feedback to Derbyshire Health United
during the reporting period in the form of comments. These comments have been received
about a range of services, some positive, some negative, and cover a variety of topics. The
organisation has fed back to Healthwatch comprehensive responses which demonstrate
actions and learning within the organisation based on these comments and experiences.
Feedback indicates some specific changes in line with the content of comments given,
which is a useful demonstration of the capacity to listen to and learn from patient
feedback.
This feedback is also fed back to the specific individuals who spoke to Healthwatch
Derbyshire, and so inspires confidence in Healthwatch Derbyshire, Derbyshire Health
United, and the value of ‘speaking up’.
Healthwatch Derbyshire looks forward to working with Derbyshire Health United in
2015-16 along similar lines.
Helen Hart
Intelligence and Insight Manager
Healthwatch
51
Derbyshire Health United Ltd. Quality Account 2014/2015
Section 11 Our Glossary
A&E— Accident and Emergency
PPG—Patient Participation Group
ANP—Advanced Nurse Practitioner
SCR—Summary Care Record
CEF—Communication and Engagement Forum
STEIS—Strategic Executive Information System
CCG—Clinical Commissioning Group
TUPE—Transfer of undertakings (Protection of Employment )
CQC—Care Quality Commission
DSE—Display Screen Equipment
DCHS—Derbyshire Community Health Services NHS Foundation Trust
DHU—Derbyshire Health United
DN—District Nurses
ECP—Emergency Care Practitioner
ED—Emergency Department
GP—General Practitioner
HCA—Health Care Assistant
HMP—Her Majesties Prison
HMIP—Her Majesties Inspectorate of Prisons
IP&C—Infection, Prevention and Control
KPI—Key Performance Indicators
NICE—National Institute for Health and Care Excellence
OOH—Out of Hours
PGD—Patient Group Direction
Derbyshire Health United Ltd. Quality Account 2014/2015
52