3
1 Year 2
Q
4
5 year
plan
uality
Account
2010-2011
Over
3000 staff
More
than
1 million
direct patient contacts per year
1 Year
2
3
Contents
4
5 year
plan
Page
1. Introduction
1.1Foreword............................................................................................ 3
1.2 Statement by the Chief Executive,
NHS Nottinghamshire County........................................................... 4
2. Establishing Our Priorities
2.1 Priorities for Improvement ............................................................... 5
2.2 Statements Relating to Quality of NHS Services Provided.............. 7
3. Our Performance 2010-2011
3.1 Review of Quality Performance...................................................... 13
3.11 Patient Experience........................................................................... 13
3.12 Patient Safety................................................................................... 19
3.13 Clinical Effectiveness........................................................................ 22
3.14Innovation........................................................................................ 23
3.2 Involvement and Engagement........................................................ 25
3.3 Statements from Other Bodies....................................................... 26
2
Over
3000 staff
More
than
1 million
direct patient contacts per year
Foreword by the
Assistant Director
Following NHS Nottinghamshire County Board approval in November
2008, Nottinghamshire Community Health, (NCH), (provider function
of NHS Nottinghamshire County) was established as an Autonomous
Provider Organisation from 1 April 2009. NCH operated separately,
had responsibility for providing community based healthcare services
primarily within Nottinghamshire, but still reported to the NHS
Nottinghamshire County Board, as the accountable organisation.
During 2010 /11 NCH had an annual budget of approximately £100m and over 2,900
staff proving a wide range of services from a number of venues across Nottinghamshire.
During 2010-2011 our vision was to be the health provider of choice for
excellent local community services. Our purpose was to provide community
services in order to optimise health and well-being and we committed to
do this in a way that delivered care and support which was of exceptional
quality. ‘Quality’ being defined across the three broad areas as identified by
Lord Darzi; patient safety; patient experience; and effectiveness of care.
This Quality Account has been developed to primarily provide information on
how we achieved our purpose of providing quality services during 2010-2011
and what plans are in place for continued improvement during 2011-2012.
Staff and patients, including the NCH Patient, Carer and Public Engagement
Group members have been involved in both the monitoring of quality
improvements during 2010-11 and also in setting the priorities for 20112012. A number of organisations have been given the opportunity to
comment on the content of the account and these will be outlined later.
On 1 April 2011, services provided by NCH were transferred to a number of alternative
providers. Priorities for 2011-12 have been agreed with commissioners and the new
providers and commissioners to ensure that continuous improvements are maintained.
Michelle Bateman
Assistant Director (Professions and Governance)
Nottinghamshire Community Health
June 2011
3
Over
3000 staff
More
than
1 million
direct patient contacts per year
Statement by
Chief Executive,
NHS Nottinghamshire County
I am pleased to present the first Quality Account produced by Nottinghamshire
Community Health (NCH), Autonomous Provider Organisation of NHS Nottinghamshire
County until 31 March 2011.
Its purpose is to demonstrate the quality of care provided and quality has improved. It contains a
review of the quality of services provided in the financial year 2010/11 and an outline of plans to
further improve quality in 2011/12.
Community based services are at the heart of a modern and flexible NHS. We are committed to
ensuring continuous improvements to the quality of services we provide.
I have been impressed throughout the year by the commitment of staff to provide high quality
care to patients and service users on a daily basis and the pride they take in doing the very best for
each and every person they meet.
The publication of this Quality Account is an opportunity to recognise the commitment of staff
towards improving the quality of our services and to be proud of what has been achieved so far.
This document is the result of a year-long focus on quality and learning from patients, carers and
staff. Services faced considerable financial challenges during 2010/11, but there was a continuous
focus on service quality.
Looking ahead, it is vital that we continue to find better and improved ways to deliver services
more efficiently. Quality is an absolute priority whilst also improving value for money.
The next twelve months promises to be no less challenging than the last, but I have every
confidence that the improvements in service quality will continue under the direction of the
new providers.
During 2010/11 NHS Nottinghamshire County has maintained a contractual
relationship with Nottinghamshire Community Health, regularly reviewing
information regarding the quality of NCH services at:
• monthly Quality Scrutiny Panel meetings,
• bi-monthly NHS Nottinghamshire County Governance meetings
• quarterly Board to Board meetings and
• Cash Releasing Efficiency Savings (CRES) Board meetings
Subject to Trust Board Approval
The Trust Board of NHS Nottinghamshire County has reviewed the content of the Quality
Account and can confirm that to the best of their knowledge and belief the information
contained in this Quality Account is accurate and represents the performance of NCH
in 2009/10 and the priorities for continuously improving quality in 2010/11.
I hope you find this Quality Account to be informative.
Andrew Kenworthy
Chief Executive
NHS Nottinghamshire County
June 2011
4
2.Establishing
Our Priorities
4
This section consists of 2 distinct areas, Priorities for
Improvement for 2011/2012 and Statements relating
to Quality of NHS services provided during 2010/2011.
Within this section there are a number of
predetermined statements to allow comparison
between Quality Accounts from different organisations.
The content and wording within the blue boxes
is a requirement taken from the Quality Account
Toolkit and provides assurance that the Board has
received and engaged in cross-cutting initiatives
which link strongly to quality improvement.
2.1 Priorities for Improvement
during 2011-12
In January 2009, the Department of Health (DoH)
published “Transforming Community Services:
Enabling new patterns of provision.” This policy
document described a vision for modern, high quality
community services that would be managed separately
from commissioning PCTs. As a result from 1 April
2011 the majority of NCH services were transferred
to County Health Partnerships (CHP), during which
time services continued uninterrupted and all quality
commitments were and will remain unaffected.
County Health Partnerships comprises of
Nottinghamshire Healthcare NHS Trust, Central
Nottinghamshire Clinical Services (CNCS) and Principia
Providers in Health (PPH), the latter two being
primary care providers. The partnership provides an
exciting opportunity to work closely with clinicians
in primary care to look at innovative approaches to
developing locally focused services and integrating
physical and mental health care closer to home.
Work so far has clearly identified a shared passion
and commitment to develop the highest quality
services for the communities we service. The quality
improvement priorities identified for 2011/12
have been shared with the new organisation to
ensure continuous improvement is maintained.
5 year plan
It is the ambition of CHP to develop services which
are more locally focussed and integrated, based
on the needs of the individual. Safe, quality and
cost-effective care can only be delivered in a coordinated and co-operative way and the Partnership
offers the opportunity for this to be achieved.
During 2010/11 we considered all that was learnt
over the last year from many sources of quality
performance, including Commissioning for Quality and
Innovation (CQUIN), Cash Releasing Efficiency Schemes
(CRES), Quality Schedule, complaints, compliments
and incident investigations. This shaped our thinking
on what areas needed to be considered as priorities
over the forthcoming year. The information gathered
was shared with staff across the organisation as
well as members of the Patient, Carer and Public
Engagement Group for consideration and comment.
Wider consultation has proven challenging this year
due to the Transferring Community Services agenda,
but we are making a commitment to consult wider
with staff, service users and partners in future years.
The quality improvement priorities have been
identified for 2011/12 and are as follows:
2.11 Patient Safety
•
We will ensure that all staff have received
the relevant level of safeguarding children
training. This will make sure that all staff
know exactly what to do if an issue arises.
•
We will ensure that all serious untoward incidents
are reported within the required timescales.
We will provide evidence that lessons have
been learnt from each investigation, ensure
that improvements are embedded within
services and that risks are reduced as a result.
•
We will monitor and investigate any ‘Never
Events’ which occur within our services
5
2. Establishing Our Priorities
1 Year
2
3
2.12 Clinical Effectiveness
CQUIN indicators 2011/12
•
We will demonstrate a reduction in the number
of medication administration errors.
•
We will demonstrate a reduction in the
number of avoidable Pressure Ulcers, grades
2, 3 and 4 that develop in our services.
Regional
CQUIN 1:
CQUIN 2:
CQUIN 3:
•
We will demonstrate a reduction in the number of
slips, trips and falls within our in-patient areas.
•
We will achieve 95% compliance against
the Essential Steps to safe, clean care
for urinary catheter care audit in inpatient and community services
2.13 Patient Experience
•
We will improve the way in which we
collect and utilise patient intelligence from
incidents, complaints and compliments
to influence the continued development
of our services by monitoring the
implementation of any actions identified.
•
We will develop our service user and carer
engagement systems and processes within the new
organisation to ensure meaningful engagement
and participation in our quality initiatives
•
We will develop our clinical staff engagement
systems and processes to ensure that our staff feel
fully able to influence quality and improvements
In addition to these priorities we have worked
with commissioners and primary care colleagues
to refine our Commissioning for Quality and
Innovation (CQUIN) indicators to ensure that they
clearly demonstrate an improvement in quality.
6
4
5 year
plan
CQUIN goals
To improve breastfeeding rates
Implement NICE Stroke quality standards
Composite High Impact indicators including,
pressure ulcers, falls and use of catheters
CQUIN 4: Waiting times for treatment & therapies
CQUIN 5: Minimum indicator set for self
management plans for COPD, Heart
failure and Diabetes Meillitus
CQUIN 6: Preventing admissions/readmissions
Local CQUIN goals
CQUIN 7: End of Life
CQUIN 8: Management of patients with
a Long Term Condition
CQUIN 9: Data sharing between community
services and primary care services
CQUIN 10:Minimum standard content for care plans
of children attending Special Schools
Nottinghamshire Healthcare Trust has developed
its own Quality Strategy. This strategy is a five
year plan to put quality at the heart of everything
they do and is based upon the seven steps to
improve quality outlined in ‘High Quality Care
for All’. County Health Partnerships will develop
its own Quality plan in line with this strategy.
The County Health Partnerships Board will agree
this Quality Plan and will take responsibility for
ensuring that this plan is implemented across our
services. The Board will receive regular Quality
reports to provide assurance of progress and to
understand any risks or barriers as they arise.
In addition to the above reports, County Health
Partnerships will also make information available
through its website, about the quality of our services to
ensure that we are publicly accountable for quality and
that this has the same priority as our financial accounts.
4
Our Quality Schedule, including our CQUIN measures
will bring focus and priority to what we are trying
to achieve. The financial reward associated with the
achievement of CQUIN will ensure added focus when
we consider our resources. Nottinghamshire Healthcare
Trust have a system of recognising and rewarding the
contribution of staff through annual internal (OSCAR)
awards. It is envisaged that CHP staff will be integrated
into this approach. Support will also be given to staff
to apply for regional and national awards and their
successes recognised throughout the organisation.
County Health Partnerships is committed to
supporting the development of research and
innovation. Wherever appropriate we will
participate in national research projects in order to
contribute to the wider research knowledge base.
2.2 Statements relating to
Quality of NHS Services Provided
2.21 Review of Services
During 2010/11 Nottinghamshire Community
Health provided regulated NHS activities
from twelve locations as registered with the
Care Quality Commission. These regulated
activities were treatment of disease, injury
and disorder, surgical procedures, nursing
care and family planning services.
Nottinghamshire Community Health has
reviewed all the data available to us on the
quality of care in 100% of our NHS services.
The income generated by the NHS services reviewed
in 2010/11 represents 89% of the total income
generated from the provision of NHS services by
Nottinghamshire Community Health for 2010/11.
5 year plan
During 2010/11 the review of the adult community
nursing service led to a redesign of the service which
has led to an integration with community matrons
and a redirection of focus and management of those
patients with long term conditions, those patients
reaching end of life and those patients with tissue
viability conditions (leg ulcers and pressure ulcers).
The review of our community podiatry
services led to a service redesign which itself
resulted in a reduction in waiting times and an
improvement of services for diabetic patients.
2.22 Participation in Clinical Audits
During 2010–2011, 1 national clinical audit
and 0 national confidential enquiries covered
the NHS services that Nottinghamshire
Community Health provides.
During the period 2010–2011 Nottinghamshire
Community Health participated in 1 national
clinical audit and 0% national confidential
enquiries of the national clinical audits
which it was eligible to participate in.
The national clinical audits and national
confidential enquiries that Nottinghamshire
Community Health was eligible to participate
in during 2010–11 is as follows:
Falls and non-hip fractures (National
Falls & Bone Health Audit)
The national clinical audits and national
confidential enquiries that Nottinghamshire
Community Health participated in during 2010–
2011 are as follows: 0
Falls and non-hip fractures (National
Falls & Bone Health Audit)
7
2. Establishing Our Priorities
1 Year
2
During 2011-2012 the community services will
pursue the involvement in national clinical audits.
Slips, Trips and Falls – identified as an area for
improvement, this audit led to a review of
current response to falls and repeat falls within
in-patient areas. Following implementation of
a number of actions, the number of slips, trips
and falls noticeably reduced during the year
The reports of 25 local clinical audits were
reviewed by Nottinghamshire Community Health
in 2010 – 2011 and Nottinghamshire Community
Health intends to take the following actions to
improve the quality of healthcare provided:
Clinical documentation – led to the implementation
of ‘records on trial’ in depth training to support
caseload holders in understanding their
responsibilities in relation to documentation.
Infection Prevention and Control – a number
of audits were undertaken to monitor
adherence to policy and review current
working practice. This has led to a review
of training packages and improvement in
response to healthcare associated infections
Safeguarding Children – a number of audits
have been undertaken to monitor adherence
to policy, review current working practices
with social care colleagues and review staff
satisfaction with current safeguarding support
and advice. This has led to development of a
competency based framework for training, colocation between health and social care staff.
8
3
Pressure Ulcers – this led to a more in-depth
understanding of number and nature of
pressure ulcers within the community.
As a result of the audits the following quality
improvements have been instigated:
•
Infection Prevention and Control audits have led to
• a revision of policy and procedures and
associated training relating to aseptic
technique for catheterisation of patients
• a focus on hand hygiene for staff
within community podiatry services
•
Safeguarding Children audits have led to
• staff from the Safeguarding Children team now
spend time in the same offices as Social Care
staff, working together to monitor the quality
of referrals made to social care and to offer a
health perspective to any appropriate referrals
• funding being provided to recruit a
safeguarding children’s specialist nurse to
work within the substance misuse services
• a comprehensive training package for those
staff who work primarily with children and
families has been developed and implemented
4
•
•
•
Falls audits have led to
• a better understanding of the nature and
number of incidents within our in-patient areas
• a review of the procedure for both the
prevention of falls and reducing the number
of patients experiencing repeated falls has
been put in place within our in-patient areas.
• a 10% reduction in repeat falls during 2010/11
Clinical documentation audits, the involvement
of NCH staff in a number of inquests and
vulnerable adults serious case reviews has led to
• commissioning of ‘Records on Trial’ training,
which includes a ‘mock’ trial where staff
experience having their records scrutinised
by staff from the Coroners office.
Audits into the incidence and treatment
of pressure ulcers has led to
• an improved awareness of the incidence
of pressure ulcers within our services,
both those inherited from other providers
and those occurring whilst in our care
• a review of policies, procedures and
associated clinical documentation
• a 25% reduction in the number of
grade 3 and grade 4 pressure ulcers
5 year
plan
2.23 Participation in
Clinical Research
The number of patients receiving NHS services
provided by Nottinghamshire Community Health
in 2010–2011 that were recruited during that
period to participate in research approved
by a research ethics committee was 166
2.24 Use of the CQUIN
Payment Framework
The Commissioning for Quality and Innovation
(CQUIN) payment framework aims to support
making quality the organising principle of NHS
services, by embedding quality at the health of
commissioner/provider discussions. The CQUIN makes
Nottinghamshire Community Health income dependant
on locally agreed quality and innovation goals.
During 2010–2011 this amounted to 0.5% (£500 000)
on top of the actual outturn value in 2009–2010.
A proportion of Nottinghamshire Community
Health income in 2010–2011 was conditional on
achieving quality improvement and innovation
goals agreed between Nottinghamshire
Community Health and the bodies with whom
they entered into a contract with for the provision
of NHS services, through the Commissioning for
Quality and Innovation payment framework.
9
2. Establishing Our Priorities
1 Year
2
Nottinghamshire Community Health
demonstrated achievement in the
requirements of the thirteen CQUIN goals:
CQUIN 1: 100% of drug delivery devices
(syringe drivers) were safety checked
CQUIN 2:There was a reduction in
unplanned readmissions following
discharge from community hospital
CQUIN 3: There was a reduction in incidence
of grade 2 and higher pressure sores
CQUIN 4: Waiting times for treatment
& therapies were reduced
CQUIN 5: At least 90% of patients classified
as Very High Intensity Users had a care plan
CQUIN 6: There was an increase in the
proportion of people living at home 3 months
post discharge from intermediate care
4
5 year
plan
Achievement of the CQUIN goals was subject to
performance monitoring review at the monthly
Quality Panel meeting between NHS Nottinghamshire
County and Nottinghamshire Community Health.
As the services have moved to a new provider,
the information is not currently available
electronically but if you require further details
of the agreed CQUIN goals for 2010-2011 and
those for the following 12 month period please
contact Michelle Bateman - Assistant Director
(Professions and Governance) on 01623 673784
2.25 Statements from Care Quality
Commission (CQC)
CQUIN 7a: There was an increase in the number of
referrals to New Leaf from internal NCH services
Nottinghamshire Community Health is
required to register with the Care Quality
Commission and its current registration
status is ‘registered without conditions’.
CQUIN 7b: There was a process in place to
monitor the number of patients quitting smoking
at 4 weeks who remain a quitter at 6 months.
The Care Quality Commission has not taken
enforcement action against Nottinghamshire
Community Health during 2010/11.
CQUIN 8: At least 95% of patients identified
as being at the End of Life who had their
preferred place of death documented
CQUIN 9: There was an increase in the number
of patients aged over 75years who have
had a falls risk assessment undertaken
CQUIN 10: There was been an increase of
breastfeeding status at 10days/6-8weeks/6months
CQUIN 11: 95% of families on the health visitors
caseload had a Health Needs Assessment
CQUIN 12: Services demonstrated 95%
compliance with the requirements of Essential
Steps Reduce risk of infection associated
with indwelling urinary catheters
10
3
The Care Quality Commission has not taken
enforcement action against Nottinghamshire
Community Health during 2010 – 2011.
The Care Quality Commission (CQC) is the
independent regulator of health and adult social
care in England. From 1 October 2010, all health and
adult social care providers are legally responsible
for making sure they meet essential standards of
quality and safety and must be licensed with CQC
under the Health and Social Care Act 2008.
4
To maintain registration, providers must show that
the new essential outcome standards of quality
and safety are met across all regulated activities.
Without registration, providers will not be allowed
to operate. There is a marked difference in the focus
of the approach to regulations, i.e. from that based
on the systems, processes and policies that providers
have in place, to regulations based on outcomes
for people in terms of quality experience of care.
5 year
plan
The CQC collates evidence against Registration
Outcomes for each Provider organisation. All the
information is contained in a Quality and Risk
Profile (QRP) for each provider, which is regularly
updated and is used to assess where risks lie and
to act as a prompt for regulatory action such as
inspection. The most recent produced in February
2011 will be used to develop actions plans where
areas for improvement were identified.
Nottinghamshire Community Health has
participated in special reviews or investigations
by the Care Quality Commission relating to
the following areas during 2010 – 2011:
•
Cleanliness and Infection Control Inspection –
On inspection, CQC found no cause for concern
regarding the provider’s compliance with
the regulation on cleanliness and infection
control. Full CQC report is available on http://
healthdirectory.cqc.org.uk/_db/_documents/5N8_
Nottinghamshire_County_Teaching_PCT_
HCAI_Inspection_Report_20100629.pdf
•
Stroke Services – The overall assessment for
services provided within the NHS Nottinghamshire
County area was judged as ‘best performing’.
The full report is available on http://www.cqc.org.
uk/_db/_documents/2010_StrokeArea_5N8.pdf
•
Integrated inspection of safeguarding and looked
after children’s services in Nottinghamshire (CQC
and OFSTED). From the aggregated findings from
the inspection, it was concluded that the overall
effectiveness of the safeguarding services in
Nottinghamshire was inadequate and capacity for
improvement was inadequate. CQC found that
these conclusions were not reflected in health
but made a number of recommendations to
improve NCH contribution to the safeguarding
and looked after children agenda. Following
publication of the report NCH produced an action
plan to respond to those actions relating to the
health service contribution to the safeguarding
agenda. The actions were monitored by the
NCH Safeguarding Children’s sub-committee
and all actions have been completed. Full CQC
report is available on http://www.cqc.org.uk/_
db/_documents/20100617_Nottinghamshire.pdf.
NCH also manage 6 Sure Start Children Centres
within Nottinghamshire which were inspected by
OFSTED. The inspection judgements received at
all sites was either Good or Outstanding for the
areas of Overall Effectiveness and Capacity for
sustained improvements. Full reports are available
on http://www.ofsted.gov.uk/oxfind/name?searc
h=nottinghamshire&type=6145&submit=Search
•
Healthcare Needs of People in Care Homes –
Ongoing. Information is still being gathered and
recommendations have not yet been made.
•
Support for Families with Disabled Children –
Ongoing. Information is still being gathered and
recommendations have not yet been made.
11
2. Establishing Our Priorities
1 Year
2.26 Data Quality
Good quality information underpins the effective
delivery of patient care and is essential if
improvements in quality of care are to be made.
Improving data quality, which includes the quality of
ethnicity and other quality data, will thus improve
patient care and improve value for money.
Nottinghamshire Community Health will be taking
the following actions to improve data quality.
CHP currently uses System One as its electronic
clinical record. In order to respond to concerns
relating to data quality, the System One User
Group will be reenergised to engage with
clinical and administrative staff involved in data
inputting. The purpose being to improve data
quality and usefulness of data collected.
Data quality audits will continue to be undertaken
on the use of NHS number and timeliness
of staff inputting onto clinical systems
Nottinghamshire Community Health
submitted records during 2010–2011 to
the Secondary Uses Service for inclusion in
the Hospital Episodes Statistics which are
included in the latest published data.
The percentage of records which included
the patient’s valid NHS number was:
100% for admitted patient care
100% for out patient care
The percentage of records which
included the patient’s valid General
Medical Practice number was:
100% for admitted patient care
100% for out patient care
12
2
3
2.27 Information Governance
Toolkit attainment levels
Nottinghamshire Community Health Information
Governance Assessment Report score overall score
for 2010 – 2011 was 72% and was graded Green
2.28 Clinical Coding Error Rate
Nottinghamshire Community Health was not
subject to the Payment by results clinical coding
audit during 2010 – 2011 by the Audit Commission.
3. Our Performance –
2010-2011
4
5 year plan
3.1 Review of quality performance
This is a review of Nottinghamshire Community
Health quality performance over the past year.
In line with Lord Darzi’s ‘vision’ for quality in the
NHS, performance is grouped under three themes:
safety, effectiveness and patient experience and
we have also included a section on innovation.
Within this section of the Quality Account
we want to demonstrate our commitment
to developing and providing high quality
services, which are safe and effective.
us to understand the patient experience of the services
we provide. We recognise that as an organisation,
we need to be bold enough to listen to patients and
carers and to take action as a result of what we hear.
We have various methods in place where people are
able to easily feedback about their experience of our
services, with opportunities to influence every level:
Level 1 - The patient/carer is involved in
their individual care requirements
3.11 Patient Experience
Understanding the patient/carer experience, and more
crucially, acting on the feedback that we receive
Patients and carers are at the heart of Nottinghamshire
Community Health. We are committed to ensuring that
they influence their own care, the services we provide
and the way that the organisation is run. In order for
us to continually improve our services, it is essential for
Level 2 - The patient/carer is involved in
feeding back on/developing the service
Level 3 - The patient/carer is involved in
developing/governing the organisation
Here are some examples of how have engaged
with patients and carers at each of these levels:
Level 3
PCPE sub-committee.
Learning from Patient
Experience group; Shared
Experience; CQUIN
Level 2
Comments, compliments, complaints,
enquiries; PALS, Customer Relations, MP’s, PCT
consultations; patient experience surveys, service
evaluation; Patient Reported Outcome Measures (PROMS)
Level 1
Care planning, referral / assessment / treatment process,
discharge plans; patient / carer informations;
communication
13
3. Our Performance 2010-2011
1 Year
3
2
3.11 Single sex accommodation
Single Sex Accommodation
Every patient has the right to receive high quality
care that is safe, effective and respects their
privacy and dignity. Nottinghamshire Community
Health is committed to providing every patient
with same sex accommodation, because it helps
to safeguard their privacy and dignity when
they are often at their most vulnerable.
We are proud to confirm that mixed sex
accommodation has been virtually eliminated in our
organisation. Patients who are admitted to any of
our hospitals will only share the room where they
sleep with members of the same sex, and same sex
toilets and bathrooms will be close to their bed
area. Sharing with members of the opposite sex will
only happen by exception based on clinical need
for example where patients need use of specialist
bathing facilities. NCH monitors patient experience
in relation to Single Sex Accommodation through
visual monitoring of compliance with Single Sex
Accommodation by Modern Matrons at each hospital.
Further information on Same Sex Accommodation
in Nottinghamshire Community Health can be found
at http://nottinghamshirecommunityhealth.nhs.uk
Patient Environment Action Team (PEAT)
The three community hospitals in the county run by
Nottinghamshire Community Health have received
some of the highest achievable scores for their
environmental surroundings in the latest round of
14
Patient Environment Action Team (PEAT)
inspections.
PEAT was established to assess NHS hospitals and under
the programme, every inpatient healthcare facility in
England with more than ten beds is assessed annually
and given a rating of excellent, good, acceptable,
poor or unacceptable against a range of categories.
In the latest round of assessments, the hospitals were
reviewed for their standards of food, privacy and
dignity and general environment – Services run by
Nottinghamshire Community Health continued to show
consistently high standards across all of these areas.
As a result of this, all three hospitals
received an ‘excellent’ or ‘good’ rating in
all PEAT categories. To read the full PEAT
assessments visit www.npsa.nhs.uk/peat.
A summary of the PEAT assessments for
2010 for sites operated by Nottinghamshire
Community Health are outlined below:
Environment
Food
Privacy &
Dignity
Mansfield
Community
Hospital
Excellent
Good
Excellent
Ashfield
Health Village
Excellent
Excellent
Good
Lings Bar
Hospital
Excellent
Excellent
Good
Site
4
Complaints Management
Nottinghamshire Community Health recognises that
suggestions, constructive criticisms and complaints can
be valuable aids to improving services. It welcomes
feedback from service users /carers and places a
high priority on the handling of complaints.
The Nottinghamshire Community Health complaints
procedure supports the implementation of NHS
Nottinghamshire County’s Complaints Policy, the
primary objective being to provide a rapid and open
process for investigation and resolution of complaints,
to the satisfaction of the complainant wherever
possible. Issues arising from complaints will be used
to improve services and linked with risk management
and governance processes to disseminate lessons
learned and influence service redesign in order to meet
the changing needs of our registered population.
5 year plan
During 2010/11 we have received 78 formal complaints
compared with 99 received during the same period
2009-10. This is a comparative reduction of 21%.
100% of all complaints have been resolved to the
satisfaction of the complainant with no further action
required following receipt of the final response letter;
100% of all complaints have successfully achieved local
resolution, with no referrals made to the Ombudsman.
An action plan is completed for every formal
complaint received, detailing service improvements
to be made in the short-term and longer-term as a
result of issues raised. Information on complaints
and other feedback is also triangulated with the
Patient Experience Tracker reporting, giving a
more rounded view of the patient experience.
Complaints are investigated with the aim of fully
addressing the concerns raised and to satisfy the
complainant, whilst being fair to staff and the
complainant alike. Nottinghamshire Community Health
try to ensure that complainants as patients and/or
carers are not discriminated against when complaints
are made, with no detriment to service provided.
15
3. Our Performance 2010-2011
1 Year
2
3
Lessons learned and service improvements as a result of complaints include:
Issues arising
Lessons learned/action taken
Assessment and management of
pressure ulcers using Vauum Therapy
Dressing Technique (VAC)
Policy for the Prevention and Management of
Pressure Ulcers updated; further guidance produced,
promoting best practice; policy and best practice
promoted within community nursing teams
Clinical documentation audit undertaken to ensure
the requirements of this policy is now met
VAC therapy ordering system coordinated by GP and
pharmacist, ensuring availability of dressings and equipment
Improved proactive communication between
community nursing team and other healthcare
providers involved in the care of individual patients
Closer liaison with Tissue Viability Nurse Specialist to
ensure specialist assessment/advice, effective follow
up and information sharing as appropriate
Issues arising
Lessons learned/action taken
Additional measures required to minimise
risk of further falls following an initial fall
Falls audit undertaken to determine current situation and
recommendations for improvement including environment,
ward set-up/processes and care planning; participation in
national Patient Safety initiatives, including monitoring
and promotion of targeted management of falls
Falls risk assessment to be completed within 4
hours of a fall, with additional equipment such
as chair sensors to be provided as necessary
Promotion of falls pathway and specific training on
falls and falls risk assessment provided to staff
Following a safeguarding referral, health
visitor unable to give family information on
what would happen next other than that
the social worker would contact them.
16
Review of referral process to Social Care to
improve inter-agency communication
Information provided for health staff to have a
better understanding of how social care will respond
on receipt of referral, in order to communicate
this more effectively to families involved
4
5 year plan
Issues arising
Lessons learned/action taken
Service unable to confirm details of child’s
placement on Speech and Language
Therapy (SLT) treatment programme
Service has reviewed the system of confirming
attendance on treatment programmes, streamlining
the process to improve access and communication
between healthcare professionals and families
Communication and approach of nurse
throughout assessment process
Staff to consider views of patient/family throughout
the assessment/treatment process
To consider offering a periodic assessment review,
particularly in the case of differing opinions
All staff undertake mandatory Customer Care training;
additional training to support communication skills as necessary
Access and use of a private telephone
number for an inappropriate purpose
Staff member seen and reissued with
the NCH Staff Code of Conduct
All staff reminded of the organisational expectation
in relation to security and confidentiality of
patient and personal information
Cleanliness of reusable blood
pressure monitoring equipment
Armbands, shoulder straps and associated tubing replaced
Staff reminded of cleaning techniques;
cleaning schedule in place
Service exploring alternative equipment
options, including single use arm bands
Cancellation/management of clinic sessions
New administrative processes introduced to ensure
patients are given sufficient notice if a clinic is cancelled
Utilisation of locality-based resources to ensure clinics
are only cancelled when absolutely necessary
Communication between GP practice and NCH
to share information on concerns raised
Joint appointments (e.g. husband and wife) to be
facilitated where requested/appropriate
17
3. Our Performance 2010-2011
1 Year
2
3
4
5 year
plan
Waiting Times
Waiting times for therapy and treatment services
within Nottinghamshire Community Health are
closely monitored both internally by the service
and externally by the commissioners as part
of the annual NHS community contract.
Nottinghamshire Community Health aim is to
assess and where possible treat all therapy patients
within a maximum wait of thirteen weeks. Our
adult therapy and treatment services have seen
approximately 36,000 patients this year and
our Children’s therapy and treatment services
have seen approximately 6,300 patients. Throughout the reporting period of 2010/11,
Nottinghamshire Community Health have breached
this time frame on two separate occasions. One breach
was for one patient in the countywide paediatric
speech and language therapy service, and one for three
patients in Principia Primary care Rehabilitation clinics.
In both instances the Nottinghamshire Community
Health corporate performance team has worked
directly with the service to improve referral
management and waiting list processes and
there have been no further breaches.
The Patient Experience Tracker –
Live Patient Feedback
Nottinghamshire Community Health sees engaging
with its patients and carers as a high priority. One of
the ways to achieve this was the implementation of
the Patient Experience Tracker (‘Tracker’) Programme.
The Tracker is a simple electronic hand-held mobile
18
device, offering the opportunity for patients to
feedback on our services at the time of their care
or treatment, giving a ’real-time’ snapshot of the
experience. Feedback from the Tracker helps us
to understand what is important to patients and
carers, and how we need to improve services.
The Tracker questions were decided by patient/
carer members of the Patient Carer and
Public Engagement Sub-Committee.
Used across all Nottinghamshire Community
Health services, the standard was set for a
minimum of 90% of people to say that they
had a positive experience of our services.
Standard
(Benchmark minimum 90%
positive patient experience
Percentage
positive patient
experience of
NCH services
Length of time waited for
first contact
95%
Treated with respect
and dignity
99%
Involved in decisions
about care
96%
Standards of hygiene
and cleanliness
99%
Given Information about
the service
97%
4
5 year plan
Improvements made as a result of
feedback from the Tracker include:
3.12 Patient Safety -
•
New and improved patient information leaflets
NHS Litigation Authority (NHSLA)
•
Review of services to improve appointments
systems and reduce waiting
•
Working with referrers to improve access to the
service and information given throughout the care/
treatment process, from admission to discharge
•
Identifying areas of priority where we need to
find out more about the patient experience
in order to make further improvements
Ensuring the services provided are always safe
During 2010/11, the NHSLA have assessed
Nottinghamshire Community Health against the Risk
Management Standards for Provider Organisations
against five standards each containing ten criteria
giving a total of 50 criteria. In order to gain compliance
at Level 1 the organisation was required to pass at
least 40 of these criteria, with a minimum of seven
criteria being passed in each individual standard.
Nottinghamshire Community Health achieved
a total of 48/50 against these standards.
Achieved Critera out of 10
10
8
6
4
2
0
Standard 1 - Standard 2 - Standard 4 - Standard 3 - Standard 5 Governance Competent Clinical Care
Safe
Learning
and Capable
Environment from Patient
Workforce
Experience
19
3. Our Performance 2010-2011
3
2
Infection Prevention and Control
30
2
March
February
January
December
October
August
July
June
1
MRSA Trajectory (Cumulative)
Actual MRSA cases (Cumulative YTD)
TABLES
The Care Quality Commission (CQC) inspected two
of our wards in June 2010, one at Lings Bar Hospital
and one at Ashfield Health Village. The outcome was
that Nottinghamshire Community Health complied
fully with the cleanliness and infection control
code of practice. There were some minor issues
identified and these were immediately addressed.
25
Number of C Diff cases
3
November
Incidence of Clostridium difficile April 2010-January 2011:
comparison against target trajectory
20
15
10
January
December
November
October
September
August
July
June
May
April
5
C Diff Trajectory (Cumulative)
Clostridium difficile cases (Cumulative YTD)
20
4
0
99.3% of patients are routinely screened
for MRSA on admission to our wards.
0
5
May
We have had one outbreak of clostridium difficile
which resulted in the ward being closed for
a short time and being fully disinfected.
6
April
There have been 2 cases of MRSA and 13
cases of clostridium difficile infection.
Incidence of MRSA April 2010-January 2011:
comparison against target trajectory
Number of MRSA cases
Nottinghamshire Community Health have
continued to ensure that reportable infections
are well below the improvements targets that
are set for the year. We have a dedicated team
of Infection Prevention and Control nurses who
are responsible for ensuring best practice and the
highest standards of hygiene and cleanliness.
September
1 Year
Nottinghamshire Community Health can also
demonstrate full compliance with the Health and
Social Care Act 2008 which sets the standards in
legislation for Infection Prevention and Control.
Our Infection Prevention and Control team provide
training for all clinical staff and undertake regular
audits of practice to ensure that all of our services
continue to meet the high standards we expect.
4
Safeguarding Children
Safeguarding children continues to be a priority
within Nottinghamshire Community Health. The Joint
Agency CQC/OFSTED inspection in March 2010 resulted
in significant developments, which have impacted
on Nottinghamshire Community Health children’s
services to improve the quality of provision and the
joint agency working to promote children’s welfare.
5 year plan
•
The development of the “think family” agenda
within Direct Access Drug and Alcohol Services
to ensure assessments include the consideration
of the needs of dependant children of adults
with problematic substance misuse.
•
Additional training for Allied Health
Professionals on “Safeguarding disabled
Children” to equip them with the skills to
offer appropriate intervention and support.
These developments have included:
•
The establishment of a database within
the Children in Care Health Team which
will improve the identification of children
with outstanding health needs.
•
The implementation of the Joint Agency
Pathway to Provision which has clarified
referral and service pathways for all children
•
The continued implementation of the CAF
(Common Assessment Framework) – an
early intervention tool to identify and
support children with additional needs
•
Co-location of specialist nurses within the
duty Reception and Assessment teams
within Children’s Social Care to improve
joint working and communication and
advise social care on health issues.
•
The development of an electronic caseload
profiling tool which will ensure that children
with additional needs are clearly identified.
Serious case reviews following local child deaths
have resulted in significant changes in practice in
order to improve services for children, for example:
•
High Impact Actions,
Patient Safety Thermometer
Nottinghamshire Community Health is one of the first
community service providers to support High Impact
Actions (HIAs), a series of priorities and accompanying
resources to improve safety, quality and productivity
in clinical areas. As part of this, Nottinghamshire
Community Health has piloted the use of the
Patient Safety Thermometer in community services,
providing a snapshot of community hospital and
community nursing teams. The Safety Thermometer
is a survey tool designed to help the NHS to build
up a picture of patient safety issues. The Safety
Thermometer collects data on pressure ulcers, falls,
Urinary Tract Infection (UTI) / catheters, and Venous
Thrombo-Embolus (VTE) risk (e.g. blood clots) to
identify themes/trends and areas for improvement.
Nottinghamshire Community Health staff have
used the High Impact Actions resources to:
• Provide training on identifying risk of falls and
putting measures in place to minimise this risk
•
More effectively plan and coordinate discharges
•
Promote best practice in the
management of pressure ulcers
The integration of school health and health visiting
services to provide and integrated Community
Child and Family Health team approach
21
3. Our Performance 2010-2011
1 Year
2
3
3.13 Clinical Effectiveness -
Making sure that the service we provide achieves the
best outcomes for the patient
Developing our Staff
We recognise the importance of investing in the
ongoing development of all employees. In turn,
individual employees are expected to make a
commitment to develop and apply their knowledge
and skills to meet the demands of their post. This year
there has been a real focus on the development of
clinical leadership and to also test new approaches.
We worked with the University of Derby to develop a
new Clinical Leadership Development Programme.
Clinical Leaders have now undertaken or are currently
undertaking the programme which attracts 15 degree
level credits on completion of the programme.
The organisation is currently realising the benefits
of clinical leaders being increasingly engaged in
the strategic aspects of the service. They have
also increased their political awareness of what is
happening to both their service and to the organisation
around them and how this impacts on their role.
Staff have been reported to be more motivated.
We have also increased the number of our clinical
staff who are able to take time out to discuss
professional issues and to receive professional
support and supervision in practice.
We also encourage the use of clinical and
business apprentices within our service which
has proved to be extremely successful not only
for the apprentices but also our staff.
22
4
5 year
plan
Using Our Resources Effectively
Productive Community Services NCH was one
of only two organisations which in collaboration
with NHS Institute for Improvement and Innovation
piloted the Productive Community Services toolkit.
The development of the productive community and
the productive ward toolkits continue across the
organisation. Many improvements have been achieved
by teams to enhance their overall productivity.
Staff themselves viewed the toolkit as,
‘Productive Community Services – enabling frontline
staff to transform their services, improving the
experience for both patients and staff.’
Some of the achievements made
during 2010/11 include:
• 25% reduction in stockholding
• standardised measures for patient
satisfaction and patient facing time
• 30% reduction in daily updating meetings
• 7% increase in Patient Facing Time
• 9% reduction in travel time
• potential 2.5 weeks per year savings
in unnecessary visiting
All of which has led to an increase in quality,
staff empowerment and patient experience.
An important focus during the year has been in the
development of regular information to enable teams
themselves to manage the demands on their services.
Using a ‘waterfall’ model we are now more able to plan
and predict the staff we need to deliver our services
in advance and also to make sure that we spend our
time more effectively and release more time to care,
thus increasing patient contact. The model asks clinical
staff to record how their time is allocated whilst on
duty and has led to an increase in patient facing time.
4
Our Adult Community Nurses have developed new
patient records to ensure that all assessments
and treatments are consistent and fully involve
patients in decisions about there care
Our Health Visitors have developed a new health
needs assessment tool which enables them to identify
the needs of families much more accurately and to
ensure that those who need the most support are
able to receive it. This also helps us to understand
more accurately how many staff we need.
Community Matrons are working closely with care
homes to educate and raise awareness on a range of
conditions. This teaching will provide the knowledge
that care home staff need to ensure that residents
are in their preferred place of care when they are
at the end of their lives, to better prevent pressure
ulcers, to identify hazards to reduce falls, to reduce
call outs for catheter problems, improve wound care
and to offer some guidance around how to manage a
person with challenging behaviours, in an endeavour
to promote the health of the resident and the carer.
Getting Better at What We Do
We continually strive to deliver the best services for
patients. Throughout the year we have worked
hard to understand more about some elements
of our services to see how we can do better:
We have reduced the number of falls by completing
more falls assessments for patients over 75 years.
We are also trying to understand more about
why some people fall more than once to be able
to understand how we can prevent them.
We have reduced the number of Pressure Ulcers which
develop whilst patients are in our care by monitoring
them much more closely, investigating the cause and
learning how to prevent them more effectively.
5 year plan
Patients with catheters are much more vulnerable
to infection. We have been monitoring practice
to understand how we can reduce the risk
and therefore the number of patients who
develop an infection from their catheter.
Nottinghamshire Community Health has Baby
Friendly Accreditation. This is a UNICEF initiative to
increase support for women to successfully breastfeed
their babies for longer. As part of this initiative,
we have we have increased the numbers of babies
who are breast-fed until they are 6 months old
We have adapted facilities to enable the use of
oxygen cylinders in the pulmonary rehabilitation
unit. The unit has also commenced organised walks
with pulmonary rehabilitation patients. This was
designed to give them confidence that they are
able to walk and to understand that they can build
walking into their everyday rehabilitation routines.
The Stroke Early Supported Discharge team has been
developed as a multi-professional approach to the
rehabilitation and support of patients who have
suffered from stroke. The service has been developed
in a way that puts the patient at the centre of the team
through shared treatment goals and documentation,
3.14 Innovation –
Constantly coming up with new and innovative ideas to
continually improve the way we deliver our services
End of Life - Prison Healthcare
HMP Whatton has an older population than most
in a prison environment and over the years have
experienced a number of patients with cancer
diagnosis requiring palliative care. The team, in
recognition of this, started to consider end of life
care for patients and putting processes in place
using the evidenced based Liverpool Care Pathway
23
3. Our Performance 2010-2011
1 Year
model, that could offer patients the ability to have
more choice in where they die, taking into account
their security requirements. A bid for “helping the
healing environment – Kings Fund” was submitted
and gained, and a team was put together comprising
members of the healthcare and prison teams. Working together they have achieved a refurbishment
of a large cell on one of the wings, for those
that may have some mobility problems due to ill
health, and a new end of life suite attached to
the healthcare department, in which patients can
choose to move into in the final days of their life. This suite affords a comfortable environment and
room for family to visit, with a new garden attached
through double doors. From the work that the
team has put into this project, the care that they
have given, using the Liverpool Care Pathway model
– they have been commended by the Butler Trust
Awards for their contribution to offender health.
Mobile Working in Community Nursing
Teams well received by staff and
enhances productivity
In order to use our resources more effectively, the
focus of this initiative was to enhance productivity
within locality based Community Nursing teams, in
terms of the number of patients visited, a reduction in
the time spent travelling and enhancing the patient
experience by having ready access to information.
A sample of 50 community nursing staff from
two teams within the chosen area were issued
with a newly developed mobile devices.
24
3
2
Benefits:
•
Evidence showed that those staff using the devices,
• attended to more patients
• had reduction in both travel
and administration time
• preferred the new way of working and
report that they perceived an increase in the
quality of care they were able to provide
Streamlining and implementing a new
Continence Pathway realises benefits for
patients, carers and staff
A review of community nursing workloads
showed a high volume of patients receiving
continence care and products across the county.
However, there was a real inequity in provision
of services from one locality to another.
A new Care Pathway has been developed and
implemented for the care of those adults identified
with a continence problem. Unless the patient is on
the End of Life Care Pathway, they are referred to a
locality based Community Nurse led Continence Clinic
and within 5 working days, offered an appointment
to attend for a comprehensive assessment. If the
patient is unable to attend a clinic (due to infirmity/
mobility problems) they are offered a home visit by a
Community Nurse for the same level of assessment.
All nurses who carry out the initial assessments
and run clinics have a recognised post registration
qualification for this specialist subject.
4
No continence products are prescribed for patients
until they have undergone a thorough assessment
and a Care Management Plan agreed with them. If
continence products are prescribed these are now
delivered direct to the patient at home irrespective
of where they live in the County, thus improving their
dignity in keeping the use of these products private.
5 year plan
The Specialist Dental Team streamline and
enhance quality of service delivery
The Specialist dental service carried out a review of all
its services and clinics across the county. The service
was not being delivered at the level of quality the
service would like and the service was spread too thinly.
Benefits:
The focus was placed on ensuring high
quality provision whilst reducing cost.
•
Focus is now on promoting continence
rather than simply providing pads
•
Service delivery sites were rationalised and
teams were skill mixed, which resulted in a more
effective and high quality service at each site.
•
All patients receive the same level
of specialist assessment
•
Patients who are not housebound are offered an
appointment in a specially run clinic environment
at a time and place convenient to them
Clinical management roles were reviewed
and clarified to support the dental service
as a whole, rather than separate units.
•
Patient access to urgent care appointments
was reviewed and revised
Additional clinics have been
established to meet demand
•
Reviewing and streamlining the service
revealed waste and resulted in savings
•
•
•
•
Proactive management has helped with
work flow and patients receive an annual
review of their needs which can be met in
a timely manner if these have changes
Patients are referred on to other services
as necessary and appropriate e.g.
Continence Advisory Service, or Medical
specialties (urology, gynaecology)
•
Productivity is improved, releasing unnecessary
travel time across community nursing teams
•
Patient time is saved and convenience and dignity
enhanced by home based delivery rather than
previous self collection from Health Centres.
Benefits:
•
The provision of more an effective and
high quality service at each site.
•
Better and more timely access for patients
3.2 Involvement and engagement
The three key areas for improvement in 2010/11
identified in this quality account have been chosen
as a result of feedback from patients, carers
and staff. We would like to thank everyone for
their valuable contributions in putting together
this review of the quality of our services.
25
3. Our Performance 2010-2011
1 Year
2
3
4
5 year
plan
3.3 Statements from other bodies
As part of the process for developing this document,
we were required to share the initial draft
with a range of third parties and publish their
responses. Below are the comments we receive
Nottingham and Nottinghamshire LINks
‘Nottinghamshire County LINk is pleased to see that
the Quality Account demonstrates that the overall
patient experience is a positive one and feels confident
that on the most part, where areas for improvement
have been identified, care pathways and action
plans have been implemented. However, the LINk
does recognise that improvement is needed with
regards to privacy and dignity at 2 out of 3 sites and
would like to see a remedial action plan in place.
Overall the LINk has noted that the referral to
external links and the lack of base line figures makes
it difficult to confidently express whether the Quality
Account is a fair reflection of the healthcare services
provided by Nottinghamshire Community Health.’
NHS Nottinghamshire County
‘NHS Nottinghamshire County monitored quality
and performance at Nottinghamshire Community
Health (NCH) throughout the year. There were
monthly quality and performance review meetings
and ongoing dialogue was undertaken as issues
arose. The information contained within this
Quality Account is consistent with information
supplied to commissioners throughout the year.
26
NCH worked constructively with commissioners on the
development of quality goals which were jointly agreed
in order to improve the health of local residents. NCH
also worked closely with commissioners and other
health partners to ensure that the level of quality
of care was not compromised during the planning
and delivery of Transforming Community Services.
The organisation has piloted the use of the Patient
Safety Thermometer which built up a picture of
patient safety from a number of sources including,
pressure ulcers, falls and infections. The Patient
Environment Action Team (PEAT) inspections identified
all three areas assessed as either excellent or good.’
Joint Overview and Scrutiny Committee
The Joint Overview and Scrutiny Committee
was invited to comment on the content of the
Quality Account within the timescale specified
by the Quality Account Toolkit 2010/11, however
the committee declined to comment.
Over
3000 staff
More
than
1 million
direct patient contacts per year
27
1 Year 2
3
4
5 year
plan
Nottinghamshire County
Over
3000 staff
More
than
1 million
direct patient contacts per year
Ransom Hall
Ransom Wood Business Park
Southwell Road West
Rainworth
Nottinghamshire
NG21 0ER
Tel: 01623 414114
This document is available
in other languages