QUALITY ACCOUNTS 2012/13
CAMDEN & ISLINGTON FOUNDATION TRUST
Quality Accounts 2012/13
Contents
Page
1.0
Statement from the Chief Executive
4
2.1
Priorities for improvement – 2013/14
7
2.2
Quality of services provided
11
2.2.1 Statements of assurance from the Board
11
2.2.2 Statements from the Care Quality Commission
15
2.2.3 Data quality
16
2.2.4 Information governance toolkit attainment levels
17
2.2.5 Clinical coding error rate
17
Review of quality performance
18
3.1.1 Safety
18
3.1.2 Effectiveness
23
3.1.3 Patient experience
27
3.1.4 Review of monitoring processes
32
3.1.5 Key quality initiatives
33
3.1.6 Patient Reported Experience Measures (PREMs)
35
3.1
3.2
3.3
3.1.7 NHS Litigation Authority – Risk Management Standards
37
3.1.8 Performance against key national indicators
37
3.1.9 Department of Health Indicators
41
3.1.10 2012/13 Quality Priorities
50
Stakeholder involvement in Quality Accounts
56
3.2.1 Trust staff
56
3.2.2 Healthwatch (LINKs)
56
3.2.3 Trust Governors
56
Stakeholder statements
56
3.3.1 Statement from lead commissioner
56
3.3.2 Statement from Camden Healthwatch
58
3.3.3 Statement from Islington LINks
58
3.3.4 Statement from Overview and Scrutiny Committee
58
Quality Report
1.0
Statement on Quality from the Chief Executive
Welcome to Camden and Islington NHS Foundation Trust’s (C&I) annual Quality
Accounts for 2012/13.
These accounts forms part of our Annual Report which is a review of our performance
against our strategic objectives. The Quality Accounts provides a summary of our
approach to quality improvement, and details the progress we have made towards
achieving the priorities we set ourselves for 2012/13. It demonstrates the trust’s
commitment to evidence based quality improvements across all services; whilst
ensuring that quality improvement is embedded into our culture and at the heart of
everything we do to ensure that our services are safe, effective, accessible, and
service user focused.
These accounts provide an opportunity to share our on-going commitment to achieve
better outcomes for our service users and carers. We state our quality priorities for
2013/14 and explain how we have worked with our stakeholders to agree these. It
highlights some areas where we did not achieve all that we set out to but reinforces
our commitment to continue to progress towards achieving our shared goals. We
welcome the opportunity the Quality Accounts gives us to be held to account by local
stakeholders and the communities we service for the delivery of quality improvement
programmes. You will see that as well as reporting on last year’s quality priorities, we
also include our current performance against priorities from previous years as we feel
this is important to maintain momentum in continuing to achieve and maintain the high
quality standards that we set ourselves.
The last three years have been a period of major change for the Trust; however we
are now strongly positioned to continue with our drive to improve quality whilst
reducing unnecessary costs. Our services have been subject to significant review,
including the realignment of services based on care pathways which are specific and
relevant to the needs of service users. The new services will be better able to meet
the needs of Camden and Islington residents by providing staff who specialise in
these interventions for service users in their care pathway which in turn delivers better
outcomes for them. The requirement to produce financial savings has meant that
these changes needed to be introduced swiftly, with a consequent unsettling impact
on staff. To support staff and increase morale the Trust has introduced an
organisational development program to capture and co-produce with staff and service
users a revised value base and vision, our Changing Lives programme.
Despite this, it is a credit to the professionalism of our staff that throughout this
process we have continued to deliver high quality services to our service users and
carers and that the Trust has maintained its performance against CQUIN
(Commissioning for Quality and Innovations) targets and standards of care set out by
the Care Quality Commission (CQC), Monitor and our local partner agencies whilst
further developing its systems for assurance and improvement.
The Trust is a strong performing, ambitious organisation focused on providing high
quality, safe and innovative care to our service users and their families. The Trust’s
quality goals are co-developed with stakeholders and communicated within the Trust
and the community it serves. This year we held two stakeholder events, engaging with
service users, carers and other internal and external stakeholders to define quality
goals and priorities for the coming year. On the 25th and 28th March 2013 respectively,
it was agreed with our stakeholders that the Trust will focus on further developing the
priorities we agreed over the last twelve months.
We are proud of our achievements in improving the quality and safety of care we
deliver. As part of our drive for excellence, the first of the Trust’s strategic goals is to
continuously improve the quality and safety of service delivery, improve service user
and carer experience and improve outcomes. The work to deliver this derives from
many programmes within the Trust. A principal pillar of the Trust’s strategy to improve
quality is the Clinical Quality Strategy which sets out our service delivery and the
structures governing care. The recommendations of the Francis Inquiry report into
the failings at Mid-Staffordshire NHS Foundation Trust are embedded within this
strategy to ensure the care we provide is of the highest quality. Through these annual
accounts, the clinical and quality strategy and the Changing Lives programme, we will
create a culture that promotes positive attitudes and behaviours and an excellent
experience for everyone.
The Trust has continued to develop its mechanisms for more specific, more frequent
and more varied ways to receive service user feedback. The Patient Experience
Tracking (PET) system has been extended to community-based care services and
action plans have been developed and implemented in response to our service users’
reported experiences. The Trust highly values the information collected from this
rolling service user survey and uses it as key evidence in its service development and
improvement programme.
Since the implementation of the CQC registration system in April 2010, the Trust has
been assessed on six occasions with visits to six different locations. We are proud
that on five of these occasions, the CQC found us compliant with all sixteen quality
standards, however on one occasion the CQC noted a moderate concern in regards
to a service provided at Stacey Street, a residential nursing home for which the Trust
has recently acquired responsibility. The formal report of this inspection has now been
received by the Trust highlighting the positive improvement in 5 of the 6 essential
standards that under the previous management were deemed noncompliant in May
2012.
The CQC’s primary tool for summarising information concerning the quality and safety
in healthcare providers on a continual basis is its Quality Risk Profile (QRP) in which
the Trust has continued throughout 2012/13, to show a very positive picture; with 712
out of 759 (94%) measures rated as similar or better than expected (as at April 2013)
and no area rated as at risk of non-compliance.
As in previous years, the Trust had agreed with its commissioners a very ambitious
and challenging set of quality targets and initiatives through its 2012/13
Commissioning for Quality and Innovation programme. These targets covered issues
relating to physical health, collaborative care planning, service user experience and
planned completion of treatment. I am very pleased that we have met the great
majority of these targets and will work in 2013/14 to continue improvement in these
areas and meet the new targets for the coming year.
Our quality priorities for 2013/14 broadly reflect the themes from last year, and we
think that this is appropriate as this is in line with the feedback from our stakeholders
and reflects that our drive to deliver high quality services is on-going. Through
2013/14, as the new health system is implemented, we are committed to
strengthening our engagement processes with GPs, Clinical Commissioning Groups
and our partners in developing future service provision with a key focus on improving
service user outcomes even further.
We greatly appreciate the external input we have had throughout the year, particularly
as part of the Quality Accounts process. Where changes have been suggested we
have incorporated them as far as possible in these Accounts. Our priorities over the
coming year are a direct result of feedback received and we have aligned our quality
priorities with the CQUIN targets whenever possible. This Account represents our
commitment to ensuring that we continue to embed our care pathway model,
developing new Integrated Care Pathways, improving service user and carer
experience and strengthening further our commitment towards recovery focused care
and continuous quality improvement.
The Board is satisfied that the data contained in these Quality Accounts are accurate
and representative.
Signed:
Wendy Wallace
Chief Executive
Dated 30th May, 2013
2.1
Priorities for Improvement
The Trust’s quality goals are co-developed with stakeholders and communicated
within the Trust and the community it serves. This year we held two stakeholder
events, engaging with service users, carers, governors and other internal and external
stakeholders to define quality goals and priorities for the coming year. On the 25th and
28th March 2013 respectively, it was agreed with our stakeholders that the Trust will
focus on further developing the priorities we agreed over the last twelve months.
Further, we have agreed to re-emphasise:



On strengthening our communication with GPs to develop a more robust
approach to working with primary care,
Creating more innovative ways of capturing service user reported experience
Expanding initiatives for the promotion of recovery and the improved health
and wellbeing of service users by developing qualitative measures in regards
to collaborative planning.
In recognising that there is more we can do the Trust has identified a set of
regional and local priorities for quality improvement for 2013/14.
This section of the Quality Accounts describes these regional and local priorities,
giving the rationale for their inclusion and how the Trust will measure its performance
against the agreed standards for these areas.
Priority area 1 – CQUIN 1: Physical Health
These measures build on the developments in improving physical health care for
people with mental health problems from previous years.
Rationale
This is a key priority nationally and for our local stakeholders. Research data has
consistently shown that mental health service users suffer significantly worse physical
health outcomes than the national average. This includes a higher risk of high
mortality physical health diagnoses such as diabetes, cardio-vascular disease and
respiratory diseases. This priority area will look to better identify physical health
morbidity experienced by our service users and improve their physical health care.
Key improvement initiatives
The key initiatives in this area relate to improved information sharing between primary
and secondary care. In 2010/11, 2011/12, and 2012/13 the physical health CQUIN
indicators related to building better systems for ensuring that service user information
stores in care settings are populated with key data fields for both mental and physical
health diagnoses and ensuring that service users are helped to access primary
physical health care for high mortality diagnoses. In addition, the CQUIN examined
systems for ensuring safety regarding continuity of medication and strong
communication across primary and secondary care. These are important patient
experience, effectiveness and safety measures that form a basis for shared care to
improve the physical health care of patients with mental health problems. Ensuring
that we support our service users to stay healthy is an integral part of the work
undertaken within Trust services. In 2013/14, this will be further developed with
stretched performance targets to ensure improvement continues.
Key performance indicators
There are six key indicator themes for this priority, set by London commissioning
organisations:


Sharing of Care Programme Approach (CPA) register with primary care;
Ensuring the recording of all relevant mental health and high mortality physical
health diagnoses on Trust patient administration systems;
 Support of inpatients and service users on CPA to access relevant physical
health checks and/or screening;
 To improve the medicines reconciliation of service users admitted to mental
health inpatient units;
 To ensure provision of discharge letters to GPs on discharge from secondary
mental health care,


Completion of a quality audit to provide assurance in regards to compliance
with agreed content of discharge letters and;
To ensure provision of care plans to GPs within two weeks of CPA review
meetings.
Priority area 2 – CQUIN 2: Recovery-orientated practice
Rationale
The rationale for including this CQUIN (Commissioning for Quality and Innovation)
indicator is in line with national policy which has increasingly recognised the
importance of creating a mental health system that promotes independence, in which
staff see the ultimate goal of their work as being to help people maintain or regain
independence. This approach is intended to improve quality of life by giving people
control over their own process of recovery.
The Trust through its recovery model is signed up to the promotion of sustainable
recovery, and increasing self-esteem and self-management, and the indicators
outlined in this CQUIN aim to monitor how well this recovery approach has been
implemented.
Key improvement initiatives
The key initiatives in this area relate to clinical services working collaboratively with
service users in setting meaningful goals to promote recovery, increase the quality of
life and reduce possible relapse. This collaboration should be evidenced through the
care planning process and the key indicators seek to monitor and ensure that this is
the case.
Key performance indicators
There are two key indicator themes for this priority:


Completion of a quality audit of recovery-orientated practice in the Trust;
Assurance that care plans show evidence of collaborative planning of care
between service user and clinician and contain at least two personal recovery
goals.
Priority area 3 – Collaborative planning of care between service user and
clinician
Rationale
This is a quality area suggested by stakeholders. To help the Trust further measure
the promotion of recovery and the improved health and wellbeing from a service users
point of view. This approach builds on the recovery orientated practice CQUINs for
2013/14 and is intended to improve quality of life by giving people control over their
own process of recovery. The Trust through its Recovery Model approach to care
delivery, subscribes to the promotion of sustainable recovery and increased selfesteem, and the indicators outlined in this measure, aim to monitor how well this
recovery approach has been implemented and enable the Trust to assess if service
users have met their expectations, when using services.
Key improvement initiatives
The key initiatives in this area relate to clinical services working collaboratively with
service users in setting meaningful goals to promote recovery, increase the quality of
life and reduce possible relapse. This collaboration should be evidenced through the
care planning process and the key indicators seek to monitor and ensure that service
users were supported to identify their own goals within the care planning process and
work towards achieving these.
Key performance indicators
There is one key indicator theme for this priority:

Completion of a quality audit ( via service user feedback) to provide assurance
from a service users lived experience that they have been supported to identify
their own goals within the care planning process and work towards achieving
these.
Priority area 4 – CQUIN 3: Smoking cessation
Rationale
The rationale for this indicator is outlined within the mental health outcomes strategy;
which highlights that increased smoking is responsible for most of the excess
mortality of people with severe mental health problems. Many mental health service
users wish to stop smoking, and can do so with appropriate support. People with
mental health problems need good access to services aimed at improving health (for
example, stop smoking services).
Key improvement initiatives
The key indicators for this priority area relate to assuring the knowledge base and
expertise of Trust staff in facilitating access to smoking cessation services and in
ensuring that information about smoking is recorded and acted upon for service users.
Key performance indicators
There are three key indicator themes for this priority:

Expansion of smoking cessation training programme for Trust staff to include
intensive one to one support and advice;


Recording of smoking status for service users in the Trust;
Production of mutually agreed care plans for smoking cessation.
All of these measures are underpinned by improving patient safety, enhancing the
service user experience and further developing the clinical effectiveness of our
services.
2.2
Quality of services provided
2.2.1 Statements of assurance from the Board
The Board is able to provide the following statements of assurance:
Review of services
During 2012/13, Camden and Islington NHS Foundation Trust provided and/or subcontracted the following four NHS services:




Adult Mental Health;
Mental Health Care of Older People;
Substance Misuse;
Learning Disability.
Camden and Islington NHS Foundation Trust has reviewed all the data available to it
on the quality of care in each of these NHS services.
The income generated by the NHS services reviewed in 2012/13 represents 100% of
the total income generated from the provision of NHS services by Camden and
Islington NHS Foundation Trust for 2012/13.
The Trust has been able to review data for each of these services in the areas of
patient safety and clinical effectiveness. It has also been able to review data relating
to patient experience for Adult Mental Health, Services for Ageing and Mental Health
and Substance Misuse, through the use of the Trust’s Patient Experience Tracking
programme.
Participation in clinical audits and national confidential enquiries
During 2012/13, three national clinical audits and one national confidential enquiry
covered the NHS services that Camden and Islington NHS Foundation Trust
provides.
During that period, Camden and Islington NHS Foundation Trust participated in 100%
of the national clinical audits and 100% of the national confidential enquiries of the
national clinical audits and national confidential enquiries in which it was eligible to
participate.
The audits and confidential enquiries were:



National audit for psychological therapies for anxiety and depression (NAPT);
Prescribing Observatory for Mental Health (POMH)
Confidential enquiry into suicide and homicide by people with mental illness
(CISH).
In comparison, the national clinical audits and national confidential enquiries that
Camden and Islington NHS Foundation Trust participated in during 2011/12 were as
follows:



National audit for psychological therapies for anxiety and depression (NAPT);
National audit of schizophrenia;
Confidential enquiry into suicide and homicide by people with mental illness
(CISH).
The national clinical audits and national confidential enquiries that Camden and
Islington NHS Foundation Trust participated in, and for which data collection was
completed during 2012/13, are listed below alongside the number of cases submitted
to each audit or enquiry as a percentage of the number of registered cases required
by the terms of that audit or enquiry.
National confidential enquiry into suicide and homicide
by people with mental illness (CISH)
Cases
Submitted
% of
cases
required
6
100%
The reports of two national clinical audits (National Audit of Psychological Therapies
for Anxiety and Depression and National Audit of Schizophrenia) were reviewed by
the provider in 2012/13.
Results from the national clinical audit programme administered by the Healthcare
Quality Improvement Partnership (HQIP) are available at the HQIP website:
http://www.hqip.org.uk/national-clinical-audit/
The reports of 167 local clinical audits were reviewed by the provider in 2012/13 and
Camden and Islington NHS Foundation Trust uses the outcome of all audits to
improve the quality of healthcare provided. Below are a few examples of changes to
improve care and treatment as a result of audits:




The Trust will ensure relevant and comprehensive physical health diagnostic
information is recorded for mental health service users;
The Trust will increase training across inpatient and community based services
to support staff in identifying and assessing dual diagnosis patients. This will
included further development of information resources and closer working with
local drug and alcohol services;
The Trust will implement local guidelines for the management of self-harm and
develop a checklist to be used by staff when assessing service users:
The Trust will commission Physical Health and Well-Being education and
training to enhance the knowledge and practice of all staff delivering care in
this area.
The Trust has worked diligently in 2012/13 to develop further its programme of clinical
audit and augment clinician participation in this audit work. All professions and
disciplines contribute to clinical audit across all services through the balanced
scorecard programme and the active programme of local audit in all
Divisions. Structures are in place locally within Divisions to encourage audit projects,
monitor their progress and analyse and share their results. The findings and
information accrued by these local groups are then shared with the Clinical Quality
Standards and Outcomes Group (CQSOG) and the Trust’s Quality Committee. The
Governance and Performance Team are responsible for co-coordinating clinical audit
centrally within the Trust.
Since 2006, the Governance and Performance Team has organised bi-annual Audit
Forums where clinicians can present the findings of their audits to their peers. In
2012/13 a prize-fund element was continued whereby the author of the best audit
presentation, as agreed by a judging panel, was awarded a grant of £300 towards
their personal professional development. Two Clinical Audit forums were hosted in
2012/13.
Participation in clinical research
The number of patients receiving NHS services provided or sub-contracted by
Camden and Islington NHS Foundation Trust that were recruited in 2012/13 to
participate in clinical research approved by a research ethics committee was 309 from
37 trials.
39 new projects were registered in the past year with 15 non-funded studies and 24
funded bringing the total number of projects registered as being active in the Trust for
the given time period to 64 (16 unfunded and 48 funded).
Staff associated with the Trust have published 110 articles in peer reviewed journals
over the past year; the Trust continues to support a significant number of studies both
funded and unfunded demonstrating its on-going commitment to embedding a
research culture in the Trust.
Quality and Innovation - The CQUIN framework
A proportion of the Trust’s income in 2012/13 was conditional upon achieving quality
improvement and innovation goals agreed between Camden and Islington NHS
Foundation Trust and any person or body it entered into a contract, agreement or
arrangement with for the provision of NHS services, through the Commissioning for
Quality and Innovation (CQUIN) payment framework.
The five quality areas included in the CQUIN framework for 2012/13 were:

Improving the physical health care of patients with mental health problems;

Ensuring fidelity to the recovery model through collaborative care planning;



Facilitating smoking cessation;
Improving care and prescribing for service users with dementia;
Increasing successful completions for service users in drug treatment.
For 2013/14, CQUINs have been agreed with commissioners covering the following
areas:

Improving the physical health care of patients with mental health problems;

Ensuring fidelity to the recovery model through collaborative care planning;


Facilitating smoking cessation;
Increasing successful completions for service users in drug treatment.
The amount of income for both 2011/12 and 2012/13 conditional upon achievement of
quality improvement and innovation goals through the Associate Commissioner
Agreements was £1,187,208 for 2011/12 and £1,922,464 in 2012/13,
2.2.2 Statements from the Care Quality Commission (CQC)
Camden and Islington NHS Foundation Trust is required to register with the Care
Quality Commission and its current registration status is unconditionally registered.
The Care Quality Commission has not taken enforcement action against Camden and
Islington NHS Foundation Trust during 2012/13.
Camden and Islington NHS Foundation Trust has not participated in any special
reviews or investigations by the CQC during the reporting period.
The Care Quality Commission has externally assessed three of the Trust’s registered
locations in 2012/13; Highgate Mental Health Centre (HMHC), Islington Drug and
Alcohol service and Stacey Street Nursing home. The CQC provided extremely
positive assessment reports and found us compliant with all sixteen quality standards
at HMHC and Islington Drug and Alcohol service; with the exception of one moderate
concern in regards to a service provided at Stacey Street, a residential nursing home
for which the Trust has recently acquired responsibility the CQC found positive
improvement in 5 of the 6 essential standards that under the previous management
were deemed noncompliant in May 2012.
2.2.3 Data Quality
Camden and Islington NHS Foundation Trust will be taking the following actions to
improve data quality:
Action
Rationale
Deadline
Introduction of a Trust Information
Assurance Framework
To provide more information in May 2013
relation to data quality
confidence and to help
strengthen assurance
processes for data that is
used to compile performance
reports.
A set of data quality indicators has
been agreed for monthly monitoring at
the Divisional performance meetings
and quarterly monitoring with the lead
commissioner
These key data quality
Quarterly
indicators are linked to CQUIN monitoring
targets and key national
indicators
The Trust will continue to monitor the
implementation of Data Quality Policy
(2012) through regular audit.
This will ensure that the solid
March 2014
data quality principles set out
in the Data Quality Policy and
Strategy are in place to assure
the validity of quality and
performance monitoring
information
Further development of data quality
and performance dashboards
These will be developed to
include the new indicator
targets and monitoring of use
of dashboards will continue.
March 2014
The Trust will continue to develop its
processes to ensure the effective and
efficient implementation of
pseudonymisation in line with
Department of Health guidelines.
During 2012/13, the Trust has
developed and implemented a
successful process for data
pseudonymisation. Data flows
in, out and around the Trust
are now conducted in line with
an agreed policy, with a series
of audits planned for 2013/14
to ensure compliance.
March 2014
The Trust submitted records during 2012/13 to the Secondary Uses service for
inclusion in the Hospital Episodes Statistics which are included in the latest published
data.
For admitted care patients, 100% of records in the published data included the
patient’s valid NHS number, and 100% included the patients validated general
medical practice code.
In 2011/12, the Trust reviewed and ratified its Data Quality Policy, taking account of
the significant developments made in the automation of monitoring and reporting
systems and in ensuring the Trust can effectively and efficiently meet the increasing
national reporting requirements of the Mental Health Minimum Dataset (MHMDS). To
assist the implementation of the revised Data Quality Policy, the Trust has introduced
a new Data Quality Strategy.
Throughout 2012/13 the Data Quality Group has continued to meet on a monthly
basis to co-ordinate the implementation of data quality strategy and monitor
performance against data quality standards. To assist this process and to provide
real-time information for service managers and clinicians, the Trust has continued its
development of electronic activity and data quality dashboards.
2.2.4 Information Governance Assessment Report attainment levels The Trust’s Information Governance Assessment Report overall score for 2012/13
was 79% and was graded ‘not satisfactory’; this is an improvement on last year’s
percentage score of 76%. This assessment provides an overall measure of the quality
of data systems, standards and processes within an organisation. The Trust scored
level one on one element relating to Information Governance training, in total, the
Trust achieved level two or above on all of the remaining 44 elements.
The Trust achieved 91% compliance in regards to the IG training and this directly
resulted in the ‘not satisfactory’ score for the IG Toolkit, as the required score for the
IG training was 95%. Subject to the Trust achieving 95% or above in the IG training
the IG Toolkit score would be graded as ‘satisfactory’ in following years. An action
plan has been implemented to ensure 95% of staff or above complete their
Information Governance Training and ensure a grade of satisfactory is achieved at the
next self-assessment. Improvements from last year’s submission include
requirements around Registration authority, clinical coding, records management
audit, pseudonymisation and anonymisation processes.
2.2.5 Clinical coding error rate
Camden and Islington NHS Foundation Trust was not subject to the Payment by
Results clinical coding audit during 2012/13 by the Audit Commission.
The Trust did undergo a Clinical Coding audit during the reporting period as required
by Connecting for Health for the Information Governance Toolkit. The rates reported
in the latest published audit for that period for diagnoses and treatment coding
(clinical coding) was 88% correct.
The aim of this audit was to assess the quality of clinical coding and make
recommendations for improvement of quality and processes related to clinical coding.
The audited spells were selected from all spells coded from episodes that ended
between July and September 2012.
3.1
Review of Quality Performance
The Quality Accounts process requires that trusts identify three key quality
performance indicators for each of three quality domains; safety, effectiveness and
patient experience. The Trust’s performance on each of these indicators during the
financial year (and in previous years where available) is set out below, along with a
description of the construction of the indicator.
3.1.1 Safety
The Trust has selected the following three indicators to represent the safety domain:
i.

The proportion of Trust inpatient service users (Services for Ageing and Mental
Health) who received assessment through the Malnutrition Universal Screening
Tool (MUST) within 72 hours of admission;

The proportion of service users receiving physical health assessments in line
with Trust policy for inpatient, community and residential and rehabilitation
based services;

The proportion of staff reporting errors, near misses or incidents witnessed in
the last month (from the annual CQC Staff Survey 2012).
Compliance with standards of MUST policy
The 'Malnutrition Universal Screening Tool' (MUST) is a validated, evidence based
tool designed to identify individuals who are malnourished or at risk of malnutrition
(under-nutrition and obesity). The use of MUST is included in NICE guidelines to
tackle the issue of malnutrition and its use is particularly important for services such
as those providing services to older people.
Numerator
All service users admitted to inpatient services at the time of the (quarterly) audit
receiving a MUST assessment within 72 hours of admission1.
Denominator
All service users admitted to inpatient services at the time of the (quarterly) audit.
Reporting
This is audited and reported internally through the balanced scorecard process with
results provided to commissioners as part of the Service Quality Improvement Plan
which is presented to the Clinical Quality Review Group.
1
This figure includes all service users receiving a MUST assessment within 72 hours and
those for whom a transfer to/from general acute care necessitated a clinically acceptable
deferment of assessment. As of 2011/12, admissions to acute wards are no longer
categorised by the age of the service user within the new acute service lines. As such, the
figures from 2011/12 onwards cover all acute wards.
Performance figures (proportion of audited cases complying with policy):
Q1
Q2
Q3
Q4
2008/09
89%
89%
77%
95%
2009/10
80%
76%
96%
94%
2010/11
73%
78%
92%
78%
2011/12
93%
79%
87%
80%
2012/13
100%
94%
100%
100%
Target 2012/13: 80%
Compliance with MUST Policy Performance chart:
100%
95%
90%
85%
80%
75%
Performance
Target
70%
65%
60%
ii.
Compliance with Physical Health Assessment Policy
The association between severe mental illness and physical health problems is well
established with the life expectancy of people with severe mental illness being nine
years less than that of the general population (Disability Rights Commission 2006).
Therefore people with a mental illness are at a greater risk of premature mortality than
the general population. The physical health care needs of people with a mental
illness are as important as the individual’s mental health care and must be part of a
holistic package of care. The Trust has agreed policies and protocols for ensuring our
service users receive effective physical health assessment and the implementation of
these policies is measured through the balanced scorecard process. Measures for
monitoring liaison between primary and secondary care in relation to physical health
care are also included in the CQUIN indicator set.
Numerator A
All current service users in Residential & Rehabilitation services at the time of the
(quarterly) audit with evidence of physical assessment being offered in the preceding
12 months.
Denominator A
All service users in Residential & Rehabilitation services at the time of the (quarterly)
audit.
Numerator B
All service users currently admitted to inpatient services at the time of the (quarterly)
audit receiving a physical assessment (or refusal noted) within 24 hours of admission.
Denominator B
All service users admitted to inpatient services at the time of the (quarterly) audit.
Numerator C
Percentage of service users having received a physical health assessment in line with
current Trust Policy.
Denominator C
Sample of 12 service users per Community Mental Health team allocated to that team
within the quarter.
Reporting
This is reported internally through the quarterly balanced scorecard process with
results provided to commissioners as part of the Service Quality Improvement Plan
which is presented to the Clinical Quality Review Group.
Action plan
The Trust has improved overall compliance and the overall quality of its services in
this area by prioritising physical health assessments across Trust services and
maintaining the Physical Health CQUIN as a quality priority throughout 2012/13. This
has supported the continued improvement of performance compliance in this area
Performance figures:
Q1
Q2
Q3
Q4
Inpatient services
88%
93%
80%
82%
Residential & Rehabilitation
78%
73%
74%
93%
2008/9
services
2009/10
2010/11
2011/12
2012/13
Inpatient services
67%
73%
72%
84%
Residential & Rehabilitation
services
86%
91%
94%
95%
Inpatient services
93%
90%
96%
87%
Residential & Rehabilitation
services
N/A2
N/A
77%
83%
Community Mental Health
Teams3
50%
73%
64%
66%
Inpatient services
80%
90%
79%
90%
Residential & Rehabilitation
services
90%
95%
82%
99%
Community Mental Health
Teams
56%
80%
91%
90%
Inpatient services
88%
89%
86%
87%
Residential & Rehabilitation
Services
97%
99%
99% 100%
Recovery and Rehabilitation
teams
N/A4
100%
92% 100%
Target 2012/13: 85%
Compliance with Physical Health Assessment performance chart:
2
A different measure was audited in Q1 and Q2: If the service user has identified physical health
needs, do they have a current support plan addressing these needs?
3
Note, this was only monitored in CMHT balanced scorecards from 2010/11
4
Recovery and Rehabilitation teams were excluded for Q1 whilst Services were reconfigured
iii. Proportion of staff reporting errors, near misses and incidents witnessed in
the month prior to the annual CQC survey
The CQC undertakes an annual survey of staff for all NHS trusts and one area the
questionnaire addresses is the reporting of errors, near misses and incidents. The
Trust seeks to maximise culture of incident reporting and learning from incidents and
an environment is provided whereby staff are encouraged and facilitated to report.
Numerator
The number of staff indicating in the annual CQC staff survey that they had witnessed
an error, near miss or incident in the month prior to their completion of the survey
questionnaire who had also indicated that they had reported this.
Denominator
The number of staff indicating in the annual CQC staff survey that they had witnessed
an error, near miss or incident in the month prior to their completion of the survey
questionnaire.
Performance:
Trust Score
National Median
2008
92%
97%
2009
90%
97%
2010
98%
97%
2011
94%
97%
2012
96%
98%
3.1.2 Effectiveness
The Trust has selected the following three indicators to represent the safety domain:

The proportion of service users receiving a weekly review of their inpatient care
plan;


The proportion of inpatient service users whose stay was 100 days or more;
Recovery rate in Improving Access to Psychological Therapies (IAPT).
i. Frequency of review of care plans in inpatient services
It is important for services to react swiftly to changes in our service users’ mental and
physical state and to their personal circumstances and we must be quick to review
and amend care plans to reflect these changes. The Trust Care Programme
Approach (CPA) Policy outlines the standards expected of our care teams in this
area. A measure to monitor this is included in the balanced scorecard process for
inpatient services.
Numerator
All service users currently admitted to inpatient services at the time of audit with
evidence that their care plan has been reviewed in the seven days preceding the
audit.
Denominator
All service users currently admitted to inpatient services at the time of audit.
Action plan
The Trusts historical performance differs across teams and divisions for this indicator.
In 2011/12 while several teams are meeting the target consistently, others are
performing less well. Review in Q.3 2011/12 highlighted that in most negative cases,
the weekly review had been completed but not recorded correctly on the Trust service
user information system (RiO). Guidance on the importance of accurate data entry
and instruction on how to achieve this was re-issued and performance monitored
throughout 2011/12 on a more frequent basis resulting in Q4 showing significant
improvement. With the exception of a slight drop in performance in Q.1 2012/13 the
action the Trust took to improve these percentages and so the quality of its services
has been maintained throughout 2012/13. The performance reflected in the table
below is a testament to this.
Performance figures:
Q1
Q2
Q3
Q4
2008/09
76%
87%
77%
82%
2009/10
67%
61%
76%
76%
2010/11
80%
75%
80%
85%
2011/12
76%
73%
65%
94%
2012/13
81%
90%
92%
93%
Target 2012/13: 85%
Frequency of review of care plans performance chart:
100%
95%
90%
85%
80%
75%
70%
65%
Performance
Target
60%
55%
50%
ii. Average length of stay – Stays of three months or more
The Trust monitors its average length of stay for inpatient care spells to ensure that
there is effective provision of care across inpatient and community-based services.
As one aspect of average length of stay monitoring, in 2011/12 the Trust set, through
review of historical and benchmarked bed usage, an internal target of no more than
20% of inpatient stays being 100 days or longer. This is part of the process of
ensuring that the realignment of services based on care pathways are better able to
meet the needs of service users by ensuring that community services are proving able
to maintain service users in the community, rather than in inpatient settings.
Numerator
Number of inpatient discharges per quarter whose length of stay is more than three
months.
Denominator
Number of inpatient discharges per quarter.
Performance figures:
Q1
Q2
Q3
Q4
2010/11
12%
11%
9%
9%
2011/12
10%
9%
11%
10%
2012/13
9%
13%
15%
12%
Target 2012/13: <20%
iii. The number of people who are moving to recovery in IAPT services
The Improving Access to Psychological Therapies (IAPT) programme was launched
in 2007. It aims to investigate ways to improve the availability of psychological
therapies, especially relating to people with depression or anxiety disorders. It also
aims to promote a more person-centred approach to therapy. This measure aims to
assess the rate of successful treatment outcomes for the services.
Numerator
Number of service users completing treatment with IAPT services in the quarter who
had recovered (i.e. who no longer met the criteria for depression or anxiety) at their
final treatment session.
Denominator
Number of service users completing treatment with IAPT services in the quarter who
at assessment had scores in the clinical range.
Performance figures:
2010/11
Numbers
Percentage
Camden
631 / 1706
37%
Islington
675 / 1740
39%
Camden
603/1622
37%
Islington
786 / 2053
38%
Camden
680 / 1684
40%
Islington
701 / 2009
35%
2011/12
2012/13
Target 2012/13 – Camden: 42.3%, Islington: 50%
Action plan
The Trust has taken the following actions to improve the recovery rates, and so the
quality of its services, by working in partnership with commissioners to aid recovery:





The service is actively investigating why recovery rates are falling. A service
recovery plan is being finalised detailing the service’s strategy for improving
recovery rates and will be presented at the next Integrated Primary Care
Mental Health Group in May.
The service plans to monitor average number of treatment sessions and to
offer extra follow-up sessions for those discharged to ensure that recovery has
continued.
Current Audits are looking at the “inclusive” criteria for entry into IAPT Services
and its effect on recovery rates. It is possible that the inclusion of certain
cluster groups in IAPT could be bringing down the overall recovery rate of the
service.
Currently undertaking research in conjunction with University College London
(UCL) looking at C&I IAPT patients to investigate factors influencing recovery
rates
Significant work undertaken to address waiting times for treatment – resulting
in vast improvements in Q4.
3.1.3 Patient Experience
The Trust has selected the following three indicators to represent the patient
experience domain:



the number of carers receiving advice or services following a carer’s
assessment;
the proportion of service users in inpatient services (and particularly Psychiatric
Intensive Care Units or PICU) being offered at least 4 activities per week;
Patient Environment Action Team (PEAT) assessment scores.
i. Advice and services to carers
The needs of carers to Trust service users are of paramount importance. Ensuring
the well-being of carers is a significant factor in also ensuring the wellbeing of the
people for whom they care.
Numerator
The number of carers receiving a ‘carer’s break’ or other specific carers service, or
advice or information, during the year following a carer’s assessment or review.
Denominator
The number of adults receiving a community- based service during the year.
(Performance for previous years is provided in the table below)
Performance figures (Historical):
In the past three years, targets for advice and services to carers have been set
separately by commissioners in the boroughs of Camden and Islington and targets
have been formatted differently as either absolute numbers of carers or as
percentages of the overall number of carers. They have also in different years been
set either separately for adults of working age and older people, or as a joint target.
This has made trend comparisons complex.
Target met
Camden 2008/9 (Adults)
Yes
Camden 2008/9 (Older People)
Yes
Islington 2008/9 (Adults)
No
Islington 2008/9 (Older people)
Yes
Camden 2009/10
Yes
Islington 2009/10
No*
Camden 2010/11
Yes
Islington 2010/11
No
* The target was raised mid-year (Nov) from 15% to 23%
Performance figures (2012/13)
2011/12
Target
Performance
Camden
30%
28%
Islington
25%
26%
2012/13
Target
Performance
Camden
35%
Data pending for performance
Islington
27%
Data pending for performance
ii. Provision of activities in inpatient teams (with particular reference to PICU)
The provision and encouragement of occupational therapy and leisure activities are a
vital component of recovery within mental health inpatient services. This provision
has been monitored by the Trust through its balanced scorecard process for several
years and quarterly audits check to see whether individual service users have been
offered or taken up at least four activities per week.
Numerator
The number of service users currently admitted to inpatient services at the time of the
audit with evidence that they had been offered or taken up at least four occupational
therapy, art therapies, or other leisure activities in the seven days preceding the audit.
Denominator
The number of service users currently admitted to inpatient services at the time of
audit.
Performance figures:
Q1
Q2
Q3
Q4
Trust 2008/09
35%
72%
59%
52%
Trust 2009/10
80%
60%
67%
86%
Trust 2010/11
88%
79%
85%
79%
Trust 2011/12
77%
83%
82%
84%
Trust 2012/13
74%
86%
89%
88%
Target 2012/13: 75%
Provision of activities performance chart:
iii. Patient Environment Action Team (PEAT) assessment scores
PEAT is an annual assessment of NHS inpatient services in England 5. It is a
benchmarking tool to ensure improvements are made in the non-clinical aspects of
service user care including environment, food, privacy and dignity. The assessment
results help to highlight areas for improvement and share best practice across
healthcare organisations in England. There are 9 Trust sites included in the
assessment. Inclusion of scores against this measure was requested by the Trust
Governors.
5
And of residential and rehabilitation services with more than 10 beds
Performance figures:
Percentage of Trust sites rated as
“Good” or “Excellent”
Environment
Food
Privacy and
dignity
2009
100%
86%
100%
2010
78%
100%
100%
2011
100%
100%
100%
2012
100%
100%
100%
The assessment uses a 5 point scale: unacceptable, poor, acceptable, good and
excellent. In the past five assessments, the Trust has not had any sites rated as
unacceptable or poor.
Please note: the data included here reflects PEAT scores for last year that were
verified by the NHS Information Centre June 2012. The new PLACE assessments will
start in April 2013 which is later than in previous PEAT years.
3.1.4 Review of Monitoring Processes
Balanced Scorecard process
The Trust completed its eleventh year of balanced scorecard service improvement
work. The balanced scorecards for services are developed on an annual basis with
performance indicators being amended to follow Trust and service need and targets
being stretched. Balanced scorecards are produced for the vast majority of clinical
teams with aggregated scorecards for service types and boroughs providing an
overall summary of Trust performance. The measures chosen for inclusion reflect
both national and local priorities and are categorised into four domains; service user
outcomes, service user processes, resources and lifelong learning. Many of the
quality indicators included in these Quality Accounts are monitored quarterly through
the balanced scorecard process. The completed scorecards for each quarter are
discussed at Trust-wide and local forums and action plans are produced at a team
level to address any concerns raised in each report.
The balanced scorecard process is a key part of the Trust’s commitment to
encouraging and monitoring multi-disciplinary participation in audit, reflective practice
and continuous quality improvement.
Performance Framework
To support the further development of the Service Line Management model within the
Trust, there was a need to establish and embed a performance management
framework that provides accountability and transparency in relation to the delivery of
performance metrics and business plans.
The Camden and Islington NHS Foundation Trust Performance Framework sets out
the Trusts performance management arrangements and how these will operate to
support and drive service line performance, and the delivery of local and national key
performance indicators (KPIs) and targets.
Monthly Divisional Performance Meetings
In line with the overarching performance framework each division/operational
department has monthly performance review meetings with the Chief Operating
Officer.
The meetings take place on the second Monday of each month.
Performance
review
meetings
are
attended
by
members
of
the
divisional/departmental team, and a representative from corporate performance, HR,
finance and information teams. On a quarterly basis, performance review meetings
are attended by the Chief Executive, Director of Nursing and People, Deputy Chief
Executive/Medical Director, Finance Director and Director of Integrated Care.
Corporate departments have performance review meetings on a quarterly basis.
Quarterly Performance Reports
The Trust Board receives a quarterly performance monitoring report covering all
national indicators and assessment processes, agreed quality indicator sets for
commissioning bodies and locally derived quality measures. Further information on
quality monitoring in relation to the implementation of QIPP programmes has been
further developed throughout 2012/13 to include measures derived from the five
quality domains of the NHS Outcomes Framework. This information is shared
publicly with performance reports published on the Trust website and information from
the performance report shared at Council of Governors meetings.
Electronic Performance Dashboards
In 2012/13, the Trust has continued to develop its set of online quality and
performance management dashboards available to staff to allow them to monitor
performance in a new and more dynamic way. Information is updated daily to allow
more responsive management of service line activity, performance against national
targets and data quality. These dashboards will further develop in 2013/14 with the
introduction of specific performance indicator dashboards. The facility will increase
for reviewing performance against further locally derived indicators such as those
included in the balanced scorecards.
Quality Reports to Commissioners
In addition to the activity reports provided to commissioners, 2012/13 saw the
continuation of quarterly quality meetings and quality reports to the Trust’s lead
commissioners. Performance against CQUIN targets and other quality indicators is
monitored along with reviews of learning from incidents and complaints. The different
commissioning bodies have significant input into deciding priorities for quality
improvement and in setting quality indicator targets.
3.1.4 Key Quality Initiatives in 2012/13
Changing Lives
Over the past 6 months over 500 staff and service users and carers have taken part in
the ‘Changing Lives’ programme – to listen to what makes the biggest difference to
each other and set shared expectations for how we continue to improve the
experience of using and providing Trust services. The outcome is a new set of values
and behaviour standards for the Trust, co-created by staff and service users, and a
plan to align our organisation to those values in order to sustain continued
improvement in staff and service user experience. Through these annual accounts,
the clinical and quality strategy and the changing lives programme, we will create a
culture that promotes positive attitudes and behaviours and an excellent experience
for everyone.
AIMS-Rehab (Accreditation for Home Treatment Services)
The Royal College of Psychiatrists have developed their AIMS scheme to include
Home Treatment Services, under the Home Treatment Accreditation Scheme (HTAS).
The North Islington Crisis Resolution Team participated in piloting the standards for
this programme and was recently accredited by the panel which is a testament to the
excellent care they provide.
The Quality Indicator for Rehabilitative Care (QuIRC)
This is a web-based toolkit (available at www.quirc.eu) which assesses the living
conditions, treatment, care and human rights of people with longer term mental health
problems in psychiatric and social care units. It was developed through a collaborative
study in ten European countries funded by the European Commission, led by a
consultant psychiatrist employed by the trust Dr Helen Killaspy from 2007-2010. Its
content was derived from three sources: a review of the published evidence on the
most effective aspects of care in rehabilitation units (Taylor et al., 2009); a review of
national care standards for these services; and a consensus exercise that collated the
views of experts in rehabilitative mental health care: service users, clinicians, carers
and advocates (Turton et al., 2010). The QuIRC is completed by the Unit Manager
and has been shown to have good reliability (Killaspy et al., 2011) and correlation with
service users’ experience of their care (Killaspy et al., 2012). On completing the
QuIRC on-line, the Unit Manager has immediate access to a report showing the
performance of their unit on seven domains of quality (Living Environment;
Therapeutic Environment; Treatments and Interventions; Self-management and
Autonomy; Human Rights; Social Interface; Recovery-Based Practice). The average
performance in these domains for similar units in the same country is also shown,
along with details of the aspects of care that may be below average and require
improvement.
The QuIRC has been used in a national study of inpatient mental health rehabilitation
units in England (Killaspy et al 2013). It has also been incorporated into the UK peer
accreditation process for inpatient mental health rehabilitation units which are run by
the Royal College of Psychiatrists’ Centre for Quality Improvement – “AIMS-Rehab”.
Both inpatient mental health rehabilitation units in Camden and Islington (Malachite
and Montague wards) are members of this peer accreditation network and four
members of staff have trained as peer assessors and been involved in the
assessment of other units across the country. Both Malachite and Montague wards
achieved AIMS-Rehab accreditation in 2011 (due for renewal in 2014).
Clinical Leadership Programme
The Clinical Leadership Programme (CLP) has been running with the Trust since
June 2009 and continues to promote improved quality of service through providing
participants with the opportunity for higher trainees and other clinicians across the
Trust to improve their management and leadership skills by working on ‘live’
management projects. As part of the programme, a project to develop ways to
improve screening and treatment of cardiovascular risk factors in the acute pathways
was undertaken. The aim of the project was to effectively improve communication of
this information to GPs to facilitate further screening and treatment in the community.
As part of this, a tool was developed in line with the Maudsley Guidelines to outline
and manage cardiovascular risk. A new Trust Discharge Summary was designed to
assist junior doctors to facilitate cardiovascular risk factor screening and
management, whilst additionally providing clear and concise information to GPs about
these requirements. An audit of Rosewood and Dunkley wards was undertaken,
comparing inpatients before use of the tool against inpatients following introduction of
the tool. Conclusions showed some evidence that a monitoring tool for cardiovascular
risk would improve cardiovascular screening and treatment as well as changes to the
discharge summary improving communication with GPs regarding physical health
monitoring. For 2013/14 the discharge summary developed as part of this project has
been incorporated into the physical health CQUIN requirements to cover two of the six
key indicator themes:


To ensure provision of discharge letters to GPs on discharge from secondary
mental health care,
Completion of a quality audit to provide assurance in regards to compliance
with agreed content of discharge letters
3.1.6 Patient Reported Experience Measures (PREMs)
In 2012, the CQC annual service user survey covered people who use community
mental health services. A high level summary of results is provided below6:
Positives (in relation to other trusts)



In the last 12 months, have you had a care review meeting to discuss your care
plan?
Before the review meetings were you given the chance to talk to your care
coordinator about what would happen?
In the last 12 months have you received support from anyone in mental health
services in getting help with your physical health needs?
6
Please note, a full summary of the Trust’s results can be found on the CQC website;
http://www.cqc.org.uk/survey/mentalhealth/TAF




In the last 12 months have you received any sort of talking therapies from NHS
Mental Health services?
Did you find the talking therapies you received in the last 12 months helpful?
In the last 12 months have you received support from anyone in mental health
services in getting help with your care responsibilities?
In the last 12 months have you received support from anyone in mental health
services in getting help with finding or keeping work?
Negatives (in relation to other trusts)


Did you have trust and confidence in your health and social care worker?
Did your health and social care worker treat you with respect and dignity?


Were the purposes of medication explained to you?
How well does your care coordinator (or lead professional) organise the care
and services you need?
Have you be given (or offered) a written or printed copy of your care plan?

In 2012/13, the Trust further developed its facility to monitor PREMs. In addition to
the annual CQC survey of community based service users, the Trust further
developed the use of its Patient Experience Tracking (PET) system across inpatient
and substance misuse services. The PET system is delivered through hand-held
touch-screen devices that ask a brief set of questions for both service users and or
carers with free-text areas allowing comment on anything the respondent wishes to
share. Service users now have more opportunity to tell the Trust how to improve their
experience of care and treatment.
The Trust works to the national models for advice and complaints services, ensuring
that all service users and carers have access to a professional and responsive
service. Integrated complaints, claims and incidents analysis reports have been
further developed to provide greater identification and analysis of themes which have
been shared with commissioners and stakeholders in 2012/13.
3.1.7 NHS Litigation Authority (NHSLA) – Risk Management Standards
assessment
The Trust successfully achieved a Level 2 assessment of the NHSLA Risk
Management Standards in September 2011. The NHSLA have since suspended
assessments whilst they work to develop a new approach to standards and
assessments. It is likely that that pilot assessments will begin during the year 2013/14
and that the new approach will be introduced during 2014.
Advice and Complaints Service
Response to complaints – timeliness
Complaints category – required
response times[1]
Q1
Q2
Q3
Q4
10 days
85%
93%
100%
86%
25 days
85%
82%
74%
60%
85%
89%
87%
84%
(28/33)
(34/38)
(33/38)
(31/42)
Total
Local target: 80%
The Trust met its target in terms of timeliness of response to complaints in each
quarter of 2012/13.
3.1.8 Performance against key national indicators
Care Quality Commission (CQC)
As of 2010/11, the CQC’s primary tools for monitoring healthcare providers are the
individual location assessments and the monthly updates to the Quality Risk Profiles
(QRP). As noted above, the CQC assessed three of the Trust’s locations (Highgate
Mental Health Centre, Islington Drug and Alcohol Service and Stacey Street nursing
home) in 2012/13 and provided an extremely positive review. Positively it found that
at two of these locations the Trust was compliant in all outcomes. On one occasion
the CQC noted a moderate concern in regards to a service provided at Stacey Street,
a residential nursing home for which the Trust has recently acquired responsibility.
[1]
Please note the timescale standards have been set locally (in line with Department of
Health guidance) as there are no national timescale reporting requirements.
The formal report of this inspection has now been received by the Trust highlighting
the positive improvement in 5 of the 6 essential standards that under the previous
management were deemed noncompliant in May 2012.
The Quality Risk Profile is a collation of all data available to the CQC from other
national regulatory bodies, local stakeholders and the NHS Information Centre. A risk
rating is calculated for each of the 16 CQC Quality Outcomes. This document is
updated using over 700 individual quality indicators and is categorised into five key
areas with a performance rating assigned to each, green being performing better than
expected, amber performing as expected and red performing worse than expected.
The Trust’s monthly Quality Risk Profile updates have similarly been extremely
positive since their introduction in September 2010. As of April 2013, the Trust is
performing as follows in the five QRP sections:
Section
Outcome
Risk estimate
Involvement
and information
1. Respecting and involving people who use
services
High green
2. Consent to care and treatment
Low yellow
4. Care and welfare of people who use services
Low yellow
5. Meeting nutritional needs
High green
6. Co-operating with other providers
Low green
7. Safeguarding people who use services from
abuse
Low yellow
8. Cleanliness and infection control
Low yellow
9. Management of medicines
Low yellow
10. Safety and suitability of premises
Low green
11. Safety, availability and suitability of
equipment
Low yellow
Personalised
care
Safeguarding
and safety
Suitability
staffing
of 12. Requirements relating to workers
Low yellow
13. Staffing
High yellow
14. Supporting staff
Low yellow
Quality
and 16. Assessing and monitoring the quality of
management
service provision
Low green
17. Complaints
Low yellow
21. Records
Low green
These ratings suggest that overall the Trust is performing as expected or better for
each of the outcomes where the CQC have collated enough data to calculate a risk.
94% of the 712 measures show the Trust performing as expected or better than
expected and no area rated as at risk of non-compliance.
Monitor
The Trust is assessed on a quarterly basis by Monitor through seven distinct
performance indicators. The measures are intended to indicate the quality of mental
health care at a service level, with quality being: care that is effective, safe and
provides as positive an experience as possible. Trust performance against these is
provided below:
Target
Method
Q1
Q2
Q3
Q4
Numerator: Number of adults in the
denominator who have had at least one formal
review in last 12 months.
CPA – having formal
review in the last 12
months
CPA – follow up within 7
days of inpatient
discharge
95%
95%
Denominator: Total Number of adults who
have received secondary mental health
services who had spent at least 12 months on
CPA at the end of the reporting period or at the
time of discharge from CPA.
Numerator: Number of people under CPA who
were followed up either by face-to-face contact
or phone discussion within 7 days of discharge
from Psychiatric Inpatient Care.
96%
98%
95%
95%
98%
95%
96%
97%
96%
96%
95%
98%
Denominator: Total Number of people under
CPA discharged from Psychiatric Inpatient Care
Admissions to inpatient
care having access to
Crisis Resolution Home
Treatment Teams
95%
This indicator applies only to admissions to the
foundation trust’s mental health psychiatric
inpatient care. The following cases can be
excluded:
(i) planned admissions for psychiatric care from
specialist units;
(ii) internal transfers of service users between
wards in a trust and transfers from other trusts;
(iii) patients recalled on Community Treatment
Orders; or
(iv) patients on leave under Section 17 of the
Mental Health Act 1983.
The indicator applies to users of working age
(16-65) only, unless otherwise contracted. This
includes CAMHS clients only where they have
been admitted to adult wards. An admission
has been gate-kept by a crisis resolution team if
they have assessed the service user before
admission and if they were involved in the
decision-making process, which resulted in
admission.
Minimising delayed
transfers of care
<7.5%
Numerator: Number of inpatients (aged 18 and
over upon admission) whose transfer of care
was delayed during the quarter, per day. (For
example, one patient delayed for 5 days would
be 5)
0.30%
1.30%
0%
0.6
95%
Quarterly performance against commissioner
contract. Threshold represents a minimum level
of performance against contract performance,
rounded down.
100%
100%
100%
100%
97%
Numerator: Count of valid entries from the
following; NHS Number, DOB, Postcode,
Gender, GP Registration, Commissioner Code.
98%
99%
99%
99%*
79%
77%
80%
78%*
Denominator: Total Number of Occupied Bed
Days during the Quarter.
Meeting commitment to
serve new psychosis
cases by Early
Intervention Teams
Mental Health Minimum
Data Set:
Denominator: Total number of entries.
Employment Numerator: The number of
adults in the denominator whose Employment
Status is known at the time of their most recent
review.
Employment Denominator: the total number
of adults (aged 18-69) who have received
secondary mental health services and who
were on the CPA at any point during the
reported quarter
Mental Health Minimum
Data Set: Data
Completeness
Outcomes:
50%
Accommodation Numerator: the number of
adults in the denominator whose
accommodation status (i.e. settled or nonsettled accommodation) is known at the time of
their most recent assessment, formal review or
other multi-disciplinary care planning meeting.
Include only those whose assessments or
reviews were carried out during the reference
period. The reference period is the last 12
months working back from the end of the
reported quarter.
Accommodation Denominator: the total
number of adults (aged 18-69) who have
received secondary mental health services and
who were on the CPA at any point during the
reported quarter.
HoNOS Numerator: The number of adults in
the denominator who have had at least one
HoNOS assessment in the past 12 months.
HoNOS Denominator: The total number of
adults who have received secondary mental
health services
and who were on the CPA during the reference
period.
* The Trust will not receive scores for Quarter 4 from the NHS Information Centre until June
2013 at the earliest. The scores indicated here are internal estimates from Trust data.
3.1.9 Department of Health Indicators 2012/13
The Department of Health has drawn up a list of indicators for mandatory inclusion in
Quality Accounts from 2012/13 onwards due to their pertinence and potential to
provide an assessment of quality across the 5 domains of the NHS Outcomes
Framework from the list of mandated indictors; six are relevant to the Trust.
Prescribed Indicator
1.Percentage of patients on CPA who were followed
up within 7 days after discharge from psychiatric inpatient care
Quality Domain of NHS outcomes
framework
1. Preventing People from dying
prematurely
2. Enhancing quality of life for people with
long-term conditions
2.Percentage of admissions to Acute wards for which
the CRT home treatment team acted as a
gatekeeper
2. Enhancing quality of life for people with
long-term conditions
3.Percentage of patients readmitted to a hospital
which forms part of the Trust within 28 days of being
discharged from a hospital which forms part of the
Trust
3. Helping people to recover from
episodes of ill health or following injury
4.Percentage of staff who would recommend the
provider to friends or family needing care
4. Ensuring that people have a positive
experience of care
5.Patient experience of Community Mental Health
Services score with regards to a patients experience
of contact with a health or social care worker
2. Enhancing quality of life for people with
long-term conditions
4. Ensuring that people have a positive
experience of care
6.Rate of patient safety incidents and percentage
resulting in severe harm or death
5. Treating and caring for people in a safe
environment and protecting them from
avoidable harm
Data for all of these measures for the reporting periods 2011/12 and 2012/13 are
provided below: Camden and Islington Foundation Trust consider that these data are
as described for the reason that these data are subject to monthly monitoring and is
regularly audited internally to assure its accuracy.
Percentage of Patients on CPA who were followed up within 7 Days after
discharge from psychiatric in-patient care
Performance figures:
Trust
Q1
11/12
Q2
11/12
Q3
11/12
Q4
11/12
Q1
12/13
Q2
12/13
Q3
12/13
Q47
12/13
Camden and
Islington
97.0%
96.6%
94.7%
95.5%
97.8%
94.9%
95.3%
98.5%
National Average
96.7%
97.3%
97.4%
97.6%
97.5%
97.2%
97.6%
N/A
Lowest Trust
score
78.4%
90.3%
60.0%
92.4%
94.9%
89.8%
92.5%
N/A
Highest Trust
Score
100%
100%
100%
100%
100%
100%
100%
N/A
* National Target - 95%
Percentage of Patients on CPA followed up within 7 Days performance chart:
100%
95%
90%
85%
Camden and Islington
80%
National Average
75%
Lowest Performing Trust
70%
Highest Performing Trust
65%
National Target
60%
55%
50%
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
11/12 11/12 11/12 11/12 12/13 12/13 12/13 12/13
*National Target – 95%
7
Please note that Q4 Benchmarking data was not available via the NHS Information centre as such
Q3 data has been used for the purposes of this graph.
Percentage of admissions to Acute wards for which the Crisis Resolution Home
Treatment Teams acted as a gatekeeper
Performance figures:
Q2
11/12
8
Trust
Q1
11/12
Q3
11/12
Q4
11/12
Q1
12/13
Q2
12/13
Q3
12/13
Q4
9
12/13
Camden and Islington
91.5%
90.6%
96.6%
91.7%
96.0%
96.5%
95.1%
97.8%
National average
97.0%
97.3%
97.7%
97.7%
98.0%
98.1%
98.4%
98.4%
Lowest Performing
Trust
37.2%
29.8%
75.7%
89.6%
83.0%
84.4%
90.7%
90.7%
Highest Performing
Trust
100%
100%
100%
100%
100%
100%
100%
100%
Percentage of admissions gatekept performance chart:
100%
90%
80%
70%
Camden and Islington
National average
60%
Lowest Performing Trust
50%
Highest Performing Trust
40%
National Target
30%
20%
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
11/12 11/12 11/12 11/12 12/13 12/13 12/13 12/13
*National Target – 95%
Percentage of patients readmitted to a hospital which forms part of the Trust
within 28 days of being discharged from a hospital10
8
National Target increased from 90% to 95%
Please note that Q4 Benchmarking data was not available via the NHS Information centre
as such Q3 data has been used for the purposes of this graph
9
Performance figures:
Trust
2010/2011
Camden and Islington
Q1
7.80%
Q2
Q3
10.50%
11.60%
2011/2012
Q1
Q2
Q3
Camden and Islington
11.60%
10.60%
10.50%
2012/2013
Q1
Q2
Q3
Camden and Islington
12.10%
7.80%
Q4
11.90%
Q4
13.10%
Q4
11.80%
9%
Local Target: 8.8%
Readmissions within 28day of discharge performance chart:
Although readmissions occur for a variety of reasons, which can include service users
being readmitted to hospital shortly after leaving as part of a care pathway, one
potential inference drawn from higher rates is that the readmission results from
ineffective treatment in hospital, in addition to poor or badly organised readmission or
support services following discharge, consequently it is important for the Trust to
measure and monitor readmission rates.
The Trust has taken the following actions to improve the readmission rates, and so
the quality of its services, by working in partnership with commissioners to:
10
The information Centre provides benchmarking data up until 2010/11 however there is no
data within for comparative mental health Trusts as such the Audit Commissions Q2 2011/12
benchmarking data has been used for reference.



Actively investigate readmission rates, by examining comparative figures and
learning lessons from the experience of hospitals with low readmission rates.
Benchmarking Trust performance and commissioner level targets set for other
Mental Health providers to understand the definitions and methodology used to
calculate and report their position.
Completion of an audit which examines the emergency readmission rates and
explores whether factors such as ethnicity, age, gender, diagnosis or contacts
with community services can predict whether service users will be readmitted.
Percentage of staff who would recommend the provider to friends or family
needing care
The Trust score from the annual CQC Staff Survey in 2012 was 3.23 out of 5 which is
marginally down on the score for 2011 (3.25).
Performance figures:
Service
Score
Camden and Islington 2012
3.23
Camden and Islington 2011
3.25
National Average 2012 (MH/LD Trusts)
3.54
Best 2012 score (MH/LD Trusts)
4.06
Lowest 2012 score (MH/LD Trusts)
3.06
The staff survey is extremely useful in helping the Trust to measure staff satisfaction
levels, as staff wellbeing and views of Trust services have a direct impact on the
quality of care the Trust provides.
The Trust has taken the following actions to improve the percentage of staff who
would recommend the Trust to friends or family, and so the quality of its services, by




Conducting monthly staff morale surveys to assess what the Trust can do to
improve the experience of staff;
Continue to use the national staff survey to measure staff satisfaction in the
workplace;
Improve staff confidence in the quality of Trust services by providing access to
real-time information regarding the quality of services and performance data.
Through the changing lives programme continue to listen to what makes the
biggest difference to both staff and service users in continually improving the
experience of using and providing Trust services;


Align the organisation to the co-created values and behaviours in order to
sustain continued improvement in staff and service user experience;
Create a culture that promotes positive attitudes and behaviours and an
excellent experience for everyone.
Patient experience of Community Mental Health Services score with regards to
a patients experience of contact with a health or social care worker
To improve the quality of services that the NHS delivers, it is important to understand
what people think about their care and treatment. To monitor this, Quality Health, on
behalf of the Care Quality Commission, conducted the Survey of People who used
Trust Community Mental Health Services 2012. The table below summarises “Patient
experience of community mental health services” and provides indicator scores with
regard to patient experience of contact with a health or social care worker during the
reporting period.
Performance figures:
Camden
and
Islington
2012
Lowest
Trust
score
achieved
Highest
Trust
score
achieved
Camden
and
Islington
2011
S.1 Patient experience
8.3
8.2
9.1
8.3
Q.4 Listening
8.6
8.2
9.3
8.7
Q.5 Involvement
8.1
7.9
9
8.3
Q.6 Trust and confidence
7.8
7.6
9
7.8
Q.7 Respect and dignity
8.8
8.8
9.7
8.7
Q.8 Time
8.1
7.7
8.7
8
The results reflect that with the exception of Question 7 “Did this person treat you with
respect and dignity? (Yes, Definitely), the Trust’s performance is on par with the
national average. Although Question 7 is lower than the national average for the Trust
this is an improved position when compared to 2011/12 survey results.
10
8
6
4
2
0
S.1
Q.4
Q.5
Camden and Islington Foundation Trust 2012
Q.6
Q.7
Lowest Trust score achieved
Q.8
Highest Trust score achieved
Camden and Islington Foundation Trust 2011
Key = Worse than the National Average
The Trust has taken the following actions to improve the service users’ reported
experience, and so the quality of its services, by



Listening to service users as part of the changing lives programme and
understanding what makes the bigger difference to them in regards to
continually improving the experience of using Trust services and,
Co – producing values and behaviours in order to sustain improvement in
service user experience
A review of the Trust whistleblowing policy to ensure that it is accessible and
understood by all staff
Our promises to service users and each other
We are welcoming
so you feel valued
We are respectful
so you can feel
understood
We are kind
so you can feel cared
for
•
Friendly and polite
Accessible and
open
Make time for you
•
•
•
Respect you
Respect dignity
Respect privacy
•
•
•
Compassionate
Helpful
Encouraging
•
•
We are professional
so you can feel safe
We work as a team so
you can feel involved
•
•
•
Safe
Knowledgeable
Self-aware of my
impact on others
•
•
Work together
Listen and clearly
communicate
Offer solutions
and choices
•
We are positive
so you can feel
hopeful
•
•
•
We aim high
Improvement
based on
evidence
Positive feedback
Rate of patient safety incidents and percentage resulting in severe harm or
death
This year is the first time that this indicator has been required to be included within the
Quality Report alongside comparative data provided, where possible, from the Health
and Social Care Information Centre. The National Reporting and Learning Service
(NRLS) were established in 2003. The system enables patient safety incident reports
to be submitted to a national database on a voluntary basis designed to promote
learning. It is mandatory for NHS trusts in England to report all serious patient safety
incidents to the Care Quality Commission as part of the Care Quality Commission
registration process. To avoid duplication of reporting, all incidents resulting in death
or severe harm should be reported to the NRLS who then report them to the Care
Quality Commission. Although it is not mandatory, it is common practice for NHS
Trusts to reports patient safety incidents under the NRLS’s voluntary arrangements.
As there is not a nationally established and regulated approach to reporting and
categorising patient safety incidents, different trusts may choose to apply different
approaches and guidance to reporting, categorisation and validation of patient safety
incidents. The approach taken to determine the classification of each incident, such
as those ‘resulting in severe harm or death’, will often rely on clinical judgement. This
judgement may, acceptably, differ between professionals.
In addition, the
classification of the impact of an incident may be subject to a potentially lengthy
investigation which may result in the classification being changed. This change may
not be reported externally and the data held by a trust may not be the same as that
held by the NRLS. Therefore, it may be difficult to explain the differences between the
data reported by the Trusts as this may not be comparable
In 2012/2013, staff reported a total of 1206 patient safety incidents. From this total,
35 were related to severe harm or death. There were 100,048 occupied bed days 11 in
the Trust in the same period.


11
Rate of patient safety incidents = 12 incidents per 1,000 occupied bed days
(although a significant proportion of these incidents occurred in community
settings).
Percentage of incidents involving severe harm or death = 2.9%
This number includes patients on leave.
Performance figures:
Trust
Camden and Islington
2011/12
Camden and Islington
2012/13
Numbers of incidents
involving severe harm or
death
Percentage of patient safety incidents
relating to severe harm or death
43
1.70%
35
2.90%
The updated requirements from Monitor coupled with the amendments to Quality
Accounts regulations required the Trust to benchmark performance against those key
quality indicators mandated for 2012/13. In the absence of a full year’s data on Health
and Social Care Information Centre, the data for the period of April 2012- September
30 2012 has been used as a reference, to benchmark Trust performance.
The Trust has taken the following actions to improve patient safety, and so the quality
of its services, by ensuring:




Risk Assessment of all patients under CPA Policy / Clinical Risk Assessment
and Management Policy
Serious Incident investigation recommendations and learning from a death by
suicide which led to actions and changes in practice to remove identified risk
factors
Removal of ligature points (using more rigorous criteria than nationally agreed)
Health and Safety Risk assessments;




Suicide Prevention Strategy
72 hour follow up of all patients discharge from inpatient care
Incident Reporting Policy and Procedure
Quarterly Aggregated incidents, complaints, claims report which provides the
Trust with trend analysis
3.1.10 2012/13 Quality Priorities - Progress
The Trust 2011/12 Quality Accounts set out five quality priorities for 2012/13:

Service User Involvement
As part of the Quality Accounts for 2011/12, the Trust recognised the benefits
that can be achieved with the constructive involvement of service users in Trust
planning and decision-making. In line with the expectations of the Care Quality
Commission, the Trust committed to adopting and developing innovative
approaches to service user involvement. This commitment required the
implementation of steps to support the empowerment of service users to play
an active role in the planning and delivering of services.
The Trust set a goal to report the proportion of Trust service lines with
registered service user leads who have received training support from the Trust
in 2012/13.
The table below provides information on this patient experience measure and
results achieved throughout 2012/13:
Staff Representative
Division
Acute12
Community Mental Health
Rehabilitation and Recovery
Services for Ageing Mental Health
Substance Misuse Services
Forensic Services 13
Camden
Islington
Service User
Representative
Camden
Islington
The service users appointed have formed the Service User Alliance (SUA), which has
become a strong and central part of Trust business through attending committees,
getting involved in consultations, working groups, taking part in recruitment and
selection as well as being involved in the decisions made about overall objectives and
direction of service development. Throughout 2013/14 the Trust will progress the
training elements of this measure by ensuring that all of the service users appointed
will now receive training which covers an Induction to the Trust, safeguarding and
interview training.

Physical Health (CQUIN)
These are important patient experience, effectiveness and safety measures
that form a basis for shared care to improve the physical health care of patients
with mental health problems in hospital and community based settings.
Association between physical co-morbidity and mental ill health has long been
established. People with severe mental illness (SMI) experience worse
physical health and reduced life expectancy compared to the general
population. On the other hand, poor physical health can have a negative effect
on mental health.
Therefore ensuring that we support our service users to stay healthy is an
integral part of the work undertaken within Trust services.
The table below provides information on the specific indicators used to monitor
this patient safety measure which form CQUIN and results achieved throughout
2012/13:
12
13
Women’s Lead Service User Representative
This line includes HMP Pentonville where restrictions apply
CQUIN Measures
Target
Q1
Q2
Q3
Q4
100%
Q2 & Q4
N/A
100%
N/A
100%
Complete set of MH and PH high mortality PH
ICD 10 codes - Recording mental health and
key physical health (diabetes, COPD, CHD,
Hypertension, Hep C) diagnoses
95%
Q2 & Q4
N/A
87%
N/A
84%
Completion of Annual Physical Health Checks
all service users with a key PH diagnosis (list
above). Need either a PH check or at least
one outreach attempt to facilitate
75%
Quarterly
97%
91%
96%
98%
Reduction of medication errors through
medicines reconciliation on admission to
hospital - Audit of care plans using POMH UK
definition and audit tool completing at least
two of the reconciliation approaches.
95%
Once in Q.4
N/A
N/A
91%
95%
Adequate and timely communication between
primary and secondary care. Inpatients Discharge Notification / GP Letter to be sent
to primary care within one week of discharge.
95%
Quarterly
75%
86%
81%
95%
Adequate and timely communication between
primary and secondary care. Sending CPA
Letter Review / Care Plan to GPs within 2
Weeks of CPA reviews
95%
Quarterly
45%
47%
43%
60%
Physical Health
Sharing SMI Registers with Primary Care

Discharge Notification / GP Letter to be sent to primary care within one week of
discharge. The 25% increase in compliance requested by commissioners as
part of 2011/12 planning round has seen the Trust struggle to embed the
requested stretch from 2011/12 despite good improvement being made quarter
on quarter, and Trust performance remaining above the 2011/2012 baseline.
The continual increase in compliance throughout 2012-13 resulting in
achievement of this measure at year end reflects the diligence in clinical
services to ensure that action plans implemented to assure compliance have
taken effect. This achievement reflects quality improvements within practice in
regards to improving communication between primary care and Trust services.

Sending CPA Letter Review / Care Plan to GPs within 2 Weeks of CPA
reviews. The disappointment of failing to achieve the target must be set in the
context of a very significant continual positive up-turn in performance from Q1
to Q4 (45% -60%) This was an extremely challenging target and operational
practice has been reviewed and changed markedly in order to meet this
requirement.
The Trust will work to maintain the improvement being made to ensure that
Trust services share information with GPs in a timely fashion; providing a
useful framework in which to improve the Physical health care of our service
users and develop closer working relationships with GPs over the coming year.
As highlighted in 2.1 above, we have once again decided to include physical
healthcare as one of our quality priorities for the next year.

Recovery-orientated practice ( CQUIN)
This CQUIN related to patient experience and effectiveness was identified by
commissioners across London in 2012/13. The Trust through its Recovery
Model approach to care delivery, subscribes to the promotion of sustainable
recovery and increased self-esteem. This London-wide CQUIN sought to
measure the application of this approach. Information on the indicator used for
this measurement and the results for 2012/13 is provided below:
CQUIN Measures
Target
Q1
Q2
Audit in
Q3
Results
reported
Q4
-
-
50%
Once in
Q4
-
-
Q3
Q4
Recovery
Completion of a quality audit of
recovery-orientated practice in
the Trust
Assurance that care plans show
evidence of collaborative
planning of care between
service user and clinician and
contain at least two personal
recovery goals.
Achieved Achieved
-
75%
The Quality Indicator for Rehabilitative Care (QuIRC) a web-based toolkit
(available at www.quirc.eu) which assesses the living conditions, treatment,
care and human rights of people with longer term mental health problems in
psychiatric and social care units was used to complete the Trust audit of
recovery orientated practice. The Trust will work to maintain our high
performance in this area, and will continue to monitor this. In 2013/14 the Trust
plans to further measure the promotion of recovery and the improved health
and wellbeing from a service user’s point of view.

Smoking cessation (CQUIN)
This was a CQUIN area related to patient safety, clinical effectiveness and
innovation was identified by commissioners across London in 2012/13. This
London-wide CQUIN sought to enhance the access that people with mental
health problems have to appropriate support with the aim of improving the
physical health of users of mental health service by providing smoking
cessation support. Information on the indicator used for this measurement and
the results for 2012/13 is provided below:
CQUIN Measures
Target
Q1
Q2
Q3
Q4
Implementation of smoking
cessation training programme for
Trust staff. To enable
professionals to give effective
stop smoking advice to their
service users
33%
Once in
Q4
-
-
-
35.10%
Recording of smoking status for
service users in the Trust
75%
Once in
Q4
-
-
-
78%
Production of mutually agreed
care plans for smoking cessation
2%
Once in
Q4
-
-
-
23%
Smoking Cessation

Dementia care and prescribing (CQUIN)
These are important patient safety, measures which were identified by
commissioners across London in 2012/13. This London-wide CQUIN sought to
reduce anti-psychotic prescribing medication to people with dementia and
improve communication between primary and secondary care. Information on
the indicator used for this measurement and the results for 2012/13 is provided
below:
CQUIN Measures
Target
Q1
Q2
Q3
Q4
Improving dementia care and prescribing in Mental Health Trusts
Auditing antipsychotic
prescribing to patients with
dementia
Regular reviews of antipsychotic
prescriptions are conducted for
people with dementia and
communicated to GPs and
patients/families
Develop and deliver a local
sustainable* quality
improvement plan** to reduce
inappropriate antipsychotic
prescribing to people with
dementia and improve the
quality of that prescribing, in line
with NICE guidance.
Improving discharge summaries
for people with dementia,
including those on
antipsychotics
-
Milestone Audit prep
Data
Submitted
Achieved
Achieved
90%
Q2, Q3,
Q4
-
100%
98%
96%
Achieved
90%
-
-
Achieved
Achieved
Progress
report
submitted
70% in
Q2
90% in
Q3 &
Q4
-
55%
73%
This is an important safety measure and communications with GPs will
promote good practice on this issue across the wider health system. The Trust
will work to maintain our high performance in this area, and will continue to
monitor this.
3.2
Stakeholder Involvement in Quality Accounts
The Trust’s quality goals are co-developed with stakeholders and communicated
within the Trust and the community it serves. This year we held two stakeholder
events, engaging with service users, carers, governors and other internal and external
stakeholders to define quality goals and priorities for the coming year. On the 25th
and 28th March 2013 respectively, it was agreed with our stakeholders that the
Trust will focus on further developing the priorities we agreed over the last twelve
months. Further, we have agreed to re-emphasise:



On strengthening our communication with GPs to develop a more robust
approach to working with primary care,
Creating more innovative ways of capturing service user reported experience
Expanding initiatives for the promotion of recovery and the improved health
and wellbeing of service users by developing qualitative measures in regards
to collaborative planning.
Trust staff
Trust staff were invited to contribute suggestions for areas of inclusion within the
priorities for 2013/14 and the review of 2012/13. Input was received from across
clinical disciplines in the Trust and from staff in central support services.
Healthwatch (Local Involvement Networks (LINks)
An invitation to contribute to the process of the Quality Accounts was provided to both
Camden Healthwatch (LINks) and Islington Healthwatch (LINks).
Trust Governors
The Trust Governors have similarly provided input to the Quality Accounts
development and again, their suggestions have been included in these Quality
Accounts. Creating more innovative ways of capturing patient experience was the
overarching request of the Council of Governors and other key stakeholders and has
been threaded through these accounts. Patient experience is complex and
multifactorial and includes elements centred on services, individual healthcare
professionals and also factors which are individual to each patient. The Governor
body is made up of representatives from staff, service users and the public.
Stakeholder statements
i. Lead commissioners
Provided below are the comments provided by the Trust’s lead commissioners:
Commissioners Statement for 12/13 Quality Accounts
NHS Islington Clinical Commissioning Group is responsible for the
commissioning of health services from Camden and Islington NHS Foundation
Trust on behalf of the population of Islington and Camden. .
NHS Islington Clinical Commissioning Group welcomes the opportunity to
provide this statement on Camden and Islington NHS Foundation Trust's Quality
Accounts. We confirm that we have reviewed the information contained
within the Account and checked this against data sources where this is
available to us as part of existing contract/performance monitoring
discussions and is accurate in relation to the services provided. We have taken
particular account of the identified priorities for improvement for Camden and
Islington NHS Foundation Trust and how this work will enable real focus on
improving the quality and safety of health services for people with mental
health needs.
We have reviewed the content of the Account and confirm that this complies
with the prescribed information, form and content as set out by the
Department of Health. We believe that the Account represents a fair,
representative and balanced overview of the quality of care at Camden and
Islington NHS Foundation Trust. We have discussed the development of this
Quality Account with Camden and Islington NHS Foundation Trust over the
year and have been able to contribute our views on consultation and content.
This Account has been reviewed within NHS Islington Clinical Commissioning
Group and by colleagues in NHS North and East London Commissioning Support
Unit.
Overall we welcome the vision described within the Quality Account, agree on
the priority areas and will continue to work with Camden and Islington NHS
Foundation Trust to continually improve the quality of services provided to
patients. The accounts provides a comprehensive summary of the work done by
the Trust in 2012/13 to improve safety for service users, the effectiveness of
care offered to service users, and the engagement of service users in shaping
the services. It is pleasing to see that the Trust has recognised and responded
to the significant impact of service redesign on service users, carers and staff
The commissioners have welcomed the improvements made by the Trust to its
Serious Incident reporting procedures, and believe this has the potential to
significantly enhance organisational learning and improve safety.
The quality improvement initiatives described in these Quality Accounts will be
monitored through the six weekly Quality Meetings held with commissioners,
service users’ representatives and the Trust managers. We look forward to
continuing our partnership with the Trust to improve both the quality and
safety of health services provided to people with mental health needs.
Alison Blair
Accountable Officer, NHS Islington Clinical Commissioning Group
ii. Camden Healthwatch (LINks)
An invitation to comment on the draft Quality Accounts was provided to Camden
Healthwatch (LINks) on 29th April 2013 to date the Trust has not received a comment
on its Quality Accounts from Camden Healthwatch (LINks).
iii. Islington Healthwatch (LINks)
An invitation to comment on the draft Quality Accounts was provided to Islington
Healthwatch (LINks) on 29th April 2013. Islington Healthwatch (LINks) has declined
to comment due to the transition to Healthwatch.
iv. Overview and Scrutiny Committee
An invitation to comment on the draft Quality Accounts was provided to the Overview
and Scrutiny Committee (OSC) on 29th April 2013. The OSC has responded to the
Trust to inform us that they would prefer not to provide any comment or feedback on
the draft quality report, and would instead wish to continue to rely on the more
general arrangements for annual performance reporting, which have been agreed
with local trusts and focuses on local issues. A meeting is scheduled for 23rd May
when they will receive a presentation from the Trust on our quality priorities.