Quality Account 2013/14
www.lincolnshirecommunityhealthservices.nhs.uk
This report can also be made available upon request in Braille, audio cassette,
large print or in other languages.
Chinese
此份單張備有中文譯本，請垂詢索取
Kurdish Sorani
‫تێرکب رهبهتسهد شیدروک ینامز هب هیهوارکواڵب مهئ تێرناوتهد‬
‫یراکاواد رهسهل‬
Lithuanian
Paprašius, šį lankstinuką galima gauti ir lietuvių kalba.
Polish
Niniejszy dokument może być na życzenie dostępny w języku polskim.
Portuguese
Este folheto também pode estar disponível, sob pedido, em português.
Russian
Эту брошюру можно также получить по желанию на Русском языке.
2
Quality Account 2013/14
Part1 - Welcome
Lincolnshire Community Health Services NHS Trust (LCHS) provides community
healthcare services for Lincolnshire, one of the largest healthcare communities in
the country.
The trust’s 2,322 staff care for thousands of patients every day in our community
hospitals, health clinics, minor injuries units and walk in centre. If you are
housebound, nurses and therapists come to you at home or in your place of
care. Health visitors and school nurses support young families; the trust provides
primary care services out of hours; teams of nurses, therapists and specialists care
for those across the county whether suffering from respiratory conditions, heart
problems, diabetes, cancer, or wounds such as leg ulcers.
Teams support rehabilitation following stroke or other illnesses and accidents
with physiotherapy, occupational therapy and speech and language difficulties;
sexual health teams provide a confidential and non-judgemental service to all
who need it and smoking cessation teams can help improve your health. At the
end of life, the trust is there to support you and your family with dignity at home if
that is your preference.
3
www.lincolnshirecommunityhealthservices.nhs.uk
Contents
Part1 - Welcome............................................................................................................... 3
Contents.............................................................................................................................................. 4
Statement from the Chief Executive and the Board........................................................... 6
Part 2 - Quality Achievements in 2013/14................................................................... 9
Clinical Effectiveness....................................................................................................................... 9
Development of Outcome measures for all core community services by March
2014....................................................................................................................................................... 9
Clinical Record Keeping – all clinical record keeping will reflect professional and
legal standards................................................................................................................................. 10
Patient Safety.................................................................................................................................... 11
Elimination of avoidable grade 2, 3 and 4 Pressure Ulcers.............................................. 11
To reduce the harm from avoidable falls in Community Hospitals.............................. 13
Eliminate all medication errors in Community Hospitals................................................. 14
Patient Experience.......................................................................................................................... 15
To be in the Top 20% of community trusts nationally for staff engagement and to
be in the top 20% for staff appraisals...................................................................................... 15
Staff Survey........................................................................................................................................ 16
Time 2 Care........................................................................................................................................ 18
Increasing the number of patients who feel they have the information which they
need is communicated in a clear and understandable way........................................... 18
Health Care Associated Infection.............................................................................................. 19
Statements relating to quality of NHS services provided................................................ 20
Review of Services.......................................................................................................................... 20
Participation in Clinical Audit..................................................................................................... 20
NICE Quality Standards................................................................................................................. 21
Examples of Outstanding Practice........................................................................................... 21
Our priorities for quality improvement in 2014/15.............................................................22
Clinical Effectiveness......................................................................................................................23
Deliver clinically effective services...........................................................................................23
Increase the uptake for clinical supervision across all LCHS services..........................23
Patient facing time will be increased through increasing ‘Time 2 Care’.................... 24
Patient Safety....................................................................................................................................25
4
Quality Account 2013/14
Deliver safe services.......................................................................................................................25
Reduce the harm from falls in Community Hospitals.......................................................25
Reduce medication errors resulting in harm........................................................................ 27
Reduction of Grade 2, 3 and 4 Pressure Ulcers.................................................................... 29
Patient Experience.......................................................................................................................... 31
Listen to our service users, value their views and improve patient and carer
experience......................................................................................................................................... 31
The Friends and Family Test (Net Promoter)......................................................................... 31
Safe staffing levels – Right people, right skills, right place, right time........................34
Review of Quality Performance 2013/14................................................................................. 35
Celebrating Success....................................................................................................................... 37
NHS Heroes 2013.............................................................................................................................38
Complaints and Compliments...................................................................................................38
National Health Service Litigation Authority (NHSLA)......................................................40
Care Quality Commission (CQC) visits.....................................................................................40
Part 3 - Other Information............................................................................................ 41
Annex 1............................................................................................................................43
Statement of Directors’ Responsibility in respect of the Quality Account................ 43
Annex 2............................................................................................................................44
Statement on Lincolnshire Community Health Services NHS Trust.............................44
Trust’s Quality Account for 2013/14..........................................................................................44
Annex 3 - Feedback from lead commissioner...................................................................... 47
Annex 4 - Feed back from membership.................................................................................48
Patient Advice and Liaison Service (PALS)............................................................................. 49
Membership...................................................................................................................................... 50
5
www.lincolnshirecommunityhealthservices.nhs.uk
Statement from the Chief Executive
and the Board
Welcome to the Quality Account for Lincolnshire Community Health Services NHS
Trust (LCHS), covering the period April 2013 – March 2014.
The Report provides an overview of the arrangements that we have in place for
monitoring and improving quality in the Trust, our achievements over this last
year, areas where we need to improve and our plans for 2014–2015.
Maintaining and improving the quality of our services is a key strategic priority for
LCHS; we monitor this through the three domains of Patient Experience, Patient
Safety and Clinical Effectiveness.
Kay Darby
Interim Chief
Executive Officer
We have identified that our main challenges over the coming years are to:
• Enable staff to spend more time delivering patient care
• Prevent people from suffering avoidable harm
• Ensure we have the right number of staff with the right skills and the right
support
• Improve our systems for gaining feedback on our services from patients and
staff
As part of this work we will, continue to incorporate the recommendations from
the Francis report (2013) and will seek to improve quality beyond the six Cs (care,
compassion, competence, communication, courage and commitment), identified
in the national Nursing Strategy to include all our staff.
The quality account has been developed through a process of consultation with
our patients, their carers, our membership, partner organisations and our staff.
Our Clinical Strategy
LCHS continues to have a relentless focus on quality, this is against a backdrop
of tighter economic constraints and national changes to the way the NHS is
managed and commissioned. The trust embraces these changes as we recognise
we are pivotal to providing care closer to home which is both safe, effective and
financially sustainable.
6
Quality Account 2013/14
Our Clinical strategy outlines the following aims:
• To be provider of first choice for care closer to home
• To enable the shift of care from acute to community
• To deliver integrated lifelong care pathways in neighbourhood teams
• To ensure continuous service improvement
• To consider service growth
• To be the specialist provider of out of hospital care
• To have a relentless focus on care and compassion
We aim to deliver this aspiration by working in partnership with other health and social
care providers to truly build services around the needs of our distinct and diverse
communities and furthermore to deliver the services required within those communities.
Our Achievements
Clinical Effectiveness
Innovative work led to the production of the Community Response Specification
this, together with review of the SystmOne templates, enabled more robust
capture of activity and patient outcomes. A new record keeping tool was
developed and trialed, the final version will become an integral part of clinical
supervision supporting our clinicianls and other front line staff to provide the
most effective care, at the right time, to improve outcomes for patients.
Patient Safety
A very successful Pressure Ulcer summit was hosted by the Trust in December,
attended by a range of partner agencies. A 25% reduction in pressure damage
was achieved across the organisation during the year.
Falls and medication incidents have reduced. From September 2013, five
consecutive months reported no medication errors, with only one occurring in
March 2014. Reporting of incidents remains consistently high giving us good
assurance on levels of safety.
In view of their importance in delivering quality care to our patients, all of our
patient safety priorities have been rolled forward to 2014/15 with increasingly
ambitious trajectories.
Patient Experience
The Picker Institute Europe conducted a survey of over 1,000 patients which,
together with a range of other initiatives designed to gather patient feedback,
identified three particular themes for development which will further improve the
experience of patient’s in our care.
7
www.lincolnshirecommunityhealthservices.nhs.uk
The three themes identified are:
• Ensure that patients and families feel involved in decisions about the care
provided
• Communicate clearly with patients and their families and check their
understanding
• Provide appropriate information in an accessible format
We monitored the Friends and Familiy Test across community hospitals
addressing changes in quality and patient experience as they arose.
Other achievements include:
• NHS Leadership Recognition Awards – our nomination for the NHS
Community Leader of the year award was shortlisted
• Royal College of Midwives Annual Awards – Slimming World Award for Public
Health - shortlisted/runner up for our Bumps & Beyond initiative
• No Smoking Day Award – Best Use of 2013 Theme – winner – Smoke free
Lincs Alliance (includes Phoenix Stop Smoking Service)
• NHS Heroes – 18 nominations through the regional scheme
We have three additional Queen’s Nurses, making a total of 11 across the
organisation. One of our community case managers, Candice Pellett, was awarded
an OBE in the New Year Honours list.
To the best of the knowledge of the Chief Executive the information reported
in the Quality Account is accurate and a fair representation of the quality of
healthcare services provided by LCHS.
Chief Executive……………………Date 27/06/14
8
Quality Account 2013/14
Part 2 - Quality Achievements in
2013/14
Clinical Effectiveness
Development of Outcome measures for all core community
services by March 2014
The Community Response Specification was commissioned to be implemented
from April 2013 with a six month period for engagement to embed the work
with clinical commissioning groups and independent GP providers. The work to
align the specification with SystmOne templates, capture of activity and patient
outcomes is now completed.
The work is seen as innovative and is drawing interest from other community and
private sector providers.
Validity of the data is on-going as teams use new revised SystmOne templates.
The activity information will be used to verify workforce plans and support
understanding of safe staffing levels.
9
www.lincolnshirecommunityhealthservices.nhs.uk
Clinical Record Keeping – all clinical record keeping will reflect
professional and legal standards
A new audit tool has been developed based on the model utilised within Family
and Healthy Lifestyles Team, which has evaluated very well.
The audit has been re-run in the North West Business Unit, a random selection of
records being scrutinised.
The Business Units are on track to commence the roll out in Q1 2014/15 and 6
monthly thereafter. Any staff undergoing training / development needs will have
records re audited at regular intervals.
This will link to the clinical supervision tool that provides clinical evidence
that record keeping audit results have been reviewed as part of an on-going
supervision programme.
The rationalisation of SystmOne templates has been completed with a reduction
to eleven templates, which are now in use across all adult business units.
The report on the LCHS, organisation wide, audit of electronic records has now
been shared. Of the 150 forms sent out to staff, 140 were returned within the
required time frame, which is an improved position. A series of recommendations
was made and will be monitored. There is a proposal to consider merging this
audit with the more detailed clinical audit to minimise repetition.
10
Quality Account 2013/14
Patient Safety
Elimination of avoidable grade 2, 3 and 4 Pressure Ulcers
The chart below shows the monthly proportion of patients on the Safety
Thermometer survey day who have a new/ existing grade 2-4 pressure ulcer up to
Q4 2013/14. This is in line with our target CQUIN requirement and shows positive
outcomes for patients as a result of the focussed delivery of AmbitionOne.
There has been a consistent organisation wide approach to reduction in pressure
damage, total incidence in LCHS has reduced by 25%. Actions have included:
• A focused approach to immediately understanding and acting on the issues
related to the development of Grade 3 and 4 pressure damage through same
day reporting to Deputy Chief Nurse or the Chief Nurse
• A monthly steering group which has made progress on supporting the
capacity of tissue viability nurses, developing information for practitioners
across primary care, community services and care homes
• A non-concordance algorithm being adopted, and as best practice
implemented, from colleagues in Suffolk
• Hosting a provider summit in December, following which the commissioners
are revising the root cause analysis (RCA) documentation. As a result of this
work, significant time is expected to be released which can be re-directed in
to patient facing time.
• An annual review being completed by the Tissue Viability Nurses, the
outcome of which will inform the new action plan for further achievement
• 55 people from South Business Unit attending an updated training event in
February, these included Specialist nurses, AHPs and community nurses. A
representative from the commissioners risk team also attended.
11
www.lincolnshirecommunityhealthservices.nhs.uk
83
75
71
69
67
63
63
F
M
57
55
45
45
28
A
M
J
J
A
S
O
N
D
J
All grade 2 pressure ulcers
43
38
31
26
27
27
24
21
17
18
18
10
A
M
J
J
A
S
O
N
D
J
F
M
All grade 3 pressure ulcers
4
1
A
2
M
1
1
J
J
2
2
2
A
S
O
1
1
N
D
2
J
0
F
M
All grade 4 pressure ulcers
12
Quality Account 2013/14
To reduce the harm from avoidable falls in Community Hospitals
Total falls with harm
Low harm
Moderate harm
Severe harm
(patient
(short term
(permanent or
required extra
harm - patient
long term harm)
observation
required further
or minor
treatment or
treatment)
procedure)
131
10
0
Death
Total
1
142
Falls with harm by hospital and ward
Hospital
Ward
Low
Moderate
John Coupland
Scotter
12
1
Johnson
Welland
26
2
Skegness
Gloucester
27
3
Skegness
Scarborough
16
0
Louth
Carlton
19
2
Louth
Manby
31
2
Severe
Death
1
The majority of falls in LCHS Community Hospitals continue to be considered as
causing a low level of harm to patients.
The falls resulting in moderate harm and death have been the subject of formal in
depth investigations.
A falls strategy has now been submitted to the Quality & Risk Committee and will
endorse the appointment of a falls lead for a fixed period of time to address the
issues emerging from the broader analysis of the performance information.
There is a need to understand which falls are avoidable through the root cause
analysis process and ensure that lessons learned locally and through clinical
networks are applied to improving practice across our hospitals.
13
www.lincolnshirecommunityhealthservices.nhs.uk
Eliminate all medication errors in Community Hospitals
The chart below shows the data for all 2013/14 medication errors with harm.
Total medication errors demonstrating
degree of harm
4
2
Quarter 2
1
Quarter 3
0 in hospital
Quarter 1
1 in hospital
4 in hospital
4.5
4.0
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0
High
Medium
Low
Quarter 4
There were no errors with harm in Q3.
In quarter 4, January and February 2014 had no errors with harm
One error with harm (low harm) was reported in March 2014
What further measures are we taking?
Whilst we can be proud of this achievement, a more open culture has been
created in the reporting of incidents, related to the management of medicines.
The total reported incidents are seen to be relatively static overall, even with the
additional scrutiny, which appears to suggest that the total incidents may be
reducing. This reduction may be in response to the additional processes which
have been initiated as a result of the audit.
We are in discussion with commissioners to develop of a Safety Thermometer
for medication errors with Commissioners as part of the Clinical Quality and
Innovations scheme for 2014/2015.
14
Quality Account 2013/14
Patient Experience
To be in the Top 20% of community trusts nationally for staff
engagement and to be in the top 20% for staff appraisals
89.98% of staff have had an appraisal to date, broken down as follows:
• North East – 96.83 completed (389 staff eligible, 367 participated).
• North West – 82% completed (424 staff eligible, 346 participated).
• South East – 89.48% completed (218 staff eligible, 195 participated).
• South West – 87.65% completed (235 staff eligible, 206 participated).
• Family and Healthy Lifestyles – 93.21% completed (471 staff eligible, 439
participated).
• Corporate – 90.81 completed (185 staff eligible, 168 participated).
In addition to staff appraisal capture, the organisation has implemented a number
of initiatives to engage with our staff and understand how we can improve their
capacity and capability in delivering care for patients.
15
www.lincolnshirecommunityhealthservices.nhs.uk
Staff Survey
The Trust annual NHS Staff Survey took place between October and December
2013. The survey provides the Trust with valuable insight into its workforce’s
employment experience.
Data is analysed independently and a report providing local outcomes as well
as comparisons against other community health NHS Trusts is issued to the
organisation. This data provides information relating to staff responses and
highlights areas where the organisation is working well and where it needs to take
further action.
LCHS achieved a response rate of 55%, a reduction from 59% in 2012 but
remaining above the national average of 50%.
LCHS results demonstrate that staff experience has improved most in the
following area:
• increase in the number of staff having equality and diversity training where
LCHS achieved the best score for Community Trusts
Areas where the Trust has performed well compared with other Community
Trusts in England include:
• the number of staff receiving health and safety training in the last 12 months
• percentage of staff reporting errors, near misses or incidents witnessed in the
last month
• the number of staff saying “hand washing materials are always available”
• percentage of staff working in an effective team
The staff survey identified that there were some areas for improvement, these
were:
• reducing staff working extra hours
• increase support available from line managers
• increase job satisfaction
• continuing to reduce work related stress
16
Quality Account 2013/14
Staff survey comparison table
2012/13
Response Rate
LCHS
2013/14
National
Average
59%
LCHS
National
Average
55%
50%
Top 4 Ranking Scores in comparison to other community trusts in England
% of staff having equality and diversity training in the
last 12 months
90
64
93
66
% of staff receiving health and safety training in the
last 12 months
92
76
94
76
% of staff reporting errors, near misses or incidents
witnessed in the last month
93
93
95
92
% of staff saying hand washing materials are always
available
64
57
62
57
Recommendations
•
•
•
•
•
•
17
Provide feedback of staff survey to staff and other stakeholders
Ask the Research and Development team to complete a “deep dive” of
survey scores and compare against other engagement activities
Through existing engagement sessions e.g. Time 2 Care in April understand
and address staff perceptions
Continue to monitor outcomes of Stress and Resilience Training through the
Health and Wellbeing action plan
Continue to develop and evaluate Excellence in Leadership through new
Leadership Framework
Continue to monitor and evaluate impact of Quality, Innovation, Productivity
and Prevention (QIPP) programme
www.lincolnshirecommunityhealthservices.nhs.uk
Time 2 Care
Time 2 Care is an internally commissioned project carried out by external experts
who held a number of staff focus groups across LCHS services. Feedback from the
focus groups has identified a number of issues and solutions related to barriers to
delivering high quality patient care. This was in response to direct feedback received
by the Trust through a variety of different routes and sources. Themes identified
are information technology, geography, travel, route planning, skill mix and staffing
models. An action plan has been developed which will address these issues with the
intention of supporting staff to focus on improving outcomes for patients.
The Cultural Barometer, an online survey developed in partnership with Lincoln
University, was successfully completed with LCHS staff during September 2013.
The outcome was very positive and there are plans to run this again in May 2014.
Increasing the number of patients who feel they have the
information which they need is communicated in a clear and
understandable way
A series of initiatives were completed during the year, these included a survey
run by the Picker institute which sought the views of over 1000 patients, LCHS
patient focus groups, Friends and Family Test, experience based design, patient
satisfaction surveys and participation in multi-agency patient focus groups .
The feedback from this report was overwhelmingly positive with the emerging
themes noted below.
• Ensure that patients and families feel involved in decisions about the care
provided
• Communicate clearly with patients and their families and check their
understanding
• Provide appropriate information in an accessible format
LCHS continues to make progress with regards to quality improvements in areas such
as Single Sex Accommodation with no breaches reported in more than two years.
From April 2013 Patient-Led Assessment of the Care Environment (PLACE)
replaced Patient Environment Assessment Team (PEAT) assessments. The
assessment regime, known as PLACE applies to all hospitals delivering NHSfunded care, including day treatment centres and hospices. Like PEAT, it is an
annual assessment and will cover the Community Hospitals run by LCHS and is
voluntary. PLACE covers broadly the same areas as PEAT – namely privacy and
dignity, well-being, food, cleanliness and general maintenance and provides
an invaluable resource in assessing the care environment. It focuses entirely
on the care environment and does not stray into clinical care provision or staff
18
Quality Account 2013/14
behaviours. It extends only to areas accessible to patients and the public - for
example, wards, departments and common areas.
A key feature of PLACE is the central role of patients, who make up at least half of
the team during assessments. Healthwatch Lincolnshire supported the public in
this process.
After the assessment had been completed the results were published following
analysis by the HSCIC (Health and Social Care Information Centre). An improvement
plan indicating how the PLACE results drive improvements was also published.
PLACE assessment outcomes by hospital
Cleanliness
Food,
Hydration &
Meal Service
Privacy,
Dignity &
Wellbeing
Condition
Appearance &
Maintenance
National Average
95.74%
84.98%
88.87%
88.75%
John Coupland Hospital
94.72%
87.20%
82.42%
86.45%
Johnson Hospital
93.30%
76.95%
83.53%
89.18%
Skegness Hospital
87.50%
83.56%
83.49%
82.50%
Louth Hospital
88.00%
81.90%
80.54%
82.60%
*LCHS Organisational Score
89.75%
82.06%
82.00%
84.30%
We are working with our stakeholders to ensure improvements are achieved in
year against the four areas being assessed.
Health Care Associated Infection
LCHS ensures that the risk of avoidable spread of infections is minimised.
We monitor the environmental cleanliness across our healthcare premises in line
with the NHS Cleaning Manual standards and report the audit results to the Board
monthly. Throughout 2013/14 we consistently achieved the target of 90% or above.
We undertake surveillance for alert organisms and additionally screen all
patient admissions for MRSA. Patients identified as MRSA positive receive MRSA
suppression therapy in line with a dedicated care pathway.
Performance in relation to MRSA screening is for the 2013/14 reporting period
2010/11
2011/12
2012/13
2013/14
Number of admissions
4838
3715
3504
3285
Number of screens completed
4877
3691
3571
3252
80
59
80
63
Number of MRSA positive screens
19
www.lincolnshirecommunityhealthservices.nhs.uk
Statements relating to quality of NHS services
provided
Review of Services
“During 2013/14 Lincolnshire Community Health Services provided and/or subcontracted 58 relevant health services.
Lincolnshire Community Health Services has reviewed all the data available to
them on the quality of care in 20 of these relevant health services.
The income generated by the relevant health services reviewed in 2013/14
represents 30% per cent of the total income generated from the provision of
relevant health services by Lincolnshire Community Health Services for 2013/14.”
Participation in Clinical Audit
The following audits were completed over 2013/14:
• Record keeping audit – outcomes fed back to Heads of Clinical Services at
QSG, recommendations collated into action plan, lead Kaz Scott
• Controlled drugs audits now passed by all community hospitals – update
being provided to Audit Committee by Pete Clarke
• Patient satisfaction surveys across community nursing – results being
provided to Quality & Risk Committee and February Board in PPI report.
• Education audits, Nottingham University and University of Lincoln – very
positive feedback to be disseminated to Heads of Clinical Services
In terms of patient safety
• Bed rail policy – completed in all hospitals now, beds, matrasses and rails
reviewed at Hospitals and Falls Groups in January
• Audit of safety around balconies on wards
• Evacuation of patients from wards with particular regard to the bariatric patient
• Egress from hospitals
• Weekly safety audits continue across all community hospital wards and are
demonstrating improved safety outcomes.
• A comprehensive suite of infection Prevention and Control audits were completed
20
Quality Account 2013/14
The draft clinical audit plan for 2014/15 has been developed and was presented
for discussion and ratification at the Quality and Risk Committee in February 2014.
The plan contains mandatory national audits and local audits related to the Board
Assurance Framework, Quality Account 2014/15, infection prevention standards
and medicines safety.
NICE Quality Standards
NICE quality standards measure NHS Trusts delivery of high-quality, costeffective patient care. LCHS is committed to achieving these standards across the
organisation’s services.
Examples of Outstanding Practice
•
•
•
•
•
An OBE for Case Manager Candice Pellett in the New Year Honours List
Bumps and Beyond (antenatal weight management) – runner up in the
Slimming World Award for Public Health category of the Royal College of
Midwives’ Annual Midwifery Awards.
No Smoking Day Award – Lincs Smokefree Alliance (includes Phoenix) – Best
Use of the 2013 theme - Big Ticket Giveaway, where quitters who reached the
four-week smoke-free milestone with the Phoenix NHS Stop Smoking Service
had the opportunity to enter one of a number of prize draws. Prizes included
family days out to the British Superbike Championships, Pleasure Island in
Cleethorpes and Natureland Seal Sanctuary in Skegness.
Queen’s Nurses - three additional members of our nursing team became
Queen’s Nurses in the last financial year making a total of 11 for the
organisation
Kai Brownhill’s nursing home support and education work - finalists in
the Nursing Times Awards Care of Older People category and the Health
Enterprise East Innovation Competition in the Patient Safety category.
We also ran events in Skegness and Gainsborough for their respective hospital
centenaries.
21
www.lincolnshirecommunityhealthservices.nhs.uk
Our priorities for quality
improvement in 2014/15
The priorities for 2014/15 have been identified using a range of information
gathered through public listening events; feedback from patients through
the Friends and Family Test and from complaints; internally through risks and
serious incidents and externally from organisations such as Healthwatch, CCGs
and NHS Choices. Staff have been fully engaged in the process through focus
groups, the Clinical Senate and Time 2 Care Roadshows. From an initial long list,
our key priorities were agreed by the Trust Board and form our aspirations and
trajectories.
22
Quality Account 2013/14
Clinical Effectiveness
Deliver clinically effective services
Increase the uptake for clinical supervision across all LCHS services
Why this is a priority
Clinical supervision is important as a framework for clinicians to undertake
supported individual or group reflection, peer review and sharing of learning to
develop individual clinical knowledge, skills and expertise, or team performance.
Clinical supervision will underpin the commitment of the Trust to ensure that
clinicians have the right skills to meet the needs of patients and their families.
How we will measure this
LCHS will review the current baseline position for practitioners working within
each of these services. Improvement trajectories will be agreed with each
professional group to ensure that there is a significant increase in uptake of
supervision and improved clinical effectiveness through evidenced sharing of
learning. There will be an expectation that all professional groups achieve a target
of 80% of staff accessing clinical supervision. Clinical supervision should take
place at least once every 3 months and may take the form of individual or group
supervision. The 80% target takes into account sickness and staff turnover and is
an effective measure of continuous improvement in clinical effectiveness.
Monthly reporting mechanisms will be put in place to monitor performance with
the expectation that all services reach 80% for the two consecutive quarters at the
end of 2014/15.
The rationale for the target is to ensure that all services across LCHS develop
a supportive model for staff to engage in clinical supervision and achieve an
appropriate baseline which provides assurance that practitioners are reflective
and continually developing their skills in providing patient care.
Board Sponsor: Sue Cousland, Chief Nurse/Director of Operations
Implementation/Programme Lead: Kim Todd, Practitioner Performance Manager
23
www.lincolnshirecommunityhealthservices.nhs.uk
Patient facing time will be increased through increasing ‘Time 2
Care’
Why this is a priority
Feedback from staff and patients during 2013/14 has indicated that there is a
need to increase time to spend on direct patient contact activities as part of the
overall job role of our clinicians and support staff. Travel, attendance at meetings,
completing administrative work, compiling reports, dealing with complaints and
computer based activities all reduce the amount of time that is spent providing
direct patient care or supporting patients and their carers by telephone.
How we will measure this
The organisation will implement a number of initiatives to increase the amount
of time our clinical and care staff have available to spend in direct contact with
patients providing assessment, care planning and support.
This will be measured as an increase in the average amount of time spent by
clinicians in activities which include direct patient contact; this will be measured
as a percent of total time available at work. The performance team will be
responsible for measuring and monitoring the changes in patient facing time.
Progress will be reported to the Quality and Risk Committee as part of the
monthly Quality Account update.
Following a review of performance in 2013/14, the average clinical contact time
was 38%. We are aiming to increase patient facing time during 2014/15 by 20% of
last year’s percentage to give a total of 45%
Current patient facing time is: 38% - Target patient facing time: 45%
The rationale for the target stems from the development of the community
response specification and our ability to report on clinical and non-clinical
activities which contribute to the delivery of services for patients. We are now
able to measure in components of time captured through clinical record keeping
and e-rostering. Large scale transformation is required to deliver the additional
time for patient contact and the target represents the ambition and commitment
of the organisation to reduce travel time and support the workforce with mobile
technology solutions.
Board Sponsor: Sue Cousland, Chief Nurse/Director of Operations
Implementation/Programme Lead: Susan Ombler, Senior Project Manager
24
Quality Account 2013/14
Patient Safety
Deliver safe services
Reduce the harm from falls in Community Hospitals
Why this is a priority
A fall can change your life. If you’re elderly, it can lead to disability and a loss of
confidence and independence. Over recent years increasing attention has been
paid to patient falls both in terms of harm and the number of falls.
In our community hospitals falls continued to be a cause for concern during
2013/14, however we are acutely aware that improving patient mobility and level
of independence leads to a range of positive outcomes for patients and their
families. This can then help reduce the extent to which people require acute
hospital admission or services at home.
How we will measure this
LCHS is setting a target and trajectory for each community hospital ward to
reduce falls resulting in harm and to reduce falls overall. The Trust will implement
a new strategy aimed at identifying and addressing the causes of falls, overseen
by an experienced clinician. A multi- disciplinary approach to the delivery
of the strategy will consider the physical, physiological, psychological and
environmental aspects and a new assessment and care planning process adopted.
Lessons Learned will be captured, reported and shared in order to support
continued improvement and reduce the risk of patient harm. Falls are reported to
the Quality and Risk Committee as part of the monthly Quality Account update
Wards will collectively reduce all falls by 25% and further reduce falls resulting in
harm by 50%against 2013/14 baseline.
The target seeks to ensure the greatest impact on improving patient safety through
systematic implementation of the falls strategy and reducing variation in outcomes
across the community hospital wards. Greater numbers of frail and elderly people are
being treated and are accessing rehabilitation pathways in the community hospitals.
The proposed reduction is set in the acknowledged context of the increasing
numbers of frail and elderly patients being cared for in the community.
Board Sponsor: Sue Cousland, Chief Nurse/Director of Operations
Implementation/ Programme Lead: Jenny Hinchcliffe, Head of Clinical Services
25
www.lincolnshirecommunityhealthservices.nhs.uk
Falls in community hospitals resulting in harm
32
30
28
26
24
22
20
18
16
14
12
10
8
6
4
2
19
2
Low
Moderate
0
Severe
0
Death
32
30
28
26
24
22
20
18
16
14
12
10
8
6
4
2
31
2
Low
County Hospital, Louth
Carlton Ward
32
30
28
26
24
22
20
18
16
14
12
10
8
6
4
2
Low
Moderate
0
Severe
0
Death
32
30
28
26
24
22
20
18
16
14
12
10
8
6
4
2
3
Moderate
0
Severe
Skegness Hospital
Gloucester Ward
2
Moderate
0
Severe
1
Death
Johnson Community Hospital
Welland Ward
27
Low
0
Death
26
Low
John Coupland Hospital
Scotter Ward
32
30
28
26
24
22
20
18
16
14
12
10
8
6
4
2
0
Severe
County Hospital, Louth
Manby Ward
12
1
Moderate
0
Death
32
30
28
26
24
22
20
18
16
14
12
10
8
6
4
2
16
Low
0
Moderate
0
Severe
0
Death
Skegness Hospital
Scarborough Ward
26
Quality Account 2013/14
Reduce medication errors resulting in harm
Why this is a priority
Medication errors are broadly errors in prescribing, dispensing or administration
of a drug. They are the single most preventable cause of patient harm (National
Patient Safety Agency 2004). The level of harm from medication errors in LCHS
is very low; however we have decided to set ourselves the goal of reducing
the level of harm even further. In addition, each community hospital will agree
a stretch target for improvement and implement staff training and audits to
improve patient safety related to medicines management. This will build on the
improvements made in 2013/14.
How we will measure this
This will be measured by the development of a safety thermometer for medication
errors based on incident reporting and root cause analysis.
We will reduce all medication errors by 20%
We will reduce medication errors resulting in harm by 25%
Incident reporting will continue to identify risk factors and all medication errors
will be reviewed and monitored by the medicines management lead. A monthly
report on medication errors will be provided to the Medicines Management
Committee.
LCHS has a good record on preventing harm related to medication errors, the
target aims to build on this and focus on improved practice in prescribing,
dispensing and drug administration. We will aim to ensure that all staff
demonstrate a consistent safety record against this agreed standard.
Board Sponsor: Dr P Mitchell, Medical Director
Implementation/Programme Lead: Petra Clarke, Medicines Management Lead
27
www.lincolnshirecommunityhealthservices.nhs.uk
Medication errors resulting in harm
300
280
260
252
240
220
201
200
10
160
8
140
7
120
6
100
5
80
4
60
3
40
2
20
1
0
0
13/14
data
14/15
target
Total Medication Errors
7
5
13/14
data
3 in hospitals
9
4 in hospitals
180
14/15
target
Medication Errors
Resulting in Harm
28
Quality Account 2013/14
Reduction of Grade 2, 3 and 4 Pressure Ulcers
Why this is a priority
Most pressure ulcers, or bed sores, are a complication of illness however with
appropriate care these can be avoided. During 2013/14 we have improved our
performance significantly in reducing avoidable pressure ulcers, although we
have not yet achieved our ambition to prevent all avoidable harm and this
continues to remain a priority. This will be measured by incident reports and
investigation into the causes of pressure ulcers.
How we will measure this
A review of practice and patient outcomes for 2013/14 has identified areas for
improved practice which are being shared across the Trust. A multi-disciplinary
approach to improved patient mobility will be taken and collaborative work with
other providers will develop shared pathways for patients to promote continuity
of care and risk management. This will be overseen by a dedicated clinician
within the organisation. Incident reporting and investigations of pressure ulcers
will continue to identify risk factors and gaps in practice. Trajectories for quality
improvement will be set to achieve improvement in key areas of harm for patients
in order to support continued improvement following the achievement of
significant reduction in harm for patients during 2013/14.
Reduce avoidable Grade 4 pressure damage by 50%
Grade 4 pressure damage is severe and may be life threatening, currently the
Trust reports one or two incidents of avoidable Grade 4 harm each month. There
are many factors which contribute to this, but earlier intervention for patients will
reduce levels.
Reduce all avoidable Grade 3 pressure damage by 50%
Grade 3 pressure damage is severe and debilitating, often experienced by patients
at end of life. We aim to develop a specific pathway for patients at risk of Grade 3
harm and provide focus on delivery with the ambition to halve this damage.
29
www.lincolnshirecommunityhealthservices.nhs.uk
Reduce all avoidable Grade 2 pressure damage by 80%
Grade 2 pressure damage may be an early indicator of deteriorating mobility and
health and can be prevented through earlier identification of risk factors in elderly
or less mobile patients. Often associated with reduced mobility following illness,
hospital admission, stroke or need for the use of appliances such as wheelchairs or
catheters, our pathway will be enhanced to ensure earlier referral from primary care,
on hospital discharge for assessment, case management and intentional rounding.
The target is significant, but necessary in preventing higher grade damage and
working towards the aspiration of zero harm from pressure damage for our patients.
Board Sponsor: Sue Cousland, Chief Nurse/Director of Operations
Implementation/Programme Lead: Sarah McKown, Head of Clinical Services
Avoidable pressure ulcers
300
280
274
260
240
220
20
200
18
180
16
16
200
180
168
160
160
14
140
140
12
120
120
10
100
8
8
84
80
100
80
6
60
60
4
40
40
2
20
20
0
0
13/14
data
14/15
target
Avoidable Grade 4
Pressure Ulcers
55
0
13/14
data
14/15
target
Avoidable Grade 3
Pressure Ulcers
13/14
data
14/15
target
Avoidable Grade 2
Pressure Ulcers
30
Quality Account 2013/14
Patient Experience
Listen to our service users, value their views and
improve patient and carer experience
The Friends and Family Test (Net Promoter)
Why this is a priority
The Friends and Family Test (FFT) is the main mechanism for gaining feedback on
patient and carer experience of services currently in use in the NHS. The ability
to gain user feedback and then act on it to improve services is a dynamic and
rewarding process for teams and the organisation as a whole. Use of the Friends
and Family Test across NHS and non NHS health providers allows for a common
understanding of what good experience of services feels like and provides data
for benchmarking.
The FFT can identify variation within an organisation, which is often more evident
than variation between organisations and provides a mechanism for identifying
trends, changes in service performance and acts as an early warning indicator of
emerging quality issues.
How we will measure this
The Trust will continue to use the FFT in community hospitals and in addition,
is committed to the roll out of the Friends and Family Test across all community
services. Real time patient feedback will be captured, analysed and acted on
through a range of methods and publication of ratings, findings and responses.
The Trust has employed the services of “iwantgreatcare” to collect and report
back on patient feedback. This will be reported monthly through the Quality and
Risk Committee
There is a National target to achieve a monthly sample of 15% of service users and
75% positive score using FFT.
LCHS will seek to exceed this target achieving a monthly sample of 20% of service
users and 80% positive score.
Board Sponsor: Sue Cousland, Chief Nurse/Director of Operations
Implementation/Programme Lead: Lisa Green, Deputy Chief Nurse
31
www.lincolnshirecommunityhealthservices.nhs.uk
Net Promoter outcomes 2013/14
Hospital
Louth
Ward
April
Scotter
Welland
Scarborough
Gloucester
Sample size
20
20
11
8
4
8
Discharges
131
131
15
27
40
40
95.00%
90.00%
90.91%
37.50%
50.00%
87.50%
Sample size
-
-
-
-
Discharges
132
20
0
55
97.50%
100.00%
52.63%
73.33%
Sample size
20
20
12
14
10
9
Discharges
132
132
20
36
55
55
95.00%
95.00%
75.00%
78.57%
100.00%
100.00%
Sample size
19
20
8
18
9
12
Discharges
155
155
19
47
52
52
78.95%
85.00%
87.50%
61.11%
66.67%
100.00%
Sample size
15
19
7
14
13
9
Discharges
135
135
15
29
44
44
86.67%
94.74%
100.00%
35.71%
69.23%
77.78%
Sample size
20
20
6
7
10
10
Discharges
129
129
13
19
40
40
88.50%
85.00%
83.33%
57.14%
90.00%
100.00%
Net Promoter
July
Net Promoter
August
Net Promoter
September
Skegness
Manby
Net Promoter
June
Johnson
Carlton
Net Promoter
May
John
Coupland
Net Promoter
32
Quality Account 2013/14
Net Promoter outcomes 2013/14
Hospital
Louth
Ward
October
Scotter
Welland
Sample size
19
20
13
8
9
Discharges
144
144
21
19
51
100.00%
95.00%
69.23%
100.00%
88.89%
Sample size
20
16
13
3
6
7
Discharges
112
112
23
11
37
37
100.00%
75.00%
100.00%
100.00%
66.67%
57.14%
Sample size
21
18
10
9
12
7
Discharges
150
150
21
36
54
54
100.00%
83.33%
100.00%
88.89%
75.00%
85.71%
Sample size
18
20
7
8
6
5
Discharges
164
164
19
40
43
43
94.44%
90.00%
100.00%
100.00%
83.33%
100.00%
Sample size
20
20
6
8
3
10
Discharges
158
158
20
27
32
32
100.00%
90.00%
100.00%
88.00%
100.00%
90.00%
Sample size
21
20
3
13
9
9
Discharges
166
166
19
42
50
50
95.24%
95.00%
100.00%
92.31%
55.56%
100.00%
Net Promoter
January
Net Promoter
February
Net Promoter
March
Net Promoter
33
Skegness
Manby
Net Promoter
December
Johnson
Carlton
Net Promoter
November
John
Coupland
Scarborough
Gloucester
www.lincolnshirecommunityhealthservices.nhs.uk
Safe staffing levels – Right people, right skills, right place, right
time
Why this is a priority
There is a national drive to ensure that lessons have been learned following
examples of care in recent times which have been identified as unacceptable
either through the Francis Inquiry or Keogh reviews.
The publication, ‘How to ensure the right people, with the right skills, are in the
right place at the right time’, sets out the national expectations for Trust Boards
and commissioners in ensuring that there is an appropriate nursing and care
workforce in place to meet the increasing health needs of local populations. LCHS
aims to be an early implementer of safe staffing levels for community hospitals
and community nursing teams.
How we will measure this
We have developed a baseline for safe staffing across a range of our services.
Compliance with safe staffing levels will be monitored with reporting mechanisms
established to identify exceptions and escalation of issues for resolution.
Community Hospitals – safe staffing levels have been assessed using the Royal
College of Nursing guidance for the care of elderly patients. This has been
presented to the Trust Board and further investment has been agreed for two of
the six wards within the organisation.
Community nursing teams – in the absence of a recognised national assessment
tool, senior clinicians within the organisation have devised their own mechanism
for assessing safe staffing levels in the community. This work is now underpinned
by a comprehensive workforce plan.
The Trust Board will receive a report on achievement of baseline safe staffing
levels on a monthly basis, to include recognition of where services are below safe
levels, and will be informed what action was taken. The principle of safe staffing
34
Quality Account 2013/14
levels is to ensure the organisation maintains the safety of patients and staff.
Nationally this is the first year that Trusts are reporting on staffing levels. LCHS
is using this opportunity to ensure our internal work informs our workforce
planning and staffing plans.
Board Sponsor: Sue Cousland, Chief Nurse/Director of Operations
Implementation/Programme Lead: Lisa Green, Deputy Chief Nurse
Review of Quality Performance 2013/14
LCHS has conducted a self-assessment of quality against Monitor’s Quality
Governance Framework. The Trust Board is responsible for overseeing the quality
of care delivered across all of the services provided and to assure itself that quality
and good health outcomes are achieved. The Quality Governance Framework is
part of the Foundation Trust application process and is defined as ‘the combination
of structures and processes at and below board level to lead in trust wide quality
performance’. In addition the self-assessment was reviewed by an independent
third party, following the review a Quality Governance Improvement Plan was
developed and monitored by the Quality and Risk Committee and Trust Board. A
further self-assessment was carried out to ensure improvements were made. The
outcome of the independent review and self-assessment are outlined below:
Monitors quality governance framework scoring system
Risk Rating (Score)
Definition
Green (0)
Meets or exceeds expectations
Amber/Green (0.5)
Partially meets expectations but confident in management’s capacity to deliver
green performance within a reasonable timeframe
Amber/Red (1.0)
Partially meets expectations but some concerns on management’s capacity to
deliver green performance within a reasonable timeframe
Red (4)
Does not meet expectations
35
www.lincolnshirecommunityhealthservices.nhs.uk
Quality governance framework scores for LCHS
Question Narrative
RSM Tenon
score July
2013
Trust self
assessed
score
February
2014
Baker Tilly
assessed
score March
2014
1 Does quality drive the Trust’s strategy?
0.5
0.5
0.5
2 Is the Board sufficiently aware of potential
risks to quality?
0.5
0.0
0.0
3 Does the board have the necessary leadership
skills and knowledge to ensure delivery of the
quality agenda?
0.0
0.0
0.0
4 Does the board promote a quality focused
culture throughout the Trust?
0.0
0.0
0.0
5 Are there clear roles and accountabilities in
relation to quality governance?
0.5
0.5
0.5
6 Are there clearly defined, well understood
processes for escalating and resolving issues
and managing performance?
0.5
0.0
0.5
7 Does the board actively engage patients, staff
and other key stakeholders on quality?
1.0
0.5
0.5
8 Is appropriate quality information being
analysed and challenged?
0.5
0.5
0.5
9 Is the board assured of the robustness of the
quality information?
0.5
0.0
0.0
10 Is quality information being used effectively?
0.5
0.0
0.5
4.5
2.0
3.0
36
Quality Account 2013/14
Celebrating Success
Our main Celebrating Success awards provided an ideal opportunity to recognise
and celebrate those members of staff who have made an outstanding contribution
to the success of the Trust and embraced our core values of Quality, Value and
Reputation. In total there were 100 nominations across the 10 categories.
The categories and winners are listed below:
Patient Involvement Award
Katie Clements (children’s physio) and Abigail Storr (children’s OT), Children’s
Therapy Services, Family and Healthy Lifestyles
Innovation Through Technology
Katie Robertson-Bailey, Project Manager and Vicki Hunter, Project Support Officer,
E-Workforce & Performance, Corporate
Equality and Diversity
Catherine Churchill Health Care Coordinator NWQ F and HLS
Karen Broadhead LCHS Family and Healthy Lifestyles NWQ.
Mary Moorman Lincolnshire County Council, Children Centres
Quality, Innovation, Productivity & Prevention (QIPP)
Liz Cammell, OD Programme Manager, Organisational Development, Corporate
The team who has shown most improvement in productivity through new
ways of working
Skegness and Louth Independent Living Team and SPA, North East BU
LCHS Leader of the Year
Allison Cooke, Community Inreach Team Lead, South East Business unit.
Care, Courtesy & Kindness
Linda Smith – Assistant Practitioner, Community Response and Rehabilitation
Team, Johnson Community Hospital Spalding, South East Business Unit
Award for the team / individual who has best represented and upheld the
vision and values of a Business Unit
Collaborative Showcase Team, East Lincs Business Unit
Chief Executive’s Award for Personal Achievement
Rachel Higgins, Equality and Diversity Advisor, Corporate
37
www.lincolnshirecommunityhealthservices.nhs.uk
Chairman’s Award - ‘Going above and Beyond’
Martin Stevens, Pam Ellis, Out of Hours, North West BU
NHS Heroes 2013
Community healthcare staff who go above and beyond the call of duty to help
their patients and colleagues have been honoured as ‘NHS Heroes’.
A total of 18 NHS Hero awards have been handed out to teams and individuals
from Lincolnshire Community Health Services NHS Trust (LCHS).
They were all nominated through a national recognition scheme by patients,
family, friends, carers and colleagues, who were asked to nominate those who
have made a difference to their lives - no matter how big or small.
Sue Cousland, Chief Nurse at LCHS, said: “We are very proud to be able to
recognise our local NHS Heroes. These awards aim to identify and celebrate some
of the more considerate things our staff do for patients and fellow staff members,
which often go unrecognised.
“These teams and individuals work across many of our services, from offices
behind the scenes, housekeepers, ward clerks, nurses and team managers. The
contribution that each of them makes to the care provided by Lincolnshire
Community Health Services is absolutely invaluable and very much appreciated
by all those who receive it.”
Complaints and Compliments
LCHS responds to all complaints received from patients or carers and ensures that
lessons are learnt from these to ensure that good quality services are delivered to
the population of Lincolnshire.
During 2013/14 LCHS received 194 complaints, of the complaints received during
this time period three have been reviewed by the Ombudsman. One has been
38
Quality Account 2013/14
returned from the Ombudsman with no further actions to be taken. Feedback is
awaited to advise if further action will need to be taken on the other two. LCHS
ensures that all complaints are acknowledged within the set National Standard of
3 working days. When acknowledgment of the complaint is made a timeframe for
the response is agreed with the complainant. This is usually agreed as 35 working
days. If however the complaint is complex, an extension on the timeframe can be
negotiated with the complainant.
During the reporting period 2013/14 complaints rose by a total of 10 on the
number received in the reporting period 2012/13 bringing the total to 193. Whilst
in real terms there is an increase in the number of complaints being recorded,
when taken into account with the general increase in service provision, these
figures represent a slight decline pro rata. The total number of complaints per
1,000 patient contacts/attendances/admissions stood at 0.23 for 2012/13 and 0.21
for 2013/14. Of the 193 complaints, 48 were upheld.
For the reporting period 2013/14, 325 contacts were made to the LCHS hosted
Patient Advice and Liaison Service (PALS) with a number of concerns being
addressed by services directly; this is a decrease of 3 from the previous year. LCHS
continue to take a proactive approach to address issues through PALS by ensuring
that action is taken to resolve the issue at local level to ensure that the contact is
satisfied with the outcome and reduce the likelihood of a formal complaint being
made.
A process to allow the organisation to implement Trust wide learning from
all complaints has been introduced and is monitored by the Quality and Risk
Committee.
Compliments are received directly by LCHS services from patients and carers.
These compliments are recorded by the services and influence the monitoring of
service quality.
39
www.lincolnshirecommunityhealthservices.nhs.uk
National Health Service Litigation Authority (NHSLA)
Lincolnshire Community Health Services Trust was awarded Level 1 compliance
against the NHSLA Risk Management Standards in 2012, with re-assessment due
to be carried out in 2014.
The NHSLA have now reviewed their processes and with effect from April 2014,
have moved away from assessment against Risk Management Standards in favour
of a more outcome based approach, focusing on supporting members to reduce
their claims. In the first instance this support will come in the form of a new safety
and learning service which includes a library of:
• ‘How-to-guides’
• Case Studies, and
• Good practice and useful reference links
In time the NHSLA will also be developing a service to offer bespoke advice and
support to members to assist them in reducing claims and provide detailed
analysis into claims and their causes.
The new approach will see an end to the discounts previously attained by Trusts,
although existing discounts will remain until the end of 2014/15. The new way
in which contributions will be calculated should ensure that those organisations
with fewer, less costly claims, pay less for their Clinical Negligence Scheme for
Trusts (CNST) contributions.
Care Quality Commission (CQC) visits
The CQC found that the Trust had made good progress in increasing the level
of appraisal and supervision and put in place new procedures to help staff in
accessing that support.
In November 2013 the CQC undertook a planned visit to review Health Services
for Children Looked After and Safeguarding in Lincolnshire. This was a combined
review involving Lincolnshire Community Healthcare Services, Lincolnshire
Partnership NHS Foundation Trust and United Lincolnshire Hospitals NHS
Foundation Trust. Whilst recommendations were made for all providers, the CQC
reported only minor concerns for Lincolnshire Community Health Services. The
Trust was asked to ensure that the roll out of new policies and systems including
the on line version of the vulnerability assessment matrix is supported by staff
training and audit to ensure use is consistent and effective and collectively to
use escalation policies to ensure that unborn babies have the protection of child
protection case conference decisions in a timely manner.
40
Quality Account 2013/14
Part 3 - Other Information
The Quality and Risk Committee and Trust Board have received previous
information in relation to the Safer Staffing / Hard Truths documentation over the
last 4 months, namely that :
• Organisations were required to carry out a review of staffing levels by the end
of April 2014 – this work was reported to the Board in April 2014
• The Trust Board receive a report every 6 months on the capacity and
capability of staff in the in-patient setting – next due in October 2014.
• Each in patient area should display the planned and actual staffing levels in a
prominent position on a daily basis
• The Trust Board should receive a retrospective monthly Board report giving
details of the planned and actual staffing on a shift by shift basis, including
narrative on appropriate risk management and actions taken where the
staffing levels fell below the planned levels
• A monthly report is published on the Trust website with a link to the
webpage of the relevant hospital
• The information is uploaded on a the monthly basis onto NHS Choices
• A clear escalation process up to and including Director level when staffing
levels fall below optimum levels is implemented
• 2 ‘stock checks’ of progress will be held on the 23rd April and 28th May 2014.
These will be a joint review by both the Trust Development Authority (TDA)
and NHS England on progress. For note the 2nd ‘stock check’ was cancelled on
the 28th May and we have been informed that the Secretary of State is due to
make an announcement in relation to staffing levels on the 24th June 2014.
The organisation was required to upload data in respect of its bed base by the
12th June and this was completed on the 5th June 2014.
A further request from the Local Area Team was received on the 12th June to
review and check the accuracy of the data, with final submission by 12 noon on
the 13th June 2014.
A paper was submitted to the Trust Executive on the 17th June and the content
was noted and approved. There was recognition of the large amount of work
41
www.lincolnshirecommunityhealthservices.nhs.uk
undertaken by clinicians and IT personnel to ensure the trust was noted as being
compliant with the guidance.
Key Issues
The organisation has achieved all of the targets in relation to the requirements
of the Safer Staffing / Hard Truths documentation apart from uploading the data
onto the website / NHS Choices. This has to be completed by the 24th June and
will be actioned after discussion at the Quality and Risk Committee on 19th June.
The key elements to note in respect of the first set of data uploaded onto UNIFY
are:
• The data is a retrospective view of the previous month – in this case May 2014
• Data is reported in planned number of hours for Registered Nurses and Care
staff
• Further column indicates the actual staff on duty during those hours
• The data covers a ‘Day’ and ‘Night period
• The average fill rate against the planned numbers are demonstrated in
percentage format for both sets of staff during the day and night period
• The data was submitted on the 5th June ahead of the deadline of the 12th
June
• The data has been verified and a factual accuracy anomaly has been declared
to NHS England via the Local Area team, in respect of the way that the
average percentage has been calculated for all organisations. A response is
awaited.
42
Quality Account 2013/14
Annex 1
Statement of Directors’ Responsibility in respect of
the Quality Account
The directors are required under the Health Act 2009 to prepare a Quality Account
for each financial year. The Department of Health has issued guidance on the
form and content of annual Quality Accounts (which incorporates the legal
requirements in the Health Act 2009 and the National Health Service (Quality
Accounts) Regulations 2012 (as amended by the National Health Service (Quality
Accounts) Amendment Regulations 2011 and the National Health Service (Quality
Accounts) Amendment Regulations 2012).
In preparing the Quality Account, directors are required to take steps to satisfy
themselves that:
• The Quality Account presents a balanced picture of the Trust’s performance
over the period covered;
• The performance information reported in the Quality Account is reliable and
accurate;
• There are proper internal controls over the collection and reporting of the
measures of performance included in the Quality Account, and these controls
are subject to review to confirm that they are working effectively in practice;
The data underpinning the measures of performance reported in the Quality
Account is robust and reliable, conforms to specified data quality standards and
prescribed definitions, and is subject to appropriate scrutiny and review; and
• The Quality Account has been prepared in accordance with Department of
Health Guidance.
The directors confirm to the best of their knowledge and belief they have
complied with the above requirements in preparing the Quality Account.
By order of the Board
NB: sign and date in any colour ink except black
ChairmanDate
Chief Executive Date
43
www.lincolnshirecommunityhealthservices.nhs.uk
Annex 2
Statement on Lincolnshire Community Health
Services NHS Trust
Trust’s Quality Account for 2013/14
This statement has been prepared jointly by the Health Scrutiny Committee for
Lincolnshire and Healthwatch Lincolnshire.
Priorities for 2014-15
The Health Scrutiny Committee for Lincolnshire and Healthwatch Lincolnshire
support the Trust’s seven priorities for 2014-2015. We understand that these
priorities have been selected from a longer list and represent the areas on which
the Trust would like to focus in the coming year.
We congratulate the Trust in presenting its targets for each of these priorities in
the form of actual numbers, as well as percentage figures. This provides clear
information to members of the public on what the Trust is aiming to achieve.
We would like to suggest that the Quality Account make clear whether the each
priority applies to community hospitals or staff working in the community, or
both.
The priority to Increase Patient Facing Time Through “Time to Care” is welcomed,
but we recognise that travelling around a rural county such as Lincolnshire
presents a challenge to staff in terms of maximising patient contact time. We look
forward to progress on this priority. We would like to stress the importance of
meaningful patient contact time, with staff giving each patient as much attention
as possible.
We strongly support the priority to Reduce Harm from Falls in Community
Hospitals. We note the work in hand to address the causes of harmful falls.
We note that the target for Reducing Medication Errors Resulting in Harm in
Community Hospitals is 10% for all medication errors, compared to a target of
44
Quality Account 2013/14
25% for medication errors causing harm. We note that most medication errors do
not cause harm to patients. However, we would like the 10% reduction target to
be set higher, if this is possible. We would like to emphasise that the inappropriate
use of abbreviations, poor handwriting and the need for translation, are all areas
that could help reduce errors in medication.
We understand that the priority for the Reduction of Pressure Ulcers applies to
patients in both community hospitals and under the care of the Trust’s staff in the
community. We are pleased to see the 50% target being applied to Grade 3 and
Grade 4 pressure ulcers. Achieving this target will lead to significantly improved
outcomes for patients and we look forward to the Trust making progress in this area.
For the Friends and Family (Net Promoter) priority, we made a comment on the
draft Quality Account that we would like to see the targets for a 15% sample size
from service users and a 75% positive rating for the Trust also expressed in the
actual number of patients. We also suggested that consideration be given to a
larger sample size than 15%.
We note that the Safe Staffing Levels priority for community hospitals will be
based on Royal College of Nursing guidelines and the Trust was devising a
formula for determining the number of staff in the community.
Progress on Priorities for 2013-14
We would like to compliment the Trust with its progress on its 2013-2014 priorities,
which has included progress with the delivery of outcome measures for core
community services; and improvements to clinical record keeping.
In relation to the priority on the Elimination of Pressure Ulcers, we accept that
there has been a 25% reduction overall, but this had not been as good as
intended. As stated above, we support the 50% target for a reduction in Grade 3
and Grade 4 pressure ulcers during the coming year. We also note that the Trust
has been providing training to residential and care homes on how to reduce the
incidence of pressure ulcers.
45
www.lincolnshirecommunityhealthservices.nhs.uk
We are saddened to hear that there was one death as a result of a fall in one of
the wards at Johnson Hospital during the last year. We have been advised of the
action taken by the Trust in response to this, for example reviewing the staffing
levels and practices on the ward in question.
Engagement
The Health Scrutiny Committee has received information from the Trust during
the last on its contribution to End of Life Care in Lincolnshire. For the coming
year, the Committee would like to engage with the Trust, in particular on its
contribution to the Lincolnshire Health and Care programme.
Healthwatch Lincolnshire has established communication channels with the Trust
and plans to carry out ‘Enter and View’ visits to the Minor Injury Units at Skegness
Hospital and John Coupland Hospital, Gainsborough in the coming year.
Conclusion
We are grateful for the opportunity to make a statement on the Trust’s draft
Quality Account. Both the Health Scrutiny Committee for Lincolnshire and
Healthwatch Lincolnshire will be seeking more engagement with the Trust during
the coming year on the progress with its priorities.
46
Quality Account 2013/14
Annex 3 - Feedback from lead
commissioner
47
www.lincolnshirecommunityhealthservices.nhs.uk
Annex 4 - Feed back from
membership
The quality account was shared with a random selection of our membership, the
responses received were varied and as such did not identify any specific areas of
concern. We were able to make minor changes in response to the comments.
48
Quality Account 2013/14
Patient Advice and Liaison Service (PALS)
PALS is a confidential service that helps patients, their families and carers to find
answers to questions or concerns regarding the care or treatment received from
NHS Trusts in Lincolnshire.
As a patient, relative or carer you may sometimes need to turn to someone for
on-the-spot help, advice and support. This is what the Patient Advice and Liaison
Service does on a daily basis. We provide confidential advice and support,
helping you to sort out any concerns you may have about the care provided by
the NHS and guiding you through the different services available.
PALS can:
• give you information about local health services
• listen to any problems you may have in relation to your health care or the
health care of a loved one or friend
• help you ask questions about your health care
• tell you about help and support groups for you or your carer
Tel: 0845 602 4384
Calls via Typetalk/Text Relay are welcome
Email: info@lincspals.nhs.uk
Write to us at:
Lincolnshire PALS
Bridge House
Unit 16, The Point
Lions Way
Sleaford
Lincolnshire
NG34 8GG
A member of the team will be available Monday to Friday, 9am - 5pm
(Except Bank Holidays)
This service is confidential
49
Membership
For further details of how you can get involved with Lincolnshire Community
Health Services NHS Trust and to find out how you can become a member follow
the link below:
http://www.lincolnshirecommunityhealthservices.nhs.uk/Public/content/
lincolnshire-community-health-service-trust-membership
Trust Headquarters
Lincolnshire Community Health Services NHS Trust
Bridge House
Unit 16, The Point
Lions Way
Sleaford
Lincolnshire
NG34 8GG
Tel: 01529 220300