Quality Account
2013-14:
Community Services delivered in Surrey
Contents
Part 1
1.1
1.2
1.3
1.4
Chief Executive’s introduction
Clinical Director’s introduction
Executive summary
Key successes and innovation delivered in 2013/14
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05
07
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Part 2
2.1
2.2
2.3
2.4
2.5
2.6
2.7
2.8
2.9
2.10
2.11
2.12
2.13
Priorities for improvement in 2013/14
Priorities going forward in 2014/15
National clinical audit participation
Core service clinical audit programmes
Research statement
Statements from the CQC
Safeguarding statement
Data quality
Information Governance toolkit attainment levels
Independent service reviews
Service recognition
Services highly valued by customers and staff
Highlights of initiatives to improve service user experience and feedback
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Part 3
3.1 Review of quality performance
3.2 Community services performance report
3.3 Customer experience in Surrey 2013/14
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Appendix 1 – Glossary of terms
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Part 1
1.1 Chief Executive’s introduction
1.2 Clinical Director’s introduction
This is our second Quality Account and I hope that, once you have read this publication, you will
agree we have achieved a great deal since we started delivering community services in Surrey.
As Clinical Director I am responsible for ensuring the clinical care we provide is safe, high quality
and continuously improving. This is achieved by having a well-defined clinical governance system
in place. That means we have processes and systems to ensure we operate safely and monitor the
quality of care delivered to patients.
Our aim is simple: we want to be the best community-based provider of care, providing care good
enough for our own families. In practice this means delivering high quality, timely and appropriate
healthcare and treatment to people in the community as close to people’s homes as possible, if
not in their own homes. We do this by strengthening our partnerships with a range of partners from
GPs to hospitals, social care and the voluntary sector.
In this publication you will find numerous examples of how we are making a difference. One of
the highlights is that in 2013/14 not only were all our community hospitals found to be meeting
the Care Quality Commission (CQC) standards, but their reports also revealed a high level of
satisfaction and positive feedback from our patients too. Inspectors from the government’s care
watchdog turn up at our community hospitals unannounced to complete the inspections each
year to check we are providing safe, effective, compassionate and high-quality care and are
compliant with the regulations. However, this welcome endorsement has not stopped us from
continuing to innovate. Patient welcome packs and a guide to improve patients’ experience of
the hospital are now in use and we also introduced the Safer Slipper campaign to help provide
footwear to the elderly to reduce the risk of falls.
I am particularly keen to congratulate the team at the Jarvis Breast Screening Centre in Guildford
who received the Mayor’s Silver Award for Access. The award was received in November 2013
following nominations from the public and users of the service. In addition, the community
musculoskeletal physiotherapists were shortlisted in the ‘efficiency in service redesign’ category at
the Health Service Journal’s annual Health Efficiency Awards while the community nursing team were
similarly shortlisted in the ‘Nursing in the Community’ category at the annual Nursing Times Awards.
The quality and safety of the care that our teams provide continues to be our highest priority. We
make sure that our clinical governance and quality systems are reviewed and updated so that we can
support the doctors, nurses, dentists, therapists and other allied professionals who provide our services.
I would like to thank the Clinical Quality Team and the Heads of the Surrey community services
for their involvement in providing information for this report, which contains many examples that
show how we place an emphasis on quality and safe care and respond to patient and customer
feedback. We will continue to work closely with our partners, the CQC and other health watchdogs
to demonstrate high standards.
One important event in 2013 was the publication of the final report of the Mid Staffordshire NHS
Foundation Trust Public Inquiry. In response to the report we convened a group of staff from across
the organisation to assess the implications of the report and make recommendations to the board
and executive team on actions needed. These recommendations were reported to the board in
June 2013, and it was agreed that they should be put into practice. The 34 recommendations that
applied to our services cover the areas of leadership, complaints, incidents, professional practice
and training, and service delivery and monitoring. Most areas of Surrey community healthcare
are already compliant with the 34 recommendations, and those that are not fully compliant have
implemented action plans to bring us into compliance.
These awards and commendations as well as our community hospital-based initiatives are just a few
of the improvements we have made. However, our aim is to keep the momentum going so that every
patient experiences high quality, safe, personalised healthcare in an appropriate setting.
In putting together this publication, we have sought feedback from staff and service users and I
would like to take this opportunity to thank them for their input.
Dr Peter Taylor
Clinical Director
I can confirm that to the best of my knowledge the data and information in parts two and three of
this report reflect both success and areas that we have identified for improvement going forward
in 2014/15.
Statements of assurance
Bart Johnson
Chief Executive
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Virgin Care Services Limited, a subsidiary of Virgin Care Limited, has reviewed all the data available
to them on the quality of care and provided monthly contract and performance data to the CCG
Contract and Patient Quality Safety meetings for the year.
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1.3 Executive summary
A Quality Account is an annual report that providers of NHS healthcare services must publish about
the quality of services they provide. This is the second Quality Account we have published on our
community services in Surrey. The service was commissioned by NHS Surrey and the contract is now
overseen by the coordinating commissioner, North West Surrey Clinical Commissioning Group (CCG).
As well as showing our commitment to providing the best quality community healthcare services
to the people of Surrey, the Quality Account is also an opportunity for us to take stock, to look at
what we have achieved in the year from April 2013 to March 2014 and help us focus on how we will
continue to make improvements.
We have collected a great deal of information on the quality of all of our services within the three
areas of quality defined by the Department of Health: safety; clinical effectiveness; and patient
experience. We used this information to examine how well we performed, but also to help us set
some priorities for improvement for 2014 and beyond.
To make sure our priorities reflect the needs of patients, the public and the people we work with
we have involved different groups to help us compile this report including patient and community
representatives, our commissioners and our staff. Healthwatch was also asked for its input into the
creation of this report.
If you would like any of the following please call 01932 723 749 or email
customerservices@virgincare.co.uk:
• a hard copy of this quality account, or you would like to read it in a different language;
• to talk to someone about your experiences of the community services or need to know how to
find a service, you can contact our patient advice and liaison service (PALS) in confidence; or
• to give us feedback on any aspect of this Quality Account.
Services we provide in Surrey:
Adult community nursing services
Six community hospitals, 24 hour district nursing,
specialist nursing, community matrons and case
management, twilight services and rapid response
Children’s services
Health visiting, school nursing, community children’s
nurses, paediatricians, therapies, audiology, health
funded continuing care and youth counselling
Specialist services
Community dental, wheelchair, sexual health, breast
screening and diabetic retinopathy services
Rehabilitation and therapies
Physiotherapy, occupational therapy, podiatry,
respiratory care, speech and language therapy
and osteopathy
Offender healthcare services
HMP Coldingly, HMP Downview, HMP Highdown and
HMP Send
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1.4 Key successes and innovation delivered in 2013/14
Table 1
Patient safety/ensuring
consistency in care
We have demonstrated the quality and safety of our
services successfully during a number of unannounced
CQC inspections throughout 2013/14. All services have
appointed safeguarding champions to lead and
provide support to the staff service teams.
Quality management systems
to improve capacity and support
to staff
We have aligned and integrated Information
Governance policies and procedures to ensure that
they are fit for all services and we developed an
in-house Information Governance NHS approved
training programme.
We have rolled out web-based reporting tools and
web-based performance reporting.
Waiting times have improved by working in close
partnership with other providers and ongoing
investment in IT and software reporting systems.
Clinical effectiveness/promoting
clinical excellence
As prioritised in our 2012/13 account we have
enhanced our national professional clinical
leadership structure to lead best practice professional
standards, shared learning and networking across our
Dental, Musculoskeletal, Primary and Urgent Care,
and Sexual Health services. Great strides have been
made in many specialty areas and work is ongoing
into 2014/15.
We introduced a central referral and triage centre in
November 2013 for Dental Services.
Access to training for front line staff has been
developed with The Learning Enterprise. This includes
an innovative induction programme for all new staff
with key statutory and mandatory learning modules,
practical courses and information.
Remote access to care
User experience
The NHS Outcomes Framework for
2012/13
“organisation’s responsiveness to
patients’ needs as a key indication of
the quality of patient experience”.
We responded to patient feedback and extended the
Net Promoter Score (NPS) tool across our services
including into the prison healthcare services. NPS is a
token system which enables services to receive timely
feedback and implement change as a consequence
of areas raised by users for improvement.
Satellite technology was piloted at the Jarvis Breast
Centre. This allows encrypted digital images taken at
a clinic on a mobile van to be transferred directly to
the Jarvis.
All dental information leaflets for patients and carers
have been updated and pictorial or Makaton leaflets
created for specialist services.
Following requests from service users, Sexual Health
services in Surrey have improved signage to their
clinics and appointment cards were redesigned to
increase confidentiality.
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Mobile working initiatives increased the amount of
time clinicians spend with patients by 30 per cent and
on average community nurses are able to see two
patients more per day.
Community Adult Services introduced
telehealth for patients’ with COPD and heart failure.
This gives early warning of any deterioration.
Listening to patients
“You Said; We Did” posters were developed and
placed in clinical areas. This led to improvements
including appointments with GPs available from 8am
to removing crusts from sandwiches which patients
said were difficult to chew.
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Part 2
2.1 Priorities for improvement in 2013/14
Our core objective is to be the best community-based provider of care, delivering care good
enough for our own families.
Priority 1 Ensuring service quality, safety and enhancing user experience: Providing excellent clinical
outcomes, meeting and exceeding relevant standards and regulatory requirements
We delivered a full roll out of web-based reporting tools across the organisation which support
incident and contract key performance indicator reporting and monitoring. This ensures all
our services consistently provide feedback on actions and learning to their teams and upwards
through the committee structure to the Board.
We delivered a revised service core audit programme inclusive of safeguarding, infection control
and medicines management electronically across the organisation. Following the analysis of these
audits, we revised several policies to support high standards and these were developed and reaudited against locally-developed procedures. We have used internal service inspections carried
out by peers for each service area to provide assurance against CQC standards and developed
on-going action plans to ensure all services maintain high standards.
Our community nursing teams have increased the amount of time they are spending with patients
and at the same time reduced the time spent at base on administrative tasks as a result of our
mobile working initiative. Community nurses are now able to access and input information thanks
to the Total Mobile IT Health System, a secure and easily accessible way of retrieving information
from the electronic care record system RiO. The system is accessible from a range of devices,
including tablets and smart phones. By the end of 2014 it is planned that this mobile working will
be available to all staff working in a wider variety of our community services.
We continue to work in partnership with North West Surrey CCG, Surrey Social Care Services,
Surrey and Borders Mental Health Trust and local 3rd sector organisations to develop the local
model of the ‘virtual ward’ for North West Surrey. These wards provide support to people with long
term health conditions, with the aim of improving the patient’s own management of their health
condition and ensure the appropriate community services are there to support the patient to
remain in their home and avoid unnecessary hospital visits and admissions. Patient experience has
significantly improved with over 90% of users confident that they can manage their own health
post virtual ward – an increase from 30% pre virtual ward. 98% felt they were fully supported by
GP/Social Services post virtual ward – an increase from 25% pre virtual ward.
We have been working in partnership with St Peters Hospital to change the care pathway for frail
older people. St Peters has put in place an Older People Assessment and Liaison (OPAL) team and
our services wrap around this providing:
• community in-reach to Accident and Emergency to turn around patients where admission is
not required and put a suitable community package of care in place for them.
• community in-reach to the OPAL team to support the team in understanding what is available
to support patients in the community and supporting the patients journey towards discharge.
• Rapid Response Plus which is a new team of highly skilled nurses who, when asked by the
GP or district nurse, visit the patient at home to provide assessment and treatment, arrange
services or access to consultant comprehensive geriatric assessment in the community. This
service provides a response within hours to avert inappropriate admission and arrive at the
best outcomes for patients. The rapid response team has been increased to have the capacity
to look after the additional patients this project is generating. Our achievements include
significantly fewer patients converted from Medical Assessment Unit to ward admission a
reduction from 90% to 75%, and reductions in length of stay from 10.1 to 9.1 over 6 months
and reduced readmissions from 20.7% to 15.3% over 6 months.
The child health service worked closely with Epsom and St Helier Hospital, BT and CSE and our
clinical management team to achieve direct transfer of blood spot recording information from the
laboratory onto our clinical system. The implementation of the project was successful and we can
now record a 97% coverage rate of blood spot recording compared with 50% in 2012.
We continue to work in partnership with Surrey County Council who has financially supported
the development of a second medical advisor post for adoption to ensure that we meet the
timescales required by the new legislation for adoption processes.
Across our Community Based Adult Services, “I Want Great Care” has been introduced as part of the
Total Mobile system. This collects, monitors and analyses feedback from patients on their experiences
of care. The system incorporates the government’s Friends and Family Test requirements and is designed
as a quick and easy way for patients to leave feedback, comments and concerns anonymously via an
independent intermediary. Importantly, the system allows us to respond to patient feedback in real time
and provides service managers with feedback reports that identify themes for improvement.
We have also trialled a “let’s talk on Twitter” campaign which is designed to enable patients to
raise their comments or concerns via social media. This is important in ensuring that we meet
patients where they wish to engage and has produced positive comments which have helped to
raise the morale of those delivering care while at the same time highlighting the good work that
goes on within our services. Where negative comments have been made, we have been able to
meet these and/or deal with the issues in real time.
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Priority 2: Robust governance: fostering safeguarding and quality assurance processes which are
standardised across the business.
Our approach to national reviews such as the Francis report is to conduct a systematic organisation
review at operational and service level with agreed actions cascaded to the business units for delivery.
Measuring and monitoring is supported by a rolling programme of leadership walk-rounds and
the Executive back to floor initiative as a mechanism to embed the organisation’s values for a
quality and safety culture. Changes that have been made include:
• All services have named safeguarding champions who have the appropriate expertise and training
to provide support to their service teams. Safeguarding children and adult information is now more
easily available for staff on the extranet including policies, procedures and flow charts;
• Our national professional clinical leads launched professional standards for primary and
urgent care, dental and sexual health services with network events to share bets practice and
monitor compliance;
• Complaints process – paying greater attention to the narrative in complaints, a centralised
complaints team was created supporting and working with services;
• Internal Service inspections undertaken across the organisation developed from our own
experience of CQC inspections and national report recommendations;
• Clinical governance RAG scorecard tool introduced across all services for monitoring
compliance for safeguarding, training, policies, incidents, risk registers and audit activity;
• Duty of Candour embedded in our culture to be open and honest;
• New training for staff when handling people with challenging behaviour, linked with the clinical
presentation of dementia, was developed in partnership with social care leads and introduced
a check list for assessing mental capacity;
• Pressure ulcer pathways were reviewed and improved and new leaflets were provided for
patients and their carers;
• Regular medication audits in the community hospitals, special schools and health-funded
continuing care services reduce risks of incidents;
• All services use best practice evaluation programmes and clinical audits and comparative
data from clinical outcomes to enhance patient experience;
• Our quality and safety dashboards and CQUIN reports are analysed by clinical leads with
participation in national benchmarking initiatives and audit programmes;
• A reviewed all of policies including whistleblowing and equality and diversity. Internal quality
meetings are held regularly and regular patient surveys are carried out. Patients’ rights
and responsibilities, for example the right to a chaperone, are all clearly displayed as are
complaints and incident reporting procedures along with examples of patient compliments;
• Following Francis in our community hospitals we have increased the time that ward matrons
have in addition to practice. We have also improved the skill mix of staff to ensure that each
shift has two registered nurses; and
• The Prisons Team have also reviewed and implemented the relevant Francis Report
recommendations. The process around complaints no longer simply reports the number of
complaints but identifies trends and actions taken in relation to the trends.
area and use this as an opportunity to discuss cases using an action learning model. There
has been a change in practice when dealing with patients who do not wait to be seen and a
process is in place to ensure that when this occurs, the necessary welfare checks are arranged.
Sexual Health Service
• The service runs an open access, confidential sexual health service for people from 13 years
of age onwards. There are a high number of young people accessing the service and a
significant proportion of these have safeguarding needs. We maintain close links with social
services and local agencies and have a robust system for checking that young vulnerable
clients have not ‘slipped through the net’.
Children’s Service
• We have worked with Parent Voice to produce our SEND (Special Educational Needs and Disabilities)
local offer, thereby ensuring that it reflects the needs of parents across Surrey and is accessible in
its presentation and content. This will be displayed on ours and Surrey SEND’s websites.
• We have taken proactive steps to ensure that we are compliant with the requirements of
section 11 Children Act 1989. We have reviewed our safeguarding supervision processes
and are implementing a model that supports staff and incorporates learning from recent
safeguarding cases. We have reviewed the family needs assessment tool used across the
health visiting and school nursing service and we have implemented a common tool with
guidance for its use and practice.
Prisons
• Audits have been undertaken into the healthcare interventions of the potentially vulnerable
prisoner group in the segregation unit. Stroke training has been undertaken by nursing staff in
response to an identified need.
Urgent Care Team
• The information sharing form for children attending walk in centres was reviewed and has
been amended. There are four key Paediatric Link Nurses who share learning across the
services and undertake joint audits. The service manager and Lead for Safeguarding Children
have implemented a quarterly safeguarding children meeting to review governance in this
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Priority 3: Continue to be recognised as an outstanding employer
2.2 Priorities going forward in 2014/15
• Launched an organisation-wide staff survey designed to understand motivation, values,
support and development so that the organisation can act on what staff say and support
them in providing care good enough for our own families.
• The development and roll-out of a talent management programme and managing the
Virgin Care way.
• The Chief Nurse awards scheme based on the ‘6 Cs’ outlined by the Department of Health to
recognise and value the work of the nursing teams: we awarded four winners and five runners
up across the services in Surrey.
• An online e-learning induction was delivered in 2013 by The Learning Enterprise.
• We will continue to invest in electronic performance management reporting tools to enable
the analysis and timely evaluation by service teams and facilitate and development of local
actions for change and/or sustained improvement.
• Access to an internal innovation fund enables frontline staff to put forward proposals that
either improve patient care, the working lives of staff, or both. One initiative proposed under
the scheme involved purchasing laptops, tablet computers and apps to work with patients
with communication difficulties. Another initiative saw a redesign of a reception area in order
to improve access for patients and improve office space for staff.
Demonstrating on-going service quality and safety remains a top priority in 2014/15.
Priority 1: Ensuring service quality, safety and enhancing user experience: Providing excellent
clinical outcomes, meeting and exceeding relevant standards and regulatory requirements
• All services will continue to strive to meet and exceed all CQC standards of care by learning
through regular audits, and reviews of complaints, compliments, risks and incidents. The
organisation’s internal service inspection programme conducted by registered managers and
quality team are supported by subject experts to ensure assurance is provided against the
safety quality and patient experience. The Executive and Board will be provided with regular
reports on the outcomes of inspection reviews.
Service Initiatives - examples
Children’s Services
• The Children’s Service will review and update its overarching strategy for 2014-15. It is in the
process of instigating reviews of 0-19 universal services (health visiting and school nursing) with
a view to improving quality and the meeting of national objectives such as the delivery of the
Healthy Child Programme. The Children’s Service will also be working with partner agencies
in reviewing our children’s safeguarding practices, including taking part in national initiatives
such as the Coping with Crying evaluation, which is a parental education programme
targeting expectant parents with the aim of reducing the incidence of non-accidental head
injuries to babies.
• Improving clinical effectiveness and pathways to service access through a programme of
transformation including reorganising the Multi-disciplinary Assessment process and initiating
a Single Point of Access hub and spoke approach to several service lines.
• We will work with partners in the Local Safeguarding Children’s Board and other organisations
to support the joint CQC and OFSTED inspection process which will focus on children in need
of protection, early help and looked after children.
• We will step up our current programme of patient engagement, involvement and feedback
from and with parents/carers/children and young people to continue to put children, young
people and their families at the heart of Children’s Services.
Prisons
• Work is being carried out on developing a formalised long-term conditions strategy for
prisoners’ health improvement and individualised care plans, which will be reviewed on a
regular basis. Prison healthcare leads and champions will evaluate outcomes and prisoner
experience through audit and satisfaction surveys and present these at Quality meetings.
• A recent pharmacy led audit has identified the number of prisoners on antidepressants
and this has resulted in a nurse-led clinic being set up to effectively review all prisoners on
antidepressants.
• Chlamydia screening in under 25s remains a key objective in order to improve uptake.
• “Smoke-free” prisons, next year will see a focus on strategies for the development and increase
in smoking cessation within the prison environment.
• Work is being carried out to introduce telemedicine in the prisons to run telemedicine clinics
linked to local hospitals.
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Sexual Health Services
• Sexual and Reproductive Health services will be expanding and upgrading their computer
system from 1 May 2014, which helps to provide a more streamlined service.
Breast Screening Service
• The Jarvis Breast Screening Centre has been chosen to pilot satellite technology on one of
its mobile vans. The pilot with the National Space Agency will enable a live clinic on a mobile
van with encrypted digital images transferred directly to the Jarvis. It is a pioneering piece of
technology and the Jarvis is delighted to be part of this advancement.
• We will also be piloting a new telephone system as the result of NPS feedback aimed at
improving user experience. The Breast Screening Service ISO 9001:2008 quality management
award is due for renewal in September 2014 and the team will make it a priority to ensure they
maintain and meet these standards.
Beacon Supportive and Specialist Palliative Care Service
• We will conduct a review of the patient palliative care pathway with proposals for
improvement to the pathway and joint working with partner organisations.
Priority 2: Robust governance: fostering safeguarding and quality assurance processes which are
standardised across the business
As part of the National CQUIN scheme for 2014/15 we will deliver:
• local provider response to local commissioners on the Friends and Family Test – early
implementation checks on implementation will be reported at the end of January 2015. This is
in line with NHS England’s roll out of the scheme; and,
• Pro-active Shared Care Planning /Coordination for the community nursing patients, inclusive
of a crisis plan and advanced Care Plan where appropriate.
We will also continue to invest in the development of our web-based performance reporting tool.
Priority 3: Continue to be recognised as an outstanding employer
• Data on staff attitudes, awareness and feedback are important resources to gain insight into
staff concerns and we will use the staff survey to action and support further improvements for
staff wellbeing education and training. Regular monitoring of appraisal and training is a key
priority set for all services in 2014/5 as well as bi-monthly morale-o- meters.
Patient pack and handbook in community hospitals:
A magic touch which makes all the difference for patients
Being admitted into hospital can be a stressful time for patients and their families and it is often
sudden or unexpected. During this time people often don’t get the chance to gather the little
essentials like a toothbrush and toiletries.
We saw this as an opportunity to make a difference by reducing the stress and to provide something
which would really help patients and their families. Working together with local staff and patient groups
as well as drawing inspiration from great customer service provided by other parts of the Virgin family
we created our patient pack and handbook to make patients’ stay more comfortable.
The patient packs contain all the essential care items that patients might need to feel comfortable in
the early stages of their stay including: soap, a hairbrush, tissues, a toothbrush and toothpaste. The
outer bag itself is perfect for transporting washing home and a small waterproof inner pocket can
be popped out as a toiletry bag. There’s also a puzzle pack to help keep patients entertained and
mentally active, plus a clever 3-in-1 magnifying glass, bookmark and ruler.
The patient handbook, called ‘A guide to your stay’,
is full of information that patients (and visitors) will
need. This includes details about services available,
hospital policies, visiting times and a guide on
how to identify different hospital staff to help put
patients’ minds at ease. We launched the patient
packs and handbooks in time for Christmas 2013
across all of our community hospitals.
The feedback from patients has been fantastic, with:
• 80% saying the patient pack was good (63%)
or great (17%)
• 97% found the packs useful
• 67% said they would reuse the pack again after leaving hospital
“The pack made me feel welcome and less of a trouble to staff. The contents have been well thought
through and covered all the things that I needed.” Patient at Haslemere Community Hospital.
“Patients have told us that the welcome packs are ‘absolutely brilliant’ and that they make their stay
in hospital much more comfortable. Many of the patients don’t have time to bring a bag with them
and these packs can help to lessen the anxiety they may experience at this difficult time.” Annie
Christie, Matron at Woking Community Hospital.
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2.3 National clinical audit participation
2.4 Core service clinical audit programmes
The national clinical audits that Virgin Care Services Limited participated in during 2013/14 are as follows:
Our core audit programme included:
• Infection Control – measures the standards for decontamination, cleaning and training against
Infection Prevention Society (IPS) tools. 100 per cent uptake of audit across services.
• Medicines Management – inclusive of prescribing using the Quality Assurance Programme Tool.
• Safeguarding audit – all services completed an audit and monitored actions for improving the
uptake of safeguarding training.
• Clinical Records audit against the HQIP tool – best practice tool.
• Local health and safety audits – all locations (quarterly).
The National Clinical Audit and Patient Outcomes Programme (NCAPOP)
Chronic obstructive pulmonary disease COPD
Diabetes (Adult) NDA (A) active
Previous bone density audit active
Patient Safety Thermometer – ongoing audit on the prevalence of falls, pressure ulcers,
indwelling catheter acquired urinary tract infections and the number of patients who have
had a Venous Thromboembolism (a blood clot) risk assessment and prophylaxis carried out
on a given day each month. Safe Smarter Nursing Metrics are reported to quality contract
meetings each month and teams are able to use the figures to inform their practice and
identify areas for improvement. Where appropriate, we have extended this programme to
our children’s services for children who fit the criteria as we want to ensure best practice for
children in these areas of care.
Breast Screening Programme Data Set (KC62) - The KC62 is a national statistical mandatory
return that all breast screening units in England are required to undertake on an annual basis.
Continence Promotion and Treatment Service Audit
Samples of service specific audit programmes reported in year have included:
Walk-in and Minor Injury units
• Audit of the radiology reporting on Walk-in Centre Patients.
• Audit on the Management of Children under two years of age attending Walk-in Centres.
• Audit on the management of patients who attend with head injury over 65 years.
Dental
• An on-going six monthly DARS (Dento alveolar referral service) audit of post-operative
complications commenced June 2013.
• Annual radiation audit on radiograph quality.
• Annual medical records audit.
• General anaesthetic audit.
• DNA (did not attend) audit.
• Infection control, inclusive of HTM01-05 decontamination audits for specialist community
dental premises.
Breast screening
• A three yearly QA Multi-Disciplinary review of breast screening by the National Screening
Programme was carried out in November 2013.
• Annual BASO audit (British Association of Surgical Oncology) completed by the Jarvis Centre
in December 2013.
The Safeguarding Children Team and wider Children’s Services
• Safeguarding Supervision Audit.
• Bruising in Non-Independently Mobile Children- audit with Surrey Safeguarding Children’s Board.
• Parental Substance Misuse – audit with Surrey Safeguarding Children’s Board.
Community Adult Services (including rehabilitation and therapy services)
• Audit of implementation of NICE guidance: Community stroke guidelines - Stroke Teams and
Community Rehabilitation Teams.
• Stroke Team Outcomes audit – Stroke teams.
• Hand hygiene audits – all services.
• Clinical Supervision – all services.
Prisons
• Prisons have complied with the relevant audits and in addition have undertaken specific prison
audits around health screening in segregation and record keeping.
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2.5 Research statement
Participation in clinical research demonstrates our commitment to improving the quality of care
we offer and to making our contribution to wider health improvement. Our clinical staff are kept
up-to-date with the latest treatment possibilities and active participation in research leads to
successful patient outcomes.
We are collaborating with the University of Surrey on an application to the National Institute for
Health Research (NIHR) Health Services Delivery Programme to study the effectiveness of nonface-to-face consultations in Parkinson’s disease. We have a number of staff engaged in research
projects of various types, as part of postgraduate studies. These contribute to maintaining a
core of research-trained staff in the organisation. Our partners in these studies include Oxford,
Cambridge, Southampton, Kent and Brunel Universities, the Royal Free Hospital, and the NIHR.
Our Research Governance Committee meets regularly, and our contract with the Sussex NHS
Research Consortium for the provision of Research Governance support continues.
Current research activity
We were involved in conducting clinical research studies in several medical and service specialties
during 2013/14. Nine active projects were included on our Research Database and are either
in progress or about to commence. Three projects are being undertaken by the Jarvis Breast
Screening Centre:
• The TOMMY trial, comparing a new form of imaging with standard mammograms;
• Extending the age range of the national screening programme, to see if there is benefit in
screening older or younger women; and
• A project to see if changing the order in which mammograms are examined affects the
number of positive results.
Contribution to learning and development
Members of the Sexual Health team have taken part in international research groups, webcasts,
and lectures and have chaired and presented at conferences throughout Europe.
The Dental Service has been working together with specialist societies to review and update
national UK Guidelines. It is also working with the Royal College of Surgeons to develop a template
for Quality Outcomes.
The Prisons team presented work to Criminal Justice Conference in September 2013 on the Pain
Management Review clinic, which generated considerable interest. The clinic ensured appropriate
management of pain and reduced prescribed medication with addictive potential. This reduced
the risk of abuse of prescribed medication by trading, increasing the safety of prisoners.
In addition:
Our Surrey community teams looking after older patients have a number projects looking at
aspects of care and treatment of their patients. New studies in development include work on
injection techniques for frozen shoulder, and a study on obesity in our prison health population.
20
21
Publications
In the last year, the following publications have resulted from our involvement in service review/
research, which show our commitment to transparency and desire to improve patient outcomes
and experience across the health care sector. The following papers in peer-reviewed journals
were written by members of our staff and published during 2013:
Peers, T. et al (2013) Tailoring Oral Contraception to each Woman. Women’s Health, 5(2).
Black, K., Lotke, P., Lira, J., Peers, T.and Zite N.B. (2013) Global Survey of Healthcare Professionals
beliefs and practices around intrauterine contraceptive methods in nulliparous women.
Contraception, 88(5), 650-6.
Buhling, K., Zite, N.B, Marions, L., Peers, T. and Black, K. Understanding the barriers and myths that
limit the use of IUC particularly in Nulliparous women; a survey of European HCP.
Hull, S., Kneebone, I. I., & Farquarson, L. (2013). Anxiety, depression and fall related psychological
concerns in community dwelling older people. American Journal of Geriatric Psychiatry, 21, 1287 – 1291.
Kneebone, I. I., Walker-Samuel, N., Swanston, J., & Otto, E. (Posted online 10 Jul 2013). Relaxation
training after stroke: Potential to reduce anxiety. Disability and Rehabilitation.
Kneebone, I. I., & Jeffries, F. W. (2013).Treating anxiety after stroke using cognitive behaviour
therapy: Two cases. Neuropsychological Rehabilitation, 23(6), 798 – 810.
Kneebone, I., Stone, N., Robertson, S., & Walker-Samuel, N. (2013). Screening for depression after
stroke: Occupational therapists performance to protocols. Occupational Therapy in Mental
Health, 29(2), 106-113.
McGurk R., & Kneebone, I. I., (2013). The problems faced by informal carers to people with aphasia
after stroke: A literature review. Aphasiology, 27(7), 765 – 783.
Phillips, J., Kneebone, I. I., & Taverner, B. (2013).Breaking bad news in stroke rehabilitation:
A consultation with community staff of a stroke team for early discharge. Disability and
Rehabilitation, 35, 694-701.
Master, S., (2013) Advisor profile: Selina Master Dental Advisor to the Down’s Syndrome
Association, 129, 20.
Peers, T. and Feltbower, T (2013) “Male Sterilisation” in Briggs, P. et al. (ed.) Contraception, a
casebook from menarche to menopause. Cambridge University Press.
22
CQC: What patients told inspectors
Community Nursing (Chertsey): “I’m more
than satisfied; I look forward to their visits”
and another person told us “The staff have
been brilliant and helpful”
Jarvis Breast Screening: “Everything has been
perfect as far as I am concerned”
Community Nursing (Surrey-wide):“Patients
who all told us that they thought the care
that they received was ‘Excellent’ and that all
of the staff were ‘lovely’.”
Haslemere Hospital: “The nurses are
marvellous here, they look after me so well”,
whilst another patient said: “It’s like being in a
hotel, I get everything I could possibly want.”
Milford Specialist Rehabilitation Hospital: “I’m
wonderfully looked after here, they can’t do
enough for me, just so kind“, while another
patient said “The hospital staff are lovely and
care for me. I cannot praise them enough,
they are wonderful“.
2.6 Statements from the CQC
2.8 Data quality
Our services are required to register with the Care Quality Commission (CQC) and we have no
conditions attached to our registration. Our services have not participated in any special reviews
or investigations by the CQC during the reporting period.
Virgin Care Services Limited submitted information during 2013/14 to the Secondary Uses Service
(SUS) for inclusion in the Hospital Episode Statistics which are included in the latest published data.
The following service inspections were conducted by CQC across Surrey – 1st April 2013 to 31st
March 2014:
Community service outpatient data for SUS submissions is being validated to ensure on-going
submissions are confirmed as being successful.
The percentage of records in the published data, which included the patient’s valid NHS Number was:
Registered location
Service
Full
Compliance
Action
Plan
Epsom Dental Clinic
Dental Community services
Met
Nil
Weybridge Hospital
Dental Community Services
Met
Nil
Jarvis Centre
Diagnostics Breast screening Met
Nil
Farnham Hospital
Dental Community Services
Met
Nil
Staines Health Centre
Dental Community Services
Met
Nil
Walton Hospital
Community Hospital
Met 2nd inspection
Yes
Haslemere Hospital
Community Hospital
Met
Nil
Milford Hospital
Community Hospital
Met
Nil
Woking Community Hospital
Community Hospital
Met
Nil
Bournewood House
Community Nursing
Met
Nil
• 100% for admitted patient care;
• 100% for outpatient care; and
• 95.85% for accident and emergency care.
The percentage of records in the published data, which included the patient’s valid General
Practitioner Registration Code was:
• 99.6% for admitted patient care; and
• 98.5% for outpatient care.
Local initiatives to improve data quality
• In June 2013 workshop sessions for the community nurses in North-West Surrey took place to
ensure caseloads are accurate, discharges are completed on the RiO IT system and there are
no duplicate referrals.
• A standard operating procedure template was developed for community nursing and has
been very effective in ensuring that all contacts are recorded appropriately and accurately.
• Service clinical records audit tools have been designed to measure service compliance with
the recording of ethnicity and other equality data and NHS numbers to ensure safe and
effective patient care is delivered.
Our CQC reports of inspections can be viewed on their website: www.cqc.org.uk
2.7 Safeguarding statement
• We are committed to safeguarding and promoting the welfare of adults, children and young
people and to protect them from the risks of harm. The organisation has in place safeguarding
guidance and practices in line with statutory and national requirements.
• Our Clinical Governance and Safeguarding Committees provide Board assurance that our
services meet statutory requirements.
• Named professionals are clear about their roles and have sufficient time and support to
undertake them.
• Where appropriate, services have submitted a Section 11 review and action plans are
monitored across the organisation at Committee and Board level.
• Safeguarding policies and systems for children and vulnerable adults are up to date and robust.
All appropriate staff have undertaken and are up-to-date with safeguarding training at Level 1,
2, 3 and 4. This is included in induction and integral to the organisation’s training policy.
24
25
2.9 Information Governance toolkit attainment levels
Our Information Governance Assessment overall score for 2013/14 was 71% and was graded satisfactory
An action plan for 2014/15 will improve our score and includes:
• Continual review of IG policies and procedures to ensure that they are fit for all services.
• Further roll out of confidentiality audits across services.
• New module being developed on an internal IT reporting system to improve the monitoring of
subject access requests and improved timeliness and completeness of responses.
• On-going development of information risk management processes including mapping and
information asset management.
• Information security management system review.
2.10 Independent service reviews
Representatives from the Cancer Screening Programme Quality Assurance team visited the Jarvis
Breast Screening Centre in November 2013 and concluded that ‘The Unit has a very good Quality
management System, being ISO accredited, and is held up to others as the standard to aim for’.
The Jarvis Breast Screening Centre also had its three-yearly Multidisciplinary NHS Breast Screening
Programme (NHSBSP) Quality Assurance visit during November 2013. It was reported that the Unit
‘regularly exceeds the minimum standard for Screening Round Length with over 96 per cent of
women being re-invited for screening within 36 months of their previous screening episode in each
of the previous three years’.
HMP Coldingly and HMP Downview received unannounced
visits by Her Majesty’s Inspectorate of Prisons (HMIP) and
the CQC during the reporting year. They found that at HMP
Coldingly ‘prisoners received a very good level of health
care and that they were very satisfied with the quality of
care. In general they had easy access to services, which
included specialist staff trained to meet the requirements of
the population.
At HMP Downview prisoners were found to have ‘good
access to primary care services and a wide range of
clinics and services were provided’. When the Inspectorate
surveyed the population, 70 per cent of women said it was
‘easy’ or ‘very easy’ to see a nurse and 44 per cent rated
the overall quality of health services as ‘good’ or
‘very good’. Both of these results were better than in
comparator establishments.
An external review was commissioned by NHS England of the in-patient department at HMP
High Down prison. Recommendations will be available shortly and the service received positive
verbal feedback.
26
Community Hospital PLACE reviews Patient-led assessments of the care environment (PLACE)
assessments put patient views at the centre of the assessment process, and use information
gleaned directly from patient assessors to report how well a hospital is performing in the areas
assessed – privacy and dignity, cleanliness, food and general building maintenance. It focuses
entirely on the care environment and does not cover clinical care provision or staff behaviours.
Hospital
Cleanliness
Privacy
Dignity
Wellbeing
Action Plan
Condition
appearance &
maintenance
Site average
Farnham
99.02%
92.01%
86.42%
92.16%
92.40%
Milford
91.74%
88.10%
84.00%
73.53%
84.34%
Walton
97.00%
91.76%
90.11%
75.26%
87.80%
Woking
97.69%
87.41%
79.49%
81.66%
89.21%
We are working with our commissioners alongside NHS Property Services Ltd to make a number of
improvements to the facilities at Walton and Milford community hospitals, with plans for the work
to be carried out currently being reviewed.
2.11 Service recognition
In July 2013 the musculoskeletal care category of the Care Integration Awards highly commended
Virgin Care’s Community Falls Team, along with Ashford and St. Peter’s Hospitals Foundation Trust,
for the project; Preventing falls in care homes - a multiagency approach.
The ‘Virtual Ward’ was shortlisted at the national Nursing Times awards in October 2013 for the
Nursing in Community category. The virtual ward team was highly commended by the judges for
significantly reducing emergency hospital admissions and increasing the number of shorter stays
in hospital for people with long-term conditions. The team led by four community matrons worked
in partnership with local GPs, social services, specialist nurses, staff at the local acute hospital trust,
the ambulance service, and out-of-hours services to provide patients with seamless care. This
ensures that they are getting the help they need by the most appropriate healthcare professional
in the most appropriate setting.
Virgin Care’s North-West Surrey Physiotherapy Service was short-listed for a Health Service Journal
Efficiency Awards in September 2013 for its Chronic Low Back Pain (LBP) Education Class. The class
improved patient treatment and reduced waiting times by encouraging and supporting patients towards
self-management of chronic low back pain. The initiative reduced patient waiting times by eight weeks
whilst maintaining a high quality of service that led to a 92 per cent overall patient satisfaction rate.
Staff at the Jarvis Breast Screening Centre in Guildford received the Mayor’s Silver Award for
Access. The award was received in November 2013 following nominations from the public and
users of the service. The centre took specialist advice on creating an accessible design and layout
when the premises were recently refurbished and added a hearing induction loop, chairs for
clients with mobility needs along with the capability for translation facilities.
27
Recognising our staff
One of our in-patient managers received the Virgin Care Chief
Nurse Award for her work in palliative care for prisoners. The
Chief Nurse Awards scheme is based on the ‘6 Cs’ outlined by the
Department of Health and recognises the value and the work of
the nursing teams.
The Prison Service Ombudsman has commended the care
given to prisoners who have died from a terminal illness whilst
in custody.
A member of staff from the dental services team based at
Epsom Hospital received an award from Epsom and St Helier
University Hospital NHS Trust. The award was one of the Nursing,
Midwifery and Support Worker Awards which are given following
a nomination for providing exceptional patient care.
2.12 Highlights of quality management systems to support staff
and services
The Learning Enterprise (TLE) has had a very successful and productive year delivering training
and education solutions and student opportunities to the staff.
In the year, 15 Health Visitor students, two community children’s nurse students and one school
nurse student have qualified following successful studies and placements. Additionally, there are a
further 33 students who have commenced their studies in BSc Health Visiting, BSc District Nursing,
BSc School Nursing and BSc Community Children’s Nursing. Education courses produced by TLE
continue to be recognised with the achievement of the ReQ mark award by Surrey University for:
•
•
•
•
•
Managing Emotional Health at Work
Managing Severely Allergic Pupils in Schools
Continence Team Male Catheterisation
Equality and Inclusion
Infant Feeding
A number of additional courses were submitted in March 2014 and results are awaited for:
•
•
•
•
•
•
HCA core care skills programme
Continence enhanced bowel care
Sexual Health Intervention and Promotion Team - National Chlamydia Screening Programme
Raising awareness of clinical supervision
Urgent care – measurement and recording of ECG’ s
Urgent wound care
TLE continues to develop e-learning modules that are available to staff remotely online and offer
access to extensive CPD courses via a number of local universities. The CPD courses are available
to all Surrey staff and include courses in:
• Complex Health Assessment
• Health Assessment
• Leading and Managing Long Term Conditions
• Chronic Wound Management
•Mentorship
• Nurse Independent/Supplementary Prescribing
• Personal and Professional Development
• Research Design and Methodology
TLE has also developed an innovative induction programme of learning for all new staff. This
includes all key Statutory and Mandatory learning modules provided as e-learning to facilitate
fast ‘on-boarding’ of new staff, practical courses where appropriate and a detailed welcome
to the organisation ensuring new staff are fully informed about essential aspects such as
whistleblowing, incident reporting, fraud and data protection.
Prisons
Joint quality meetings with the HM Prison Service continue to ensure that all providers work
together to improve the prisoner journey, improve health and contribute together towards the
goal of reducing reoffending.
Prison Health staff have benefited from easy access to TLE’s e-learning tool to complete training
in the workplace. Several members of staff have successfully completed degree programmes and
leadership development.
In order to reduce waiting times for dental treatment at HMP Downview prison, our Head of
Healthcare worked jointly with prison staff and the dental team to facilitate those who could
be released on temporary licence to attend a local dental practice. This improved patient
satisfaction and reduced waiting times.
Dental
The Virgin Care Community Dental Services
introduced a Central Referral & Triage Centre,
which provides a central point of access for
referrals into the service. The new system was
introduced at the beginning of November 2013 to
give the service better visibility of the number of
referrals being received, improve waiting times and
give patients more choice of where they would like
to be seen.
Sexual and Reproductive Health Services
Our Sexual and Reproductive Health services have been involved in the organising and delivery of
training for doctors and nurses in conjunction with the Faculty of Sexual and Reproductive Health.
This has included running courses including the Diploma in Reproductive Health, the Letters of
Competence for Subdermal Implant contraceptive technique and Letters of Competence in
Intrauterine Devices as well as Medical Education.
• Advanced Assessment and Diagnostic Reasoning
• Community Practitioner Nurse Prescribing
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29
Community Hospitals
A main medicines stock list review took place across our community hospitals, with the aim of
ensuring all medicines are in line with current national and local formulary recommendations,
service specifications and clinical governance arrangements. This also helped to ensure that
cost-effective medicine choices are made and that stock is kept at a level adequate for patient
requirements but which reduces waste.
In order that staff within the Children’s Services can have a greater understanding of being the
parent of a child with profound disabilities, three patient insight DVDs have been produced. The
DVDs relate to how a profound disability as a result of being born prematurely can affect not just
the child, but also their parents and siblings and the impact the potential need for 24 hour nursing
care has on a family. The DVD aims to build up awareness within the Children’s Service of the
patient’s point of view, but also to recognise what staff can do to improve the service they provide.
Haslemere Hospital has reduced its stock levels by 50 per cent by centralising storage rather
than maintaining two complete medicines stock lists on each ward. Similarly, Woking Hospital has
initiated a shared medicines list across three wards.
Virgin Care and the NSPCC are implementing a Coping with Crying Project that aims to prevent
non accidental head injuries in infants. There are six Health Visitor Champions who will be
delivering this intervention as part of young parents groups and supporting teams with delivering
the intervention at antenatal contacts.
Community Based Adult Services
Community Heart Failure Nurse Specialists have continued to develop their practice through
their involvement in the Department of Health recognised Enhancing Quality Programme for the
Management of Heart Failure for Kent, Surrey and Sussex. This is a programme closely linked with
NICE Guidelines to demonstrate clinical quality and improve patient outcomes.
A set of quality metrics was developed to measure optimal drug therapy, information given to the
patient to aid self-care, care planning and end of life care. Working with Ashford and St Peters
Hospital and The Royal Surrey County Hospital the team has been able to capture information on
all patients referred into the Heart Failure Service enabling them to measure themselves against the
metrics developed and then share anonymised data with the other teams across Kent, Surrey and
Sussex. This data has shown continuous improvement in all areas during 2013/14. This is an on-going
programme which is now working on reporting patient experience and readmissions to hospital.
Children’s Services
Paediatric therapies have combined nine different referral forms from the three services
(occupational therapy, physiotherapy and speech and language therapy) into one, making the
referral pathway for GPs and others simpler and faster.
They also successfully negotiated a new model with Surrey County Council for supporting the
Special Educational Needs (SEN) tribunals and enhanced occupational therapy and speech and
language therapy services to Local Authority Education.
The 0-19 Health Visiting Services have been able to ensure all health visitors and health visitor
students having access to corporate membership of the institute of Health Visiting (iHV).
The 0-19 Health Visiting Services were also successful in their application to participate in the
NHS England bespoke one-to-one support scheme. Virgin Care was selected as one of only three
providers receiving this support in the whole of the South Region. This provides an opportunity to
look at the challenges of HV workforce retention and share subsequent learning outcomes.
Surrey Children’s Services managers have been working closely on the new integrated delivery
of services to children with Special Educational Needs and Disabilities (SEND). Surrey is part of
the pathfinder group (‘SEND 14’) of local authorities who are leading the implementation of the
new way of assisting children with special needs with their education, health and care needs. This
will replace the Statement of Special Education needs when the new Children and Families Bill
becomes law in 2014. Instead of a Statement of SEN children will have an ‘Education, Health and
Care Plan (EHCP) that will encompass their health and care needs as well as any additional help
they’ll need at school.
30
31
Sexual Health dual testing
The team from Sexual Health Surrey have
undergone training to enable them to
provide dual screening for Chlamydia
and Gonorrhoea as part of their testing
programme. Chlamydia and Gonorrhoea are
the two most common sexually transmitted
infections (STIs) and, while both infections
can be fully treated, they can have serious
consequences including infertility if untreated.
It was identified by the team that a dual
screening process that tests for both STIs at
the same time would be the most effective
way to combat the lower awareness
about Gonorrhoea and address the recent
increase in cases, which Public Health England
reported is growing by about 10% a year. It’s
hoped that the increase in screening as part
of this programme will help to slow down the
spread of STIs.
2.13 Highlights of initiatives to improve user experience
and feedback
Urgent Care Team
The NEWS (New Early Warning Score) Tool is used to ensure that there is early communication
with patients in their patient journey. This speeds up the patient journey which in turn encourages
appropriate use of out-of-hospital care.
The team also developed a card for patients explaining the service, giving Lead Nurse contact
details, advising how to raise concerns generally, and what to do if they felt progressively unwell
whilst waiting to be seen and treated.
Dental
All dental information leaflets for patients and carers have been updated.
Sexual Health Services
The Guildford Hub clinic moved into new and improved premises at Buryfields, Guildford. This clinic
has also extended the test results line from three to four times a week and now has contraception
services available in all three of its walk-in clinics and three bookable days each week.
Following requests from service users, signage was improved and posters introduced. Appointment
cards were redesigned to include only essential information, enabling more room for larger
lettering. A numbering system has also been introduced in several walk-in clinics to ensure people
are seen in turn.
Breast Screening
In January 2014, to meet the NHS Breast Screening Programme key performance indicator, the
Jarvis Centre redesigned its clinics to create a more accessible layout, adding a hearing induction
loop and new chairs for clients with mobility needs.
Community Hospitals
The Butterfly scheme has been introduced to all of our community hospital wards and the South
Rapid Response Team (one of the first community based schemes nationally) with the aim of
increasing the quality of care offered to patients with dementia and their carers.
Haslemere Hospital has had work carried out to upgrade and refurbish its facilities and all
inpatient neuro-rehabilitation services were brought together into one site at Woking, both of
which have improved patient experience.
The average length of stay in our Community Hospitals has reduced by 10 days in 2013/14.
Community Adult Services
A comprehensive feedback project on the patient carer experience was undertaken by an
external consultancy “Where There’s Smoke” and a team from across Virgin Care to help define
and develop the role of our community nurses. The aim of the project was to make the service
better for patients and staff alike by defining what the ideal patient journey would entail and to
then provide objectives and means for making this a reality. Following “Where There’s Smoke”,
name badges with larger writing for those with impaired vision were introduced.
33
You Said, We Did dual testing
We made more than 350 improvements to
our services in Surrey last year, both big and
small, as a direct result of patient feedback.
Parents of patients cared for by our Children’s services team
in Surrey told us:
They didn’t want their children with Down Syndrome to miss
school for healthcare assessments.
In response we:
Now come to them to conduct 100% of the assessments in
schools, so the children don’t miss out.
The Respiratory Care Team has worked with St Peter’s Hospital to improve admission and
readmission rates for patients with chronic respiratory disease. The Respiratory care team has
optimised in-patient treatment, provided an early discharge scheme for appropriate patients and
supported all patients on discharge.
A quarterly dashboard produced by the Quality Observatory illustrating rates of COPD admissions
and readmissions to acute trusts as well as length of stay shows there has been a sharp reduction
in 90 day readmission rates to St Peter’s Hospital which was approximately 40 per cent in 2012/13
and is currently around 30 per cent. There has also been a reduction in 30 day readmissions and
this is currently 19 per cent which is lower than the regional and national average and is still falling.
Children’s Services
All children attending a special needs school with Downs Syndrome are now seen in the school by
special school nurses instead of attending paediatric outpatients’ clinics.
Coverage for New Born Hearing Screening is 98% which is nationally considered outstanding
Nursery nurses as well as health visitors at dedicated clinics for babies who fail the new-born
hearing test are now trained in the Otto Acoustic Emission testing. This has improved the pathway
and reduced waiting times for anxious parents.
The 0-19 Health Visiting Services team passed the UNICEF Baby Friendly Initiative Stage Two with
outstanding results and has been asked to submit early for stage three.
Patients in our End of Life service told us:
They did not understand how to ensure their affairs were in
order and that this was causing them stress.
0-19 Health Visiting Service has liaised with and secured funding from the Local Authority and
Youth Services to deliver an intensive antenatal programme to vulnerable teenage parents.
In 2013 further engagement with and support for health visitors working with other child-in-need
Local Authority area teams and youth workers expanded the programme from one to three areas
of deprivation.
In response:
Now our bereavement group holds wills and probate sessions to
help patients ensure that everything is in order.
In an annual satisfaction survey to schools, 88% of staff responders agreed or strongly agreed
they were satisfied with the overall quality of speech and language therapy intervention in the
North West Surrey locality. Positive responses to this question have more than doubled since 2012
(41 per cent).
Patients at Farnham Community Hospital told us:
Their meals sometimes got cold quite quickly.
In response we:
Introduced plate warmers so the food now stays warmer
or longer.
Prisons
The Prisons team rolled out a Pain Management Review clinic ensuring clinically appropriate
management of pain, reducing prescribed medication with addictive potential, increasing safety
within the prisons as reduces the abuse of prescribed medication by trading.
The team also improved patient experience for a renal patient by negotiating with the renal team
at the local hospital to provide a dialysis machine for the prison and facilitate staff training. This
allowed the patient to receive dialysis in prison so improving privacy and dignity.
In addition the Prisons team is currently undertaking a number of user involvement projects to
run alongside the Net Promoter Score. A patient satisfaction metric is currently in circulation and
wing-based focus groups are in the early stages of providing the patient a voice in determining
the direction of prison-based healthcare in the future.
35
Patients in both our Breast Screening clinic told us:
The quietness in the waiting room added to their nervousness.
In response we:
Now play music in the waiting rooms to help make patients
more relaxed.
Patients in our End of Life service told us:
It makes a huge difference to them when we cut the crusts off
their sandwiches as some of them struggle chewing.
In response we:
Now offer to cut the crusts off patients’ sandwiches.
Patients using our wheelchair services told us:
They wanted lighter wheelchairs.
In response:
we changed the supplier of wheelchairs to one that means we
are able to offer patients lighter models.
The Innovation Fund
The Innovation Fund is available to all Virgin Care services operating across Surrey. Each year
a protected amount of money is set aside for frontline staff to put forward ideas for improving
services. In 2013/14 the following projects received funding to help transform and improve services
across Surrey:
Service
Improvement project
Community Hospitals
Printed cable ties have been introduced to ensure that bed rails
are used appropriately and to improve patient safety
Community Hospitals
Safe Slippers to Save Slippers scheme has been introduced to ensure
that patients are able to access safe footwear and reduce falls risk
Children’s Services
Pilot language enrichment programme into pre-school settings
Children’s Services
Review of the way baby clinics are run
Children’s Services
Developing access to health information via websites and apps
Children’s Services
A baby change unit was added in to the toilets at Ashford clinic to
provide a safe place for parents to change their babies ready for
the baby clinic
Children’s Services
Six iPads with educational apps were introduced to the speech
and language therapy service to support assessment and
education of parents and children
Children’s Services
New assessment tools and toys have been introduced across the
speech and language therapy services in North-West Surrey
Children’s Services
Nursing baby resuscitation equipment has been purchased
to support the training for parents in their own homes on
resuscitation techniques
Community Adult Services Create of a website that reflects the excellent service that Virgin
Care’s First Steps service delivers. To provide a website that is easy
to use for members of all communities, has up to date relevant
information, looks and feels inviting and modern and that First
Steps can be self sufficient in its maintenance
Community Adult Services Development of electronic record for the Beacon Service
Rehabilitation and
Therapies
Physiotherapy purchase of up to date books and charts to use
with patients
Community Adult Services Purchase of equipment to provide refreshments for patients at
group sessions in the community
Rehabilitation and
Therapies
The Speech & Language Service purchased a laptop to use with
tools to improve therapy outcomes. Rehabilitation and
Therapies
Implementation of an IT system in the Wheelchair Service to improve
speed of ordering and maintenance.
37
Part 3
Reducing DNAs in Prison dual testing
An overview of the quality of care offered by the Provider based on performance in 2013/14
against indicators selected by the Board in consultation with stakeholders
3.1 Review of quality performance
A proportion of Virgin Care Services Limited income in 2013/14 was conditional upon achieving
quality improvement and innovation goals agreed between NW Surrey CCG. As a result of
successfully achieving quality improvement targets which complement our priorities for improving
quality, we met our contract requirements in 2013/14.
Key Performance Indicators 2013/14
KPI and quality
improvement targets
2013/14
Target
Full year
VTE Risk assessment
100
Achieved
Dementia screening
100
Achieved
Dementia risk assessment
100
Achieved
Dementia referral for
specialist Diagnosis
100
Achieved
Data Collection and
submission linked to
Safety Thermometer tool
100
Achieved
Patient Experience:
5 ‘responsiveness
to inpatient needs’
questions
Component 1 (involvement in decisions)
Component 2 (talking about concerns)
Component 3 (privacy when discussing treatment)
Component 4 (medication side effects when you
went home)
Component 5 (who to contact after you left hospital)
‘yes’ score
Final score for full year not available at time of print.
Community Hospitals
There were no breaches against admissions to single sex accommodation.
No reported MRSA Bacteraemia.
No reported C-Difficile cases.
Virgin Care community services will continue to work in partnership with its commissioners and
acute hospitals going forward in 2014/15 to support delivery of CQUIN and contract targets.
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The Primary Care team at HMP High
Down ran a focus group with patients to
explore why there were so many missed
appointments. The feedback from patients
was that they were not getting their
appointment slips in a timely fashion, which
meant that very often they had conflicting
commitments.
In response, an administrator from the
healthcare team delivers the slip at lunch
time to individual cells and they check with
each prisoner on the wing that they have
received their appointment and if they are
attending. If they are not attending, they
complete a cancellation form straight away,
which then means the slot can be rebooked
from the waiting list. This new system is
reducing DNA’s, but also prisoners are happy
as they are receiving timely notice of their
appointments and given an opportunity to
change them if required.
3.2 Services highly valued by customers and staff
Urgent Care Team
A local Member of Parliament has fed back that his constituents are regularly advising him that
the community Walk-in Centres are highly valued.
Staff survey results have been overwhelmingly positive about the team and the service. They
identified that they would like increased joint training and have had three events since. Staff
valued the opportunity to work in different roles and develop new skills. IT changes to patient
software were requested and these have in part been completed.
Community hospitals
We worked with teams to theme the results of the staff survey. Staff prioritised what they wanted to
see happen. Updates on actions each month are included in monthly newsletters to staff.
3.3 Customer experience in Surrey 2013/14
In 2012 we decided that we should make it easier for patients and carers to tell us about their
experiences. The recommendations of the Francis report have helped us to continue to improve
that approach and the challenge for us is still how we are able to get the views of patients and
carers where we provide a domiciliary service. We have written to a number of patients in the
homes asking whether they would like to speak to our Patient Advice and Liaison Team regarding
their views and we are just about to embark on a similar process for parents in regard to the
Health Visiting service. We want to ensure that people feel confident about giving frank and
constructive feedback without fear of reprisal.
You said: the paediatric audiology unit in Woking looks shabby and old
We did: we replaced the door and improved the condition of the unit
With our token box system and You Said We Did, at Virgin Care we put the people we serve at the
heart of our service innovation.
Our other emphasis has been on how we share the learning from comments and complaints, both
with patients and carers and also with other staff. We have encouraged all teams to utilise action
plans after all complaints (be they formal or informal).These are reviewed at the various Quality
meetings which has raised their profile with more services adopting a diligent approach to them
but there is still room for improvement. We continue to emphasise the importance of letting our
patients know that we do take their concerns seriously and take appropriate action wherever
possible. As part of this work we have recently invited three patients who had complained back to
the service to see what improvements have been made as a result of their feedback.
To assure our processes
We carried out a review of our complaint handling, contacting 100 complainants to ask them their
view of the process. As a result of the responses, we are making it more evident that complainants
can ask for a meeting at any stage and we are telephoning as many complainants as possible
following receipt of their complaint.
We carried out videoed interviews of parents of children with profound disabilities where they talk
about the impact of the conditions on their lives and that of their families and we are using these
in our staff training. We are preparing to carry out more of these through 2014.
You Said We Did
We drive innovation by listening and responding to what patients have to say. Our token box
system, introduced in 2010, allows people to tell us quickly and anonymously what they think of
our services. Patients are given a token which they post into a slot numbered one to ten on how
likely they are to recommend the service to friends and family based on the service they received.
Comments cards are provided for additional feedback. This was developed by responding to an
idea suggested by someone using one of our services and produces a Net Promoter Score.
Community Adult Services
Patient Questionnaires are carried out on discharge from service and face-to-face discussions take
place with patients/families that have made complaints. The team manager shadows staff once a
month accompanying them on patient visits and obtains feedback form patients and their families.
To reassure patients that their comments are acted upon, in 2012 Virgin Care introduced ‘You Said
We Did’ which is reported by all services each month. This is where services show the changes they’ve
made to improve the patient experience as a result of themes identified from patient comment
cards. Examples of patient feedback received in year resulting in positive changes include:
Sexual Health Services
A service user satisfaction survey of the Sexual Health Services in November 2013 revealed a
“Dignity Always” composite score across Surrey of 98% on average. The score was based on the
results of six questions asking patients if they felt they had been treated with dignity and listened
to carefully, were given enough time and privacy, had treatment options explained to them and
were involved in decisions regarding their treatment. Additional comments also described the
service as “amazing” and “life-saving”.
You said: Not enough appointments available at 8am
We did: Changed the rota to make appointments with a GP available from 8am
You said: Difficult for vulnerable clients to access a service
We did: Developed ‘Hard to Reach’ team of two nurses who provide support in the community to
minority groups and vulnerable young people and adults
The team manager has also attended local League of Friends Meetings to hear feedback from
members of the public.
Children’s Services
In paediatric audiology, patient satisfaction scores are consistently above 90%.
You said: Crusts on sandwiches are difficult to chew
We did: Removed sandwich crusts
You said: Delays in repeat prescriptions
We did: Introduced a repeat prescription form to be filled in five days before prescription is due
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41
Appendix 1
Glossary of terms
Term
Explaination
Care Quality Commission
The Care Quality Commission (CQC) replaced
the Healthcare Commission, Mental Health Act
Commission and the Commission for Social Care
Inspection in April 2009.The CQC is the independent
regulator of health and social care in England.
It regulates health and adult social care services,
whether provided by the NHS, local authorities,
private companies or voluntary organisations.
Visit: www.cqc.org.uk
Clinical audit
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Clinical audit is a quality improvement tool that
compares current care with evidence-based practice,
to identify areas that have the potential to be
improved, for consistently safe, clinically
Commissioning for Quality
and Innovation(CQUIN)
Visit: www.dh.gov.uk/en/Publicationsandstatistics/
Publications/PublicationsPolicyAndGuidance/
DH_091443
Community services
Health services provided in the community, for
example health visiting, school nursing community
nursing, special dental services, physiotherapy,
podiatry (foot care).
Healthcare
Healthcare includes all forms of healthcare provided
for individuals, whether relating to physical or mental
health, and includes
HQIP
Healthcare Quality Improvement Partnership
Visit: http://www.hqip.org.uk/
National Institute for Health and
Clinical Excellence
The National Institute for Health and Clinical
Excellence is an independent organisation
responsible for providing national guidance on
promoting good health and preventing and treating
ill health.Visit: www.nice.org.uk
Net Promoter Score
This is a way of collecting user experience at the time
of their care. A green disc is given to the service user
or their carer and they have the opportunity to drop
it into a series of slots numbered 0 -10 on a token box,
which best reflects how they felt about the service. At
the end of each day the discs are added up and an
overall score is given to that service in a report.
NHS Outcomes Framework
2012/13
This is the document which sets out the outcomes
and indicators that will be used to hold all providers
of healthcare to account and provides the financial
planning and business rules that support the delivery
of NHS priorities.
Patient reported outcome measures
These are self-reports from patients which tell us
if they felt satisfied in terms of treatment and
services given.
PALs
Patient advice and liaison service.
Virtual ward programme
The “virtual ward” programme provides multidisciplinary case management services to people
who have been identified, using a predictive model,
as high risk for future emergency hospitalisation.
Virtual wards use the systems, staffing, and daily
routine of a hospital ward to deliver preventive care
to patients in their own homes.
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How to provide feedback on the account?
We welcome comments on how to continue to improve our Quality Account.
Any feedback can be sent to: communications@virgincare.co.uk
Quality Account team
Virgin Care
Lynton House
7-12 Tavistock Square
London, WC1H 9LT
www.virgincare.co.uk
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