First-rate people. First-rate care.
First-rate value.
Quality Account 2014/15
02
CONTENTS
PREFACE
About our Quality Account
What is a Quality Account and why do we produce one?
How have we involved our stakeholders in our Quality Account?
What does our Quality Account include?
PART 1: INTRODUCTION
04
04
04
04
04
About First Community: Who are we and what do we do?
Our values
Our services
Introduction from our Managing Director
05
06
07
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10
PART 2: OUR PRIORITIES FOR IMPROVEMENT
13
Looking back
• Priority 1: Patient safety
• Priority 2: Clinical effectiveness
• Priority 3: Patient experience
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15
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Looking forward
• Priority 1: Patient safety
• Priority 2: Clinical effectiveness
• Priority 3: Patient experience
• Priority 4: Staff experience
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Statutory statements of assurance
Review of services
• Participation in clinical audit
• Reviewing reports of national and local clinical audits
• Participation in confidential enquiries
• Research
• Goals agreed with our commissioners (CQUINs)
• CQC
• Data quality
• NHS Number and General Medical Practice code
• Clinical coding error rate
• Information Governance Toolkit attainment level
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PART 3: REVIEW OF THE QUALITY AND PERFORMANCE
OF OUR SERVICES
28
New services for 2014/15:
• Stroke review service
• Speech and language therapy for people with dementia
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Overview of our services:
Patient safety
• Adult Safeguarding
• Children’s Safeguarding
• Safety Thermometer
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31
• Incident reporting
• Medicines management
• Infection Prevention and Control
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Clinical effectiveness
• Online access to Royal Marsden Manual of Clinical Nursing Procedures
• Annual Quality Improvement Day
• Examples of quality improvement
• NICE
• Productive Community Services
• Enhancing Quality Initiative
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38
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Patient experience
• Parkinson’s Practitioner
• Complaints and compliments
• Waiting times
• Baby Friendly Status - UNICEF
• Health Visitor ‘Call to Action’
• Conversation Partnership Scheme
• Patient satisfaction surveys/Friends and Family Test with iWantGreatCare
• The Information Standard
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Staff Experience
• Council of Governors
• Staff survey with iWantGreatCare
• Appraisal
• Behaviours Framework
• Clinical supervision
• Learning and Development
• Developing our leaders
• Publications
50
STATEMENTS
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Statements from our commissioners (East Surrey Clinical Commissioning Group)
Statement from Healthwatch Surrey
Statement from the Health Overview and Scrutiny Committee
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GLOSSARY AND FEEDBACK
60
03
04
Preface
About our Quality Account
What is a Quality Account and why do
we produce one?
Each year all providers of NHS healthcare
are required to produce a Quality Account
to inform the public about the quality of
the services they provide. It follows a set
structure to enable direct comparison with
other organisations.
It enables us to share with the public and
other stakeholders:
• what we are doing well
• where we can make improvements in
the quality of the services we provide
• how we have involved our service
users and other stakeholders in
evaluation of the quality of our services
and determining our priorities for
improvement over the next 12 months
• how we have performed against our
priorities for improvement as set out
in our last Quality Account. For each
of these priorities we will tell you if we
have delivered them and how we
know this. If we have not delivered
any we will tell you how/why not and
what we will be doing in the future to
address this.
How have we involved our stakeholders
in our Quality Account?
We welcome the views of our
stakeholders in the development of our
account and have consulted with a broad
range of stakeholders, including our
commissioners, Healthwatch Surrey and
our Community Forum asking them to tell
us what is important to them, their thoughts
on how we presented our information
last year and what they would like to be
included in our account going forward.
Our published Quality Accounts are
also available for public scrutiny on our
website here.
What does our Quality Account include?
Our Quality Account is divided into four
sections:
Part 1
Part 1 gives a statement of quality from
the Managing Director with an introduction
and overview of who we are, what we do
and why we produce this annual account.
In Part 2 we look at our priorities for
improvement in the quality of our services.
We start by looking back at each of the
three priorities we set last year, reviewing
our progress and outlining our plans for
future development.
We then look forward, setting new
priorities for improvement for the coming
year. The priorities, both looking back
and looking forward, reflect the three
domains of quality to ensure a balanced
view of the services we provide: patient
safety, clinical effectiveness and patient
experience. First Community recognise
the importance of staff engagement,
satisfaction and development in the
provision of high quality services. We
have, therefore, included a fourth priority
for improving our staff experience.
Part 1:
Introduction
We then provide statutory statements
of assurance which relate to the quality
of the services we have provided in the
period 1st April 2014 to 31st March 2015. The
content is common to all NHS providers,
allowing direct comparison across
organisations.
Part 3 gives us an opportunity to review
the quality and performance of our
services. This is set out around the three
domains of quality: clinical effectiveness,
patient safety and patient experience and
reflects the Care Quality Commission’s five
key lines of enquiry. Essentially these are
questions asking:
• Are we safe?
• Are we effective?
• Are we caring?
• Are we responsive to people’s needs?
• Are we well-led?
Glossary of terms: We have included
a glossary of terms (page 60) which
explains some of the terminology used.
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06
About First Community
Who are we and what do we do?
First Community Health and
Care Community Interest
Company (CIC) is a notfor-profit social enterprise,
providing community
healthcare services to
people living in east Surrey
and parts of West Sussex.
First Community Health and
Care is still part of the NHS
family and continues to
deliver NHS services, but
any profit is used for the
benefit of the community.
We are constantly striving
to improve services for our
community, and our passion
is to deliver the highest
quality of care for our
patients, service users and
carers.
As a Community Interest
Company, we are an
employee owned, not-forprofit organisation. Every
member of staff is invited
to become a shareholder.
This doesn’t mean they
receive a financial dividend if
the organisation is successful.
Rather, it is a symbol of their
commitment to patient services
and gives them a formal voice,
through the elected Governors,
to help make decisions on
how money is reinvested,
developing existing services
with our commissioners for the
good of the community.
We are passionate about the
communities where we work
and we really do put the
community first.
We connect with the
community through our
Community Forum; a network
of groups and organisations
linking together to ensure we
provide the best possible
service locally.
Our aim is for people to stay
in their own home, promoting
independence, well-being
and preventing unnecessary
hospital admission.
Mission
Values
Services for our community
How will we behave?
• Enable people to maximise their
health and well-being potential
We will provide
• Meet and exceed quality and
safety requirements
First-rate care
•P
revent unnecessary hospital
admissions and facilitate hospital
discharge
• Caring
• Deliver integrated services with a
single point of access
• Empathetic
Business capability
First Rate Value
• Be customer focused at all
levels within the organisation
(commissioner and patient)
•D
evelop our business skills that
allow First Community Health and
Care to respond to and shape
market opportunities and threats in
line with our vision and values
We will be
• Conscientious
• Sensitive
• Approachable
We will ensure
• Our customers are valued
• We are skilled in business
• We offer bespoke care
• We are productive and efficient
First Rate People
We will ensure our staff are
• Well trained and knowledgeable
Infrastructure (valuing our staff)
• Become the employer of choice
• Develop IT systems and
infrastructure that maximise service
productivity and patient outcomes
• Use our estate efficiently and
ensure a welcoming environment
for patients and staff
• Using the best care and treatments
available
• Professional and helpful
• Compassionate, caring and kind
• Supported to develop their
potential
Customer Service Excellence
Wherever we can we will ensure
• Patient choice
• Integrated services
• Timely services
• Continuity of care
Vision
To be recognised, respected and
trusted by patients, carers and staff
as the best provider and innovator
of integrated community services.
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Our services
Here is a list of the services we provide with a brief description of what they do. For
further information about the services we provide please visit our website:
www.firstcommunityhealthcare.co.uk/all-services.
Community Nursing: provides a broad range of specialist nursing
interventions and care mainly in the home setting.
Nurse Advisors for Care Homes: provide support, advice and facilitate
training to care home staff.
Heart Failure Service: provides specialist assessment and support to
promote self-management for people with heart failure.
Respiratory Team: a multidisciplinary team providing care for patients with
certain types of respiratory disease.
Specialist Nurses: we have specialist nurses providing care for people with
skin conditions for both children and adults (dermatology), multiple sclerosis
and Parkinson’s disease. We also have specialist nurses who advise and
manage the prevention of infection and wound care.
Rapid Response Service: a nursing therapy rehabilitation service that
can respond within two hours to facilitate patient discharge and to support
patients at home to prevent unnecessary admission to hospital. Patients can
be in their own home or in rehabilitation beds in nursing homes.
Podiatry: formerly known as chiropody, podiatrists assess and treat a range
of foot problems.
Orthotics: assesses patients who have a weakness or deformity in a part of
the body as a result of a long term condition to see if provision of an orthotic
appliance e.g. splints, braces, calipers, would help improve mobility and
support the affected area.
Community Neurological Rehabilitation Team: consists of a range of
therapists with specialist rehabilitation skills to assist people with neurological
conditions (e.g. stroke, brain injury, multiple sclerosis) to maximise their
independence particularly after a hospital admission.
Integrated Care and Assessment Treatment Service (ICATS): provides
assessment and diagnosis of joint and muscle injury or conditions such as
arthritis, back pain and other joint problems.
0-19 Universal Children’s Services: Health Visitors, School Nurses, Staff
Nurses, Community Nursery Nurses and Administration Support Workers
working together with children and young people and their families, offering
advice and information to support their health, development and well-being.
Audiology: provide specialist assessment and diagnosis for people with
hearing loss and balance problems and provide appropriate support such
as digital hearing aids and specialist advice.
Caterham Dene Ward: a 28 bed inpatient ward for people aged 18 years
and over requiring a period of rehabilitation after illness, injury or for certain
conditions. Admission to the ward prevents such patients being admitted to
the main acute hospital and enables them to return home after a period of
assessment and treatment provided by a close-working, multi-disciplinary
team.
Nutrition and Dietetics: provide a service in community for children and
adults. As Registered Dietitians, the team assesses, diagnoses and treats
dietary and nutritional problems for people with a range of conditions
including diabetes, unplanned weight loss, enteral nutrition, gastroenterology
issues, allergies or intolerances.
Rapid Assessment Clinic: a GP, community nurse or ambulance crew may
refer patients here for assessment, investigations (such as blood tests and
X-rays) and treatments to prevent them from being sent to an Emergency
Department of a hospital or being admitted to hospital for treatment such as
a blood transfusion.
Occupational Therapy: provides a holistic assessment of how an illness or
disability affects an individual’s daily life and helps the individual overcome
these.
Minor Injuries Unit: for people aged 18 years or over with minor injuries that
cannot be managed by GP or practice nurse.
Physiotherapy: provides specialist assessment and treatment to help
restore movement and function when someone is affected by injury, illness or
disability (such as heart attack, back pain, broken bones or arthritis).
Speech and Language Therapy: provides specialist assessment and
advice to both patients and carers for speech, language, communication
and/or swallowing difficulty.
Proactive Care Team: the Community Matrons aim to work with patients to
plan, develop and implement a personalised care plan, which will be tailored
to their health needs and support them to manage their long term conditions
safely and effectively. They co-ordinate the patient’s care and liaise closely
with GPs and other community services, to ensure patients receive the right
care, in the right place at the right time.
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Introduction
From our Managing Director
It gives me great pleasure
to introduce the Quality
Account for First Community
Health and Care covering
the reporting period 1st
April 2014 to 31st March
2015. The Report provides
an overview of the
arrangements we have in
place for monitoring and
improving the quality of our
services, a review of our
services over this last year,
including areas where we
need to improve, and our
priorities for improvement
for the reporting period 1st
April 2015 to 31st March 2016.
We are committed to
continually building on our
quality priorities. To improve
patient experience, we
have introduced our
‘patient stories’ and
‘customer care training’
for all of our staff. We
have addressed services
with longer waiting times
such as Dietetics, Speech
and Language Therapy
and Audiology. We
continue initiatives such as
Enhancing Quality and the
Safety Thermometer and
are 97.2% harm free. There
is further information on all
of these in our account.
Our staff experience is
core to our values and
we know that our staff are
committed to providing
the best possible care
for patients. We have
invested in our commitment
to be ‘first rate people’.
We have developed a
Behaviours Framework to
support staff in working
to our values. This takes
forward our priority for
improvement about
appraisal and personal
development plans. It
continues our commitment
to clinical supervision,
protecting time for our
staff to reflect, restore
and develop. I am really
proud of the commitment
and dedication of
every member of staff
in this organisation and
recognise each individual’s
valuable contribution to
the quality of care that is
delivered every day.
I was extremely delighted
to see so many of our staff
and external stakeholders
at our Annual Quality
Improvement event. It
provides us with an ideal
platform to share the
quality improvement work
we do and instil passion
in our staff to continually
review and improve the
quality of services they
deliver. To this end I was
particularly encouraged to
see quality improvement
included in the newly
published Nursing and
Midwifery Code which sets
out professional standards
of practice and behaviour
for nurses and midwives.
This year the ‘Hello my
name is…’ campaign
was threaded through
the activities for the day.
This powerful campaign
reminds clinicians of the
importance of introductions
when providing clinical care
with a short film at the start
of each session and each
presenter starting their
presentation with ‘hello my
name is…’.
We now provide a stroke
review service to ensure
stroke survivors in the east
Surrey area receive ongoing post stroke review.
We will be using the
Sentinel Stroke National
Audit Programme to
review and improve the
quality of stroke care by
auditing stroke services
against evidence based
standards, and national
and local benchmarks.
We can also offer a
more holistic speech
and language service
to those with dementia,
as we can now support
communication as well as
swallowing difficulties.
I was extremely proud of
the health visiting teams
(health visitors, staff nurses
and community nursery
nurses) at First Community
Health and Care who
achieved outstanding
results as part of the
Stage 3 assessment of
UNICEF’s and the World
Health Organisation’s
‘Baby Friendly Initiative’.
This helps us to know that
we are able to offer the
highest standards of care
for pregnant women and
breastfeeding mothers
and babies. The initiative
ensures that our health
professionals are trained
to offer the best possible
advice and support to
breastfeeding mothers so
that their babies can have
the very best start in life.
I would like to take this
opportunity to thank
all of our staff for their
continued commitment,
professionalism and hard
work. The achievements
of the organisation are
a credit to our staff and
the pride they take in their
clinical work and being part
of the organisation.
“I hereby state that to the best of my
knowledge the information in this
document is accurate”.
Signed
Philip Greenhill
Managing Director
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Part 2
Statement of directors’
responsibilities
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 2010 (as amended by the
National Health Service (Quality Accounts) Amendment Regulations 2011).
In preparing the Quality Account, directors are required to take steps to
satisfy themselves that:
• the Quality Account presents a balanced picture of the organisation’s
performance over the period covered;
• the performance information reported in the Quality Account is reliable
and accurate;
Part 2:
Our priorities for improvement and
statutory statements of assurance
In our last account we chose three
priorities for improvement, one in each
of the three domains of quality – patient
safety, clinical effectiveness and
patient experience. We will review our
progress against each of these priorities
before outlining our priorities for the
coming year.
Goal achieved
Goal not fully
achieved but
improvements
made
Improvements not
demonstrated
• 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
Chair
25th June 2015
Managing Director
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Priority 1 update
Priority 2 update
Patient safety
Clinical effectiveness
“We will measure medication error and harm from
error identifying the proportion of patients that are
‘harm free’ on a given day each month on Caterham
Dene Ward.”
First Community participated in the NHS Medicines Safety
Thermometer which is a national pilot to measure harm
from medication error. First Community was one of two
community providers in England who were participating in
the pilot. The monthly audit is carried out on the inpatient
ward at Caterham Dene Hospital. Results are submitted to
the Health and Social Care Information Centre (HSCIC) and
are in the public domain.
The Medication Safety Thermometer is a
measurement tool for improvement that
focuses on:
• Medication Reconciliation
• Allergy Status
• Medication Omission
• Identifying harm from high risk
medicines in line with Domain 5 of the
NHS Outcomes Framework.
Results:
Caterham Dene Ward has completed
12 months of data collection with the
following results:
1. Medication Reconciliation: Proportion
of patients with reconciliation started
within 24 hours of admission (median
was variable dependent on the hours
available by the Ward Pharmacist).
The First Community Lead Pharmacist
is preparing a Business Case to
increase the Ward Pharmacist hours
and improve the Reconciliation
percentages.
2. Allergy Status: The percentage of
patients with a documented medicine
allergy status was 100%.
3. Medication Omission: First Community
compares favourably with National
Data on medication omissions. We
continue to raise the importance of
Medicines Management Administration
training to address this.
4. Identifying harm from high risk
medicines in line with Domain 5 of the
NHS Outcomes Framework: Although
some high risk medicines were omitted,
there was no serious harm to any
patients.
“We will have a transition contact with 85% of children
in year 7.”
All Year 7 classes at one of our secondary
schools were visited by a school nurse
in October 2014 with 95% of pupils in
attendance. An assembly to all Year 7
pupils at a second school was delivered
on 4th March 2015; unfortunately we were
unable to obtain accurate attendance
numbers. Moving forward, we plan
to refine our processes for the next
academic year to ensure robust data
collection and recording of numbers in
attendance when a transition contact is
being delivered.
We are confident we can offer contact to
the remaining five Year 7 cohorts in east
Surrey schools by the end of the 2014/15
academic year.
There have been significant staffing
issues for the school nursing health team
over the last year.
However, a recent recruitment drive has
proved successful and staff numbers are
beginning to increase, including three
School Nurse students who commenced
the Specialist Community Public Health
Nurse (SCPHN) course in February 2015,
with a plan to recruit these students on
successful completion of the course.
This will expand the Band 6 School Nurse
numbers in line with the recommendations
set out in the School Nurse Specification
of one Band 6 School Nurse to each
secondary school in our area. By
February 2016 the plan is to have six of the
seven School Nurses required in post, with
a further two commissions secured for the
SCPHN School Nurse course commencing
in February 2016.
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Priority 3 update
Patient experience
“We will increase our stakeholder engagement in
clinical audit.”
What we said we would do in our last
Quality Account 2013/14
Implementation of the clinical audit strategy 20132016 operational action plan (section 4):
4.1 To promote service user involvement in clinical
audit and other quality improvement activities
including evaluations and surveys, in line with the
‘In Your Shoes’ strategy to enable the shift from
consultation to collaboration.
4.2 To involve members of the Community Forum
and other stakeholders e.g. Healthwatch Surrey
in the operational action plan for the clinical audit
strategy and keep them informed of clinical audit
and other quality improvement activities through
presentations and reports.
4.3 To invite service users to get involved in the
planning of specific clinical audit and other quality
improvement activities (training will be needed).
What we’ve done
4.1 Launched the ‘In Your Shoes’ patient
experience strategy to create a platform for focus
on service user involvement in clinical audit and
other quality improvement activities.
What we will do:
•
•
•
•
Share our clinical audit priorities with our stakeholders
Service user questionnaires alongside clinical audits
Consult with service users regarding action plans from clinical audits
Service user led clinical audit/quality improvement projects
4.2 We invited members of our Community Forum,
Healthwatch Surrey and East Surrey Clinical
Commissioning Group (our commissioners) to our
Annual Quality Improvement Day as described
below.
4.3 We have implemented quality improvement
and clinical audit training for staff at all levels in
the organisation and adapted the clinical audit
cycle to emphasise the importance of stakeholder
engagement at every stage of the process.
Consultation regarding audit priorities with our
commissioners (East Surrey Clinical Commissioning
Group (CCG) & Surrey County Council), Community
Forum and Healthwatch Surrey.
We are currently undergoing significant
restructuring of our clinical services influencing
the way in which we plan our clinical audit activity.
We are, therefore, in the process of reviewing our
priorities.
Invite stakeholders to our Annual Quality
Improvement Day.
We held our quality improvement day on 11th
December and invited stakeholders from our
CCG (Commissioners), Healthwatch Surrey, our
neighbouring community provider organisation
CSH Surrey and members of our Community
Forum. We were really pleased to welcome
representatives from our CCG, Healthwatch Surrey
and CSH Surrey. This enabled us to share some
of our quality improvement work with them and
enabled them to question and comment on our
on-going work.
Monitoring / recording patient / user involvement
in clinical audit at individual and business unit level
and looking at ways in which we can increase it
further.
We have monitored this and can see that our
clinicians do not appear to consistently engage
with stakeholders when undertaking quality
improvement work. We will include this in planned
training sessions during 2015. We will continue to
monitor this, to enable us to understand if our
training has had an impact.
Implementation of “you said… we did” feedback
across all services, via noticeboards and our
website.
We have implemented these in our ward area.
We have included a list of service user reviews on
our website.
Ultimately we will work towards enabling carer or
service user led audits.
We are working towards this as part of our three
year strategy.
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Looking forward
Priority 1
What we will do next year
Patient safety
Identifying our priorities for 2015-16
1
We put together a list of possible priorities by considering our
performance over the past year and national/regional priorities.
“90% of our clinical staff will have received training
by March 2016 to enable them to prevent/manage
pressure damage effectively”
2 We considered how we would be able to measure these possible
Why we have chosen this…
3 The list was then arranged under the headings of the three domains of
“Pressure ulcers are caused when an area of skin and the tissues below are damaged
as a result of being placed under pressure sufficient to impair its blood supply.
Typically they occur in a person confined to bed or a chair by an illness and as a result
they are sometimes referred to as ‘bedsores’, or ‘pressure sores’.” NICE 2014
priorities by considering what measurements and data collection was
already in place.
quality: patient safety, clinical effectiveness, and patient experience with
the ambition of having one priority under each domain.
4 The list was discussed and consulted on internally through our Business
Partners, service leads and our Council of Governors (a group of
elected staff shareholders) to ensure staff engagement.
5 To ensure our priorities for the coming year match those of our patients,
carers and partners we also went through a process of external
consultation inviting contribution from a range of stakeholders including
our Community Forum and Healthwatch Surrey.
6 The final selection was made by the Board after reviewing this
For our patients who are at risk of developing pressure damage it is vital that all of our
relevant clinical staff are trained to prevent and manage pressure damage effectively.
How we will achieve this…
We will make training available to all of our clinical staff.
How we will measure this…
We will keep records of all attendees to ensure we meet our 90% target. We will also
use our incident management reporting process to understand if the training received
has a positive impact on the care of our patients with regard to preventing and
managing pressure damage. feedback.
Each priority has been allocated to a responsible board member to
ensure commitment at board level to these quality improvements.
http://www.nice.org.uk/guidance/cg179/resources/guidance-pressure-ulcers-prevention-and-management-of-pressure-ulcers-pdf
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Priority 2
Priority 3
Clinical effectiveness
Patient experience
“We will support people at the end of their life by
continuing to develop a ‘bereavement pack’ which will
provide helpful information for people at this difficult
time.”
“50% of First Community staff will have received
training on Dementia by March 2016, 75% by March 2017
and 100% by March 2018.”
Why we have chosen this…
Why we have chosen this…
Health Education England’s ambition is that every NHS staff member is dementia
trained by 2018.
We understand how difficult this time is for our patients and their families. We know that
people often have a lot of questions and decisions to make, whilst needing support.
We want to provide a bereavement pack with information to help people at this difficult
time.
This pack is just part of the bereavement CQUIN, which will also be supported by
bereavement awareness training for the District Nursing teams and the development of
a bereavement pathway.
According to the Alzheimer’s Society there are around 800,000 people in the UK with
dementia. One in three people over 65 will develop dementia, and two-thirds of
people with dementia are women. The number of people with dementia is increasing
because people are living longer. It is estimated that by 2021, the number of people
with dementia in the UK will have increased to around 1 million, with the numbers
expected to double by 2040. It is known that early recognition of the signs of dementia
by healthcare staff can enable them and their carers to live a better quality of life for
longer.
Dementia is associated with complex needs and, especially in the later stages, high
levels of dependency and morbidity challenge the skills and capacity of carers and
services.
How we will achieve this…
We will continue to develop a bereavement pack which will include information for
families and carers and a questionnaire to enable feedback. By doing this we will be
able to learn and constantly strive to improve the way we support patients and their
families and carers at the end of their life.
Dementia training was introduced as a mandatory requirement in First Community
in October 2014 for all staff (not just those who have direct contact with people with
dementia).
The pack will be given out by the community nurses (predominantly the District Nurses)
to families/carers pre-bereavement.
It will include:
• our information leaflet “Information for families and carers when a person is
approaching the last weeks and days of life”,
• the Department for Work & Pensions (DWP) booklet “What to do after a death in
England and Wales”
• a bespoke bereavement booklet being produced for us by RNS publications called
“Help for you following a bereavement”
• ‘iWantGreatCare’ patient stories booklet inviting families/carers/patients to give
feedback on the care they have received at a time that feels appropriate to them.
How we will achieve this…
How we will measure this…
We will make training available for all of our staff over a three year period.
Bereavement Packs
We will monitor the number of bereavement packs offered to and accepted by families
at ‘end of life’.
Training
We will measure the number of staff completing ‘end of life’ training and compare this to
the number of bereavement packs offered to and accepted by families at ‘end of life’.
iWantGreatCare
We will monitor feedback from families and carers.
The National Institute for Health and Care Excellence (NICE) published a quality
standard for dementia (QS1) in 2010. This covers care provided by health and social
care staff in direct contact with people with dementia in hospital, community,
home-based, group care, residential or specialist care settings.
Quality statement 1: People with dementia receive care from staff appropriately
trained in dementia care.
How we will measure this…
Training
We have baseline data indicating the number of staff who have already completed
dementia training to the end of March 2015 (n=85, circa 19%) which we can measure our
improvement against.
NICE guidance
Provides clear criteria, standards and guidelines on how to care for our patients with
dementia.
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Priority 4
Staff experience
“100%* of our staff will receive an appraisal and
personal development plan (to reflect our new
framework†) within the preceding 12 months by March
2016.”
Why we have chosen this…
In 2013 the annual NHS staff survey reported
that an average of 84% of staff had received
an appraisal within the preceding 12 months.
The 2013 NHS Staff Survey involved 265 NHS
organisations in England. Over 416,000 NHS
staff were invited to participate and 203,000
NHS staff responded, a response rate of 49%.
How we will achieve this…
We have made appraisal training mandatory
and are currently offering one training session
each month.
We will continue to raise the importance of
appraisal throughout the organisation.
How we will measure this…
Quarterly statutory and mandatory training
reports record this data.
Statutory statements of
assurance
The statutory statements in this part of our Quality Account relate to the quality of the
service we have provided in the period 1st April 2014 to 31st March 2015. The content is
common to all providers allowing comparison across organisations.
Review of services
During March 2014 to April
2015 First Community Health
and Care provided NHS
services. First Community
Health and Care has
reviewed all the data
available to them on the
quality of care in all of
these NHS services.
Participation in clinical
audit
During the period April
2014 to March 2015 four
national clinical audits and
no national confidential
enquiries covered
NHS services that First
Community Health and
Care provides.
During that period First
Community Health and
Care participated in all
four national clinical audits
which it was eligible to
participate in.
The national clinical audits
that First Community Health
and Care was eligible to
participate in during the
period 1st April 2014 to 31st
March 20015 are as follows:
*The exceptions to the 100% target allows for those staff on maternity leave, sickness
absence, agency staff, students on placement and staff on secondment. This also
applies to new members of staff in their first three months of employment.
†The new framework will include the behavioural competencies (see pages 52-53).
National Diabetes
Foot-care Audit (NDFA)
Initial submission to the
audit was made by First
Community in July 2014
with official registration
completed by our Caldicott
Guardian in January 2015.
The scope of this audit
covers all diabetic patients
who attend podiatry
clinics with new foot
ulceration. Data collection
has commenced with
24 patients currently
registered.
This is an on-going audit
with periodic reviews.
The first deadline is 31st
July 2015 when a report
will be generated. If data
has been collected on
more than 100 patients,
then a specific report for
First Community will be
generated, if not a generic
report will be generated.
The audit will seek to
answer the following key
questions:
• Structures: are
the nationally
recommended care
structures in place for
the management of
diabetic foot disease?
• Processes: does the
treatment of active
diabetic foot disease
comply with nationally
recommended
guidance?
• Outcomes: are the
outcomes of diabetic
foot disease optimised?
National audit of
intermediate care
We took part in the National
Audit of Intermediate Care;
however, we are currently
undergoing re-structuring
of our clinical services
integrating intermediate
care within community
hubs. We are diversifying
with our bed based care
i.e. we are providing care/
rehabilitation for more
varied time periods and
needs. Therefore we have
decided, in agreement with
our commissioners not to
take part in this national
audit for 2015/16.
National Chronic
Obstructive Pulmonary
Disease (COPD) Audit –
commenced in January
2015, data collection
finishes in July 2015.
Sentinel Stroke National
Audit Programme (SSNAP)
The First Community Health
and Care Community
Neuro Rehabilitation Team
(CNRT) registered for the
Sentinel Stroke National
Audit Programme (SSNAP)
in August 2014. The SSNAP
audit programme was set
up by The Royal College
of Physicians (RCP) in 1998.
SSNAP aims to improve the
quality of stroke care by
auditing stroke services
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24
against evidence based
standards, and national
and local benchmarks. It
is expected that health
economy commissioners
will commission stroke
services to the RCP
Stroke standards when
commissioning services for
stroke patients.
SSNAP is an audit focussing
on individual patients who
have suffered stroke from
admission to an acute
hospital through to ongoing support and review
in the community following
discharge.
The main focus of the
SSNAP audit until recently
has been on the care and
therapy intensity provided
in the acute sector.
Focus of the audit is now
moving to encompass the
whole pathway including
community services.
Providers of stroke services
are required to participate
in this on-going audit
programme.
In respect of community
services, First Community
is required to record the
following details for all
Stroke referrals:
• which therapies the
person is referred to
and has received.
• number and length
of time of therapy.
interventions received
• date of discharge from
individual therapies.
• discharge destination
and on-going support
that they are receiving
at time of discharge (i.e.
via social care).
• modified Rankin Score
at discharge.
• Barthel score at
discharge from service
(this is currently optional
but will become
mandatory).
• if they receive a six
month review (+/- two
months).
Surrey and Sussex
Healthcare Trust (SASH)
is the main acute referrer
of stroke patients to First
Community and have
forwarded details of
patients who have been
entered into the SSNAP
cohort from admission
to acute hospital since
October 2014. The patient’s
SSNAP record is forwarded
to CNRT when a referral
is made from the Stroke
Rehabilitation Ward at
Crawley Hospital. Data
collection for these patients
has now commenced.
The First Community Stroke
coordinator offers a six
month review to all patients
with an East Surrey CCG
GP who are referred to her
directly (see Page 29 for
further information). The
Stroke Coordinator is also
working with East Surrey
GPs, to gather details of
patients who have been
discharged not requiring
CNRT or from acute centres
other than SASH to ensure
that these patients also
get a review and on-going
support.
Due to the acute
focus of SSNAP, only
limited data regarding
community services has
been collected to date.
Therefore, a post-acute
organisational snapshot
audit 2015 has been
devised, focussing on
the care provided once
patients have left the acute
setting. First Community
completed Phase 1
(registration) in December
2014 and registered to
participate in March 2015.
Phase 2 (data collection)
will commence in April 2015.
Reviewing reports of
national and local clinical
audits
Each of our Business
Units reports their clinical
audit activity to our Clinical
Quality and Effectiveness
Group which reports to the
Board.
Participation in
confidential enquiries
First Community Health and
Care was not required
to participate in any
confidential enquiries
during this reporting period.
Research
The number of patients
receiving NHS services
provided or
sub-contracted by First
Community Health and
The modified Rankin Scale (mRS) is a commonly used scale for measuring the degree of disability or dependence in the daily
activities of people who have suffered a stroke or other causes of neurological disability. It has become the most widely used clinical
outcome measure for stroke clinical trials.
Care in March 2014 to April
2015 that were recruited
during that period to
participate in research
approved by a research
ethics committee was zero.
Goals agreed with our
commissioners (CQUINs)
The key aim of the
Commissioning for Quality
and Innovation (CQUIN)
framework for 2014/15 is to
support improvements in
the quality of the services
and the creation of new,
improved patterns of care
(NHS England, 2013).
First Community Health
and Care (First Community)
has embraced the CQUIN
framework to incentivise
the Company to deliver
quality and innovation
improvements above the
baseline requirements set
out in our NHS Standard
Contract.
For First Community Health
and Care, the expected
financial value of the
2014/15 CQUIN Scheme is
2.5% of contract value.
A proportion of First
Community Health and
Care’s income in the period
April 2014 to March 2015 was
conditional on achieving
quality improvement and
innovation goals agreed
between First Community
Health and Care and our
commissioners for the
provision of NHS services,
through the Commissioning
for Quality and Innovation
payment framework.
Care Quality Commission
(CQC)
First Community Health and
Care has not participated
in any special reviews or
investigations by the CQC
during the reporting period.
The organisation continues
to monitor its compliance
with the CQC outcomes.
This is undertaken in a
number of ways such as:
• CQC outcomes, which
ensure care provision
is safe and of quality,
have been attributed
to specific groups
to be monitored
and interrogated as
standing agenda items
to ensure compliance
and robustness. For
example, the medical
devices we use and
the safety and suitability
of our premises is
monitored through
our Health and Safety
Group, safeguarding
adults and children
scrutinised through our
Safeguarding Group
and complaints and
medicines management
are reported and
monitored through our
Clinical Quality and
Effectiveness Group.
• The CQC Registered
Manager, the Managing
Director and a NonExecutive Director run
quarterly sessions for
our Business Partners
(each of our services
has a Business Partner,
a senior member of
staff managing and
leading the service)
to present evidence
against specific
outcomes. This has
ensured the evidence
is collected, assures
the board that the
organisation complies
with CQC registration
and provides a forum to
discuss and interrogate
the issues and evidence
and plan any actions
required to continue
to meet the standards
set out in the CQC
Outcomes Framework.
For example, these
sessions have enabled
the organisation to
appraise the provision
and uptake of statutory
and mandatory training.
We are in the process of
reviewing all the training
identified as statutory
and mandatory to
establish if it continues
to be required and
by which staff groups.
This will enable us to
simplify and clarify the
guidance we provide
for our staff so they can
access correct training
and do not become
overburdened by
training not required for
their role. We are also
investing in a learning
management system to
enable us to accurately
monitor this.
Going forward, the CQC
have changed the
way they will inspect
organisations and First
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26
Community is undertaking work to ensure
we evidence the five Key Lines of Enquiry
(KLoE) set out in this new framework. More
information about KLoE can be found on
the CQC website.
April 2014 to 31st March 2015 by the Audit
Commission.
Data quality
First Community’s Information Governance
Assessment Report overall score for
the reporting period was 66% and was
graded green (Level 2).
At First Community Health and Care,
we see data quality as everybody’s
responsibility. Such an approach helps us
ensure high standards in data quality are
maintained throughout the organisation.
Information Governance Toolkit
attainment level
We are currently putting an action plan in
place for 2015/16 to enable us to achieve
Level 3, a score of 70% or over.
We continue to compare information
such as incident reports, complaints,
compliments, activity data and data
quality within our IT systems. This enables
us to see how our services are performing
in their entirety, to identify risks and take
any actions. We have reported this data
as part of our quality account.
We also use our data to ensure that we
are driving improvement in our services
which represent good value for money
and best patient care. We are currently
using RiO R2; as a secure electronic
patient record system which connects
to the central NHS Spine. In August 2015
we are changing our electronic patient
record system from RiO R2 to EMIS Web,
which will give First Community Health
and Care the potential to integrate with
other NHS systems such as local GP and
acute systems to improve patient care
throughout more pathways in all settings.
NHS Number and General Medical
Practice Code Validity
First Community has submitted, on a
monthly basis, records to the Secondary
Uses Service (SUS) complying with national
standards. This data has been used by
local commissioners.
Clinical coding error rate
First Community Health and Care was
not subject to the Payment by Results
clinical coding audit during the period 1st
27
Part 3
New services for 2014/15
New stroke review service
Part 3:
Review of our services
First Community is now commissioned to provide a review service for adult stroke
survivors registered with an east Surrey GP. A Stroke Co-coordinator was appointed
in 2014 to ensure stroke survivors in the east Surrey area receive on-going post stroke
review, following hospital discharge. The Stroke Co-ordinator holds a clinical caseload
and liaises with other appropriate professionals in the stroke pathway, including stroke
consultants and GPs. Review clinics are held twice weekly and home visits and visits
to nursing and residential homes are also provided on a needs basis. The six month
and annual post stroke reviews provide an opportunity to consider the survivor’s
health and social well-being post stroke and to assess how individuals are coping
and adjusting to life post stroke. Reviews are carried out using a nationally recognised
review tool (GM-SAT tool) and encompass the following areas:
•
•
•
•
medicines and health need.
mood, memory, cognitive and psychological status.
on-going rehabilitation and therapy needs.
social-care needs, carer’s needs, benefits and finance and driving and transport.
The first six month review typically takes 45 minutes – 1 hour. During the review
individuals receive advice and screening, information in relation to stroke recovery,
signposting and reassurance. The reviewer is able to make onward referrals to
therapies, continence service, smoking cessation service, dietetics, as well as offering
first line support in these areas.
Speech and language for people with dementia
Patients with dementia are currently
seen on a cost-per-case basis for up
to three sessions per episode of care.
Until recently the team were only able to
support people with dementia with their
swallowing difficulties, and were not able
to assess or support communication
difficulties. We have recently had
agreement from the CCG that we can
now also support communication
difficulties under the same cost-per-case
arrangement, which enables us to offer a
more holistic and equitable service to all
patients who have dementia.
GM-SAT Greater Manchester Stroke Assessment Tool : Assessing the long term needs of stroke patients and their carers. 2010.
Online: http://clahrc-gm.nihr.ac.uk/stroke/GM-SAT_The_Greater_Manchester_Stroke_Assessment_Tool-1.pdf
Accessed: 08/04/2015
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30
Overview of our services
We will now provide an overview of some of our quality improvements for the
period 1st April 2014 to 31st March 2015.
Patient safety
Adult Safeguarding
First Community has a dedicated Adult
Safeguarding Lead in post to provide
advice and support to staff relating to
Adult Safeguarding matters. This post
reports directly to the Executive Lead
for Safeguarding, the Clinical Operations
Director.
Over the last year we have developed
First Community Adult Safeguarding
guidance, including Mental Capacity Act
and Deprivation of Liberty Safeguards
guidance. In March 2015, the First
Community Board received Adult
Safeguarding training, which focussed
on the implications of the Care Act 2014
and an update on actions following the
Winterbourne View and Jimmy Saville
enquiries.
During the year, we have introduced inhouse Mental Capacity Act training, to
ensure that all patient-facing staff are
aware of the implications of this Act.
In July 2014, First Community introduced
an awareness programme relating to
‘Prevent’ which is part of the government’s
counter-terrorism strategy, and seeks to
identify people who may be susceptible
to radicalisation. This programme is
now included in induction and all Adult
and Children Safeguarding updates.
In addition, prioritised services have
received the full Prevent training.
There were no Deprivation of Liberty
Safeguards applications at Caterham
Dene ward during the year.
Safety Thermometer (service specific data - also see CQUINS)
The NHS Safety Thermometer is a point prevalence survey to allow teams
to measure ‘harm’ and the percentage of patients that receive ‘harm free’
care from pressure ulcers, falls, urinary tract infections in patients with urethral
catheters (UTIs) and venous thromboembolism. We report on this monthly and
feedback to our teams. We have compared our data with the national picture
as a method of benchmarking our results and have provided our data for the
entire organisation for comparison in table 1.
Children’s Safeguarding
In the reporting period, 88% of staff (n=54)
in the Children’s 0-19 Service, who are
required to (not including members of staff
with less than three months service), have
completed Level 3 Safeguarding Children
training. A further 16 new members of staff
joined the 0-19 service from September
2014 and are completing modules working
towards Level 3. Staff who have not
completed the multi-agency training do
not carry a safeguarding caseload. All
staff who have previously completed this
training and who hold a safeguarding
caseload have received their annual
update during the reporting period.
We have continued to ensure support
for our 0-19 staff with a safeguarding
caseload by increasing the number of
staff trained to provide safeguarding
supervision; an additional three members
of staff trained as safeguarding
supervisors in the reporting period.
All registered staff continue to receive
safeguarding supervision every three
months.
We collect monthly performance data with
regard to safeguarding which enables us
to assess the quality of our 0 -19 service
and informs our service redesign. For
example, if we have a high number of
young parents (under 18s) we can tailor
services to meet their needs. This data
also ensures that the health professionals
carrying a safeguarding caseload receive
the appropriate levels of supervision and
support.
table 1
We continue to monitor the
number of new and old
pressure ulcers for patients
cared for within our services.
We also compare this with
the national data which
can be seen in table 2. This
demonstrates we have a lower
incidence of pressure ulcers
when compared with national
average.
table 2
For more information go to: http://www.harmfreecare.org/wp-content/uploads/DH%20ST%20Guidance%2025%205%2012.pdf
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Incident reporting
District Nursing
Adverse incidents (something that was
not expected to happen) will occur within
any organisation and when they do it is
important to ensure that what happened
is documented and shared with the aim
of preventing, or reducing the likelihood
of a recurrence. In some circumstances
the incident will be a “near miss” or “good
catch” which means that an adverse
event would have happened but action
was taken to prevent it. The National
Patient Safety Agency acknowledged
that ‘Organisations that report
incidents regularly suggest a stronger
organisational culture of safety. They take
all incidents seriously and link reporting
with learning’. Our staff are encouraged to
report all incidents as soon as practicable
to enable the organisation to identify any
trends as quickly as possible.
We have a no blame response to
incidents and encourage staff to report
incidents and “near misses”. This culture
has seen a 50% increase in reported
incidents from our district nursing teams
during the period 1st April 2014 to 31st
March 2015 as compared to the previous
year.
Over the last year 845 incidents have
been reported, 675 clinical incidents and
170 non clinical incidents, an increase of
246 from the previous year. None of these
incidents have resulted in severe harm
or death. The organisation has seen an
increase in reporting of the incidence of
pressure ulcers, slips, trips and falls and
medicines related incidents.
We have completed Root Cause Analysis
(see glossary) on all grade 3 and 4
pressure ulcers. During the period 1st April
2014 to 31st March 2015 we had a total of 10
Serious Incidents (1.2% of the total incidents
reported) – 9 concerned the acquisition
or deterioration of pressure ulcers, and
one was in relation to a fracture as a
result of a patient sustaining a fall on the
ward at Caterham Dene Hospital. Root
Cause Analysis identified the need for
Record Keeping Training for all staff, and
Motivational Interviewing Training for
clinical staff. This training has been rolled
out across the organisation during 2014/15.
Reporting of incidents and monitoring what these incidents involve enables us to learn
and take steps to reduce the likelihood of further incidents occurring and mitigate the
risk of harm to our staff, patients and the community. For example, we have been able
to identify an increase in incidents related to high risk drugs e.g. insulin and warfarin
within community nursing. This was an increase from no incidents in quarter 1 (from April
to June 2014) to 6 incidents in quarter 3 (October to December 2014). To address this
First Community Learning and Development has developed training on the “use of high
risk drugs”. We have introduced a process for sharing medicines incidents involving
other provider organisations to ensure learning to improve communication between
organisations.
Over the last year we have completed
Root Cause Analysis on all reported grade
3 and 4 pressure ulcers. This has enabled
us to implement learning on record
keeping, pressure ulcer identification and
classification, suitability and provision
of equipment, as well as teaching and
education of our partners in care, such as
carers and relatives.
We have had three reported needle stick
injuries this year related to insulin pen
devices and as a result have updated our
training and changed our equipment to a
safer device.
table 3
Medicines management
Infection Prevention and Control
We monitor our medicine safety incidents
on an on-going basis and report on these
quarterly to a Board committee through
our Clinical Quality and Effectiveness
Group. We continually work with our staff
to promote the reporting of incidents
through on-going feedback on incident
trends, organisational learning and
actions taken as a result of this reporting.
Quarters one, two and three of 201415 showed this promotion has had an
effect with an increase in the reporting of
medicines incidents; quarter four shows a
slight decrease in overall reporting but an
increase in reporting of near misses which
would indicate that staff are becoming
more aware of the need to identify and
address potential threats to medicines’
safety before they happen, please see
table 3.
• Infection rates – During the reporting period, there were no cases of MRSA
bacteraemia or Clostridium difficile (C. difficile).
• Hand Hygiene Audit – At our community hospital we observe our staff washing
their hands to ensure they are doing this properly on a monthly basis. All community
based healthcare teams undertake a peer review of their hand hygiene technique
at least annually. Some results from this are:
- Our Rapid Assessment Clinic and Minor Injuries Unit audit of staff hand-washing demonstrated that all staff (100%) were washing their hands properly and effectively.
- Our community nursing team were able to remind staff of the importance of not wearing rings and keeping nails short.
• National Standards of Cleanliness – Cleanliness within our community hospital
continues to be audited monthly using the standard 49 point audit form, providing a
useful indicator of cleanliness standards.
• MRSA screening - Patients within our community hospital are screened on
admission and re-screened four weeks following admission. During the reporting
period, we completed this screening in 100% of our patients.
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Clinical effectiveness
Online access to the Royal
Marsden Manual of Clinical
Nursing Procedures
First Community has signed a three year
licence to have access to the online
version of the Royal Marsden Manual of
Clinical Nursing Procedures 9th Edition. This
will enable staff to access robust clinical
information to help their practice to be
safe, evidence based and up to date.
Annual Quality Improvement Day
Our Annual Quality Improvement Day
was held on 11th December 2014 and
was a great success with 108 delegates
attending, including external stakeholders
from East Surrey CCG, Healthwatch Surrey
and CSH Surrey. This was an opportunity
to celebrate and share the excellent
quality improvement work undertaken
within the organisation.
The quality of the stands produced by
services across the organisation was
extremely high, showcasing a crosssection of the quality improvement work
being done in our teams throughout the
year. Seventeen people presented on the
day and we were delighted to welcome
Kirsty Maclean-Steel, an Audit Programme
Manager with the National Institute for
Health and Care Excellence (NICE), as our
guest presenter.
The following comments were just a few
received from attendees:
“Excellent choice of presentations from
across the organisation. Thank you –
really enjoyed the day. I learnt a huge
amount from other departments.”
“Having only been here a few weeks,
this was a very insightful day. Excellent
Informative Day!”
“Fantastic day showcasing the excellent
quality improvement initiatives within
our organisation.”
Throughout the day we raised awareness
of the ‘#hellomynameis…’ campaign which
encourages and reminds healthcare staff
about the importance of introductions in
the delivery of care. We played a video
clip at the beginning of each of the three
sessions and had a longer video running
on a dedicated stand in the exhibition
area. Staff were encouraged to make
the following pledges in support of the
campaign:
“I pledge to take extra time with every
individual I look after to ensure they are
comfortable and pain free”
“I will start every encounter with a client
with ‘Hello, my name is… and I am a …’”
For more information go to:
www.hellomynameis.org.uk
Some examples of other quality improvement work
Is the Malnutrition Universal Screening Tool (MUST) completed monthly and used to
inform the care plans of care homes residents?
During 2014, our Prescribing Support Dietitian for Care Homes used standards from
the “NICE Quality Standard for Nutrition Support in Adults (QS24)” and “CQC Outcome
5: Meeting nutritional needs” to review 145 nutrition care plans (out of a total of 430 – a
sample of 34%) in 10 care homes. This highlighted that only 39% of residents included in
the audit who were screened for malnutrition had a care plan detailing how nutritional
requirements will be met. Only 9% had the results of the screen and goals documented
in their care plan.
This has prompted greater access to training for care home staff in West Sussex, both
in-house training and as part of a rolling training programme. We will be re-auditing in
July 2015 to ensure this training has increased the completion of MUST screening and
improved care planning to meet nutritional requirements.
How effective are the anxiety and relaxation classes we provide?
Our Rapid Response and Falls Team reviewed the effectiveness of patient classes to
help manage anxiety and promote relaxation techniques. The aim was to demonstrate
that the teaching style used was appropriate for the classes to maximise the benefit
of the sessions. The survey sought feedback from service users on the quality of the
classes and how this can be improved for the future. The survey aimed to find out if
people felt able to apply the techniques learnt in the future to improve their anxiety and
help them to relax.
Feedback was collected from everyone (48 people) who had attended the classes
over a period of seven months. All patients surveyed were over the age of 65 or had
long term health conditions.
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Findings
Observations
Criteria:
Did you find the anxiety management class helpful?
Standard Achieved:
Very helpful = 35.4% (17)
Helpful = 52.1% (25)
Not sure = 8.3% (4)
Not helpful = 4.2% (2)
Criteria:
Were you satisfied with the length of time the session
ran for?
Standard Achieved:
Very satisfied = 33.3% (16)
Satisfied = 50% (24)
Not satisfied = 14.6% (7)
Don’t know = 2.1% (1)
Comments:
Those who were not satisfied with the length of time of the session either felt that they
needed more time or they did not feel that the session was for them.
Criteria:
Do you feel you are able to apply some of the
techniques discussed?
Standard achieved:
Yes = 89.6% (43)
No = 2.1% (1)
Not Sure = 8.3% (4)
Criteria:
Would you recommend this session to others?
Standard Achieved:
Definitely = 85.4% (41)
Maybe = 14.6% (7)
No = 0% (0)
Criteria:
Would you participate in similar sessions in the future?
Standard achieved:
Yes = 81.3% (39)
No = 2.1% (1)
Not sure = 16.7% (8)
Doesn’t add up to 100% due
to rounding
Criteria:
Out of 10 how was the session scored?
Standard achieved:
7-10 = 81.2% (39)
4-6 = 18.8% (9)
0-3 = 0%
Areas of good practice:
• Feedback taken into account to improve the sessions for the future.
• Large percentage of people felt that they would be able to apply some of the
techniques learned in the future indicating teaching was effective.
• All patients were given a self-help booklet on relaxation and anxiety management
to remind them of what they had learned so they can apply this in the future if
required.
Areas for improvement:
• Patients felt that sometimes the background noise was distracting in the relaxation
session and at times was off putting for those taking part. In response to this cards
were put on the door of the session asking for silence. Also a CD player was used
to play relaxing music which was favoured by participants as this aided relaxation.
• Many people felt that not enough time was spent on the session and they would
have liked the class to be longer. A programme will be developed in the future for
longer sessions which are specifically for those with an identified anxiety disorder.
• People would like to be able to self-refer to an anxiety and relaxation class that
any member of the public can attend. This is something to consider for the future.
At present there is not a base or staff to be able to meet this need.
• Specific classes designed just for those with an anxiety disorder would be
beneficial. This is work for the future and can be set up via a referral from anyone
in First Community who would benefit from this class.
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NICE
We have also reviewed our process
for implementing and monitoring the
implementation of NICE guidance and
have provided some examples below
of how this has had a positive impact on
the services we provide and the care our
service users receive.
Alarm Clinic: NICE CG111 Nocturnal
enuresis: The management of
bedwetting in children and young
people
In 2012 our 0-19 service undertook an
Criteria
Standard
set
Prior to attending the alarm
clinic there is evidence
that the child was offered
advice on fluids, toileting
or an appropriate reward
system.
100%
The response to the alarm
was assessed by four
weeks (or one month)
Where a child was
discharged there is
evidence they had
achieved a minimum of two
weeks uninterrupted dry
nights.
audit of the enuresis (bedwetting) service.
This highlighted the need for a clinic
specifically for children who are identified
as needing alarms. Alarms are one of
many methods of treating children who
bed-wet.
In January 2014 we set up an alarm clinic
and in August 2014 we undertook an audit
to establish if we were providing care in
line with the standards set out in NICE CG111
Nocturnal enuresis: The management of
bedwetting in children and young people.
We looked at the records of all children
referred to the alarm clinic from January
2014 to July 2014 (n=9). We have provided
some results below.
Standard achieved
Standard achieved in
2012
•
7/9 referrals came
from our enuresis clinic and
100% of these achieved the
criteria
•
2 referrals were
external to our organisation
and these did not achieve
this
98% (53/54) 98%
Please note this is a larger
sample number as a larger
number of clinics were
included.
100%
100%
53% (9/17) in 2012
Please note this is a larger
sample number as a larger
number of clinics were
included.
100%
3/9 discharged having
achieved dryness for
minimum of two weeks
4/9 still in treatment
2/9 parents withdrew from
the treatment
No children were
discharged dry after using
alarms
Observations
Areas of good practice:
•
The alarm clinic has enabled 3 children to achieve dryness (for the time period of the audit)
compared with no children achieving dryness in 2012
•
The alarm clinic has enabled clinicians to assess the response to an alarm after one month of
commencing the treatment for 100% of referrals compared with 53% in 2012
What we will do next:
•
Obtain formal feedback from parents and children on the alarm clinic
•
Extend the alarm clinic to other areas
•
Re audit enuresis clinics using NICE CG111
What we have changed:
•
We have reviewed our referral pathway and no longer accept referrals directly into the alarm
clinic. All referrals go through our enuresis clinic so we can ensure all children receive care and advice
in line with best practice as set out in NICE CG111
Podiatry: Retrospective Audit of
the Appropriateness of Referrals
to the Vascular High Risk Foot MultiDisciplinary Team (MDT) Clinic
• 4% of referrals required microbiology as
primary input.
This retrospective audit was completed in
2014 to review appropriateness of referrals
to the MDT clinic, in line with NICE guidance
CG147 Lower Limb Peripheral arterial
disease: diagnosis and management
(2012). An appropriate referral was defined
as a referral that had a definitive MDT
intervention i.e. either diagnostics or
surgical input.
A total of 51 referrals were reviewed and
the findings were as follows:
• 100% of referrals to the MDT were
appropriate.
• 96% of referrals required vascular
intervention.
In line with NICE guidelines (TA249 and
TA256) both Rivaroxaban and Dabigatrin
(oral anticoagulants) have been added
to the VTE (venous thromboembolism)
pathway in the past year and are being
offered as an alternative to Warfarin
therapy for those patients that fall within
the criteria for treatment.
We are also in the process of purchasing
a C-reactive protein machine to ensure
that patients presenting with community
acquired pneumonia can receive
evidence based care and treatment
in line with the new NICE guidelines for
pneumonia (CG191).
Rapid Assessment Clinic (RAC)
Productive Community Services
The aim of the Productive Community
Service (PCS) programme has been twofold with a focus on both enhancing
quality and reducing inefficiencies,
through the application of Lean Based
Techniques leading to an increase in
the organisation’s capacity to care for
patients and capability for continuous
improvement.
The objectives of the PCS programme
overall have been:
• To release time to care and maximise
efficiencies through the implementation
of a series of nine pre-defined
modules.
• To align with First Community strategic
objectives, both enhancing quality and
increasing productivity.
• To work with services to get the right fit,
aligning the right module with service
priorities.
C-reactive protein is produced by the liver. The level of CRP rises when there is inflammation throughout the body. The C-reactive
protein (CRP) test is used by a health practitioner to detect inflammation.
CG191 recommends: “For people presenting with symptoms of lower respiratory tract infection in primary care, consider a point of care
C‑reactive protein test if after clinical assessment a diagnosis of pneumonia has not been made and it is not clear whether antibiotics
should be prescribed. Use the results of the C‑reactive protein test to guide antibiotic prescribing in people without a clinical diagnosis
of pneumonia.”
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An example of this is the Community Neuro
Rehabilitation Team who completed the
module ‘Working Better with Key Partners’.
By using the self-assessment tool and
following a six week audit period, a series
of interventions were undertaken resulting
in an improved referral process and
increased capacity.
This will be undertaken in four phases.
The analysis of this data collection post
mobile working will further inform services
regarding the impact of mobile working
and where further potential capacity and
efficiencies can be realised.
In addition, the objectives overall have
been to enable the behavioural and
cultural changes required to embed
mobile working and to support the
achievement of the following outcomes:
Enhancing Quality (EQ) is an innovative
clinician-led quality improvement
programme launched in January 2010
across Kent, Surrey and Sussex.
•
•
•
•
•
•
•
Improving the flow of information
Reducing travel time
Reducing meeting and handover time
Increasing patient facing time
Reducing office-based time
Maintain/Improve communication
More efficient record keeping
Using a champion model, clinical staff
were provided with data collection
tools and baseline data was collected,
pre mobile working, across all relevant
services regarding the following:
•
•
•
•
Face to face contact time
Travelling time/Mileage
Handover
Record keeping
This data was analysed and presented
back to services allowing them to draw
insights into existing work patterns and
practices and to develop and implement
action plans which would in turn support
and embed mobile working services
and enable services to identify where
the potential for maximum efficiencies
from mobile working lay for their
particular teams. The data also provided
benchmarking opportunities across
services enabling insight into how teams
were performing.
Now that laptops have been issued to
clinical staff, re-measurement is underway.
patient beta blocker medication, with an average for South East Coast level of 88.96%.
These figures show how we are supporting patients to improve their heart function
and lessen their symptoms associated with heart failure e.g. shortness of breath, ankle
swelling and fatigue.
Our performance has been recognised in the form of an award at the EQ Expo Awards
in January 2015 – ‘Most consistent top performing community provider’.
Enhancing Quality Initiative
By clinicians analysing where to intervene
for greatest quality improvement, EQ aims
to improve patient outcomes and reduce
variation in care, every patient, every time.
The programme is evidence-based and
data-driven, providing the opportunity
to benchmark our patients’ outcomes
with other organisations across the three
domains of quality: clinical effectiveness,
patient safety and patient experience.
Out of six work-streams, managing heart
failure in the community was the only one
relevant to First Community Health and
Care.
Our Heart Failure Team has successfully
supported 262 patients with heart failure
since joining the EQ initiative in October
2011 and have exceeded all targets set
by EQ for our local area as of December
2014. At present, we are no longer set
targets under the Commissioning for
Quality and Innovation (CQUIN) framework.
EQ have discussed using an alternative
system of a kite mark of best practice,
however at present we have no targets
set, but continue to provide high levels of
care when we benchmark against other
provider organisations in Kent, Surrey and
Sussex. For example we have improved
from 98.0% to 99.49% effectiveness at
managing ACE Inhibitor (see glossary)
and ARB medication which exceeds
South East coast level target of 91.15%.
We have also improved from 95.6% to
99.44% effectiveness at managing our
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Within a month we had feedback from an
attendee that she was able to put into
practice what she had been taught to
help her get up after a fall in her garden.
Patient experience
Parkinson’s Practitioner
In September 2014 a Parkinson’s
practitioner was appointed in
collaboration with East Surrey
Clinical Commissioning Group and
Parkinson’s UK. The role of the
Parkinson’s Practitioner is to provide
specialist care and advice to people
with Parkinson’s in the east Surrey
area. The Parkinson’s Practitioner
will visit patients in their homes as
well as running a clinic. She will also
work closely with other multi-skilled
team members as appropriate. This
means that people with Parkinson’s
in east Surrey will once again benefit
from the expertise of a Parkinson’s
nurse. Parkinson’s is a complex and
varied condition which affects each
person differently so it is vital that
people have access to a specialist.
Complaints & compliments
All teams receive compliments not
only verbally but also by way of
‘thank you’ cards, e-mails, and
letters. For this period the teams
received 157 written compliments and
gifts. Teams also receive feedback
through the Friends and Family Test
(see pages 47-48).
We have received a total of 29
complaints between 1st April 2014
and 31st March 2015. Four of these
complaints related to incidents where
Surrey & Sussex Healthcare were the
lead organisation.
Our complaints policy states that
we will acknowledge all complaints
within two working days. In the
reporting period, 100% of complaints
were acknowledged within two
working days.
The actions arising from the learning of the
investigations into the complaints received
include:
Training
Customer service training was identified
as a need following an analysis of trends
in complaints. This training has been
implemented and is being undertaken.
Outpatient Physiotherapy
Following feedback from a patient who
attended our Balance Class, we have
added a section to teach patients at risk
of falling how to get up from the floor.
Kevin Shergold, who was diagnosed with
Parkinson’s in 1999, says:
“Parkinson’s nurses are an absolute
lifeline. Being able to speak to someone
who truly understands what life with
Parkinson’s is like makes the world of
difference.”
Dr Joe McGilligan, Chair of NHS East Surrey
Clinical Commissioning Group (CCG), said:
“Providing specialist support to patients
with Parkinson’s in their own homes is a
crucial part of managing this
life-changing condition, and reflects a
broader shift in our work to give patients
the care they need in their community. This
has been the result of real partnership
working with a range of healthcare
organisations and we’re confident it will
bring better outcomes for our patients.”
For this period the teams received 157
written compliments and gifts. Teams
also receive feedback through the
Friends and Family Test.
Caterham Dene Ward
Ward based staff undertook assessment
and management of continence training.
A review of prescribed food and fluid
regimes for ward-based patients was
undertaken to ensure staff received
training in managing patients who are
prescribed food and fluid precautions.
Registered staff have been trained to
undertake swallowing assessments and
implement appropriate management and
care plans.
Community Physiotherapy
Our community physiotherapy staffing
was increased to reduce waiting times for
those patients requiring physiotherapy in
their homes.
Waiting times
Dietetics
We have reviewed and simplified our
processes to help reduce clinic waiting
times. The main change is that we now
send all of our new patients a letter asking
them to call the department to make an
initial appointment. This has reduced the
number of people not attending and
increased the number of appointments
available.
reducing risks associated with nonassessed swallowing difficulties, and also
reducing stress for the patient.
Outstanding results in UNICEF
Baby Friendly Initiative Stage 3
The health visiting teams (health visitors,
staff nurses and community nursery
nurses) at First Community Health and
Care achieved outstanding results as part
of the Stage 3 assessment of UNICEF’s
and the World Health Organisation’s ‘Baby
Friendly Initiative’.
The Baby Friendly Initiative (BFI) is a
worldwide programme developed
by UNICEF and WHO to ensure that
healthcare organisations are able to
offer the highest standards of care for
pregnant women and breastfeeding
mothers and babies. The initiative ensures
that all health professionals are trained
to offer the best possible advice and
support to breastfeeding mothers so that
their babies can have the very best start
in life.
Speech and Language Therapy
The outpatient/community Speech and
Language Therapy team have worked
hard to reduce waiting times significantly
this year. Patients referred for urgent
dysphagia assessments were previously
waiting up to eight weeks for an initial
assessment. The majority of these are
now being seen within two weeks, and
all of them within three weeks, thereby
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44
We have already achieved high
results when passing Stage 1 and 2
of the initiative. Stage 3 assesses the
implementation of the Baby Friendly
standards in the care of pregnant
women and new mothers. Our staff
were presented with a plaque for their
achievements.
Our Health Visiting teams were interviewed
against a set of criteria to demonstrate
high standards of care for all families.
Mothers were also interviewed to rate
their overall satisfaction with the service
and given a chance to feedback further
comments.
The initiative ensures that health visiting
teams can help mothers (and just as
importantly, their partners) overcome the
inevitable difficulties and challenges that
many experience in the early days, weeks
and months of parenthood to carry on
breastfeeding for as long as they wish to.
Helen Bennett, Lead for Children’s
Services in First Community Health
and Care said:
“We are very proud of
all our clinical staff who
are committed to high standards of care
for all the families they see in east Surrey.
Our Specialist Health Visitor for Infant
Nutrition has strived tirelessly to create
a bespoke training programme for First
Community staff, to ensure mothers and
babies have the best possible start.
Receiving this commendation from UNICEF,
the world’s leading organisation working
for children, was highly valued feedback
for our hard working teams.”
The UNICEF assessor stated in the report
“It was clear to the assessment team that pregnant
women and new mothers receive a very high standard
of care. In particular the mothers interviewed commented
on how much they appreciated the sensitive nonjudgemental approach adopted by the staff across
health visiting, support staff and Children’s Centres”.
Health Visitor ‘Call to Action’
• We have had nine Health Visitor
students and one School Nurse student
all qualified and staying in employment
with First Community, in line with our
mission to become the employer of
choice
• As part of the ‘call to action’ we have
undertaken ‘building community
capacity’ projects which have resulted
in the successful development of a
section on the First Community website
for 0-19 service users and an up-todate Postnatal Depression leaflet
• Innovations from our workforce
to improve service delivery and
client experience have included
the introduction of Family Foods
Workshops and a supporting leaflet
which was developed in accordance
with the Information Standard (see
page 50).
Since the start of the Health Visitor Call
to Action in March 2012 to March 2015 we
have increased the number of Health
Visitors in post as shown in below.
(WTE = whole time equivalent)
We also work with local partners including
Children’s Centres, National Childbirth
Trust, Mum2Mum peer supporters and
Tandridge Education Partnership to offer
Baby Cafés in the area. Baby Cafés are
a relaxed, friendly place to drop in for
support and advice for breastfeeding
mothers.
Mothers said:
‘I don’t think I would have
made it without the support I
received. My friends in other
areas have nothing like this
and are really envious of
everything that is available
for us’.
‘Everyone takes the time
to really listen to you and
you feel that they genuinely
care’.
This means we have been able to increase the number of parents with new
babies we visit before the baby is 14 days old. This is demonstrated overleaf.
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46
Eight conversation partners were trained
in September 2014 and have been paired
with eight people living with aphasia for
regular visits.
We know this scheme is having a positive
impact because volunteers have told us
they feel more confident, enjoy the visits,
have a better understanding of stroke
and aphasia and are well supported by
the Speech and Language Therapists.
People with aphasia have told us they
look forward to visits, can discuss a
wide range of topics as visits give them
a chance to chat and they enjoy the
company.
We are committed to transforming the Health Visitor Service incorporating the “four level”
service model (see glossary) and focussing on the five universal reviews:
• Antenatal health
• New baby review
• 6-8 week assessment
• 1 year assessment
• 2-2½ year review
We are addressing the needs of the ‘six high impact areas’ (see glossary) by
professional development of existing staff to lead on areas such as parent infant
mental health, breastfeeding and transition to parenthood in early years. We have
introduced specialist posts to lead on these areas which will support improved service
user access and experience leading to improved outcomes and reducing health
inequality.
Conversation Partner Scheme
In our last Quality Account we reported on
this new initiative which was developed in
response to an identified need for more
long term support for people living with
aphasia living in east Surrey.
Aphasia is a communication disability that
affects communication after brain injury,
most commonly stroke. This can result in
difficulty talking, understanding, reading
and/or writing. Things we take for granted
like chatting to friends and family, reading
an email, or making a shopping list may
become difficult or impossible. People with
aphasia can become isolated and lack
the regular company and conversation
that they used to have. This may lead to
mental health issues and have a negative
impact upon their lives.
We wanted to provide supported
conversation to people at home who may
be unable to access therapy or support
in groups, and have little opportunity
for social interaction. The speech and
language service provides training,
support and supervision for the volunteer
conversation partners in the Tandridge
Conversation Partner Scheme.
The speech and language therapy
service has collaborated with Tandridge
Voluntary Services Council and
Befriending Scheme to recruit volunteers.
Recruitment for volunteers and promotion
of the project has involved presentations
in local newspapers and magazines, as
well as a radio interview on BBC Radio in
September 2014.
We have trained three groups of
volunteers over the last three years, to be
conversation partners so they can visit
people with aphasia, providing company
and supporting conversation.
Patient satisfaction surveys/
Friends and Family Test (FFT)/
‘iWantGreatCare’
First Community piloted the Friends and
Family Test question in the community
using the iWantGreatCare solution in
April 2013 on our Ward, Minor Injuries
Unit and Rapid Assessment Clinic. Since
then we have collected over 8,040
individual responses. Our full solution
was introduced across all our services in
October 2013. From April 2014 – March 2015
we collected over 5,808 responses and
our FFT average score was 97% of our
service users would recommend our
services.
The Friends and Family Test and
comprehensive patient experience survey
is now implemented across all services
in First Community. We commissioned
iWantGreatCare as our technical partner
to ensure that there is a consistent and
objective methodology to our patient
feedback process. Patients can feedback
their experience in different formats:
• Paper version with FFT questions and
further bespoke questions pertinent to
the service
• Paper version – easy read format for
patients with communication difficulties
or where English is not their first
language
• Paper version – designed for children
and teenagers
• Electronic version – via web-link and
a unique service code given via
business card
• Development of electronic version via
tablets for 0-19 Service
We have also developed a ‘patient story’
feedback card with iWantGreatCare
to enable patients and carers with an
opportunity to provide a more detailed
account of their experience. These stories
will not be published in the public domain;
however, they will provide additional and
invaluable patient and carer feedback.
We publish our patient FFT results on our
website and all direct electronic feedback
via iWantGreatCare is published in real
time on our Company home page.
Improving our reporting
Each comment we receive is read, valued
and acted upon if needed. We have
improved our reporting this year to ensure
the experience our patients receive is firstrate.
We keep a log of how many responses
each service has so we can see trends in
high/low figures or high/low scores in our
star ratings.
We also track themes of any negative
comments which get reported to our
Clinical Quality and Effectiveness Group
and to the Board. We expect our team
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48
leaders to add information to this sheet on how they are making improvements and set
a target date when the improvement will be actioned.
We have made improvements to the way we report our FFT scores internally. We
publish it via a ‘good news’ feed in our weekly e-bulletin and share positive comments
at our staff survey. We have developed our dashboard on patient experience for the
Executive Team to included qualitative feedback as well as statistical data. We used
a computer programme called ‘wordles’ to give us a quick insight into positive and
negative themes arising. Here is our ‘wordle’ (most frequently quoted words in our
feedback) for February 2015:
This year we have introduced a patient
stories’ card. We felt that some of our
patients want to leave more than a few
words on their care and want to ‘tell their
story’. It is important for us that as well
as collecting their feedback we help
our patients to tell their story to help us
understand what it is like to be in their
shoes. This is not reported nationally but is
an extra way we are collecting feedback
internally.
Here is some of our service specific
feedback.
Dietetics
Dietetics consistently score highly through
the FFT. Some recent quotes from service
users:
All service users would be ‘extremely likely’
to recommend the service.
Our contracted Homecare Company
surveys those individuals receiving home
enteral (tube) feeding and includes
questions about the service provided by
First Dietitians. There were 41 responses
from a possible 188 giving a response
rate of 21%. 94% of our patients thought
the service provided was excellent. This
was an improvement on the previous
results of 89%. We are pleased to see this
improvement as we have worked hard to
improve our staffing levels and continue to
work closely with the Homecare Company
and their nurses to ensure consistent
messages, timely review and support.
Audiology
“An excellent professional service”
“Very friendly and professional with
great understanding”
The Audiology Service has high scores
in relation to the FFT questionnaires.
However, our service users have
expressed concern about the difficulty
in contacting our service, specifically via
the telephone. Currently, the receptionist
answers the telephone and emails as
well as addressing patients who walk in
for assistance. The number of patients
the service supports is ever increasing
and as such the service needs to more
accessible via the telephone.
To address this it has been necessary to
re-develop the reception desk area so
it can accommodate two work stations.
We have an additional desk in place and
are in the process of securing computer
and telephone access. We have also
recruited a new member of staff to work
at this desk. We will continue to monitor
our feedback to understand if this has
improved our service users’ experience.
needed to pay more attention to hygiene
so we have ensured that our teams are
up to date with infection control training
and have completed hand hygiene audits
to ensure 100% compliance.
Some comments received from patients
and their carers about the district nursing
teams:
“Friendly, efficient, sympathetic
nurses, I feel confident that when
I ring up they will deal with me
carefully and promptly.”
“Nurses are kind, considerate and
helpful.”
Physiotherapy
“Friendly, helpful, good advice. We
feel we have excellent support.”
We have been concentrating on
improving our patient information following
comments from FFT. We now have a new
professionally printed leaflet and some
much clearer maps that we send out to
patients.
“The care I received was exemplary.
The staff were dedicated and very
caring. As far as I’m concerned
nothing could be improved.”
0-19 Service
Since we began collecting feedback
through FFT in April 2014 our results have
been consistently excellent with 96% of
service users recommending our services.
To increase our scores we have been
trialling a tablet solution as well as the
paper and online feedback. This is to
ensure we are offering families and young
children a range of ways to feedback.
Podiatry
We have introduced a new cancellation
line that is available between 9am –
4pm daily. Our patients can also leave
messages on an answerphone which is
checked daily.
District Nursing
We have introduced ‘you said, we did’
methodology across our District Nursing
teams. Our patient feedback told us we
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50
Staff survey (‘iWantGreatCare’)
Information Standard
First Community Health and Care was part of the second stage pilot for The NHS
England Information Standard. The Information Standard is a certification programme
for all organisations producing evidence-based health and care information for the
public. Any organisation achieving The Information Standard has undergone a rigorous
assessment to check that the information they produce is clear, accurate, balanced,
evidence-based and up-to-date.
We were accredited in February 2014 for our 0-19 service. We received a Gap Analysis
Report at accreditation which identified specific improvements to make for the following
year. These were largely around being able to see our processes in practice –
because this was our first year being accredited there was no evidence that the
processes we had put in place for The Information Standard would work.
We were re-accredited in February 2015 and have further recommendations for 2016.
We have pledged to take the whole organisation underneath the umbrella of The
Information Standard in our 2016 accreditation. We have streamlined our process,
updated our branding guidance and templates and have a more accurate record of
which leaflets are in use and are up for review.
Staff experience
Council of Governors
ACHIEVEMENTS 2014-15
We have:
• Presented at the Community Forum and
Annual General Meeting (AGM), feeding
back on the work CoG have achieved
in the last year
• Been involved in the appointment of a
Non-executive director
• A nominated CoG member is a Trustee
of First Community Trust (Charity)
• Attended and promoted First
Community events reinforcing our
commitment to add social value to our
organisation including attendance at
the community forum and AGM
• Appointed a new CoG member
representing Caterham Dene
Constituents.
• Continued to be a staff voice at Board
level
• Had our Key Messages from our
meetings published in the First
Newsletter.
PRIORITIES 2015-2016
• To consider opportunities to add social
value to our community for the year
• To continue to be a staff voice at Board
level, and to contribute towards the
Organisation’s Development Plan
• To successfully recruit to vacant CoG
seats, to ensure that all staff groups’
views are represented
• To review constituencies once the Hub
structure is embedded and recruit
more CoG members as deemed
necessary
• To attend and promote First Community
events including Community Forum
to enable us to network with our
community and other stakeholders and
reinforce our commitment to add Social
Value to our organisation
• To attend Coffee Breaks and the AGM
to enable us to engage with staff
about the company’s Social Mission
and Community Interest Strategy and
increase the number of staff shareholders and our collective staff voice.
• To continue to produce ‘key messages’
to keep shareholders informed of our
work, and review how these messages
may best be delivered to staff.
• To continue to perform our Governor
role as part of the Company Articles
promoting and encouraging
participation by Members in the
Company’s affairs.
Last year we reported that we had decided to pilot the Staff Survey in January and
February 2014. Feedback from these surveys indicated that a staff survey each month
was too often. We decided to continue with the FFT for staff on a quarterly basis in line
with national reporting and guidance.
Since formal launch we have had three further reporting months June 2014, September
2014 and January 2015. Results for all five survey months are as follows:
Survey Month
Responses
‘Would you recommend’ question
January 2014
February 2014
54 (13.5%)
39 (9.75%)
86% (4.3 out of 5 star rating)
84% (4.2 out of 5 star rating)
June 2014
September 2014
January 2015
57 (14%)
56 (14%)
55 (13.75%)
92% (4.5 out of 5 star rating)
90% (4.51 out of 5 star rating)
88% (4.38 out of 5 star rating)
We have continued to feedback - ‘you said, we’re listening, we’re doing’. We analyse
themes from free text comments and from the statistics and feedback on how we are
making changes based on what staff have said.
This year we aim to introduce more robust reporting of internal engagement via a
dashboard to the Executive Management Team. We will use a mix of qualitative and
quantitative measures from staff engagement channels such as the e-bulletin, Coffee
Break and Staff Survey. One qualitative measure we will introduce is ‘wordles’ which
analyses the frequency of words in the free text comments of the staff survey. This
highlights positive and negative themes. Here is a ‘wordle’ for the January staff survey:
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We have also benchmarked our figures against national reporting.
Question (FFT and
NHS Staff Survey
questions)
First Community
NHS England Staff
NHS Staff Survey
Staff Survey
FFT Survey Results
2014 results
(average across 5
(QTR 2)
month collection)
88%
77%
64% (67.8% in
community)
Briefing sessions have been attended by more than 80% of staff to date and the
Behaviours Framework is now introduced to all new staff at induction. A ‘Developing
Your Potential’ booklet has been made available to all staff which outlines the
core behaviours framework (see diagram 1). This framework is based on some key
psychological principles that define the core skills required to be effective in any role,
with relevance across the whole organisation, at all levels. These core behaviours will
help us to deliver at our best and to have consistently effective daily conversations to
support measuring performance and developing potential.
Would you
recommend
services/care to
Friends and Family
81%
61%
79%
Job Satisfaction/
Support Given (FFT
recommend as a
place to work)*
Good
73%
N/A
37%
Communication
(keep informed)
*only last three months of data, did not include this question in pilot months)
We have compared our results over the
last five months of collection against
the data released by NHS England from
their quarter 2 staff survey. We have also
compared our results against the national
NHS Survey which currently First Community
does not complete, but have mapped
the FFT questions against similar metrics.
This shows more of our staff would
recommend services compared to the
national average and staff are, largely,
happier within their workplace and with
the support they receive.
We would like to raise our response
rate to further validate this data as a
representative figure of our staff group.
We are increasing the way we feedback
results from the staff survey to try and
improve response rate, sharing themes at
Coffee Break, with managers and at team
meetings.
Appraisal
The appraisal data was calculated up to
December 2014 and looked at appraisals
conducted within the preceding 12 months.
From a total staff headcount of 435, it
was identified that 261 had a recorded
appraisal within this period. However there
was missing data for 69 members of staff
where no appraisal date was provided.
Calculating the appraisal rate on the
staff that did provide appraisal data
(366) we have calculated that 71% have
had an appraisal in the last 12 months.
This figure could however be higher
dependent on the numbers of staff who
have not submitted data but have had an
appraisal within the last 12 months.
We recognise the need to improve our
systems to ensure that all staff receive
an appraisal and that we can accurately
monitor this. We are investing in training
to improve our staff’s knowledge and
skill around appraisal and in a learning
management system to enable us to
accurately monitor appraisal activity.
Behaviours Framework
First Community staff have always strived
to make patient care in our community the
best it can be, as reflected in our vision
and values (see page 7). However, for
our organisation to continue to perform
at the highest level possible, and for
all staff to reach their full potential, we
recognised the need to have a structured
approach to managing our day-to-day
performance. To this end we introduced
our Behaviours Framework in May 2014.
diagram 1
Clinical supervision
Clinical supervision was included as one of our priorities in our Quality Account 2012-13
and our progress against our action plan was detailed in last year’s account.
First Community remains committed to the provision of clinical supervision for all our
clinical staff, through protected time for reflection and learning. Clinical supervision
plays a key role in supporting and empowering our staff to achieve their potential and
thus provide the highest quality of care. We continue to offer staff a ‘menu of options’
enabling them to access clinical supervision in their preferred format, time and place.
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Learning and
Development
Our achievements this year:
What we said we’d do in 2013-14
We will continue to review our guidelines
at least annually to ensure they remain
fit for purpose and reflect local need
and national best practice and ensure
recurring learning themes from group
supervision inform clinical practice and
management.
We will explore further options for nonregistered staff.
Our facilitators will continue with annual
development days and facilitator
supervision groups for their support and
development.
Our Chief Nurse will continue to champion
clinical supervision and quarterly
reporting will continue.
What we’ve done in 2014-15
• The learning from clinical supervision
and clinicians’ commitment to their
chosen option is monitored through
the appraisal process, whilst quarterly
analysis and reporting of attendance
and learning themes emerging from
group-facilitated clinical supervision
inform the organisation’s learning and
development programme.
• We have appointed a new Practice
Development Facilitator who is leading
on the introduction of the new ‘Care
Certificate’ for non-registered clinical
staff during 2015 which will include
clinical supervision group support.
• We trained five new facilitators in March
2015 to ensure that we have enough
expertise within the organisation to
support staff opting for the groupfacilitated supervision.
• We have developed a facilitator log
book and on-line reporting template
to monitor attendance and learning
themes from groups.
• We held our annual development
day for facilitators in May 2014 which
focused on the re-defining of the
learning themes and managing nonattendance.
• Presentation to the Senior
Management Team and introduction
of a quarterly reporting schedule from
August 2014. All information is recorded
on a central database.
Other developments:
• supervisee log books have been introduced to provide structure for clinical
supervision sessions and to support supervisees in their reflection on practice
• we have produced an information leaflet which is given out at induction with a brief
introduction to clinical supervision.
Going forward we are planning an evaluation event in June/July 2015 to enable all staff
to contribute to the formal review of our guidelines for clinical supervision.
Achievement of the Care Certificate should ensure that the support worker has the required values, behaviours,
competencies and skills to provide high quality, compassionate care.
Developments during the
period April 2014 to March
2015:
We now source a greater
proportion of our training
directly from both internal
and external providers.
This enables us to tailor
the training we offer to
the specific needs of our
staff and the services that
we provide, helping us
to embed learning and
development across the
organisation, for the benefit
of our patients and service
users.
• Due to the range and
volume of training
courses now available,
we have introduced a
bi-weekly newsletter
which is sent to all
staff; this includes all
information on training
and professional
development
• We appointed a
Practice Development
Facilitator in January
2015 who is responsible
for leading on clinical
training and supporting
newly qualified nurses
and therapists
• We delivered
behaviours framework
briefing training
providing staff with
an awareness of the
behaviours framework
tool to underpin and
support positive
communication within
the organisation
and with external
stakeholders
• A new Statutory and
Mandatory Training Log
Book was launched
in February 2015 - this
updated version aims to
help our staff to identify
the training required
for their role and make
it easier for them to
keep track of their own
individual training as it is
completed.
• A comprehensive
Management
and Leadership
Development
programme has been
introduced to ensure our
managers and service
leads are fully equipped
to support the staff that
report to them
• The following training
has been made a
mandatory requirement
for all First Community
staff:
- Appraisee/er training
- Dementia awareness
- Customer care
• In response to reported
incidents and Serious
Incidents (SIs) we have
introduced:
- pressure relieving training
for all patient-facing staff
as one of our priorities for
2015-16 (see pages 18-22)
- record-keeping training
for all clinical staff
• We have also sourced
Root Cause Analysis
training to ensure that
staff who lead on SI
investigations are
equipped to do so
• Other training that has
been introduced in
the reporting period
includes:
- Motivational interviewing
- Bereavement Awareness
Training, provided by St
Catherine’s Hospice for all
of the community nurses,
to support them with the
provision of end of life care.
Customer Care Training
First Community has been
fortunate in sourcing an
excellent customer care
programme for our staff.
The course is provided by
an external company with
substantial experience and
a successful track record in
developing and delivering
this kind of training for
public, private and
voluntary sectors, including
health care organisations.
At the end of the
programme course
participants will have
covered:
• Delivering service
excellence consistently
• Understanding the
needs and expectations
of customers e.g.
patients, families, carers,
GPs, commissioners,
colleagues
• Making a positive first
impression
• Communicating with
internal and external
customers to inspire
confidence and build
trust
• Identifying barriers to
delivery of good service
and how to overcome
them
• Dealing with difficult and
challenging customers
and situations
• Obtaining and using
customer feedback
• Meeting, managing and
exceeding expectations
• Planning for service
improvement.
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Statement
Developing our
leaders
From our commissioners (East Surrey Clinical
Commissioning Group)
District Nursing
“
We have introduced
clinical leads to support
teams. Band 7 staff have
attended leadership
development workshops
and we are now
encouraging Band 6
staff to attend leadership
development workshops.
Band 5 staff identified they
would like some clearer
leadership, so we are
starting dedicated Band 5
meetings to enable Band 5
staff to meet one another
and feel they get a chance
to get some information first
hand.
Dietetics
Two members of our
dietetics team are
completing the leadership
and development
training provided by First
Community Health and
Care. This has helped
both team members to feel
valued and supported
in their roles. Our Head
of Dietetics has been
supported to undertake
an MSc in Healthcare
Leadership with the NHS
Leadership Academy.
Inpatient & Therapies
A member of our
Community Neuro
Rehabilitation Team,
Jenny Moye, is on a year’s
secondment, attending
the University of Brighton’s
Master of Research
On behalf of East Surrey CCG we welcome the opportunity to comment on the draft
Quality Account received on 12th May 2015. We have reviewed the document and
consider that it meets the Department of Health national guidance on Quality Account
reporting.
We were impressed by the range of innovations detailed within the report including the
development of a postnatal depression leaflet, family foods workshops and the health
visitor call to action. We were also pleased with the significant efforts First Community
have made in achieving their Commissioning for Quality and Innovation (CQUIN)
requirements, particularly in their CQUIN for improvements in end-of-life care.
We have worked closely with First Community during the year through the clinical quality
review meetings and over this time we have seen a great improvement in the quality of
data supplied through these meetings.
(MRES) in Clinical Research
programme. She is looking
at ‘seating post stroke’ as
her research proposal.
All the Band 7 staff in this
business unit are in the
process of attending
leadership development
courses.
Queens Nurse Award
One of our School Nurses
- Kath Gregory - became
a Queen’s Nurse during
the year. A Queen’s
Nurse is someone who
is committed to high
standards of practice and
patient-centred care. This
brings our total number of
Queen’s Nurses working
with us to four.
Publications
In early 2015, one of our
Health Visitors - Lena Abdu
- had a paper published
in the Journal of Health
and Social Care entitled:
‘Exploring the health
visiting service from the
view of South Asian clients
in England: a grounded
theory study.’
As a commissioner we would have liked to have seen a clearer response by First
Community to the comments we made on the 13/14 Quality Account, which we feel are
not fully reflected in the 14/15 Quality Account. In our statement for last year’s report,
we requested that the account for this year focused more on outcomes for patients
rather than performance data. We would have liked to see more evidence to support
the innovations mentioned throughout the report and further information on how this
improved outcomes for patients.
We continue to be of the opinion that by using more year on year comparative data in
the report, First Community would have been able to demonstrate real evidence of the
impact of changes to services and outcomes for patients.
In accordance with the CCGs governance arrangement, the Quality Account has been
shared with the GP Clinical Leads for their comments and whilst they were generally
satisfied with the account, they felt that the priorities for improvement need to be
focused more on patient outcomes and less on process.
Overall this Quality Account represents a fair reflection of the work undertaken by First
Community during the year. In this statement we have highlighted some areas where
we feel First Community could better reflect the progress made and their innovative
work in the future.
As reported in our statement for the 2013/14 Quality Account, in next year’s accounts
we would like to see the report focus more on outcomes, particularly from the patients’
perspective. To this end, commissioners would like to see progress of your quality
improvement plan on a quarterly basis. We look forward to continue working with First
Community to improve quality, embed learning and deliver excellent services to the
local residents of East Surrey.
”
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58
Statement
Statement
From Healthwatch Surrey
From the Health Scrutiny Committee
cover the work and plans of First Community
“ We
Health and Care as accurately recorded in the Quality
“ We welcome the opportunity to comment on this
Account.
Quality Account.
This opportunity has been considered taking into
account our current priorities and the most effective
way to achieve these. With this in mind we have taken
the decision not to comment on your organisation’s
Quality Account on this occasion.
”
We look forward to continuing to work with your
organisation over the next year. In particular we look
forward to continuing discussions in 2015/16 around
how to:
• Amplify the voice of Young People
• Make it easier to make NHS complaints
• Increase involvement of people, patients and
service users in decision making
• Promote and support people, patient and service
user focussed cultures
”
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Glossary of terms
ACE Inhibitor
An ACE inhibitor (or angiotensin-converting-enzyme inhibitor) is a medicine used
primarily for the treatment of hypertension (elevated blood pressure) and congestive
heart failure (CHF)
Angiotensin II
Angiotensin II receptor antagonists, also known as angiotensin receptor blockers
(ARBs), are medicines that are often used to treat high blood pressure.
Appraisal
The staff appraisal is an annual review and support discussion between a staff
member and their line manager, which reviews performance over the past year, sets
objectives and identifies learning and development needs for the year going forward.
Baby Friendly Initiative (BFI)
The Baby Friendly Initiative is a worldwide programme developed by UNICEF and WHO
to ensure that health care organisations are able to offer the highest standards of care
for pregnant women and breastfeeding mothers and babies. The Initiative ensures that
all health professionals are trained to offer the best possible advice and support to
breastfeeding mothers so that their babies can have the very best start in life.
Beta Blockers
Beta-blockers (also known as beta-adrenoceptor blocking agents) are medications
used to treat several conditions, by reducing the workload of the heart so as to put it
under less strain.
Care Quality Commission (CQC)
The CQC is the regulator for all health and social care services in England, ensuring
that the Government standards or rules about care are met.
Clinical Coding Error Rate
Clinical coding translates the medical terminology written by clinicians to describe a
patient’s diagnosis and treatment into standard, recognised codes. The accuracy of
this coding is a fundamental indicator of the accuracy of patient records.
Commissioning for Quality and Innovation (CQUIN) payment framework
The CQUIN payment framework enables commissioners to reward excellence, by
linking a proportion of NHS providers’ income to the achievement of local quality
improvement goals.
Deprivation of Liberty Safeguards
The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005.
They aim to make sure that people in care homes and hospitals are looked after in a
way that does not inappropriately restrict their freedom. The safeguards should ensure
that a care home or hospital only deprives someone of their liberty in a safe and
correct way, and that this is only done when it is in the best interests of the person and
there is no other way to look after them.
Four level Service Model
The new health visitor ‘service offer to families’, which provides four levels of help and
support - from a universal service for all, through to specific help for those who need it.
Information Governance Toolkit attainment level
The Information Quality and Records Management attainment levels assessed within
the Information Governance Toolkit provide an overall measure of the quality of data
systems, standards and processes within an organisation.
Lean Based Techniques
Lean is an improvement approach to improve flow and eliminate waste.
Management Actual Score
Management Actual Score (ACS) is the percentage of people titrated on the
medications who have not reached the maximum recommended dose of 10mg but
have reached the maximum that they can tolerate.
Management Complete Quality Score (CQS)
Management Complete Quality Scores (CQS) is the number of patients who have
reached the maximum target amount of 10mg of ACE (Ramipril) and beta blocker
(Bisoprolol).
Definition of Median
The middle number in a sorted list of numbers.
Medicines Omission
An omitted medicine is the failure to prescribe a drug in a timely manner. It is also the
failure to administer a dose when the next dose is due or, in the case of once only
doses (stat doses); failure to administer a drug within 2 hours of the time the dose is
due.
Medicines Reconciliation
Medicines Reconciliation is a process designed to ensure that all medicines a patient is
currently taking, are correctly documented on admission and at each transfer of care.
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National Patient Safety Agency (NPSA)
Social Enterprise
The NPSA leads and contributes to improved, safe patient care by informing,
supporting and influencing the health sector. It aims to reduce risks to patients
receiving NHS care and improve safety.
The Government defines social enterprises as “businesses with primarily social
objectives whose surpluses are principally reinvested for that purpose in the business
or in the community, rather than being driven by the need to maximise profit for
shareholders and owners.” As with all businesses, they compete to deliver goods and
services. The difference is that social and environmental purposes are at the very
heart of what they do, and the profits they make are reinvested towards achieving
those purposes.
Net Promoter Score (NPS)
Net Promoter Score (NPS) measures the loyalty that exists between a provider and a
consumer. The provider can be a company, employer or any other entity. The provider
is the entity that is asking the questions on the NPS survey. The consumer is the
customer, employee, or respondent to an NPS survey.
NHS Number and General Medical Practice Code Validity
The patient NHS number is the key identifier for patient records. Improving the quality of
NHS number data has a direct impact on clinical safety.
Participation in Confidential Enquiries
UNICEF
United Nations Children’s Fund (formerly United Nations International Children’s
Emergency Fund). UNICEF UK is a registered charity raising funds and awareness
to support UNICEF’s work to protect child rights worldwide, in accordance with the
UN Convention on the Rights of the Child (CRC). UNICEF UK also runs programmes in
schools, hospitals and with local authorities in the UK.
WHO
Confidential Enquiries are special enquiries that seek to improve health and health
care by collecting evidence on aspects of care, identifying any shortfalls in this,
and disseminating recommendations based on these findings. They include the
Confidential Enquiry into Maternal Deaths and Child Health (CEMACH), Confidential
Enquiries into Stillbirths and Deaths in Infancy (CESDI), the National Confidential Enquiry
into Patient Outcome and Death, and the National Confidential Inquiry into Suicide and
Homicide by People with Mental Illness.
The World Health Organisation is the directing and coordinating authority for health
within the United Nations system. It is responsible for providing leadership on global
health matters, shaping the health research agenda, setting norms and standards,
articulating evidence-based policy options, providing technical support to countries
and monitoring and assessing health trends.
Root Cause Analysis (RCA) investigation
Every day a million people are treated safely and successfully in the NHS.
However, when incidents do happen, it is important that lessons are learned to
prevent the same incident occurring elsewhere. Root Cause Analysis investigation
is a well-recognised way of doing this. Investigations identify how and why patient
safety incidents happen. Analysis is used to identify areas for change and to develop
recommendations which deliver safer care for our patients.
This is a tool for generating “word clouds” from text. The clouds give greater
prominence to words that appear more frequently in the source text.
Wordle
Six High Impact areas for Health Visiting
The purpose of the High Impact Areas is to describe areas where health visitors have
a significant impact on health and well-being and improving outcomes for children,
families and communities.
The six High Impact Areas are:
• Transition to Parenthood and the Early weeks Maternal Mental Health (Perinatal
Depression)
• Breastfeeding (Initiation and Duration)
• Healthy Weight, Healthy Nutrition (to include Physical Activity)
• Managing Minor Illness and Reducing Accidents (Reducing Hospital Attendance/
Admissions)
• Health, Well-being and Development of the Child Age 2 – Two year old review
(integrated review) and support to be ‘ready for school’
https://www.gov.uk/government/uploads/system/uploads/attachment_data/
file/413127/2903110_Early_Years_Impact_GENERAL_V0_2W.pdf Accessed March 2015
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Further Information and Feedback
If you would like to find out more about our services, please visit our website at
www.firstcommunityhealthcare.co.uk.
If you would like this information in another format or language, or would like to provide feedback about
this account or any of our services, please contact:
Communications Manager
First Community Health and Care
2nd Floor
Forum House
41-51 Brighton Road
Redhill
RH1 6YS
Telephone: 01737 775450
Email: fchcenquiries@firstcommunitysurrey-cic.nhs.uk
Twitter: @1stchatter
www.firstcommunityhealthcare.co.uk