Suffolk Community Healthcare Quality Account 2014/15
The QA outlines how well we are doing against national and local targets, where we need to improve the quality of services and our priorities for the coming year.
Delivering high quality, safe care is ou r fi rst priority and overrides any other. We focus on treating each patient as an individual, helping join up their care with other agencies, and seeking to provide services as close to home as possible, whilst balancing our available resources. We are always looking for new ways to provide higher quality, more ef fi cient services, while facing the challenges of an ageing population with increasingly complex health needs, plus inevitabl e fi nancial constraints. We are committed to working closely with our commissioners and partner organisations towards the planned redesign of health and social care in Suffolk. We look forward to the opportunities this will bring for greater integration with our partners and more joined-up care for the people of Suffolk.
• We have improved patient safety by focusing on the quality of our Community Equipment Service including:
• Simplifying the ordering and reporting processes across the service and equipment ordering system, and made it easier to use for clinicians
• Removing bar codes from all equipment that does not need regular maintenance, speeding up ordering for clinicians and ensuring patients receive equipment more quickly
• Improving our on-call service for end of life equipment requests, including service at evenings and weekends
• Reviewing delivery delays with feedback given both within the service and to clinicians requesting equipment.
• We have improved our clinical effectiveness by introducing the balanced scorecard
• This is a new approach to monitoring our services to ensure that quality is understood, measured, reported and owned by our clinical services
• It includes a wide range of indicators including staff appraisal and training rates, patient feedback and budget position, giving a clear overview of the service
• This has helped teams identify areas for development and highlight where they are progressing well
• This has helped us to be more open and transparent with our staff, partner organisations and our patients.
We are approaching the end of a three-year contract, during which our services have been provided by Serco. On
1 October 2015 the contract will be transferred to a new provider. At the time of writing the preferred bidder to take on the contract has recently been announced. This is a group led by West Suffolk NHS Trust and includes Ipswich Hospital
Trust, and Norfolk Community Health and Care. Every effort is being made to ensure we work together towards a seamless transition for our patients and staff.
We have a range of contracted key performance indicators
(KPIs) set by our commissioners, the two Suffolk Clinical
Commissioning Groups (CCGs). By March 2015 SCH was achieving 88.89% of its KPIs, a slight drop from 2013/14.
This is due to two services performing less well, but after concerted efforts by the teams, both services are now increasing their compliance and are on an upward trajectory.
Patient feedback shows high levels of patient satisfaction, averaging well over 90 per cent compared to the NHS average of about 75 per cent.
Good progress has been made on all of the QA priorities set for 2014-2015:
We have improved staff engagement in SCH, as it is fundamental to the quality of service we provide and the experience of our patients
Staff who feel informed, valued, happy at work, respected and supported are more likely to deliver a consistently high quality level of service
• We provide regular updates from senior and wider leadership team meetings, and our Board meetings, covering a broad range of topics including good practice and staff achievement
• Senior managers have spent more time with teams in their bases, joining them in their work
• Our annual Viewpoint Serco staff survey scores showed a marked improvement on engagement scores from the previous year
A range of initiatives such as the staff-led Fix100 scheme, employee communications forum, and pilot radio show have also helped up to improve engagement and morale.

Suffolk Community Healthcare Quality Account 2014/15
To improve the way we look after and advise people who have fallen to ensure the best possible outcome for them
To provide an improved dementia care service for patients and carers affected by complex physical healthcare conditions and cognitive impairment
To review the information we give to patients and their families and improve the material we offer them to enhance recovery and reduce anxiety.
There are many other initiatives within our organisation beyond these three QA priorities as we have a comprehensive commitment to quality and safety. This account is an attempt to take a snapshot of a year in Suffolk
Community Healthcare and show how proud we are of the work we do.
At Suffolk Community Healthcare we constantly strive to improve the quality of services we provide to our patients.
Our Quality Account is our annual report of:
• How well we are doing against targets we are set by the
Department of Health, our Clinical Commissioning Groups
(CCGs), and those we set ourselves as an organisation
• Where we need to improve the quality of the services we provide
• Our priorities for the coming year.
The following report outlines the quality improvements the
Suffolk Community Healthcare Board has agreed for the coming year 2015/2016. It also summarises the organisation’s performance and improvements against the quality priorities and objectives we set ourselves for the year 2014/2015.
We have reported against the priorities, including explanations where we have not met these and how we are addressing any issues.
Throughout the year we work with stakeholders and staff to establish the priorities for the coming year and address the challenges we faced throughout 2014/2015. Our new priorities are detailed under the headings Patient Safety;
Clinical Effectiveness and Patient Experience. We explain how we decide on our priorities and how we measure performance against them.
Finally, we provide information to review that is relevant to the quality of our services and include statements from
Healthwatch, Health Scrutiny Committee and the Clinical
Commissioning Groups submitted in response to this Quality
Account.
“...your standards of care and the staff that administered it are beyond reproach and show what can be done for vulnerable persons in these days of criticism of the Health Service...”
Community Hospital Patient
“As a team you are all amazing. I cannot believe how many times we were laughing with her despite the situation she was in - we were very lucky to have had a final Christmas with her and you made it special...”
Adleburgh Community Hospital
Progress against Quality Improvement Priorities for 2014/15
If you would like more information about our Quality
Account, or t o fi nd out more about our services, please contact Christian Jenner (details below).
We would like to hear your views on our Quality Account.
Please contact Christian Jenner by telephone on 01284
718259, or by email at christian.jenner@suffolkch.nhs.uk.
The Quality Account is available in large print and other languages on request.
Please contact Christian Jenner by telephone on 01284 718259, or email christian.jenner@suffolkch.nhs.uk.

Suffolk Community Healthcare Quality Account 2014/15
1:1 CEO’s statement
1:2 Introduction to Suffolk Community Healthcare
1:3 Putting qualit y fi rst
1:4 Highlights from 2014/15
1:5 Featured service – PACE
2.1 Our priorities for quality improvement in 2015/2016
Priority One – Patient safety to improve the way we manage people who have fallen to ensure the best possible outcome for them
Priority Two – Clinical effectiveness to continue to develop an improved dementia care service for patients and carers affected by complex physical healthcare conditions and cognitive impairment
Priority Three – Patient experience to review the information we give to patients and their families and improve the material we offer to them to enhance recovery and reduce anxiety
2:2 Other improvements we plan to deliver
2:3 Statements of assurance – review of service
2:31 Participation in clinical audits and national co nfi dential enquiries
2:32 Commissioning for Quality and Innovation
2:33 Care Quality Commission and specialist reviews
2:34 Data quality
2:35 Information governance
2:4 Featured service – to be decided
3:1 Progress against Quality Improvement Priorities for 2014/5
Priority One – Patient safety to improve the quality of our community equipment service
Priority Two – Clinical effectiveness to introduce a comprehensive approach to monitoring services to ensure that quality is understood, measured, reported and owned by our clinical services (balanced scorecard)
Priority Three – Patient experience to improve the experience of people using our services and their families/carers by reviewing and enhancing the way we receive and collect feedback
3:2 Summary performance indicators
3:3 Learning from incidents and complaints
3:4 Safeguarding adults and children who are at risk of abuse or neglect
3:5 Infection control
3:6 NHS safety thermometer and safety cross
3:7 Services provided by our partners
3:8 Adult services provided by SEPT (South Essex Partnership University NHS Foundation Trust)
3:9 Workforce
Summary performance indicators
Annex statements from CCG, Health Scrutiny Committee and Healthwatch
Glossary

Suffolk Community Healthcare Quality Account 2014/15
Hello and welcome to our Quality Account for 2014/15. This document is the equivalent of an annual report, but rather than focus on numbers and performance, it is primarily concerned with quality and safety. With our partners, Serco has been delivering NHS community health services in
Suffolk as Suffolk Community Healthcare since October
2012. Our partnership has brought together Serco, South
Essex Partnership University Foundation Trust (SEPT)
Community Dental Services (CIC) Bedford (CDS) and Bromley
Community Healthcare.
We are now nearing the end of the three-year contract. Our priority remains keeping our patients at the heart of our service, providing high quality, safe care that meets people’s needs in their community. We have faced challenging times, especially as we are caring for an increasing number of patients who have increasingly complex clinical needs. I am proud to say that we consistently deliver or surpass the majority of our performance targets set by our commissioners. Even more pleasing is the consistently excellent feedback we receive from our patients and their families.
There is never any room for complacency in healthcare, and this year we have made great efforts to investigate more detail of what our patients, their families, and our staff think about us. This is helping to improve quality across our services. We have also focused on improving the morale of our colleagues, whatever their role in our organisation.
Everyone has a role to play in our patients’ experience, and as a management team we have been listening to, observing and learning from our colleagues, valuing their opinions and respecting their skills and experience. Leading this innovative, ef fi cient and effective service with its dedicated workforce has been an immense privilege for me. It is therefore with great regret that we have taken the decision that Serco will no longer be providing SCH services after 30 September
2015. Serco has been reviewing its global business and has had to make hard decisions about the level of investment required to provide some of its contracts. Following lengthy and in-depth research and discussion at the highest level, it is felt that Serco can no longer sustain its considerable investment in SCH when our contract comes to an end.
This is no way re fl ects our belief or pride in what we have achieved - and continue to achieve - with everyone at SCH.
We are committed to this contract until it ends, and will continue to focus on providing high quality and safe services for our patients. I have made my own personal commitment to all my SCH colleagues that we will endeavour to make this transition as smooth as possible for them and the patients they serve.
I want to take this opportunity to thank our staff at SCH and partners across Suffolk for all their hard work and commitment, and wish them all the very best for the future.
I am pleased to co nfi rm that the Board of Directors has reviewed the 2014/15 Quality Account and co nfi rms that it is an accurate and balanced re fl ection of our performance.
We hope that this Quality Account provides you with a clear picture of how important quality improvement and patient safety are to everyone at SCH.
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Suffolk Community Healthcare Quality Account 2014/15
h fi
The Quality Account has been prepared in accordance with the Department of Health guidance and presents a balanced picture of the organisation’s performance over the period covered. The performance reported in the Quality Account is reliable and accurate.
There are proper internal controls over the collection and reporting of the measures of performance in the Quality
Account and these controls are subject to review to ensure they are working effectively in practice.
The data underpinning the measures of performance reported in the Quality account is robust and reliable and conforms to speci fi ed data quality standards and prescribed de fi nitions and is subject to appropriate scrutiny and review.
Directors’ Declaration: We can co nfi rm that to the best of our knowledge and belief the information contained in the
Quality Account is accurate and represents our performance in 2014/2015 and our commitment to quality improvement.
Abigail Tierney
Dawn Godbold
Pamela Chappell
Dr Timothy Reed
Peter Forrester
Janet Ettridge Andrew Hardman

Suffolk Community Healthcare Quality Account 2014/15
Our vision for Suffolk Community Healthcare, a partnership between Serco, South Essex Partnership University NHS
Foundation Trust (SEPT) and Community Dental Services
(CDS), is to provide high quality accessible and responsive community and children’s services in people’s homes and their community through an integrated model of care.
Service delivery across Suffolk Community Healthcare is provided by a range of professionals which includes district nurses, physiotherapists, occupational therapists, generic workers and healthcare assistants.
They work in Integrated Community Health Teams arranged around a cluster of GP practices and working with social care, managed within four geographic patches. Community
Health Teams work closely with Community Matrons,
Community Cancer Nurses, Specialist Nursing (Neurology,
Parkinson’s, Epilepsy), Falls and Fractures, Heart Failure and Cardiac Rehabilitation. SERCO also provides other services which include Admission Prevention (Community
Intervention Service), Pulmonary Rehabilitation, Chronic
Obstructive Pulmonary Disease (COPD) service, a Minor
Injuries Unit in Felixstowe, Continence Team, Community
Equipment (independent living) and Wheelchair Service.
Other services include four Community Hospitals in
Aldeburgh, Felixstowe, Ipswich and Newmarket plus NHSfunded nursing and residential home beds at a number of sites in the county.
Is a single point of referrals for GPs, hospitals, other statutory and voluntary organisations and patients and carers, 24 hours a day, 365 days a year.
Provides a range of Community Paediatric Services, Podiatry,
Foot and Ankle Surgery and Adult Speech and Language
Therapy.
Provides a full range of dental care to both adults and children with special needs and those from marginalised and vulnerable groups. CDS also carries out dental screening of primary school children.
The map above shows the geographical area covered in Suffolk.
• Delivers community based services to people of all ages across Suffolk
• Provides services to West Suffolk CCG, Ipswich and East
Suffolk CCG, Ipswich Hospital, West Suffolk Foundation
Trust, South Norfolk CCG, East Coast Community
Healthcare, Cambridge University Hospital Foundation
Trust (Addenbrookes Hospital), Cambridge and
Peterborough CCG, Suffolk County Council
• Serves an estimated population of 650,000 people in
Suffolk, with the exception of the Waveney area
• Delivers services in a variety of settings including people’s own homes, care homes, community hospital in patient units and clinics, day centres, 31 schools, GP surgeries and health centres
• With our partners SEPT and CDS, we employ around
1,400 staff, including nurses, healthcare assistants, physiotherapists, occupational therapists, specialist clinicians, generic workers, healthcare assistants, technicians, administrators and support staff
• Has a range of corporate functions to support clinical excellence, includi ng fi nance, performance, quality and risk management and workforce development
• Our income in 2014 was £57,859,685
“...many thanks for your visit last week, you were very helpful to us in many ways. The information you gave us which included brochures, contact phone numbers and much advice was most useful.
What was so good about your visit was the fact that it is the kind of information that does not appear to be within the scope of many of the other good people who come to see us...”
Progress against Quality Improvement Priorities for 2014/15
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Suffolk Community Healthcare Quality Account 2014/15
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High quality care is all about ensuring that those who require our services receive the right care, when they need it, delivered with care and compassion by the most appropriate person.
Quality is much more than a word or a set of action plans, it is about how we as an organisation and individuals within that organisation live by our values and our behaviours.
Inextricably linked with quality is patient experience, as an organisation we believe that where these are aligned, patients will receive high quality care with better outcomes, improved patient experience and for our staff better job satisfaction and a sense of wellbeing.
The Mid Staffordshire NHS Trust public inquiry and the
Francis Report (www.midstaffspublicinquiry.com) highlighted for us all the importance of keeping our patients and the quality of care we provide at the heart of everything we do. We have continued to focus upon th e fi ndings and recommendations of the inquiry and are committed to the delivery of high quality patient-centred care delivered by caring, compassionate staff. The recommendations are on many different levels from changing clinical practice to a new focus on more effective leadership and changes throughout our systems. We recognise that changes take time – some actions need long-term planning, while others can be more easily achieved.
We have done lots of work throughout 2014 and 2015 to develop a quality culture that listens – a culture where the Board actively works to create a positive emotional environment, valuing staff, promoting their health and wellbeing and supporting them to cope with the demands of their work.
As a Board we have accepted that we have not always got this right, and have continued with efforts to demonstrate that we appreciate the contribution made by staff and by so doing i nfl uence the quality of care their staff deliver. During
2014/2015 we have continued back to th e fl oor days with senior leaders meeting teams at least twice each month to understand teams’ key issues and achievements.
An annual staff survey helps us understand how employees feel about the organisation and we are acting on what we learn – this year’s survey showed improved staff engagement but there is still a long way to go. That is why we made staff engagement one of our quality priorities for 2014/2015. (see page 39).
Our organisation is now facing another time of change, with all the uncertainty that brings for our staff. We are committed to maintaining our focus on excellent, safe care for our patients; and on supporting our staff through the challenges they are facing once again.
SCH introduced the post of medical director in 2013 to support the focus on quality in patient care and improve links and partnerships with the medical profession. Ou r fi rst clinician in the post, local GP
Dr Amit Sethi, left us to take up a new opportunity at the start of 2015. The post is now held by Dr Timothy Reed (pictured), a GP in Ipswich. He has taken on the role of engaging with and listening to other
GPs across Suffolk as well as meeting and talking to as many of our staff as possible to ensure frontline views go direct to the board. With other senior staff, Timothy is closely involved with informing the current system redesign with the CCGs.
To understand how well (or not) we may be doing and assess our performance we monitor a number of
“indicators” (aspects of a service that can be measured).
Examples include the number of patients waiting for a particular treatment or the number of complaints or compliments a service may have had. Measuring such indicators demonstrates how ef fi cient the organisation is in using its resources and how effective it is in achieving the best patient outcomes.
Indicators are measured daily, monthly and quarterly. Some data is compared with national data so that we may learn from, and share good practice with, other organisations.
Information is collected and presented in a number of different ways allowing:
• The Board to scrutinise the quality of services, with information providing an accurate, timely and balanced picture of performance including patient, clinical, regulatory, staf fi ng an d fi nancial perspectives
• Trend analysis of speci fi c indicators
• Comparisons with other organisations (known as benchmarking).
Information is presented to a variety of committees for monitoring and to a number of departments and service areas for their review and improvement where necessary.

Suffolk Community Healthcare Quality Account 2014/15
A dashboard is a visual and simple way of presenting information which gives a clear and comprehensive picture of how an organisation is performing against important measures. Last year we developed a balanced scorecard for and with our community health teams (see page 38). This year we have further developed this approach to monitor the services we provide for the people of Suffolk.
We have developed three high level dashboards which support the strategy and management of the organisation and the services we deliver. Our approach to management information has created easy to read, graphical presentation of any given month plus historical trends of SCH key performance indicators. This enables informed decisions on the quality and performance of our services.
Our staff and how we support them to deliver our services
The standards we reach in delivering our services
Are we managing our budgets effectively and ef fi ciently and delivering value for money.
The SCH Board, senior leaders and managers use this approach constantly to monitor these three areas to ensure balance across the organisation. This management information is also used as a means of holding to account for the quality of the care we deliver, how we support SCH staff and to ensure ou r fi nancial resources are being used appropriately. We are looking to extend the CHT dashboard template across other services, e.g. CES (Community
Equipment Services), Specialist Services, customising the dashboard to include the services’ speci fi c requirements.
The balanced scorecard is now in use across SCH. Quality should be the driving force of any health organisation.
The balanced scorecards provide accountability and focus and drive continuous quality improvement across SCH.
SCH has a well-established quality framework structure to ensure accountability through its committee and management structures and support quality. The Clinical
Quality and Safety Assurance Committee and Compliance
Committee oversee all aspects of quality ensuring responsible of fi cers are held to account for their relevant areas.
The main subgroups for monitoring quality are the
Medicines Management Group (chaired by the Medical
Director), Patient Experience Group, Safeguarding Group and
Infection Control Group (chaired by the Director of Nursing,
Therapies & Governance). There is also representation from
SEPT and CDS on a number of the groups above to ensure quality is monitored throughout the SCH partnership. Each committee receives structured reports from teams and individuals for monitoring and assurance purposes.
Each locality is managed by an area manager, supported by nursing and therapy professionals. Together they are accountable for quality within the operational management structure. This was an identi fi ed area of development for this year. Indicators of performance and quality (the balanced scorecard) are now in place so teams have information at thei r fi ngertips about their area of practice. This allows teams to identify where things are progressing well and where improvements are required.
Critically we recognise that ensuring quality throughout the organisation is more than holding regular Board and
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Suffolk Community Healthcare Quality Account 2014/15
Committee meetings and scrutinising data. It is about actively seeking opportunities to hear the voice and experiences of staff, patients and the public. This is a lesson we have learned since 2012, with a higher than acceptable percentage of staff reporting that they have felt disengaged from the senior management of the organisation. More of our staff now report that they feel engaged, but we are committed to maintaining the focus on fostering a culture of engagement.
That is why all leadership team members have made the commitment to step out of the board room and engage directly with our frontline staff, gaini ng fi rst-hand knowledge of the staff and patient experience in giving and receiving care. Leadership team members attend a minimum of two team meetings per month, with the medical and nursing directors working clinically with staff in the community. Leaders also visit teams as they work to see the issues they face and their commitment to qualit y fi rst-hand.
We have reinstated leadership “quality walkabouts” to make sure we make real differences, using what we learn from observing and listening to staff.
There are many ways that the views of the public are heard:
• Surveys – Postal and Telephone
• Letters of thanks and other compliments
• Complaints
• A close relationship with Healthwatch Suffolk
• Feedback from the CCG through their PALS service and through other communication channels: MPs, local groups
• Patient and carer interviews.
All of this information is reviewed and used to make improvements where required. It shows us where we have speci fi c challenges with some areas of our services. In
2013/14 we listened to concerns regarding our Community
Equipment Service, and made this a focus for quality improvement in 2014/5. (see page 37).
We know that in all organisations an engaged workforce with good staff morale, will be more ef fi cient and productive. This is vital in a healthcare organisation where the focus must be on providing safe and effective care of a high quality. Our staff are engaged with their colleagues and teams, and most of all their patients. We have faced signi fi cant challenges of engaging our staff with the wider organisation, especially in the wake of problems encountered after Serco took over SCH in October 2012.
For this reason we made staff engagement a priority for improvement in 2014/5 – see page 39. This year we have maintained our focus on supporting our staff to feel engaged and valued, and their feedback through the
Viewpoint and other surveys has shown us improvements have been made.
This year we have developed our work with Healthwatch
Suffolk (HWS), which has given us a way of learning more about the views of service users, especially through voluntary organisations which work with them.
As part of our aims to improve the information we give our patients (see page 22), we are seeking to expand our work with voluntary agencies such as Suffolk MIND, Age UK
Suffolk and Suffolk Family Carers. These organisations can help us to understand more about the speci fi c needs of our patients and their families, and help us to “signpost” our patients to valuable support services.
With HWS, staff from across SCH, and colleagues from the voluntary sector we have established a patient and carer forum which meets every two months and is chaired by the
HWS chairman. This group is still in its early stages, but we are committed to building a partnership that will help us to be open about where we are succeeding and where we need to improve.
We have this year developed our public website, www.
suffolkcommunityhealthcare.com This site includes a general overview and speci fi c information about the services we provide; a section with information useful for health professionals; general facts and news updates about SCH; and how t o fi nd the places where we care for patients.
The site also has full contact details, and a facility for contacting us by email to comment and ask questions, which are dealt with as soon as possible.
We hope this year to add more information for professionals, a better self-care section and expand the details about what we provide. Our work on improving patient information (see page 22). will help us as we will be scoping and collating the printed material we offer, which we plan to make available for download on the site.
• Through these forums, SCH has made good progress with rolling out a new way of identifying, treating and supporting frail elderly patients, by working with colleagues in mental health, social care, GPs and consultants from the acute hospital.
• We are an integral part of a pilot project in Sudbury which is designed to change the way we work with partners across health and social care.
• We have also been instrumental in developing multidisciplinary team meetings in primary care that have changed the way we work with GPs and others to care for our most vulnerable patients. We have also led the PACE service (see page 11); and made great progress on our integrated working CQUIN (see notes further on).
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Suffolk Community Healthcare Quality Account 2014/15
• Our Community Health Teams’ response times have maintained at 95% or above for 2014/15 for the fourhour, 72-hour and 18 week targets
• Our services have consistently achieved high levels of patient experience
• Adult Consultant led services (Foot and Ankle and
Dermatology until Dec 2014) have been above 95% for referral to treatment for all 12 months of 2014/15
• Paediatric consultant-led services were doing very well with waiting times until March 2015 when they fell below
95%, due to increase in referrals and service capacity
• Combined non consultant-led services waiting times have been above 95% for all 12 months
• SCH children Safeguarding training for ALL staff has been
95% or above all year
• SCH adult Safeguarding training for ALL staff as been
93% or above all year Venous thromboembolism assessments in our community hospitals have been above
98% for all year
• The Pulmonary Rehabilitation service (see page xx) has improved throughout 2014/15 and are now meeting their targets, and exceeding them for the number of courses offered and completed.
• We have had no incidence of MRSA bacteraemia in
2014/2015.
Suffolk Community Healthcare continues to be committed to working in partnership with other health and care providers in a more integrated way that improves patient experience.
During the last 12 months there has been good progress at both strategic and local level.
Strategic involvement is through the System Leaders
Partnership Board, which is a countywide group; and the
Integrated System Forums in both east and west Suffolk.
All of these groups consist of both statutory and non- statutory organisations and has representation from across health, county council, police, housing and voluntary organisations.
In the coming year SCH will continue to be heavily involved the system-wide health and care review for Suffolk. This will include co-locating our teams with partners where possible, taking opportunities to share learning and experiences to develop a better joined up system.
We will be strengthening our involvement and joint working with the voluntary sector especially around services for admission and discharge from hospital.
• Progress in moving towards a shared information technology system by which patient records can be safely and securely shared
• Joint workforce and education plans to help overcome the recruitment challenges in the system and develop integrated roles that can work across traditional health and care boundaries.
• We have also developed a stronger relationship with the
GP Federation in Suffolk as we believe this is key to good patient experience, and have worked with them on a scheme for patients with respiratory problems over the winter and have plans to integrate some services such as nurse training and phlebotomy going forward.
• We have worked with our partners in the acute hospitals to improve how transfers work between us, sharing of important information, and joint schemes to help ensure those patients who no longer need to be in an acute hospital are supported to go home.
Nurse and patient in garden
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Suffolk Community Healthcare Quality Account 2014/15
One of the greatest opportunities of the 21st century is the potential to harness the power of the technology revolution, which has transformed our society, to meet the challenges of improving health and providing better, safer, sustainable care for all.
The health and care system has only just begun to exploit the potential of using data and technology at a national or local level. Better use of data and technology has the power to improve health, transforming the quality and reducing the cost of health and care services. It can give patients and citizens more control over their health and wellbeing, empower carers, reduce the administrative burden for care professionals, and support the development of new medicines and treatments.
SCH has embraced digital technology and patient records are held primarily in a computer programme called SystmOne and data is collected by the clinical staff treating the patient.
These data are extracted from the system to allow us to monitor the quality of care and report on SCH performance against targets set as part of our contract with the Suffolk
CCGs.
We carry out regular audits of the use of SystmOne and how our staff are using the system to record the work they do with patients. This has led to improved quality and accuracy of data and 2014/15 has seen an increase in the use of
SystmOne by our clinical staff.
During the year over 420,000 clinical activities with patients were recorded on SystmOne and month on month there was an increase in electronic records.
In addition 90% of these records were made within 12 hours of seeing/treating the patient in line with professional codes of quality record keeping.
We have successfully trialled a new mobile version of
SystmOne – the “mobile app” which is being mobilised across all of our community services.
Rigorous evaluation has co nfi rmed the bene fi ts of using mobile technology which include:
• Up to 20% increase in patient facing time (the time spent with a patient in their home, hospital, clinic setting)
• Improvements in timeliness of record keeping
• Staff and patient safety enhancements
• Access to clinical records at point of care – up to date information available
• Access to shared records enhancing quality and safety
• Improvements in care planning and work loads.
Systmone Is a computer system used by Suffolk
Community Healthcare to record all contacts, care and treatment for patients under our care.
SystmOne is a National IT system used by many other community providers, GP practices, and Out of Hours services across the country and provides many bene fi ts including, sharing electronic patient records with other healthcare providers involved in the patients care, providing standard tools and ways of working for all of our services and providing mobile access to patient records at the point of care whilst securing patient records from inappropriate & unauthorised access.
To ensure that we maximise the bene fi ts of using technology and mobile working we have invested in system and staff training support. As teams adopt new technology they are supported by experienced users and IT staff in making the necessary changes in the way they work.
Our Care Co-ordination Centre (CCC) is our centralised service set up to manage initial referrals and support the management of our teams’ schedules. Based in Ipswich, the
CCC operates 24 hours a day, 365 days a year. Referrals are managed for all the community health teams and a number of the specialist services.
The CCC has grown considerably in the last 12 months and this is re fl ected in the increased call volumes, referrals and interactions being handled. The CCC now handles in excess of 20,000 interactions per month which arrive in the form of phone calls, faxes and emails. A comparison of April 2014, saw the CCC handle 12,500 calls, against more than 17,000 calls in April 2015. The highest recorded number of calls received in one day is 798.
Feedback received through patient surveys consistently rate the service received as good or very good and patient comments are very positive. The call analysts that work in the CCC are committed to co-ordinating great patient care.
We have seen more new staff join the CCC in 2015, many of whom come from a healthcare background and the knowledge, experience and teamwork demonstrated by analysts is testament to their efforts. There are some challenges for the CCC ahead, namely the smooth transition of further specialist services into the centre.
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Suffolk Community Healthcare Quality Account 2014/15
PACE was led by Suffolk Community Healthcare, and was a partnership with Adult Community Services from Suffolk
County Council, Age UK Suffolk and Suffolk Family Carers, with support from Ipswich Hospital Trust.
Operated from November 2014 to April 2015 and was developed to ease winter pressures at Ipswich Hospital. The service brought together health and social care professionals with voluntary organisations; providing enhanced care at home for patients.
The service was provided by:
• An acute therapy liaison post
• Staff nurses
• Quali fi ed therapists
• Nursing rehabilitation assistant
• Care managers / social worker
• Care workers (Suffolk County Council – Home First Service)
• Age UK Link worker
• Suffolk Family Carers Link Worker
Age UK Suffolk offered practical support such as shopping and cleaning. It also guides people to other services to help them to regain their former independence, not feel lonely, and promote health and wellbeing. Suffolk Family Carers offers information, advice and guidance tailored to the needs of the family carers. This might cover moving and handling training in the home, falls assessments and sources of funding.
Based at the hospital, the focus of PACE was to identify inpatients who, with support to meet their speci fi c needs, were suitable for a safe early discharge to their home.
The model initially developed by our partners Bromley
Healthcare had the added bene fi ts of extended support for patients following discharge from the core PACE service delivered by Age UK Suffolk. Further supported help for carers and patients during and at the point of exit from the
PACE service came from Suffolk Family Carers.
The service was commissioned by Ipswich and East Suffolk
Clinical Commissioning Group and successfully reduced patients’ length of stay on the acute hospital ward and reduced the number of patients whose discharge was delayed. The service cared for about 265 patients and saved more than 600 bed days at the acute hospital. People cared for ranged in age from 33 to 101, with an average age of 81.
Members of the PACE team
“...the PACE service is one that all relatives of patients who are being discharged should engage with. It really helped set our minds at rest to know that she was going to be looked after and encouraged to look after herself”.
“I would like to thank the PACE team for helping a resident return home. My observations were that this was well planned and organised with your team arriving 40 minutes after my resident had returned home. Thank you for the excellent service which you have provided...”
11

fi

Suffolk Community Healthcare Quality Account 2014/15
Throughout 2014/2015 there has been much discussion with our stakeholders, staff and patients about the performance of our services.
We have developed our quality priorities for 2015/2016 based on their feedback. The Board has considered the proposals developed and agreed the priorities set out below.
These priorities span the three domains of quality: patient safety, clinical effectiveness and patient experience.
Progress against our priorities will be measured and monitored through the monthly balanced scorecards, which will include indicators developed from the Quality Account.
The balanced scorecard helps staff to be more involved in measuring their performance and monitoring progress against targets. We will also review at our governance committees and provide exception reports to the Executive
Board.
We have tried to make our quality account accessible and easy to read. If you are interested in being involved in the development of our quality account in the future please contact Christian Jenner by telephone on 01284 718259, or email christian.jenner@suffolkch.nhs.uk
To improve the way we manage people who have fallen to ensure the best possible outcome for them
To provide an improved dementia care service for patients and carers affected by complex physical healthcare conditions and cognitive impairment
To review the information we give to patients and their families and improve the material we offer them to enhance recovery and reduce anxiety.
Suffolk Community Healthcare is committed to providing a safe environment for patients and ensuring that patient safety and high quality care is delivered at all times.
People are living longer and there is an increasing older population in Suffolk, many of whom have one or more long term conditions that makes them susceptible to falls.
Many patients come into our Community Hospitals that are at risk of falling due to their existing health conditions.
Many patients are referred to our community services who have already fallen or are at risk of falling.
It is estimated that around 3 million people in the UK have osteoporosis. This can lead to bones becoming fragile and breaking easily, resulting in pain and disability.
We have very clear processes in place to reduce the risk of people falling when they are under our care, but still some patients fall, sometimes more than once.
We are receiving more and more referrals to our community therapy services to help people who have fallen become stronger and more co nfi dent, or to recover after a hip fracture. In April 2014 we received 178 referrals of this kind; in April 2015 th e fi gure was 279, with a peak of 324 in
January 2015.
When the Ambulance Service attends a person who has fallen at home, that doesn’t need to be taken to hospital, they send SCH a noti fi cation so we can offer some help and rehabilitation.
There are many different factors that need to be addressed to manage falls, and each patient will have different needs depending on their own circumstances – we need to get better at ensuring that all relevant assessments and interventions are available, depending on each persons need.
In partnership with our commissioners, we are looking to improve our falls pathway to ensure that a comprehensive falls assessment is offered by the right person, at the right time, in the right place.
13

Suffolk Community Healthcare Quality Account 2014/15
• Specialising (one to one care) where appropriate
• Ensuring that patients at high risk of falling are in rooms with greater visibility. One inpatient unit has improved its close monitoring of patients most at risk by ensuring a member of staff is always along the corridor of the six rooms to respond to any call for assistance or assistive technology alerts
• All patients are on intentional care rounding (hourly or more) in th e fi rst 48 hours. If necessary, this is continued for as long as it is needed.
• Use of assistive technology such as a sensor mat where appropriate
• Providing falls and bone health training for staff including lessons to be learned from patients with moderate harm and monitor any actions plans that result from areas for improvement.
SCH has been working in partnership with the CCGs and other stakeholders through the Integrated Falls Fragility
Fracture Groups and achieved:
• Development of a Falls Directory (http://www.
ipswichandeastsuffolkccg.nhs.uk/FallsDirectory/Home.
aspx )
• Ambulance noti fi cation of fallers to the Care Coordination
Centre in SCH. This showed that between 15 Sept 14 when the new referral process started and 31 Dec 2014, a total of 419 noti fi cations were received. Of those, 217 were people who were not previously known to SCH
• Another part-time osteoporosis nurse specialist has been employed
• Creating pathways on SystmOne (data recoding system) so that all organisations who have access to SystmOne can share data
• Additional OTAGO (strength and balance) exercise classes are now being offered by ActivLives which SCH and other professionals can refer patients to
• Falls and bone health training DVD to be used by all stakeholders currently being produced.
• Interface Geriatricians service has improved medical assessment and medication review
• Our falls and fragility fracture policy has been reviewed to ensure it aligns with NICE guidance
• SCH Falls and bone health staff were instrumental in organising 2 large falls and bone health event in partnership with the National Osteoporosis Society and
University Campus Suffolk. The events drew over 300 professionals from stakeholder organisations. Harm free CQUIN targets helped analyse falls rates an d fi nd innovative solutions to improving falls and falls related injuries.
• SCH is always looking for new and creative ways to meet patient needs in a timely manner. As a result of our therapy review, we have launched a pilot scheme in the
Ipswich areas which will see Band 4 Assistant Practitioners assessing patients who have fallen and are on a waiting list. Appropriate patients are selected by senior clinicians, and after assessment the interventions will be discussed with clinicians with onward referral or signposting as appropriate. The Assistant Practitioners will be given extra training on falls and bone health provided with a standard operating procedure. If the pilot is successful, it will be spread to other teams in SCH.
We are looking to develop a Falls Co-ordinated Pathway, which will use our skilled Band 4 assistant practitioners as coordinators of the multi factorial assessment.
We recognise that sometimes social isolation and decreased activity can often lead to falls and so part of this pathway will be giving information and advice to support patients to stay well and minimise the risk of further falls. Patients will be offered 3rd sector exercise groups where appropriate.
The pilot is starting with the Ipswich teams and the bene fi ts of the proposed model are: Patients referred for falls assessment and management will no longer wait on waiting lists until a therapist is available.
• Patients will be managed through the falls pathway by band 4 staff who will coordinate the input of the relevant registered staff at appropriate points in the pathway.
• A pathway will be created based on the NICE guidelines for falls and SCH stage 2 assessment checklist.
• Clinical time of Occupational Therapists and
Physiotherapists will be freed up to deliver their critical support and interventions
• All patients will have a comprehensive assessment with the input of a Physiotherapist, an Occupational Therapist, an Osteoporosis nurse, a Consultant at the right time in their pathway, and appropriate to individual needs.
Figure 3: Number of inpatient falls by month in the Community Hospitals.
Falls are the most common patient safety incidents reported in hospitals including community hospitals. Preventing falls in hospitals is always challenging as staff try to strike the right balance between falls prevention and providing rehabilitation
SCH has made inpatient falls a priority and has written in its policy that falls and fracture risk assessment will be
14

Suffolk Community Healthcare Quality Account 2014/15 commenced on admission and completed within 24 hours, giving the patients the best possible chance of recovery and avoiding further or future falls.
Although many people come to our Community Hospitals that have already fallen or are at risk of falling, we want to ensure we have done everything we can to reduce the number of falls and to reduce the impact of falls when we cannot prevent them.
The inpatient teams have been working with our Consultant
Geriatrician to look at new ways of looking at an old problem to ensure that quality and service improvement is considered at all times.
We are looking to introduce
• Review and design training framework and deliver falls and bone health training for SCH staff
• Review with the CCGs and partners the current falls assessment tools used by stakeholders and agree way forward
• Complete production of falls and bone health training
DVD
• Develop roles of falls champions
• Update falls content on SCH staff intranet and review public website
• A falls algorithm (logical step by step procedures to ensure each patient receives consistent and safe care based on nationally agreed standards)
• A post fall s fl ow chart (when a patient has fallen all patients will receive appropriate/agreed care.
Focus on a service
The Specialist Neurology Nurse Service has been established in West Suffolk for more than 20 years and is provided by two nurses. We see people with a number of progressive neurological conditions, predominantly multiple sclerosis, but also motor neurone disease, muscular dystrophies and Huntington’s disease. We offer an open referral system, allowing easy access for people to consult us when they have problems or concerns.
We hold a number of regular clinics across the area to give ease of access to our service. The nurses also visit people at home if they are housebound, or to discuss dif fi cult issues in a relaxed setting.
We offer a monthly multi-disciplinary - specialist clinic for people affected by Motor Neurone Disease (MND), in conjunction with a neurologist with a special interest in MND from West Suffolk Hospital NHS Foundation
Trust. This is held at the Disability Resource Centre in Bury St Edmunds, away from a hospital setting and which most peopl e fi nd easier to access.
There are different types of MND, some of which progress more rapidly than others. People affected by the condition and their families need to access support as soon as new problems occur. MND can affect a number of different muscle groups including those governing speech, swallowing and breathing.
Speech and language therapists and dieticians are vital members of our team and are always available at the clinic. We also work closely with our colleagues at Papworth Hospital where a specialist MND respiratory service has been developed. As the disease progresses, high quality palliative care is also required, and we have developed excellent links with the team at St Nicholas Hospice Care to enable timely and appropriate referral to the services they provide. We support those with MND i n fi nding other sources of treatment within SCH, support from Suffolk Social Services and voluntary agencies.
Regular surveys of those attending the clinic are conducted to ensure that it meets their needs and to seek ideas about how it may improved. There has been overwhelming positive feedback for our use of this approach to helping families manage this complex, often rapidly progressive condition.
15

16
Suffolk Community Healthcare Quality Account 2014/15
Focus on a service
The National Osteoporosis Society (NOS) reports that about 3 million people in the UK have osteoporosis. This can lead to bones becoming fragile and breaking easily, resulting in pain and disability. SCH has falls and fracture specialist nurses working across the county. The West Suffolk Fracture Prevention Service continues to respond to all patients over the age of 50 who havesustained a fragility fracture. Based in the community, the two specialist nurses have established the following processes with West Suffolk Hospital and the DEXA (bone density scan) service, and strengthened links with Addenbrookes Fracture
Liaison Service to embed an integrated approach to fracture prevention:
Keep active and reduce your risk of falling
Health & wellbeing
• Pro-active patient identi fi cation i.e.: following fracture, DEXA result
• Establishment of clinical pathways
• Ensuring compliance with osteoporosis medication long-term
• Ensuring communication and integration across acute, community and primary care.
AgeUKIG14
A total of 1364 patients were triaged in 2014. Patients receive targeted assessment which identi fi es the most appropriate treatment and intervention which will support medication compliance, support self-management and help the patient regain independence. The specialist nurses continue to work closely with the community health teams to support the patient’s rehabilitation and aim to be a source of knowledge and support for community clinicians.
The service also responds to patients who have had a positive DEXA result following a fragility fracture, and are sent information and contacted by telephone. 206 patients were contacted in this way during 2014.
• Continue to raise awareness within primary care, SCH, and the general public
• Continue to assess patients over the age of 75y to ensure that they are compliant with their medication
• Improve patients’ compliance with bone health medication
• Identify work streams and prevention to reduce the fall rate of older patient
• Closer working with the CHTs and other agencies
• Work the NOS to establish educational programme for patients newly diagnosed with osteoporosis
• Support delivery of a structured approach to falls and fracture prevention training for clinicians.
The osteoporosis nurse specialist based in the east of the county receives about 30 referrals a month, from
CHTs, GPs, care homes and people over 75 who have had a fragility fracture.
• 100% patients reviewed and started on bone protection medication if appropriate
• All patients offered advice on preventing falls
• Follow-up calls have supported excellent compliance rate of patients taking bone sparing medication
• Working with care home staff to offer general falls and bone health advice
• Providing falls and bone health training to community teams and inpatient units
• Second osteoporosis nurse in post
• Held successful training events on falls and bone health at University Campus Suffolk
• Successful events held at Trinity Park for care home and practice staff.

Suffolk Community Healthcare Quality Account 2014/15
Focus on a service
• Tissue Viability is a term used to describe how healthy a person’s skin is. Patients who are unwell are susceptible to poor healing. Looking after surgical wounds and pressure ulcers is a large part of what community nurses do, and pressure ulcers in particular can be very distressing for patients and their families.
• We have recently appointed a Tissue Viability Nurse (TVN) to our Quality and Governance team, supporting our teams by providing specialist clinical advice and support in complex wound management.
• Her work will include:
• Ensuring guidelines and recommendations from NICE (National Institute of Health and Care Excellence) are followed by our staff, hence we will provide evidence-based practice
• Improve patient care by critically appraising the relevance of research and manufacturers’ information
• Be the key professional for updated information and good practice affecting tissue viability locally and nationally by:
• Developing links with TVN services within the local acute trusts
• Attending conferences and East Of England TVN network
• Sharing this information with colleagues to enable the provision of evidenced based care
• Visiting teams and professional forums to highlight TVN role and inform staff of current issues
• Supporting new referral process for teams to refer patients for assessment/advice
• Development of link nurse/champion roles for tissue viability and pressure ulcers to share learning and improve practice
• Developing information for staff on the SCH intranet.
17

Suffolk Community Healthcare Quality Account 2014/15
SCH aspires to act on the patient/carers voice. Families and carers want to feel more knowledgeable, supported and empowered to easily access care, support and advice via a consistent contact point. SCH is piloting models of service delivery that echo the requirements of those living with dementia and long term physical healthcare challenges.
During the past nine months a Dementia Link Practitioner role has been developed to enable SCH to provide enhanced services for patients who have dementia and long-term complex physical healthcare needs. Two members of staff were seconded into the named worker role to provide services to patients/carers in order to improve, memory, orientation and day to day living activities.
One practitioner developed a pilot service in East Suffolk and the other in West Suffolk. Over 270 patients/carers received a service that ensured that they had a named Dementia Link
Practitioner.
The range of services offered include: (see page xx)
• distribution o f fl uid intake charts to prompt people to drink
• education about nutrition
• prompt cards to aid people to remain independent
• loan of assistive technology equipment
• engaging patients with a wide range of home healthcare services
• listening and providing information about dementia.
Feedback has been obtained from 10% of those receiving the service, GPs and other dementia care specialist services.
The feedback has been very positive and encouraging.
The Dementia Link Practitioners also provided a support service to SCH dementia care champions in our inpatient units and community health teams.
One practitioner is continuing to provide an enhanced service for people with dementia in six SCH Community
Health Teams in East Suffolk. The other practitioner has returned to the Bury St Edmunds (rural) community team and is piloting a project to enable us to assess if an enhanced dementia care service can be offered to all patients with dementia and long term physical conditions via each of our
15 Community Health Teams.
The pilot started in April 2015 and will be reviewed in
September 2015.
“...on behalf of my mother I wanted to thank you for visiting her. The information you provided was most useful ...
I found the meeting very useful and appreciated the time you spent with us. The service you provide is invaluable to the patients and those that assist them.”
“My mother-in-law suffers with Alzheimer’s and the advice I received was invaluable to me. I was unaware of a lot of the information I was given and that even home visits could be arranged for eyes/teeth etc. …having these home visits is fantastic. I also had advice on courses, money matters etc. I am sure that many other families, carers will find all the information invaluable too...”
“...I am writing to express how grateful we were for her visit and how impressed we were with the support she was able to provide us. She really understood the personal nature of dementia and left us feeling much more positive than ever before. Dementia is a cruel disease and coping with it is often heart-breaking but it is made easier by the work and support of people like her.”
“She explained everything in wonderful detail without causing concern (we were in fact much more at ease about this condition as a result of her visit.) She did a lot of tests on Mum in a non-threatening way and explained everything in a clear, logical but non-patronising manner. She informed us of many types of support open to us that we have in fact taken on board. She clearly had put in a lot of extra time producing information solely as a result of her own research and that was very much peculiar to my mother’s personal circumstances. Her visit provided an informative , compassionate and pleasant experience that has had a positive effect on my mother and that has made my job as a carer more effective...”
18

Suffolk Community Healthcare Quality Account 2014/15
Memory suitcase – supports dementia work ensure patients and carers had a single named worker to help join up health and social care across all agencies and to enable patients with dementia and their carers to live at home for as long as possible.
At the heart of our project was the belief that patients with complex physical and cognitive disabilities can feel safer living in the community if they are offered re-ablement programmes that provide what the patient needs while reflecting aspirational and optimistic app oaches to dementia care. Programmes that can bring about improved physical health, memory, orientation, changes in behaviour, increased levels of involvement in day to day living tasks and community interactions. The services most favoured by families were carer support, sign posting to other support services, learning to adapt communications and information about the dementia.
Other services that many individuals valued included for example the provision of adapted fluid charts, advice about nutrition, exercise, mobility, falls prevention, assisting carers to engage with continence services, home dental, optical and podiatry services.
• Continue to pilot complementary models of good dementia care practice for patients with long-term physical conditions and dementia in east and west Suffolk
• Review those pilot projects to gain a fuller understanding about the bene fi ts and challenges arising from the work
• Audit dementia care services offered to patients in the pilot project areas and also to our clinical teams providing care in other areas
• Provide workforce development opportunities, such as training and supporting dementia care champions across the county
• Develop standards to ensure SCH patients with dementia are offered at least a minimum range of services that will contribute towards improved physical wellbeing, memory, increased levels of independence and opportunities to remain engaged in community activities
• Work in partnership with other dementia specialist services to support other organisations in Suffolk to work towards providing a minimum range of services for people with dementia, cognitive impairment and their carers.
The 2013 Suffolk Dementia Needs Assessment concludes that “there are signi fi cant differences in the number of people living with dementia in Suffolk and the number of people who have a diagnosis and receive services”.
People with dementia and their carers continue to tell commissioners that services are fragmented, disjointed and dif fi cult to navigate. Having listened to the voice of those affected by dementia Suffolk Community Healthcare implemented its pilot programme “maximising enablement, success and productivity” in June 2014 Our aim being to
Dementia aids used to help people manage at home
19

Suffolk Community Healthcare Quality Account 2014/15
20
Focus on a service
The team continues to deliver a community based programme for those who have recently had an acute cardiac event or surgery. We now are offering seven clinical sites for initial assessment and education groups. We now have six venues for group exercise programme across various sites in Suffolk and we are also working collaboratively with local leisure centres and voluntary groups to promote long term exercise and health education in this group of patients.
A recent audit completed for the East of England
Cardiac Rehabilitation group showed very positive outcomes for the Cardiac Rehabilitation service in
SCH with 57% patients taking up a group exercise programme and 42% a home base programme, leaving only 1% who declined the programme. On discharge we were also able to demonstrate a 68% increase i n fi tness in only an 8 week period.
We are looking at providing a programme in the evenings or at weekends for people who need to return to work or who have other commitments.
The community heart failure team in the last year has been reviewed and is working collaboratively with the
CCGs, Ipswich Hospital, and West Suffolk Hospital to improve the patient pathway for heart failure.
Our performance indicators show that we are now offering all new patients an appointment within
10 days of referral which is an excellent achievement
One of our cardiac rehab patients
All patients once they have been seen by the community heart failure nurse specialist will have a clinical management plan shared with the GP and other healthcare professionals involved.
We are also pleased that from 1 April 2015 a new blood test called BNP-NP* testing has been available to speed up the process of the correct diagnosis of heart failure to enable patients to start on treatment sooner and reduce the amount of hospital admissions.
*BNP is a natural substance secreted by the heart muscle when it is stretched, and identifying it helps the team to offer appropriate treatment.
Patients taking part in cardiac rehab exercise class

Suffolk Community Healthcare Quality Account 2014/15
Focus on a service
A stoma is a surgically created opening on the abdomen which allows waste to be excreted from the body.
Our stoma care service provides support for patients in the community setting before and after stoma forming surgery.
We believe that individuals undergoing stoma surgery have speci fi c needs and a right to comprehensive care provided b y a fi rst level nurse with specialist skills in stoma care. Our skills are clinical, educational and supportive, allowing us to develop a close relationship with patients and their family in the community setting and to facilitate continuity of care with the acute hospitals.
Our stoma care nurses have a responsibility to inform and to educate ourselves and others. We offer resources to our colleagues and patients and our practice is research-based to improve clinical competencies and the standard of nursing care.
As with all our specialist services, our stoma care nurses work closely with our own teams and professionals from other services to achieve the best possible care for our patients.
• Pre-operative information
• Practical and psychological support
• Education for patients, family and carers
• Liaison between patients and other services
• Impartial product advice and sampling of stoma appliances
• Advice on diet, travel and relationships
• Advice on stoma care problems i.e.: - sore skin, bag leakage, constipation/diarrhoea, Parastomal hernias, and appliance allergies
• Fistula and advice on wound management.
We offer outreach clinics at Felixstowe, Woodbridge, Ipswich and Aldeburgh. We hope in the future to extend clinics to cover Stowmarket and Eye.
Recent patient satisfaction audits show 97% of patients would recommend the service to family and friends and 100% of patients felt the staff made them feel comfortable about asking important questions.
21

Suffolk Community Healthcare Quality Account 2014/15
“Ideally a home-based service should NOT simply be a care service. It should provide trained workers who can facilitate and support the person with dementia continuing to perform tasks and pursing activities as before. Someone needs to get to know me, to be able to match people/ services with my requirements”.Our loan scheme of equipment adapted for people with dementia enabled individuals to try out equipment that assists with memory, orientation and occupation before purchasing the kit for themselves.
Eighty-five per cent of SCH sta f at all levels have undergone training about how to work alongside patients and carers in order to promote independence, wellbeing and choice an ethos that is at the heart of our dementia care.
Our 20 plus Dementia Care Champions continue to support their colleagues in improving the experience, care, treatment and outcomes for people with dementia and their families in our inpatient units and community settings.
Patient experience is a key element of quality alongside providing clinical excellence and safer care.
How we deliver care has an impact on the experience our patients have. This is from the way we answer phone calls, to how we explain assessments that may be necessary and how we agree plans of care.
Our organisation and the staff working within it recognise the need to provide opportunities for patients to tell us about their experiences.
Patient feedback is very important as not listening to patients has been identi fi ed as a root cause of poor care in
NHS services
During 2014/15 we have extended use of the “Friends and
Family Test” (FFT) to all patients across the service and have continued the Patient Voices work we started last year in the community hospitals. Incident reports and complaints are also taken into account.
Research has demonstrated that staff experience impacts directly on patient experience. With this in mind a staff version of the Friends and Family Test has been developed nationally. The questions from this survey ask, as a member of staff working in the service, would you recommend the services provided by Suffolk Community Healthcare to Family or Friends. Secondly would you recommend working within the service to Family and Friends.
The feedback patients and their relatives and carers have provided, has allowed the senior leadership team and staff to look ‘with fresh eyes’. This, in many cases, has challenged accepted assumptions and perceptions. Improvements to services have directly resulted from ‘hearing’ these voices.
Results from the FFT are now displayed on a national website and responses to the question “Would you recommend
SCH services to Family and Friends” falling into the ‘very likely’ or ‘likely’ categories are given as a percentage of total responses.
The latest results displayed on the national database for SCH are:
• Community Hospitals 98%
• Community Nursing 100%
• Rehabilitation and Therapy Services 100%
• Specialist Services 100%
• Community Healthcare other 97%
Looking back over old times
22

Suffolk Community Healthcare Quality Account 2014/15
Average scores for the NHS in England are around 77%. In order to gain greater depth and quality 36 Patient Voices video interviews have been carried out with patients, their relatives and carers and with the staff providing their care.
See more information on page xx
• expectation that staff adhere to the uniform code
• ensuring care planning is carried out with patients
• the need for improved information for patients
• the need for improvements in the speed of repair and provision of wheelchairs.
Some areas the patients have identi fi ed in need of improvement on the FFT responses have also come across in the patient videos. An area highlighted is poor communication following referral. Patients do not have reassurance a referral has been received and have no clear understanding of how long it will be before they are seen. This is a source of anxiety which impacts on patients’ conditions and is a priority for action.
The Staff FFT has been sent out to all Clinical Staff this year, resulting in a 38% response rate. The emphasis this year has been on increasing the response rate and feeding back results and comments to teams.
Patient, relative, carer and staff feedback have been discussed at all levels of the organisation.
• To ensure the voice of people who use the service is heard, from April 2015 a patient, a relative, carer or patient video will start every Board meeting
• Patient and Staff FFTs will continue to be offered and we will aim to maintain and if possible increase response rates
• We need to continue to encourage a culture where patients and staff expect to be given the opportunity to give feedback and where our staff value and act on issues identi fi ed
• We will develop the Patient and Carer Forum, working closer with patient representatives and voluntary organisations
• We will monitor the FFT responses through this forum and when issues arise that require further investigation
• Patient voice interviews will continue to be carried out
• We will focus on the communication issues raised through
FFT and the Patient Voices interviews.
• Staff at our Care Co-ordination Centre are already involved in developing solutions for and with callers
We aim to develop a range of digital and paper-based means of communication which ensure that referrers and patients have clear expectations about the services they will receive and when the services will be received
Our CCC receives over 10,000 referrals per month which are entered into the electronic record known as SystmOne. The volume of referrals we receive presents a challenge to SCH to be able to ensure that patients are aware their referral has been received and what will happen next with their care
With the CCC, we have an ideal opportunity to use a centralised care coordination service to provide fi rst-class communication to suit people’s preferences using a range of techniques. These could include:
• Email
• SMS/texts
• Voice Messaging
• Via the postal service.
Our Patient Record system has a range of functionality within it to automatically communicate. We intend to maximise the use of the system to produce timely and appropriate information for patients.
One of our Dementia Link Practitioner offers the following information and resources to the people she sees, and their families. We will use this good practice to inform and improve our work across our service.
• Signposting to support services: Dementia Advisors
Suffolk Helpline; AgeUK for bene fi ts check, befriending, domestic services etc.; Suffolk Mind (Counselling
Dementia Service); social/support groups such as Suffolk
Family Carers, the Debenham Project, Alzheimer’s Society,
Synergy café, Luncheon Clubs, Care UK Wellbeing
Centres.
• Services people can receive at home: opticians, dentist, chiropodist, hearing advisory, library, hairdresser, key safes, Suffolk Careline, trial assistive technology, British
Legion handyperson service
• If required clients are referred to dietetics, speech and language therapy, our community nurses and therapists, and our continence team
• Provide signage/prompt stickers as navigation aids, if required, following an environmental assessment.
• Information on nutrition, food intake , fl uid intake education and monitoring
• Give clients “This is Me” booklet, the Dementia Guide,
Memory Handbook, Council Tax exemption application forms and Lions `Message in a Bottle` medical details container.
• Let the client know of charities that will help them care for their pets
• Register clients with the telephone and mail preference services; ensure they receive a free TV license and winter fuel payment if eligible
• Offer support and information about public and private transport, from free bus passes to aids to assist getting in and out of a vehicle
• Offers a booklet about dementia for children and young people
• Information on hygiene products for clients who have an aversion to water
23

Suffolk Community Healthcare Quality Account 2014/15
During 2014/2015 Suffolk Community Healthcare has provided or subcontracted 40 NHS services. SCH has reviewed all of the data available on the quality of care of in
40 services.
The income generated by the 40 NHS services reviewed in
2014/2015 represents 100% of the total income generated from the provision of NHS services for Suffolk Community
Healthcare for 2014/2015.
fi
During 2014/15 there were two national clinical audits for which SCH were eligible and appropriate to community services. These were the PLACE (Patient Led Assessment of
Care Environment) and Safety Thermometer audits.
Type of Audit
Safety Thermometer
Place
ü
ü
Eligible
ü
ü
Participation % Submitted
100%
100% reviewed within the organisation’s quality and governance system.
• A new monitoring process was implemented regarding the action plans when produced by the individual teams where results did not meet the required compliance set for the audit. This helps to improve the quality of healthcare provided by the service. These action plans were closely monitored until completion by the Audit
Of fi cer.
• The results of the audits were shared throughout the organisation via monthly, quarterly and annual reports, the Audit Champions Forum, Take Care Take Note monthly bulletins and SCH intranet.
• As in previous years, the mandatory audit plan for
2014/15 is a live working document. This ensures the plan is reviewed and updated throughout the year in line with benchmarking audits, incidents, new policies and changes in service provision.
• The audits undertaken included mandatory, infection control and safety medication audits. Records of all results are held by the clinical effectiveness and audit department within the clinical governance team. Audits were designed against standards using good practice guidelines, service delivery requirements and SCH clinical policies. Examples of audits undertaken are documented on the following pages.
• Between April 2014 and March 2015 Suffolk Community
Healthcare carried out in excess of 150 individual local, national and mandatory clinical audits. Each audit was
Taking a call in the Care Coordination Centre
24

Suffolk Community Healthcare Quality Account 2014/15
Audit
Record Keeping
Community
Hospital
Monthly: National Audit:
Safety
Thermometer
Local: IV VIPS Score
(intravenous therapy)
ü
ü
(if applicable)
ü
Community
Teams
SEPT
ü
ü
(If applicable)
ü
Not
Applicable
ü
(CCNTS)
ü
Wristband ü
MRSA Specialised areas ü
Quarterly:
Decontamination
ü
Not
Applicable
Not
Applicable
ü
Not
Applicable
ü
ü
Uniform &
Dress Code
ü ü ü
6 monthly:
Anaphylaxis Shock Pack
Not
Applicable
Dementia ü
Quarterly:
Food and Nutrition
ü
WHO (World Health
Organisation) checklist for surgery patients
Not
Applicable
ü
ü
Not
Applicable
Not
Applicable
Not
Applicable
Not
Applicable
Not
Applicable
ü
Actions to improve Healthcare
Providing local area monthly results which are discussed at team meetings.
Monthly report produced. Results discussed at clinical meetings. Continue to monitor results.
The results are discussed at team meetings to address non-compliance. Areas around the recording of next of kin, carrying out risk assessments, obtaining consent, recording any special requirements are areas which have improved in the last 12 months. A new SCH abbreviation list produced and in now in use.
New audit tool produced and audited against new policy. Results monitored and discussed at
Modern Matron meetings.
Any issues raised are dealt with by the Infection
Control Lead.
Results are discussed at team meetings with clinical staff. Use of single use handling belts to be made available. Replacing pulleys with wipeable alternatives.
New Policy published with new audit tool in use.
Auditing all clinical staff. Results are discussed at team meetings with nursing staff. Staff are reminded the importance of their appearance and the wearing of an appropriate uniform.
Results discussed with the nursing staff at team meetings. New anaphylaxis shock pack log sheets produced devised and now in use.
Results discussed at the Dementia Champions
Group, teams to be supported to improve their practice by the champions, completing the assessment paperwork. Re-auditing in 6 months.
A new audit tool was devised using national guidelines. Results discussed at Modern Matrons meetings and with staff at team meetings.
Results discussed at team meetings, new procedures put in place as consequence of audit.
25

Suffolk Community Healthcare Quality Account 2014/15
Monthly:Antibiotic
Medication
ü
Not
Applicable
Not
Applicable
Community
Health Teams
SEPT Audit
Community
Hospital
Monthly: Drug Chart
(Prescription chart) including Insulin
ü
Quarterly: Safe and Secure
Handling of Medicines -
SSHOM
ü
Control Drug safety and security
One Off/Yearly Audits
ü
Not
Applicable
Not
Applicable
Not
Applicable
Not
Applicable
Not
Applicable
Not
Applicable
Annual: Mattress
Vaccination
Safety - Cold Chain
End of Life (EOL)
ü
ü
ü
Needle stick
(EU Directive)
ü
Figure 4 – Examples of local and mandatory audit
Not
Applicable
ü
ü
ü
Results discussed at the Infection Control
Committee and recommendations are fed back to the teams. Practise has improved over the year.
Actions to improve Healthcare
New audit tool devised. Monthly results are discussed at team meetings with nursing staff.
New audit tool devised. Results are discussed at team meetings and monitored by the Medicine
Management Committee
Results discussed at team meetings. Staff reminded of the importance of the SOP (Standard
Operating Procedures).
Not
Applicable
Not
Applicable
Not
Applicable
ü
(If applicable)
A new policy was published. Mattresses are now inspected after every patient discharge.
Any found not fit for purpose are immediately replaced. The results discussed at team meetings.
The results were discussed at Team meetings. All vaccines when required are now transported in a validated cool box. These boxes were found to be required after 2013 audit.
Results discussed at team meetings. New procedures were put in place. The patient electronic system was improved to allow staff universally to view which patients were EOL this was instigated after auditing.
SCH is now fully compliant with EU directive. Old stock taken out of use. All staff now trained to use the new Safety Needles.
Key: √ taken part in audit x did not take part in audit
CQUINs (Commissioning for Quality and Innovation) are projects agreed between the commissioners (who buy our services) and our organisation. The projects are set up to improve quality standards in key areas.
The table below shows the agreed CQUIN targets and outcomes up to 31 March 2015. Summaries of our achievements in last year’s CQUIN projects are also highlighted. It has been agreed with our commissioners that due to our impending re-procurement the new CQUIN will commence from October 2015 at the start of the new community services contract.
26

Suffolk Community Healthcare Quality Account 2014/15
2
3
4
5
6
1
CQUIN Description of Indicator Areas of quality improvement addressed and outcomes 2014 - 2015
Friends and Family Test
Harm free care
The first priority for seven day services is focussed on urgent and emergency care services and
SCH have been working with our acute partners to develop integrated services to deliver seamless, consistent, highquality seven day services that prevent unnecessary admissions into hospital and support early discharge
Integrated working -
The purpose of the integrated working CQUIN was to build on the transformation work already underway and support us to focus on the delivery of some of the key elements of integrated care that require an enhanced level of joint working and collaboration to deliver on the local vision. The areas we focussed on were Information
Sharing and Flexible Workforce
Development.
Use ‘patient voices’ methodology to collect meaningful information from patients, to improve services
Pilot Dementia Link Practitioners to offer low intensity rehab and advice for patients with dementia and a
The ‘Friends and Family Test’ (FFT) is a simple feedback tool which allows patients and staff to give their feedback on services provided by the NHS.
The purpose of this quality improvement has been to increase the opportunity for our patients and staff to provide feedback.
The FFT asks how likely patients and staff are to recommend the services they have received, or work in, to friends and family who need similar treatment or care to that which they have received or deliver.
This area of quality improvement encourages health providers to work together to reduce the number of falls and pressure ulcers across all their different areas. This has resulted in a new range of pressure relieving products being introduced, close monitoring of pressure ulcers and falls, a reduction in the incidence of pressure ulcers and falls, closer working between services and development of a common set of ambitions.
Community Intervention Service have been working with East England
Ambulance Trust (EEAST) to increase the number of patients we manage on Saturday and Sunday to prevent an admission.
We have looked to increase the number of patients we helped home from our community hospitals at the weekend.
We have sought to provide senior clinical advice to a nursing home to prevent unnecessary admissions.
We have worked with each hospital in our patch to identify when patients will benefit from community services and to ensure we are involved at the earliest opportunity to reduce a patients length of stay.
Information Sharing - record keeping is an essential component of deliveringsafe and effective care. By using electronic systems we were able to share specifi information with other organisations involved in a patients care. For example, If a patient arrived at A&E at West Suffolk Hospital, the A&E team would be able to see whether SCH have been involved with this patient and if so, some specifi details about the patients care and function to date. So far, 1724 patients have benefitted from shared information along their path ay of care.
Flexible Workforce Development – By working collaboratively with our partner organisations we were able to share opportunities for joined up training and staff development.
We were also able to identify where we could work with other partners to enhance the service to our patients. The NSFT (mental health trust) Wellbeing service now present a session to the patients on the Pulmonary Rehab course which helps with relaxation and anxiety management for their breathlessness.
We are developing formal clinical supervision across organisational boundaries to support clinical leadership development. We are focussing on a band 5 development programme, and respiratory skills for band 6s.
Building on the work carried out last year with patients and their relatives and staff in the Community Hospitals, we carried out 36 video interviews this year.
These interviews were with patients, their relatives/carers and staff from four of the Community Health Teams, the Community Cancer Nurse Team and the
Wheelchair Service. Videos were played back to staff and they were able to collect valuable information on the experiences of their patients. These often challenge assumptions and perceptions about what staff think the patient or family member feels and needs. From these insights the teams were able to draw up actions to carry out in order to improve their patients’ experiences.
The Link Practitioner role has proved to be a very successful pilot in East
Suffolk. Following patients being referred, the link practitioner has been a consistent point of contact for patients and their families, providing information about dementia and relevant additional practical supports ‘tailor made’ to the needs of the individual.
Outcome
Partially achieved
Partially achieved
Partially achieved
Achieved
Achieved
Achieved
27

Suffolk Community Healthcare Quality Account 2014/15
The Care Quality Commission (CQC) is the independent regulator of health and social care in England. Suffolk
Community Healthcare is registered with the CQC. Our current registration status is: “registered with no conditions”.
From 1 April 2015, all health and adult social care providers in England are following new regulations called the Fundamental Standards. These are the Care Quality
Commissions new expectations and monitoring processes, which are more focused and clearer about the care that people should always expect to receive.
As the regulator the CQC is responsible for ensuring providers meet these requirements, which are based on what matters most to people who use services.
The new standards ask if services are:
• Safe
• Caring
• Effective
• Responsive to people’s needs
• Well-led.
In the past SCH has experienced unannounced CQC visits, the most recent to Aldeburgh Community Hospital in December 2014 (see below). The new approach is for announced visits requiring the provider to submit evidence in advance of the inspection. A team of inspectors will visit for several days and interviews, observations and evidence gathering using Key Lines of Enquiry across all levels of the organisation will take place. The outcome scores will be based upon th e fi ve questions; is it safe, caring, effective, responsive to people’s needs and well-led. Scores will be either Outstanding, Good, Requires Improvement or
Inadequate.
In response and in preparation of our own anticipated visit SCH has reviewed our own internal quality reviews to mirror the CQC approach. In order to prepare staff for these more intensive visits we have set up a working group which is overseeing the preparation process and will assist all teams in gathering the evidence they will need in advance so they will be ready when we are given noti fi cation of an assessment. One way we are doing this is to send out a regular newsletter to all staff to update them on current issues and impress that the CQC is everyone’s business.
In our only CQC visit of the year, Aldeburgh Community
Hospital was assessed under the commission’s previous standards, which have now been replaced as explained above.
• 4) Care and welfare of people who use services
• 16) Assessing and monitoring the quality of service provision
The inspection found non-compliance with Outcome 4,
“Care and Welfare of People who use Services”
The subsequent local action plan to address the CQC’s recommendations has been approved by the CQC. The CQC inspection team has not yet returned to re-assess the unit.
Gingerbread house – this was made by our staff for a christmas party on the inpatient unit at Aldeburgh Hospital
28

Suffolk Community Healthcare Quality Account 2014/15
Examples of areas identified for development
Examples of actions achieved
To ensure that all staff understand the requirements of assessment, evaluation and monitoring of pressure area care plans
Review care plan paperwork format to enable wound care to be clearly documented
Implement 1:1 coaching and group awareness sessions
Communication with staff undertaken to reinforce importance of completion of all assessment tools.
Tissue Viability awareness sessions and assessment of pressure care competencies
Monitoring / evidence
Case note review undertaken by Modern
Matron on weekly basis with intention of immediate action upon identification of documentation failing to meet agreed standards.
Where issues are identified they are flagge immediately with staff, and their level of documentation challenged and addressed with them.
To ensure that all staff are able to complete a patient-centred assessment with care plans demonstrating person centred care.
New care plan trialled including index
New care plan documentation implemented following trial
Programme of Care Plan audits (including care plan completion, evaluation, monitoring and assessment tool completion.
Do Not Attempt Cardio-Pulmonary
Resuscitation (DNACPR) to be appropriately completed with patient discussions recorded.
Each Modern Matron to review the current
DNAR forms in use in their units and ensure that forms are completed in their entirety
DNACPR quality audit tool developed and to be completed monthly commencing Dec 2014
100% audit results Jan 15
Our community health teams and our community hospitals are assessed regularly in line with the new fundamental standards. This helps us to ascertain which teams are already well prepared and which teams are in need of help in gathering the evidence required. Using a series of questions or Key Lines of Enquiry which sit behind, and contribute to, th e fi ve standards we are able to guide staff on their progress and help them produce action plans where there is still work to be done.
These visits are designed to mimic as closely as possible a real CQC visit. Moving forward we are hoping to work more closely with partner agencies in both the public, private and voluntary sectors to gain their support with the inspections.
It is our belief that the greater the level of diversity and expertise we create within our internal auditing processes the more proactive we will become in addressing concerns and ultimately able to demonstrate how increasingly Safe,
Responsive, Effective, Caring and Well led we will become.
Quality Improvement Visits are inspections undertaken by the CCGs. Visits occurred during 2013-14 to the four inpatient services, Minor Injuries Unit; the Community
Equipment Service (CES); and the Care Co-ordination Centre
Figure 5 – Aldeburgh CQC Action Plan (summary)
CCC). The CCG’s recommendations based upon those visits have been actioned during 2014-15 and examples of some of the activities undertaken are described below.
• Public facing information boards have updated analysis of infection control, patient satisfaction surveys and recent
CQC information.
• A short induction sheet was introduced for agency staff, identifying key information includi ng fi re and medical cover, whilst also co nfi rming the staff member’s clinical competency.
• Information boards in the nurses’ of fi ces now include expected discharge dates and relevant therapy updates of assessment dates and any mobility or other therapy needs a patient may have.
• Inpatient pressure area assessments are now carried out within 4 hours of admission.
• Arrangements have been made for the provision of bariatric equipment when required.
• Patient call bell systems have been replaced in each of the inpatient areas.
• Several new outpatient orthopaedic clinic sessions have been commenced at Newmarket hospital to improve utilisation of clinic space.
29

Suffolk Community Healthcare Quality Account 2014/15
• Our QAVs have revealed that we already have teams that are very well prepared and rated as “outstanding” but that there are teams who will need further support.
Rating
Safe Effective Well led
Aggregate
Rating
Outstanding Outstanding Outstanding Outstanding
• Three key questions were addressed (see above) as it was felt the remaining ones needed to be assessed during clinical visits/ activities with the staff.
• The Team Lead was extremely well prepared for the visit and has an evidence folder which also acts as an on-going resource folder for all members of the team; her staff were well supported, well trained and as a result highly motivated, engaged. In turn they were able to demonstrate that they are delivering safe and effective care.
with the patient to offer an apology and a truthful account of what has happened. This includes agreement on a course of action to treat any consequential harm, investigation, appropriate support and apology.
Within SCH we have been practicing Being Open for a number of years and already have in place a ‘Being open’ policy and procedure. These documents have been revisited to include the expectation of the duty of candour into policy and procedure, based upon our principle and aim to be open at all times.
We have introduced three checkpoints to trigger when such an event occurs, these are questions raised at the initial reporting of the incident by the Line Manager, by the Risk
Team when an incident form is received, an d fi nally within an investigation pack for the investigator of the event. These checks will ensure we comply with and meet our obligations.
Safe
Rating Inadequate
Effective
Requires
Improvement
Aggregate Rating
Inadequate
• Up to date environmental audit results to be displayed.
• Evidence required of equipment testing (EME and PAT)
• Need to demonstrate evidence/ learning that actions from investigations and complaints has been cascaded to team
• Staf fi ng levels do not aid support beyond that which attempts to cover for inadequate numbers or skills of staff present.
• Heavy reliance on agency staf fi ng due to recruitment dif fi culties.
Following an extensive inquiry into failings at Mid-
Staffordshire NHS Foundation Trust, Robert Francis QC published hi s fi nal report in February 2013 which described the suffering of many patients within a culture of secrecy and defensiveness. The 290 recommendations had major implications for all levels of health care across England and called for a whole service review to ensure that this poor approach cannot happen again.
These recommendations included the Statutory Duty of
Candour which implies an organisation is obligated to behave in an open and honest way when a serious patient safety incident occurs. It describes the expectation that such an event will be managed through prompt communication
Good nutrition and hydration for patients are priorities for our inpatient units
30

Suffolk Community Healthcare Quality Account 2014/15
High quality information underpins effective and safe patient care and is key to improvements in quality of care.
SCH is currently working towards providing Children and
Young Person’s Health dataset (CYPHS) which is a nationally mandated dataset for persons aged up to 18 years and 364 days. The timeline for this is September 2015 with the data to be provided in October 2015, good progress has been made towards this tight deadline. This dataset will be the fi rst one that makes use of the Community Information Data
Set (CIDS) data de fi nitions that have been agreed nationally in previous months.
SCH now uploads all outpatient, inpatient and minor injuries unit data to Secondary User Services for inclusion in hospital episode statistics (HES). SCH is consistently above the national average for data quality in NHS number and
GP practice for all three commissioning datasets. SCH is not subject to ‘payment by results’ so the clinical coding audit is not applicable during this period.
Although there have been improvements and innovations in the reporting processes during 2014/15, it has also been a period of stabilisation of practices and monitoring. SCH has introduced several data quality checks on the processes monitoring the timeliness of recording clinical data on our main IT systems to ensure patient’s records are up to date and accurate at all times. This includes checking that incoming information from external sources is acted upon in a timely manner and monitoring the timeliness of our clinician’s recording in the patient record.
SCH has worked with the CCGs to rationalise the number of key performance indicators (KPIs) reported on each month/ quarter/6 months this rationalisation means SCH has more time to focus on key service information that drives service ef fi ciency and effective pathways.
SCH submitted records during 2014/15 to the Secondary
Users Service or for inclusion in the Hospital Episodes
Statistics which are included in the latest published data. The percentage of records in the published data which included the patient’s valid NHS number was:
• 100% for admitted patient care
• 100% for outpatient care and
• 99.2% for accident and emergency (Minor Injury Unit) care
SCH submitted records during 2014/15 to the Secondary
Users Service or inclusion in the Hospital Episodes Statistics which are included in the latest published data. The percentage of records in the published data which included the patient’s valid General Medical Practice code was:
• 100% for admitted patient care
• 100% for outpatient care and
• 99.2% for accident and emergency (Minor Injury Unit) care
The information governance 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.
The information governance toolkit is available on the Connecting for Health website: www.
ig.connectingforhealth.nhs.uk.
Recording accurate data is a key part of modern healthcare
31

Suffolk Community Healthcare Quality Account 2014/15
Assessment Overall Score
Information
Governance
Management
Version 12
(2014-2015)
Version 11
(2013-2014)
80%
80%
Overall Score
Confidentialit and Data
Protection
Assurance
Information
Security
Assurance
Clinical
Information
Assurance
Secondary Use
Assurance
Corporate
Information
Assurance
Overall
Not satisfactory
Satisfactory with
Improvement Plan
Satisfactory
Assessment
Version 12
(2014-2015)
Version 11
(2013-2014)
Assessment
Version 12
(2014-2015)
Version 11
(2013-2014)
Assessment
Version 12
(2014-2015)
Version 11
(2013-2014)
Assessment
Version 12
(2014-2015)
Version 11
(2013-2014)
Assessment
Version 12
(2014-2015)
Version 11
(2013-2014)
Assessment
Version 12
(2014-2015)
Version 11
(2013-2014)
Not evidenced Attainment
Level 2 or above on all requirements (Version 8 or after)
Not evidenced Attainment
Level 2 or above on all requirements but improvement actions provided (Version 8 or after)
Evidenced Attainment
Level 2 or above on all requirements (Version 8 or after)
75%
70%
Overall Score
69%
66%
Overall Score
80%
80%
Overall Score
66%
66%
Overall Score
66%
66%
Overall Score
72%
71%
Self-assessed Grade
Satisfactory
Satisfactory
Self-assessed Grade
Satisfactory
Satisfactory
Self-assessed Grade
Satisfactory
Satisfactory
Self-assessed Grade
Satisfactory
Satisfactory
Self-assessed Grade
Satisfactory
Satisfactory
Self-assessed Grade
Satisfactory
Satisfactory
Self-assessed Grade
Satisfactory
Stage
Published
Published
Stage
Published
Published
Stage
Published
Published
Stage
Published
Published
Stage
Published
Published
Stage
Published
Published
Stage
Published
Satisfactory Published
Figure 6 – SCH Information Governance Attainment Levels
32

Suffolk Community Healthcare Quality Account 2014/15
A person-centred approach
• Medication review and general medical assessment/nursing needs
• Mobility assessed
• Environment assessed
• Social dif fi culties discussed.
• To be able to speak to her daughter on the phone and be understood
• To be able to walk in a shop and see clothes at eye level
• To be able to keep upright for more than a few steps
• To help mend her relationship with her concerned and tired husband.
• To live in a more adapted and supported environment.
• Speak clearly so her daughter can understand her on the phone
Our multi-sensory environment at Aldeburgh Community Hospital
• Able to walk with proper aides
• Has moved to a supported environment with the help of a voluntary service – Salvation Army
• Go shopping and see clothes at eye level, and manager a personal budget.
She feels so much happier such that her antidepressants are being reduced, and her relationship with her husband has improved.
Comment from a patient
33

34
Suffolk Community Healthcare Quality Account 2014/15
Focus on a service
Community matrons are highly experienced senior nurses who care for patients with a variety of long term conditions in their own homes. We teach patients to self-manage their current problems and help prevent the future ones. By so doing we enable people to take more control of their lives leading to greater empowerment.
All matrons can assess, diagnose and prescribe medications for a variety of conditions.
We also liaise with other services each month at multidisciplinary meetings to share information and plan care. Our referrals come from a variety of sources including GPs, hospitals, therapists, social services and district nurses.
Our goal is for early discharge where possible from a caseload o f fi fty complex patients.
Families greatly appreciate the service as it helps support them in what is a very stressful role.
We do this through close communication, care planning and referring on to an increasingly large number of other community services.
There are currently nine community matrons in
Suffolk managing patients with a number of long term conditions such as COPD, heart failure,
Parkinson’s Disease and diabetes.
A rehabilitation session at Felixstowe Community Hospital
Comment from GP practice:

Suffolk Community Healthcare Quality Account 2014/15
35

Suffolk Community Healthcare Quality Account 2014/15 Suffolk Community Healthcare Quality Account 2014/15
36

Suffolk Community Healthcare Quality Account 2014/15 Suffolk Community Healthcare Quality Account 2014/15
The Community Equipment Service (CES) provides equipment across Suffolk as well as Great Yarmouth and Waveney. It operates from three main stores in Ipswich, Bury St Edmunds and Ellough and supports 67 satellite stores across the county.
During 2013/14 our data, as well as comments from people using our service, from other professionals and our commissioners told us that this service was not fully meeting all the needs of our patients.
• Delivery within 4 hours: For End of Life patients (24/hour
7 day per week service).
• Deliveries next working day: For urgent delivery of equipment. This is a Monday to Friday only service with order cut-off at 1530hrs each working day.
• Deliveries within 2 working days: For deliveries to assist in hospital discharge or prevention of admission. This is a Monday to Friday only service with order cut-off at
1530hrs each working day.
• Deliveries within 7 working days: This is a Monday to
Friday only service with order cut-off at 1530hrs each working day.
• A standard 10 working day collection service is provided with urgent collections possible within 3 working days or in some urgent cases next working day. All collections have an order cut off of 15.30hrs each working day.
At the end of last year (March 2014) our performance against each service delivery target was:
• 4 hours 89.28%
• Next working day 91.63%
• 2 days 97.07%
• 7 day 88.20%
In 2014/15 to improve the service delivery, a Remedial Action
Plan (RAP) was put in place in consultation and agreement with the CCGs. Our plans for last year saw us redesign the ordering process with a focus on clinical prioritisation, re fi ning the delivery process and reviewing those deliveries where delays occurred. The following changes have been implemented based on expert clinical inputs:
• New simpli fi ed and clear ordering and reporting processes were designed and implemented across the service and equipment ordering system (CEquip). There were also changes made to improve the CEquip system itself making it easier to use for clinicians.
• Bar codes have been removed from all non-maintainable products (that do not need regular maintenance, eg crutches). The has resulted in signi fi cant timesaving in raising/processing and completing order requests, speeding up the process for clinicians and ensuring patients receive equipment in a timely manner
• An enhanced on call service for 4hr End of life equipment requests has been implemented, including an out of hours service (evenings and weekends)
• Delivery delays are reviewed internally and feedback given both within the service and to clinicians requesting equipment.
Since the implementation of the new system our performance has improved on nearly all KPI indicators. This improvement detailed below has been recognised by the
CCGs.
• 4 hours 94.77%
• Next working day 94.71%
• 2 days 93.52%
• 7 day 95.89%
This improved performance has occurred during a period of signi fi cantly increased demand for equipment. In 2014/15 there has been a 15% increase in the number of items of equipment ordered over the same period in 2013/14.
The improved service performance is strongly re fl ected in recent Healthwatch and Friends and Family Test surveys which have reported:
• 85% of those surveyed said they were either satis fi ed or extremely satis fi ed with speed of the service delivery,
• 95% said CES staff were more than helpful and polite
• out of 10 gave positive comments of the service overall.
For the duration of the current contract (until 1 October
2015) we will:
• Work closely with the clinical teams to ensure improved quality control mechanisms are put in place to ensure patients are receiving the best equipment
• Work with all providers who use the Community
Equipment Service to ensure the service meets the needs of all providers and their patients.
Community matrons are highly experienced senior nurses who care for patients with a variety of long term conditions
37

Suffolk Community Healthcare Quality Account 2014/15 in their own homes. We teach patients to self-manage their current problems and help prevent the future ones. By so doing we enable people to take more control of their lives leading to greater empowerment.
All matrons can assess, diagnose and prescribe medications for a variety of conditions.
We also liaise with other services each month at multidisciplinary meetings to share information and plan care. Our referrals come from a variety of sources including
GPs, hospitals, therapists, social services and district nurses.
Our goal is for early discharge where possible from a caseload o f fi fty complex patients.
Families greatly appreciate the service as it helps support them in what is a very stressful role. We do this through close communication, care planning and referring on to an increasingly large number of other community services.
There are currently nine community matrons in Suffolk managing patients with a number of long term conditions such as COPD, heart failure, Parkinson’s Disease and diabetes.
“We value the services provided by the community matrons.
It is often dif fi cult for the GP to really understand the bigger picture of what is going on for a patient and the CMs are often able to ‘ fi ll the gaps’. Ideally we would like to see the CM resources expanded to include a speci fi c focus on working with practices to reduce unplanned admissions to hospital”. Comment from GP practice:
Taking part in a rehab session – lady having pulse taken
Through our partnership with Bromley Healthcare we have introduced “Balanced Scorecards”, a comprehensive approach to monitoring our community health teams to ensure that quality is understood, measured and reported on at all levels of the organisation. We examine four quadrants:
• Quality
• Productivity
• Finance
• Compliance
The information within the balanced score card has been gathered from many sources and up until now has not been easily available in one place or used at a local level. It includes data about a wide range of indicators, such as staff appraisal rates, budget position and patient surveys to create a balanced view of the service. All of the data is on one sheet and is available to all staff, giving them a quick, easy to understand overview. We know from the Francis Report that there are risks in organisations focussing exclusively o n fi nancial information and targets, and the Balanced
Scorecard provides a wider view of performance.
Using this approach has enabled the team leads and local area managers to identify areas of development for their teams and also highlighting where they are progressing well, which they share with their teams on a monthly basis enabling the staff to have oversight and take ownership of their performance. The Balanced Scorecards are part of our success over the last year to be more open and transparent with our staff, patients and others about the performance of our services. This has led to improvements in key targets such as response times. By clearly understanding the targets and how we are doing, staff can focus on improving services so that patients are seen quicker and receive the best possible care. Team leads and staff alike have embraced the balanced scorecard approach and these are now fi rmly embedded as an operational quality tool within the community health teams.
These are measured green, amber and red against a range of agreed indicators on a monthly cycle and published for our teams and our Board. Green indicates that a team has met its target in that area, amber means that the team is working towards the target and red means that the team is failing to reach this target.
In one team it was shared with a District Nurse who was trying t o fi nd the direction to take the team and focus on improving the service delivered to patients. She found the plan simple following the key headings.
It helped her to ensure the team were on the same path as the organisational leaders and focusing on the same priorities.
It helps staff to understand how the data collected is used to inform the monitoring of what is happening across the organisation.
38
Suffolk Community Healthcare Quality Account 2014/15

Suffolk Community Healthcare Quality Account 2014/15 Suffolk Community Healthcare Quality Account 2014/15
It provides a visual tool for teams and senior managers with an overview of how the organisation is managing and monitoring overall performance in the key areas within quality, compliance, productivity and fi nance.
• To continue to share the information on areas identi fi ed for improvement
• To share any learning across all levels of staff within the organisation
• To build in a tracker process to be able to monitor trends over a period of time.
• To continue the roll out the balanced scorecard to other clinical areas.
Staff engagement is fundamental to high quality services.
Staff who feel informed, valued, happy at work, respected and supported are more likely to deliver a consistently high quality of service. People with an active involvement in the way their organisation and service is run have an even greater investment in it, and inspired to use their experience to suggest innovation and improvement.
Health services across the country face challenges in recruiting trained staff, so retaining and nurturing the people that work for us is a priority. Recruitment costs time and money, and our commitment to ensuring new colleagues have time to develop their skills in a community setting requires considerable investment. SCH is more likely to be seen as an attractive place to work if we can offer new staff a happy working life that will give them opportunities for further development.
Lack of trust and mutual respect between health service staff in frontline roles and those in management has been shown, for example in the Francis Report, to be detrimental to patient care.
From the end of 2012 and into 2013/14 our surveys indicated that trust was damaged for our staff, with many feeling their views were being ignored, and that changes were being
“done” to them despite their concerns. These concerns were voiced in public and also through internal staff surveys. As a result a programme of change was put into practice to improve engagement for all our staff.
We have stressed a culture of openness with all staff encouraged to voice their concerns and ask questions as they arise.
• Regular updates from the senior leadership team are now compiled after their fortnightly meetings and sent to all staff from Dr Tierney. These cover the wide spectrum of topics discussed at this forum, including operations, quality , fi nance, governance, and facilities. They are also used to highlight good practice and achievements among our staff
• A similar update is sent after the monthly Board meetings, including news about the transition to a new provider in
October 2015; and the health and social care redesign planned for Suffolk
• During 2014 we developed a pilot audio show for SCH,
Suffolk Punch, to which people could listen to via the phone or internet. We included an update on the plans for the future of SCH and health services in Suffolk, key changes of which people needed to be aware, focus on a service and a regular wellbeing slot. While those who listened to the show enjoyed it and found it useful, we did not attract enough listeners to make it worth th e fi nancial cost, or the investment in people’s time. The pilot was thus ended after 12 programmes.
• Senior managers have made great efforts to be more visible across our bases and to teams, attending team meetings and spending time with staff as they carry out their daily activities. This is principally with clinical teams, but has also included facilities and support staff.
• In common with all Serco staff our colleagues were invited to complete the annual Viewpoint survey in the Autumn.
After problems at some of our bases in 2013, we made every effort to ensure that every staff member was given a survey. Our response rate was 48% - about the same as the average response rate to the annual NHS staff survey.
• Having seen very poor engagement scores in 2013, we set targets for improvements, which were largely achieved.
The overall engagement score, while still low, had increased by 19%, and other scores had increased by up to 50% across the board.
• We have developed a Fix100 initiative, which asks colleagues to suggest the one thing that would make their working lives better. We aimed to get 100 responses, but received 173. These ranged from small, local issues to major concerns. The senior leadership team took ownership of achieving change where possible, and we have kept the staff up to date with “You Said, We Did” posters.
Each of our teams is working on an action plan following up on the Viewpoint surve y fi ndings, addressing concerns that remain such as the visibility of senior staff, and opportunities for professional development
We will be reporting back to staff on our FIX100 scheme outlining progress made on each of the “ fi xes” raised. We will then ask for a new batch to address.
The biggest challenge will be supporting our people through another period of change, with uncertainty facing them for some time to come. Th e fi rst task has been to ensure staff know about and understand not only the current procurement process for our service; but also the ongoing longer term plans that will radically change the health and social care landscape in Suffolk.
39

Suffolk Community Healthcare Quality Account 2014/15
We are developing a schedule of roadshows and workshops for our people, and will work closely with the new provider to ensure our staff’s views are heard, and that they are supported through the transition to a new employer.
This year we have built on the work carried out last year with the community hospitals. Video interviews were carried out with patients, carers and staff in order to capture their experiences. The interviews were played back to staff groups so they could be aware of areas considered to be good practice, as well as areas where action was needed in order to improve the quality of the service we provide to our patients.
The same approach was used this year, as this was found to provide a different perspective on patients’ experiences compared to the Friends and Family Test (FFT) surveys. The
FFT outcomes are very bene fi cial for highlighting issues which can be acted on quickly in order to investigate and progress. The video interviews were able to capture a broader perspective on what matters to patients.
While our FFT scores and comments from our surveys are overwhelmingly positive, with an average of 97 per cent of our patients likely to recommend our service, we know that there are always things we could do better. The interviews provided a method of “digging down” into what it means to receive our services, care for a patient, or be a staff member providing that care.
Four community health teams from across Suffolk and two specialist teams, the Community Cancer Care team and the
Wheelchair Service, took part in this year’s project. Thirtysix video interviews were carried out with patients, carers/ family and staff and these have been shared with colleagues at feedback days and following these at staff meetings with the teams involved. The approach helps individual staff members and teams to challenge assumptions and perceptions about what they may think the patient or family member feels and needs.
A number of issues were highlighted for our colleagues from listening to people’s experiences. After careful and collaborative consideration, our staff chose the areas they felt most important for their team to address in order to improve patient care.
Issues highlighted by people interviewed included:
• Patients need to be reassured that a referral has been received by the SCH service that will be caring for them
• Patients need to know how long they will have to wait before they receive a response to the referral (for nonurgent cases this may be some weeks, but people can accept this as long as they know they will be seen as soon as possible)
• Signposting - patients, carers and families need improved information about other services they can access to provide support
• Patient information lea fl ets highlighted as needing to be updated
• Patients attending clinics need to be informed of any delays, and we need to be open about why that delay has occurred.
• More effective communication processes needed between acute hospitals and community services
• Need for care planning to take place with patients so their priorities can be recognised
• Patients need access to their Care Plan
• Need to improve the wheelchair repair service and speed up the provision of wheelchairs.
We are committed to supporting changes necessary to improve the quality of service to our patients. The teams involved are progressing action plans aimed at achieving change. The next step is to provide information back to our patients to show them: You Said/We did.
Improving information for patients is one of our priorities for
2015/6 – please see page xx.
We have worked hard to ensure that our leadership team, and staff across SCH, are aware of the issues raised above, and others highlighted by those interviewed. We have held workshop days for the staff involved in the project, and fed back th e fi ndings to teams. Videos of patient stories have been shown at Board meetings and in other settings to bring the voices of the patients, their carers and our colleagues to a wider audience.
Providing the best possible experience for patients continues to be a founding priority for Suffolk Community Healthcare.
Listening to our patients and their families is a vitally important way for us to measure and improve the quality of the services we deliver.
One of our key achievements over the past year has been the roll out of our patient surveys to all parts of our service.
This means that more of our patients than ever before have the opportunity to provide their feedback about the quality of the service they have received. In partnership with
Healthwatch Suffolk, we have also undertaken two major pieces of work to get detailed feedback on our Community
Equipment Service and Wheelchair repair service.
Also new for 2014/15 is our Patient and Carer Group – this is a forum comprised of local voluntary groups who represent a variety of different patient and carer groups in Suffolk and senior staff members from Suffolk Community Healthcare.
The group is designed to increase the involvement of patients/carers in the development of SCH services.
The following sections summarises the key areas of our patient experience work during 2014/15.
40
Suffolk Community Healthcare Quality Account 2014/15

Suffolk Community Healthcare Quality Account 2014/15 Suffolk Community Healthcare Quality Account 2014/15
Whilst 2013/14 saw the roll out of a new, more comprehensive patient survey, 2014/15 has been focused on rolling out this survey to an increasing number of our services. During 2014/15 our patient surveys have been rolled out to patients using the following services:
• Outpatient clinics (continence, stoma, neurology, epilepsy, pulmonary rehabilitation
• Community Equipment Service Wheelchair Service
Respondents who would recommend our service to family and friends:
SCH overall
Community
Hospitals
MIU CHT LTC CES WCS Clinics
95%
218
%
No.
96%
2606
94%
567
98%
701
96%
610
96%
219
*MIU – Minor Injuries Unit; CHT – community health teams; LTC – long-term conditions;
CES – Community Equipment Service; WCS – wheelchair service; CCC – Care Co-ordination Centre
95%
367
Patients who agreed that their treatment/care plan was explained in a way they could understand
Patients who agreed they were involved as much as they wanted to be in decisions about their care/treatment
96%
47
%
96%
95%
CCC*
95%
585
No.
2102
2078
%
94%
93%
Patients who agreed that the care/treatment they had been given had a positive effect on their wellbeing
Patients who agreed that they feel that the care/treatment they have been given has helped them better manage their condition
Patients who agreed that they had complete co nfi dence in the staff treating/caring for them
Patients who agreed that staff made them feel comfortable about asking important questions
Patients who agreed that the staff made them feel that they really cared about them and their condition
Community Hospitals
MIU
Community Health Teams
2717
604
713
638
Wheelchair Services
Community Equipment Service
%
98%
97%
97%
229
49
386
No.
1401
1369
No.
2190
2127
1472
41

Suffolk Community Healthcare Quality Account 2014/15
The FFT was initially introduced to acute health services in
2013. From January 2015, it has become mandatory for all health services, including community services, to use the FFT and to report the results to NHS England on a monthly basis.
The preparation work we undertook in 2013/14 and during
2014/15 ensured we were well prepared to meet our FFT reporting obligations.
While our patient surveys are tailored to our different services, the FFT question is central part of all our surveys.
The table below shows the FFT scores across our key services during 2014/15
Is a single question, which asks patients whether they would recommend the NHS service they have received to friends and family who need similar care or treatment. The score is calculated using the proportion of patients who would be extremely likely to recommend the service minus those who would be either unlikely or extremely unlikely to recommend.
The FFT score falls within a range of -100 to +100 with a positive score indicating a higher proportion of service users who would recommend the service. In essence, the score is designed to provide patients with a measure of the quality of the service. As well as the central FFT question, our surveys also ask our patients to explain the reason for their rating and to suggest service improvements where appropriate.
We are determined to build upon the work we have undertaken to date to ensure the best possible experience for all of our patients across all of our services.
• We have made excellent progress in increasing the number of survey responses we receive – we will ensure we continue to build on this progress to increase our response rates across all of our services. This will include exploring new methods for capturing patient feedback;
• Patient surveys are an important way for us to hear what our patients think about our services and where improvements can be made – we will ensure that this feedback is shared across the organisation – from ward to board – and empower our staff to act on this feedback to improve our service for all of our patients.
Pulmonary Rehabilitation team members Sarah Bruin and Penny Waggott
SCH
(overall)
+ 74
Community hospitals
MIU
+ 68 + 90
CHT LTC
2013/14 Year + 61 + 76
Q1 2014/15
Q2 2014/15
Q3 2014/15
Q4 2014/15
2014/15 Year
+ 79
+ 80
+ 77
+ 78
+ 78
Figure 9: FFT scores – quarterly breakdown by service
+ 79
+ 66
+ 63
+ 66
+ 66
+ 94
+ 92
+ 86
+ 87
+ 89
+ 90
+ 75
+ 73
+ 80
+ 77
Extremely likely
Likely Neither likely nor unlikely
%
No.
80
2170
16
436
Figure 10: Breakdown by rating (Suffolk Community Healthcare overall – 2014/15):
1.6
43
+ 91
+ 76
+ 83
+ 79
+ 81
Unlikely
0.7
18
CES
N/A
N/A
+ 73
+ 82
+ 76
+ 78
Extremely unlikely
0.4
11
WCS
N/A
N/A
+ 50
+ 65
+ 76
+ 69
Don’t know
1.4
39
Clinics
N/A
N/A
+ 89
+ 86
+ 74
+ 77
42
Suffolk Community Healthcare Quality Account 2014/15

Suffolk Community Healthcare Quality Account 2014/15 Suffolk Community Healthcare Quality Account 2014/15
The Community Intervention Service encompasses a range of admission prevention teams across Suffolk.
Included are:
• Admission prevention service
• Chronic Obstructive Pulmonary Disease (COPD) team
• Pulmonary rehabilitation team
• Integrated discharge planning team (IDPT)
• Post Acute Care Enablement Service
• Early intervention team (EIT)
These teams are linked together but each carries out a speci fi c function within the county. Central to the whole CIS model is the admission prevention service (APS).
With bases in Ipswich and Bury St Edmunds the APS provides a 24 hour Nurse-led service which operates across the county. Staffed with Registered Nurses and Healthcare Assistants, the service responds to referrals for patients aged 18 and over, registered with a Suffolk GP who have an acute health need, are clinically stable, but require nursing interventions which can be safely delivered in the community, preventing a hospital admission, for example;
• Assessment for health crisis including urgent blood tests to aid diagnosis,
• Assessment for health and social care crisis including urgent care packages to prevent admission
• Short term administration of intravenous antibiotics for conditions such as cellulitis or infections not responding to oral antibiotics eg urinary tract inefection, chest infection, wound infection
• Management of dehydration using subcutaneous infusion therapy
• Anti-coagulation management including administration of oral Vitamin K and monitoring for unstable INR (a coagulation test)
• First catheterisations following medical assessment
• Referral triage in the care coordination centre
• SOS nurse interventions out of hours e.g. blocked catheters and wound care
The COPD team is co-located with the APS in Ipswich and Bury and have a supportive working relationship. The
COPD team provides three core functions.
• Admission avoidance for patient in acute COPD exacerbation at the stage admission to hospital is indicated
• Assisted discharge for patients in the acute hospitals who need specialist inpatient assessment prior to community follow up.
• Oxygen recall management
The team works closely with the pulmonary rehabilitation team, local smoking cessation groups and breathe easy groups as part of a wider on-going health promotion initiative for people with COPD.
At any one time the team will manage the oxygen therapy for over 400 people and take around 12 referrals each day for admission avoidance and assisted discharge.
Both the APS and the COPD team have close links with the acute hospitals providing direct links with
Acute Medical Unit’s through the sub-acute pathway,
PACE, EIT and link nurses supporting the clinical teams to identify suitable patients for discharge into community support.
Pulmonary Rehabilitation session
43

Suffolk Community Healthcare Quality Account 2014/15
44
• Around three million people in the UK suffer from COPD. The disease is chronic and usually progressive marked by symptoms that produce disability and impaired quality of life. SCH provides a six week, 12 session, course of Pulmonary Rehabilitation to patients with COPD. The programmes are delivered around the county by a team of physiotherapists and assistant practitioners all experienced in managing the symptoms of COPD.
• In November 2014 an audit of clinical outcome measures of 50 people who had recently completed the programme was undertaken by the team. Participants were aged 55-86, 26 male and 24 female. Clinically signi fi cant improvements in exercise tolerance of 62% were evidenced in the group, with an average increase of 73.2 metres walked. This in a group where the average walk distance before the programme was only 235 meters.
• Quality of life indicators also showed an improvement with 72% (CAT Score), of patients reporting a signi fi cant improvement in health status. Indicating patient’s improved co nfi dence in the understanding and self-management of their condition, and levels of anxiety and depression were also reduced.
• Thes e fi ndings support the positive patient feedback received via Patient Satisfaction Surveys and re fl ect the commitment of the Pulmonary Rehabilitation team in delivering a quality service.
• The Parkinson’s service covers west Suffolk, for all those with a west Suffolk GP. Based in Bury St Edmunds, it provides clinic and home assessments and reviews for those living with not only Parkinson’s but also other differential movement disorders, including multiple systems atrophy, progressive supranuclear palsy, cortical basal degeneration and Lewy body dementia.
• Clinics are held in Bury St Edmunds, Haverhill, Sudbury and Newmarket, allowing people to be seen nearer to home. The service links closely with the local hospitals, community therapy teams, speech and language therapists and voluntary agencies.
• The main bene fi t within the service is the ability of the nurse to prescribe independently. Parkinson’s is an extremely diverse condition and affects each person uniquely, so specialist assessment of a patient is vital to provide the best possible outcomes and quality of life. This is determined by many factors, but is underpinned greatly by medication. The ability of the nurse to assess and prescribe for the patient allows for immediate and accurate / appropriate prescribing. Regular clinics or home reviews allow careful monitoring of drug changes. GPs often do not feel co nfi dent, or have the specialist knowledge to feel able to manage the medications, and appear to appreciate the support in prescribing that the service offers. Also, access to the consultant neurologists can be limited and not always possible at short notice, or able to provide ongoing close monitoring.
• Some drugs used for Parkinson’s can obsessive, compulsive impulsive behaviours in a minority of patients, needing immediate response and support for the patient and often their families. Offering nurse prescribing allows for evidence-based prescribing, reduction / withdrawal of the medication with continual specialist assessment and appropriate compensatory prescribing to manage the underlying condition. It also provides specialist support knowledge and reassurance. For most patients this will improve symptom control, reduced side effects and understanding of their medication. We hope this will give them co nfi dence in a service that is supportive, proactive, reactive and effective, allowing for optimum management of the condition resulting in good quality of life for all involved.
Suffolk Community Healthcare Quality Account 2014/15

Suffolk Community Healthcare Quality Account 2014/15 Suffolk Community Healthcare Quality Account 2014/15
We aspire to deliver the highest standards of care and treatment to all of our patients at all times. However, we recognise that sometimes things can go wrong, which is why we have a robust procedure in place for the investigation of concerns and complaints. Furthermore, we recognise the importance of ensuring all concerns and complaints are properly investigated and responded to promptly, with action taken swiftly to bring about improvements where necessary.
• During 2014/15, we received 53 formal complaints compared with 65 received during the previous year.
• 58% of complaints were responded to within the 25 day timescale, up from 49% the previous year.
Whilst this is an improvement we recognise the importance of providing responses within the 25 day timescale, so we are determined to ensure 100% of complaints are responded to within this timescale.
A fundamental part of the complaint process is the opportunity to learn and improve. Where investigations reveal areas for improvement or action, we make sure this is implemented as swiftly as possible and that any learning is shared across the organisation where necessary. The following are examples of some of the actions we have taken in response to complaints we received during 2014/15:
• Increased staff training/awareness of the ‘Fast track’ continuing care process, designed to provide continuing care at short notice to patients in their own homes
(following a complaint we received about how the fast track process was implemented for an end of life patient);
• Focusing staff in our community hospitals on the importance of involving family members in the care and treatment provided to patients ( following a complaint we received from a family member who did not feel that they had been given the opportunity to be involved in their loved one’s care at one of our community hospitals);
• We are currently reviewing how we can best keep patients informed about when they will be visited by our community health team following a referral (following a complaint we received from a patient who felt that they had not been given a clear idea of when their physiotherapy treatment would commence from their local community team).
During 2015/16 we will continue to work to ensure our complaints process works effectively for patients and their families. We will also be working to integrate the learning we identify from our complaint investigations with our incident recording procedure to ensure common themes and issues are identi fi ed and dealt with promptly.
Formal complaints
- Total
Acknowledged within 3 days
%
Formal responses within 25 working days
No.
%
No.
Formal responses outside 25 working days
%
NOS.
Complaints by service area
Community Health Team
Community Hospitals - Inpatients
CIS
SEPT - Podiatry
Continence service
Wheelchair Services
Specialist Nursing
Community Equipment Service
CCC
Community Hospitals - Outpatients
SEPT - Other
Phlebotomy
Apr
7
71%
5
29%
2
71%
5
4
80%
4
20%
1
May Jun
5 7
80% 71%
5
29%
2
57%
5
1
2
1
2
1
3
2
5
5
3
23
5
July
5
60%
Aug Sep
3
100%
7
86%
Oct
6
100%
Nov
3
100%
Dec
2
100%
Jan
1
100%
Feb
2
100%
Mar
5
80%
YEAR
53
83%
3
60%
3
33%
2
3
33%
1
67%
2
6
86%
6
14%
1
6
67%
4
33%
2
3
33%
1
67%
2
2
100%
2
0%
0
1
100%
1
0%
0
2
50%
1
50%
1
4
80%
4
20%
1
44
58%
31
42%
22
Figure 11: Number of formal complaints and response time
Complaints by subject area
All aspects of clinical treatment
Appointments, delay / cancellation (outpatient)
Attitude of staff
Aids and appliances, equipment, premises (including access)
Other
Communication / information to patients (written and oral)
Failure to follow agreed procedures
Admissions, discharge and transfer arrangements
Patients property and expenses
7
6
6
14
9
2
2
4
3
Figure 12: Complaints by service and subject area
45

Suffolk Community Healthcare Quality Account 2014/15
We received a total of 366 compliments during
2014/15. We collate compliments and post a selection on our staff intranet site. We have selected a number of these to share with you throughout the document.
“...the help I was given made me feel safe and also gave me confidence. It was good to have someone to ask questions and understand what was happening...”
Patient cared for by Community health Team
“...CES staff are always extremely helpful and accommodating. If something needs delivering quicker than anticipated, they will do their best to help...”
Patient receiving service from Community Equipment Service
Last year, a patient was admitted to one of our community hospitals for end of life care. The patient and their long-term partner had always planned to wed, and asked if they could be married on the ward. The staff were more than happy to do all they could to help, and with just 48 hours to make it all happen, work got under way.
With the support of the registrar, the ceremony took place in the garden, which staff set up with seating, parasols, and the patient’s bed was wheeled outside.
Staff did all they could to make it special for the couple and their guests – laying on fre sh fl owers, bunting, a wedding guest book, cupcakes and other food, and photographs. The patient died shortly afterwards, but the staff felt privileged to be able to help the couple achieve their wish.
The Liverpool Care Pathway (LCP) was a plan of care used by many health organisations including SCH, to help alleviate suffering in th e fi nal stages of a person’s life.
A Government-commissioned review called for an overhaul of end-of-life care as it showed that not all staff using the
LCP had had suf fi cient training in its use and it did not meet the individual needs of patients or their families. The report recommended that the LCP be phased out and replaced with individual care plans for the dying. In SCH we have developed a new template and patient lea fl et to guide staff and provide information for their patients to ensure everyone gets the care they want and need.
Death is a sensitive subject and one that many people are not comfortable discussing. The lea fl et will give patients some information about questions staff are frequently asked. We hope that patients wil l fi nd it useful during this dif fi cult time. The care plan is put into place when the health professionals looking after an unwell patient, feel they are in the last few days of life. It is dif fi cult to be precise in these circumstances hence the need for sensitive discussion to ensure that the treatment given is in the best interests of the patient. Every situation is slightly different and a speci fi c plan will be designed for the patient. However there are certain considerations that are common to all people near the end of life. A plan will be carefully thought through and aim to balance any treatment with comfort and dignity. On occasion, a patient’s condition improves and the plan of care needs to be adjusted or discussed again.
The reporting of patient safety events is recognised, promoted and viewed as a positive organisational indicator of good practice, as those with an open culture are more likely to have established processes to learn from these untoward events. Staff are encouraged from the time of their induction to the organisation to report untoward events that have occurred or considered to be ‘nearmisses’. These incident reports are reviewed, logged and investigated, where appropriate, and any learning opportunities shared across the service.
Keeping patients safe remains the highest priority for Suffolk
Community Healthcare. It is important not only that services are as safe as they can be, but that we demonstrate and share this amongst ourselves, our partners, our patients and carers and the general public. We encourage all staff to report any untoward events as part of our open and honest culture and aim to embed shared learning.
Taking this a step further, the organisation plans to register for ‘Sign up to Safety’. This is a national patient safety campaign announced in March 2014 by the Secretary of
State for Health, with the mission to strengthen patient safety in the NHS and make it the safest healthcare system in the world. The Secretary of State for Health set out the ambition of halving avoidable harm in the NHS over the next three years, and saving 6,000 lives as a result. This is supported by a campaign that aims to listen to patients, carers and staff, learn from what they say when things go wrong and take action to improve patient’s safety helping to ensure patients get harm free care every time, everywhere.
Clinical teams are to be encouraged to identify speci fi c opportunities they themselves recognise and wish to develop as part of the campaign. Aspects that offer potential for this work include patient engagement, medicine management, falls prevention and pressure care.
Unfortunately the complexities of modern healthcare mean that things may occasionally go wrong despite our having the relevant processes and procedures in place. Suffolk
Community Healthcare follows appropriate policies in order to identify any failings or weaknesses and then ensure that
46
Suffolk Community Healthcare Quality Account 2014/15

Suffolk Community Healthcare Quality Account 2014/15 Suffolk Community Healthcare Quality Account 2014/15 investigation and learning from incidents or complaints takes place. Incident reporting is constantly promoted to encourage staff to report and record actual and near miss events.
A patient safety incident is any unintended or unexpected incident which could have or did lead to harm for one or more patients receiving NHS care.
The National Patient Safety Agency encourages the reporting of all patient safety incidents.
This includes:
• Incidents that you have been involved in;
• Incidents that you may have witnessed;
• Incidents that caused no harm or minimal harm;
• Incidents with a more serious outcome;
• Prevented patient safety incidents (known as ‘near misses’).
During this year the risk management team further developed the presentation style of incident data. Included now is comparative data and identi fi cation of ‘hot spots’.
This enables clinical services to compare themselves with each other and also identify to managers and the board any emerging themes or potential organisational weaknesses or risks. It also supports the sharing of best practice.
Serious Incidents in health are adverse events where the consequences to patients, families, carers and/or staff are so signi fi cant or the learning potential so great that a heightened level of response is required. All Serious Incidents
(SIs) are required to have a Root Cause Analysis (RCA) investigation undertaken. An RCA investigation encourages the question “Why?” to be asked and learning to be identi fi ed. RCAs inevitably result in actions for changing practice or recognising where excellent care and clinical judgment has taken place.
Figure 13: Top 5 themes of all reported incidents
Thes e fi gures include all reported events, those that are clinical (relating to patient care) and also non clinical (not relating to patient care), and include issues beyond the remit of Suffolk Community Healthcare responsibilities, for example pressure ulcers that develop before the patient is received into Suffolk Community Healthcare care, or referrals received with incomplete patient information that prevent our immediate response.
Incidents are classi fi ed as to whether they are clinical or nonclinical, or attributable to Suffolk Community Healthcare interventions or if the responsibility of other services i.e. a medicine dispensing issue by an independent pharmacy.
Of those incidents classi fi ed as relating to patient safety and, which meet the criteria for sharing with and reporting to the National Reporting and Learning System (NRLS).National
Reporting and Learning System (NRLS).
Figure 15: Reported Serious Incidents 2014.15
Our reporting framework has been developed to ensure that agreed actions and lessons learnt from incidents,
RCAs, complaints and claims are disseminated across the organisation. A summary report of key elements is presented to the Compliance Committee ensuring organisational wide sharing and learning is re fl ected in the monthly Take Care
Take Note bulletin and summarised learning reports. All staff throughout the organisation receive Take Care Take Note which includes relevant national patient safety updates
See below for examples of actions taken following Serious
Incident investigations.
As part of a Suffolk-wide campaign to ensure the safety and security of Controlled Drugs within community settings,
Suffolk Community Healthcare, in association with Suffolk
Constabulary and other agencies have purchased and are rolling out Envopak® bags for the Community Health Teams.
These are strengthened plastic pouches which can be sealed using a numbered seal which can be removed and replaced every time a controlled drug is placed into or removed from the bag.
This was implemented to reduce the risk of controlled drugs going unaccountably missing; all schedule 2 and 3 controlled drugs are now being stored in sealed Envopak® bags. Staff must check that the serial number on the Envopak®
Figure 14: The graph above highlights the top 5 incident categories received during Oct 2014 - March 2015 inclusive.
47

Suffolk Community Healthcare Quality Account 2014/15 nursing staff always attempt to immediately resolve this promptly by liaising with the relevant service such as the patient’s GP, acute hospital or the pharmacy to prevent risk of potential harm from medication not being received in a timely manner.
54 medication events (1/3rd of the year’s total) were attributable to medicines management by SCH. 80% of these ‘errors’ had no consequential effect upon their patients with 11 patients experiencing a ‘low level‘ of harm recorded as such due to requiring possibly an additional blood test to check their blood sugar level or clotting factors.
Although the patient’s doctor is always noti fi ed in such an event no patients required any remedial medical care as consequence.
Suffolk Community Healthcare Quality Account 2014/15
Figure 17: Nos. of patients experiencing harm following medication incident matches the serial number recorded in the patient record. If it does, then they can access the medication by breaking the seal. If it does not, then they know the bag has been accessed by an unauthorised person and an incident can be raised within the organisation and with the police.
Approximately 160 incidents included medication related aspects:
• The development of a clinical audit program of inpatient medication prescription charts
• a bespoke teaching package for community staff
• re-design of prescription chart
• To ensure the safety of controlled drugs within the home the implementation of controlled drug storage bags.
Figure 16: Number of reported 2014/15 medication incidents non-attributable/ attributable to SCH
Two thirds of the total number involved situations arising outside SCH control, for example patients referred into care without their appropriate medicines or the prescription chart to enable SCH nursing staff to safely administer the patient’s medication. These situations may lead to delay, potential omission of doses of medication. To ensure those within their care receive their correct drugs at the correct time, SCH
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Suffolk Community Healthcare Quality Account 2014/15 Suffolk Community Healthcare Quality Account 2014/15
Suffolk Community Healthcare aims to safeguard all our patients from abuse and/or neglect in line with new legislation, government policies, and guidelines. Our main priorities during this past year have been to:
• Contribute as healthcare experts to the work of Suffolk’s
Adult Safeguarding Board and other forums to ensure
SCH works closely with colleagues in social care and the police to minimise harm to those at risk in Suffolk
• Audit our organisation to ensure that our safeguarding policies and procedures are comprehensive and robust enough to satisfy ourselves, our patients, visitors and staff that their safety and wellbeing is a very important priority. The audit covered leadership, staff recruitment, training, staff supervision and the management of concerns about those at risk
• Ensure all our staff are given appropriate training to ensure they know how to respond to a situation where there are concerns about abuse and/or neglect. Support all staff to ensure they act in a timely and proportionate manner on any concern or suspicion of abuse and/or neglect.
To work with the Suffolk Adult Safeguarding Board to ensure SCH as a partner organisation contributes to the implementation of the Care Act 2014 by:
• Ensuring staff are given appropriate levels of training and support.
• Implementing recommendations made following serious case reviews.
• Alerting the Multi-Agency Safeguarding hub where our staff have concerns about the safety of our patients.
Safeguarding children has remained very much in the public eye in the last 12 months, in particular there has been a focus on Child Sexual Exploitation (CSE) and Female Genital
Mutilation (FGM).
There has been a shift to strengthen local accountability frameworks and a need for staff to be aware of local professional guidance. They also need to demonstrate the knowledge, skill, and attitude to be effective and work with multiagency partners in protecting vulnerable children.
SCH are required to assure services are safe via submission of Section 11 (Children act 2004) evidence to the CCG and will be reviewed as part of the Care Quality Commission
Inspections Assurance framework and more speci fi cally the
CQC inspection framework for safeguarding and looked after children.
SCH have committed to ensuring polices support the changes in practice and the training and supervision of staff working directly with children are meeting current requirements.
We have also raised awareness of the need to be alert to indicators of abuse for children and be able to report their concerns Safeguarding children support has been provided by Ipswich Hospital Safeguarding Children Team during the last 12 months.
• Training compliance has remained consistently high throughout the year with complianc e fi gures not falling below 90%
• Feedback on training showed staff felt more co nfi dent in being able to recognise and respond to child protection concerns.
• Between 1 October 2013 and March 2015 the safeguarding team have received noti fi cation of 20 referrals from SCH staff, and audits show staff are submitting appropriate referrals of a good standard
• Signi fi cant changes have been made to ensure the quality experience and outcome of training remain high, ensuring compliance with statutory recommendations
• Training now includes an awareness of CSE and the local safeguarding children board (LSCB) toolkit, and will be updated to include FGM when new guidance is released.
• Additional online training is now available to SEPT and
CDS staff.
• Staff in the MIU at Felixstowe have received bespoke Level
3 training speci fi c to their unique needs.
Safeguarding supervision is recommended for all staff working directly with children who have caseload responsibility and are expected to contribute to multiagency planning and assessment of children at risk.
In July 2014 all safeguarding team members undertook
NSPCC training in safeguarding supervision skills. This ensures those delivering supervision are adequately skilled and able to support staff.
Attendance and engagement at supervision sessions remains high. Changes were introduced in January 2015 to provide supervision using the Suffolk Signs of Safety and Well-Being (SSOSWB) approach adopted by Suffolk
County Council in 2014. Themes emerging from supervision are the commitment to explore concerns, but the need to understand the local the Local Threshold of Intervention criteria, and the new MASH (multi - agency safeguarding hub) process. This will be addressed in future supervision sessions and the enhanced training programmes.
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Suffolk Community Healthcare Quality Account 2014/15
The lessons from a serious case review Suffolk have been embedded into the training programmes and CCG action plan for health providers completed. In addition the named nurse for safeguarding has participated in a local case review.
Learning from this event will be circulated via the LSCB
We started the year with a target of no more than FOUR
Clostridium dif fi cile (C.diff) cases and we achieved this with only THREE cases over the year. All of these cases have been thoroughly investigated using root cause analysis
(RCA) methodologies and the key learning points have been implemented to prevent reoccurrences as far as possible.
In all of these cases the environment and staff hygiene practices were found not to be an issue and as such there was no evidence of transmission from the either staff or the environment between patients. In all cases the cause was identi fi ed as being as a result of antibiotic treatments, and as such much of our efforts to prevent this infection are focused on the close monitoring of these treatments.
It is estimated that 3% of people carry MRSA harmlessly on their skin, but for hospital and patients within the community the risk of infection may be increased due to wounds or invasive treatments which make them more vulnerable.
Serious MRSA infections may result in MRSA blood stream infections.
C-diff is a common cause of hospital acquired diarrhoea. It is bacteria that are harmlessly present in the bowel of 3% of healthy adults and up to 30% of elderly patients. When certain antibiotics disturb the balance of bacteria in the gut,
C-diff can multiply rapidly and produce toxins which cause diarrhoea.
During th e fi rst half 2014/15, staff continued to have a choice between face to face/ attended training and e-learning enabling them to access training in a manner that better suites their learning styles. Whilst our own target for the number of staff trained remains at 100%, our commissioners set a target for 2014/15 of having 95% of all our staff trained, our own target remains 100%We have, unfortunately, not managed to achieve this – as our Infection
Control Lead post became vacant during the third quarter of
2014. We are now working hard with our partners at SEPT who are currently providing our Infection Control support and expertise to improve our overall compliance.
The link workers are continuing to deliver practical hand hygiene sessions for all of the staff in their areas.
Figure 18: Nos. of CDiff cases reported in 2014/15
Figure 20: % compliance with Infection Control Training
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Figure 19: % compliance for Equipment Decontamination for 2014/15
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Suffolk Community Healthcare Quality Account 2014/15 Suffolk Community Healthcare Quality Account 2014/15
• Our hand hygiene results have remained steady; the average compliance for the year for all four community hospitals, minor injuries unit, and SEPT Foot and Ankle service was 96.98% since the introduction of the new audit tool as data gathering process.
• Implementation of all key learning from RCA
• A thorough and continuous monthly environmental hygiene monitoring programme across all sites. This is carried out by the Facilities Department staff and is reported upwards via the audit and contract reports.
• The embedding of the infection prevention and control link worker network so that all locations have access to onsite training & audit functions for infection control
• MRSA Screening – 100% for foot and ankle surgery patients
• C.Diff reported cases halved from 6 to 3 during 2014/15
• Greater control and monitoring of antibiotic prescribing practices through the introduction of a more in depth audit process. The catheter care audit programme was introduced and embedded within our four community hospitals with a compliance rate against the validated audit tool at 99.12%.
We want patients being cared for in our inpatient units to have the best environment possible, and our facilities staff work with our clinical and support teams to ensure we offer a clean and comfortable setting with good and appropriate food.
Our facilities team includes 90 colleagues providing domestic and catering services across our four community hospitals and 18 clinics and health centres. We ensure that the cleaning of all healthcare environments follows the 49 cleaning standards set out by the NHS.
We are committed to ongoing training for our catering and domestic staff, and a number of them have this year completed NVQ apprenticeships.
All our hospitals are assessed through PLACE – patient-led assessments of the care environment – which judge:
• Cleanliness
• Food
• Privacy and dignity
• Condition appearance and maintenance.
Our hospitals also receive food hygiene ratings, currently
Aldeburgh, Bluebird Lodge and Felixstowe Hospitals have fi ve-star ratings and Newmarket has a four-star rating. Three of our hospitals provide traditional cooking services, while one provides cook-chill meals. We also have a restaurant open to staff, patients and public at Newmarket Hospital.
SCH produces 87,360 meals for patients a year, and ensures that the food we offer meets their speci fi c needs, such as soft foods. All four hospitals signed up to Nutrition and Hydration
Week, and regularly hold themed days and weeks to coincide with events such as British Food Fortnight and VE day.
In a year which saw the re fi tting of the Aldeburgh Hospital kitchen, local schoolchildren learning about healthy food for people in hospital worked with us to prepare a menu and met patients and staff. Our patients regularly comment on the quality of the food served in our inpatient units.
Suffolk Community Healthcare continued to participate in this important national audit.
Engagement from clinical teams has improved steadily throughout the year with increased visibility and assistance from the Clinical Audit team.
Reports comparing involvement and performance between our Community Hospitals and Community Health Teams have provided the impetus for continual improvement and focus on patient safety.
Safety Thermometer data is compared to data received from other sources such as incident reports and this helps to focus resources where they are most needed and ensure that the principles of “harm-free care” continue to be part of the ethos of daily care within SCH
SCH has had 100% participation in this audit from all the
Inpatient and Community Health Teams. The audit sample for the quarter 3 was 2678 patients.
Since June 14 harm free has improved by 2.41% across the organisation. In addition over this period there has been a signi fi cant increase of patients audited across Suffolk
Community Healthcare of just over 4%.
The results for both the Community Hospitals and
Community Health Teams for the last quarter were:
Figure 21: % of Harms by month 2014/15
Figure 22: Replace with up to date
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Suffolk Community Healthcare Quality Account 2014/15
Suffolk Community Healthcare is a partnership of three organisations providing care to people of all ages across the county. In this section we focus on the work of our partner services, starting with the community paediatric service.
The Integrated Community Paediatric Services (ICPS) are provided for SCH by SEPT, South Essex Partnership
University Foundation Trust. ICPS operate within a structured governance framework within SEPT with a local Quality and Risk Committee established for the Suffolk adult and paediatric services. This committee reports up to the corporate SEPT governance committees and is used as a route for assurance and to disseminate key messages regarding quality and compliance.
The agenda for the Suffolk Quality and Risk Committee informs the work priorities for the ICPS alongside local service priorities. These are all managed via the Paediatric
Services Service Management Group (SMG) chaired by the
Associate Director for ICPS.
There are also a number of formal subgroups to the SMG, speci fi cally supporting the work of the paediatric services - these are:
• Safeguarding Children Operational Group
• Service Development Group
• Patient Experience Group
• Child Development Centre Management Group
• SEND reform implementation Group (time limited)
The Associate Director for ICPS represents the local services on a number of SEPT corporate groups (Clinical
Effectiveness, Safer Staf fi ng, Workforce and Development).
• Response to the SEND reforms within the new Children’s
Act. ICPS has been actively involved with the Suffolk
County Council Steering Group in order to respond to the new statutory frameworks to develop individualised
Education, Health and Care plans. Our services available to children have been described on the council’s
“infolink”.
• Autism Diagnostic Pathway review (development of pathwa y fl owcharts)
• 0-5yrs pathway
• 5-11yrs pathway
• Review of pre-school Multidisciplinary Assessment
Pathway within the Child Development Centres
• Social and communication dif fi culties (autism)
• Physical disability
• Autism Pathway interface with “CAMHS” over 11yrs diagnostic service
• Initial Health Assessments for Looked After Children
– implementation of new service model with a Specialist
Nurse supporting the medical assessment of children under Local Authority care
• Consent to treatment – guidance for service users and clinicians
• Paediatric Speech and Language Therapy Service review – focus on services to children within mainstream schools
• Specialist commissioning of communication aids. Service lead is pivotal in contributing to the working group overseeing the development of the regional specialist hub
• 0 – 25 year SLCN (Speech Language and Communication
Needs) Review with Suffolk County Council
fi
• Physiotherapy – use of gym based groups
• Use of Baileys as an assessment tool: internal use and possibilities in developing service within Ipswich Hospital
• Community Respiratory Pathway
• Bowel Clinic
• Melatonin Pathway
• Sensory Pathway for children who are hearing impaired
• Specialist Commissioning and sexual abuse elements – input into pathway
• Postural Pathway
• Paediatric clinical assessment of genital conditions where there are no safeguarding concerns
• Audiology pathways across Acute and Community teams
• Auditory Processing Disorder
• ADHD pathway – west Suffolk
This year there has been an increase in activity to engage with parents and service users to obtain their feedback on their experience of our services.
“Friends and Family” (FFT) questionnaires are widely used across all services with positive scores being received. The main highlights from the FFT scores are that the number of detractors (“Extremely unlikely” to “Neither likely or
Unlikely”) have stayed very low and promoters (“Extremely likely”) have stayed very high. 87% of all service users surveyed were “extremely likely” to recommend the team or service they used to friends or family members who needed similar care or treatment.
• Samples of parental feedback received
• Paediatric medical team “Paediatrician was very attentive to my child’s needs, putting him at ease. As a parent, I felt very well informed and co nfi dent that my child’s needs had been thoroughly assessed.”
• Paediatric medical team “Our daughter’s doctor listened carefully to our opinions and gave good advice. He has continued to be very supportive and kind in nature. He quickly reacts to suggestions made at our visits and we always receive feedback through the post promptly”
• Child development centre – multidisciplinary assessment
“Other areas of the NHS relating to my daughter’s care
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Suffolk Community Healthcare Quality Account 2014/15 Suffolk Community Healthcare Quality Account 2014/15 haven’t been too good but this was the NHS at its best.
Impressive, effective and ef fi cient. I can’t fault any aspect of it. The CDC team and the multidisciplinary assessment
- they performed”
• Children’s community nursing “I would like to say Steph is amazing, she helped me understand stuff that was going on, always happy and helpful and my son loved her!!”
• Paediatric physiotherapy “Extremely helpful and useful advice”
• Paediatric occupational therapy “They were extremely patient and made sure my son understood what was being asked of him which was great”
• Paediatric speech and language therapy “We received an appointment very quickly and the person we saw was very polite and professional. She chatted well with my daughter and put her at ease”
• Paediatric audiology “Staff were friendly -Waiting room had activities for my child to play with -The hearing test went smoothly and quickly and unintimidating for my 8 year old. Thank you”
• Child and family clinical psychology service “Very professional, relaxing, reassuring. Well explained and advised. Compassionate”
• Paediatric medical team/occupational therapy/ physiotherapy “As a parent that knows their child so well it was wonderful that we were listened to. Time was given and the ‘service’ was very thorough in our case, a multiple of minor concerns added up to a considerable worry about our child, Communication between O.T and Physio was spot on. The staff at St Helens were fantastic with the way they dealt with my daughter; patient, compassionate, fair an d fi rm”
• Child and family clinical psychology service “Brilliant idea on other ways to interact with my child”
• Paediatric Speech and Language Therapy “I was extremely impressed by everything. Amy and her Colleague were very friendly, polite, patient and caring. I was not expecting that much from them before the session”.
Staff were very friendly and explained everything they were doing in great detail and explained everything in a language I could understand, not in jargon.
• Child and family clinical psychology service Fantastic service, all staff are very friendly and helpful. It has been an immense help for us. A fabulous service - one of the best we have used - and we have used a lot of services over several counties. Thank you to all the staff for going above and beyond to help and being so patient and caring.
Service lea fl ets have been introduced across our seven core services and staff are continuing to work on other service/ condition specifi information.
“Let’s talk about Therapies” - A parent engagement/focus group session was held on 13 November 2014 with parents of children at Thomas Wolsey School. This was a valuable experience and has led to a plan to introduce an annual workshop for parents of children starting at the school to help them to understand the services available for them throughout their “school career”.
• “Trying equipment and resources very bene fi cial to see how it’s used and experienced all together in the same room”
• “Fantastic – always there to offer advice and support.
Thank you.”
• “Found the workshop very useful – need to have more in the future”
• The Child and Family
Clinical Psychology
Service, based at
Woodbridge Clinic, have been exploring ways in which to obtain feedback directly from children on their experiences of the staff in the clinic. An initial traf fi c light system was used however the team is now using an
“Experience Tree”, pictured, where the
The “Experience Tree” children can write their comments on leaves to place on the tree.
• Stakeholder Event 17 March 2015. An event was held for “Partners in Care” where professionals who refer to us, or are important partners in supporting children and young people on our caseloads, were invited to learn more about the services available within ICPS. It is hoped that this interactive session will increase awareness of our services and establish new opportunities for engagement and partnerships moving forward.
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Suffolk Community Healthcare Quality Account 2014/15
• Completed service variations to implement signi fi cant improvements to the level of service we provide for patients within Ipswich Hospital
• New graduate therapists are now in post, and the service is providing them with signi fi cant support in order to develop their dysphagia (swallowing) competencies
• Two experienced locums and bank staff have been appointed to address patient need and maintain service delivery whilst recruitment to specialist roles gets underway
The service offers monthly speech support groups to help patients with Parkinson’s Disease maintain their progress, and clients are experimenting with leading part of the group for themselves as a means of maintaining their “loud” voice.
This specialist intervention has enabled several clients either to keep their jobs or to remain active participants in key community roles.
Community speech and language therapists also work closely with their MDT colleagues for the bene fi t of patient care, including in joint sessions with dieticians when seeing clients with swallowing dif fi culties and joint working with specialist neurology nurses. Speech and language therapists often work alongside the same MDT colleagues to support training events for care staff in the community, again for the bene fi t of patient care.
• Staf fi ng rosters have been revised to achieve podiatric surgeon cover for all of the working week
• Multidisciplinary podiatry and foot surgery clinics have been held for musculo-skeletal patients
• The PASCOM Audit System for patients receiving surgery has been fully implemented which provides evidence of the service’s performance against national benchmarks for all outcomes of surgery
• New protocols for MRSA Screening have been implemented
• One of the consultant podiatric surgeons has started
Independent Prescribing Training.
• Foot Protection Team slots have been further increased through being incorporated into routine clinics so as to improve access to high risk patients in more locations
• The service has worked with the West CCG to further develop the diabetic foot pathway ensuring communication between all agencies is improved
• Electronic waiting lists have been set up for all clinic locations to improve the appointment access process for higher risk patients
• Peer review sessions have been undertaken on all quali fi ed staff
• Supervision sessions have been provided for all staff
• The service has now relocated from Lakenheath, where the environment was unsuitable, to Mildenhall (with patients being informed of the change through individual letter)
• In addition to Newmarket and Ipswich, some additional nail surgery sessions are now being provided in
Stowmarket, meaning some patients have less far to travel
• Despite signi fi cant increases in new patient referral rates the service has complied with 18 Week RTT deadlines.
...they have always been professional, caring and done a good job...
...I have been treated with care and consideration always. The treatment rooms are spotless, the staff always neat and clean, I count myself lucky to have this service and attention...
...excellent service, has given me positive help and encouragement...
...a lifeline for myself and my husband...
...I found the people very helpful and friendly. I experienced the service to be run very efficientl ...
...I was given the best attention, advice and kindness. The appointment was at a time to suit me. I was seen on time...
...the podiatrist was very caring and explained what was happening very clearly...
...my condition was well diagnosed and explained.
The treatment was provided promptly and has been very helpful thank you...
Community Dental Services (CDS) provide dental care to those who are unable to access care from a General
Dental Practitioner. Client groups bene fi tting from the service include those with special needs, marginalized and vulnerable adults and children, and patients with complex medical histories. Community Dental Services also provides a treatment on referral service for anxious and phobic patients, offering treatment under inhalation sedation, intravenous sedation and under General anaesthesia at West
Suffolk Hospital.
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CDS have worked hard in the last year to improve their referral service, developing a single point of referral in Bury
St Edmunds supported by a referrals co-ordinator and clinical triage staff, whilst still allowing direct access to all clinics for patients with special needs. We have worked with referrers to ensure entry criteria and referral processes are understood so that patients receive a seamless transition of their care from General Dental Services to Community Dental Services.
CDS have seen rapid growth in referrals for anxiety management services during 2014-15. In treating these patients we utilise inhalation sedation, intravenous sedation and, in rare and selected cases, general anaesthesia. More than this, we rely on the skills of a dedicated team of dentists and dental care professionals who, with skill and compassion, allow patients others considered untreatable to access care
Patients are at the heart of our service and, for that reason, the opinions of our patients is vital to us. All the comments are direct quotes from patients who have been cared for by our team.
At the end of treatment, we ask all our patients for feedback. This information is shared with the team and is used to improve our service. Some of the data from this ongoing feedback exercise is also included in this account.
The patient journey begins with our referral coordinator. Our experience is that when patients are disempowered they feel more scared. For this reason, ou r fi rst step is to send them more information on the different approaches our service can offer, and invite them to contact us if they wish to make an appointment. By informing and empowering them, we hope to reduce their anxiety before they have stepped foot in the building.
We ask patients about their past experiences of sedation and dental care, and about key areas of dentistry which cause anxiety. From this we calculate a Modi fi ed Dental Anxiety
Score (MDAS) which gives us an objective measure of their anxiety. We also ask, “Do you have any special requirements, likes or dislikes that may help the dentist treat you?” and
“Is there anything else the dentist should know?” It’s a two-way process: the more information we have about our patients the better we are able to treat them as individuals; the more relaxed they feel the more information they will share.
All patients are assessed by a senior clinician working with an experienced dental nurse. The assessment begins with the patient sitting in a normal chair; only once a rapport has been built up is the patient invited to sit in the dental chair. The intent is to assess the patient’s dental needs but, more importantly, to explore the level of help and support that they need in order to accept care. The intent is that patients should have time to express their concerns fully and to negotiate a treatment plan with their clinician which is agreeable to them. The hope is that the treatment appointment should hold no surprises. As the extract from our survey of 103 patients seen in quarter 2 1014-15 shows, the evidence is we succeed.
At the end of the assessment process, if the patient agrees, appointments are booked for treatment. Where appropriate, patients are offered one or more appointments with an oral health educator (reducing dental need is a very effective way of managing dental anxiety); they may also be offered information on our local CBT service, with which we are developing links, and which accepts self-referrals from individuals wishing to address their dental anxiety more fully.
As a service, we pride ourselves in providing patient-centred care, and so the patient experience is tailored to the needs of the individual patient. This is best illustrated by individual cases, in which the voice of the patient takes centre-stage.
All parties have given their opinions in their own words, and all have consented to being included in this account.
Patient A is a retired military of fi cer. He has always suffered from dental anxiety, but this is now signi fi cantly complicated by severe PTSD related to his combat service.
He dissociates and experiences blackouts in stressful situations and, at assessment, his primary concern was that he might experienc e a fl ash-back and attack a member of staff. In particular, he is acutely anxious that any contact to his neck may trigger his PTSD. He is well-motivated, a reliable attender, and needs straight-forward direct restorations in posterior teeth. He attends the clinic with his wife, who is his primary carer.
Assessment focused primarily on negotiating a management strategy which would allow him to feel co nfi dent that he would not panic and become aggressive. This allowed him to relax somewhat, which in turn made care possible. His anxiety was such that operative care was only possible with intravenous sedation; the following variances from our normal practice were agreed:
His wife would be present throughout treatment, and would take the lead in managing any PTSD symptoms, as she is familiar with doing this on a daily basis.
Our normal practice is to canullate the right hand simply because surgery layout makes this more accessible for our sedationist. For patient A, his wife sat and held his right hand, and so cannulation was on the left.
We did not use a bib in order that there was no possibility of it touching the patient’s neck and triggeri ng a fl ashback.
All staff are aware that they must not lean over the patient.
We would normally offer highly anxious patients multidrug sedation which includes ketamine. Ketamine can cause signi fi cant dissociation. For patient A, we only used midazolam in order to minimise the dissociative effects of the sedation.
Patient A is treated last on the list in order that he can be recovered in the surgery as he is concerned that changing
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Suffolk Community Healthcare Quality Account 2014/15 room whilst disorientated may trigge r a fl ashback.
Patient A has been treated with intravenous sedation on three occasions, and all planned work has been completed successfully. He now attends for routine check-ups with minimal anxiety.
We are committed to supporting not only our own staff to develop their skills as healthcare professionals, but also to developing the workforce of the future. You can read more about our workforce, Practice Development Team and training on page xx. This year a number of our colleagues were nominated in the Norfolk and Suffolk Partnership
Practice Education and Learning Awards Support (Health
Education East of England), which celebrate excellence.
• Team Award: Ipswich CHT 2; Hadleigh Community Health
Team
• Mentor/Practice Teacher Award: Jo Hall and Laura Gilligan
(Ipswich CHT 2)
• Mentor/Educator support Return to Practice Award: Anita
Lenihan (Aldeburgh Community Hospital).
The Practice Development Team has continued to evolve since last May, with the introduction of our four new team members.
The team has been developed around the Quality
Improvement and Performance Framework (QIPF), and its investment with our key stakeholders, patients, staff and students. The framework has 6 key performance indicators
(KPIs) are measured in a traf fi c light system. The team has worked hard other the year ensuring that our KPIs are green by then end of the year.
The current team remain focused on Pre-registration
Education, Staff development and future development of the practice development role.
The Practice Development Team provide a valuable contribution in ensuring the delivery of a quality service by an effective, knowledgeable and supported workforce.
• Head of Nursing and Professional Practice
• Clinical Effectiveness Manager
• District Nurse Development Lead
• Tissue Viability Nurse
• Practice Development Facilitator for Nursing
• Practice Development Facilitator for Therapy
• Apprentice Administrator
The introduction of a Practice Development Facilitator for Therapy has enabled a more focused approach to the management of therapy students, and the clinical skills training of therapy staff.
A system for allocating students to teams has been established which will ensure that clinicians ful fi l their professional obligations in contributing to the development of the future workforce. This process has encompassed a comprehensive data-gathering exercise which has enabled us to maintain the live database of mentors, establish how many Practice Educators we have, and actively promote the
Practice Educator course to those not yet trained.
A comprehensive therapy skills audit, combined with discussion at the professional forums, has resulted in a shortlist of topics identi fi ed by staff as a priority for clinical training. The outcome of this is that several external courses are already in place addressing some of the topics identi fi ed, and we are in th e fi nal stages of organising a training programme from UEA which has been directly led by the results of the audit. These results will continue to inform the future development of a competency framework and clinical skills training calendar for Therapy.
The development of the Practice Development Facilitators has prompted the development of a system to allow students to access all of the Electronic Documentation system, used by our clinicians, known as SystmOne. Countersigning functions are now also in place to ensure documentation standards are maintained and patient safety is also maintained. This new system was presented in a poster presentation at a national
Royal College of Nursing Education Conference in March.
This is a brand new induction fo r fi rst year nursing students which the organisation supports form the local University.
This induction provides an insight into the learning opportunities currently within the community setting.
It also provides the opportunity for students to experience an introduction to or awareness to popular subjects within nursing in today’s current climate. This day is supported and incorporates collaborative working within the private and independent sector. There are plans to have this induction published for article in the future.
These workshops have been developed to help Nursing and
Therapy students to learn together and ensure the clinical learning environment is of a high standard. These workshops are planned around student’s placements and are designed to allow feedback to be fully qualitative and be ‘fed up’ throughout the organisation within the different meetings that address pre-registration development. The workshops consist of both practice facilitators with full support from our
Board and Senior leaders.
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Our plan is to have a fully functioning simulation suite within the community. This enables the organisation to provide simulation training within a person’s home environment.
The suite will incorporate a state of the art SimMan which can be programmed to run different scenarios to support our staffs learning and development needs. Speci fi c training needs are able to be met along with dealing with challenging situations, and taking learning from case studies and incidents. Full evaluation of the suite will be completed after
6 months from opening, with planned exposure of over 80% of all clinical staff within a 12 month period. We believe that this suite will b e a fi rst within a community setting and are excited to see how it develops.
This year one of the main objectives is to develop a clinical training calendar for therapy, which will be directly informed by a staff competency framework as well as individually identi fi ed training needs. The main focus initially will be on reinforcing core skills throughout the workforce, whilst also identifying where there is a need for more advanced skills. The establishment of a therapy skills spreadsheet will facilitate the sharing of knowledge and skills, and enable staff to consolidate their specialist knowledge.
There is an increasing need for district nursing expertise if health services are to effectively meet emerging demographic, social and disease challenges. These challenges include:
• A growing number of older people and other patients at risk of abuse or neglect who need nursing at home
• A rise in the number of people with long-term conditions requiring complex nursing care
• An associated drive to prevent hospital admissions and to ensure end of life care at home.
We recognise we need to train and nurture our staff to meet these growing needs and retain and develop community nursing in Suffolk.
To meet this growing need we have developed three areas:
• Created a band 5 community nursing development programme
• Employed a band 7 District Nursing Development lead
• Supported 12 community nurses to commence the district nursing specialist practice course.
Together these will strengthen leadership in our community nursing teams, ensure we are looking ahead and pre-empt the retirement and resignations of our District Nurses and help retain our community nurses by providing them with career development opportunities.
The community nursing Band 5 development programme is based upon the patient pathway, underpinned by key drivers such as the NHS Values, Leadership and the Patients journey.
The purpose of this non credited programme is to provide a structured and supported pathway on which senior community nursing staffs within the Band 5 role can develop towards a District Nursing Specialist Practice, Advanced
Practitioner, Modern Matron or Community Matron role.
The programme will also support those staff wishing to remain within band 5 but have the opportunity to develop the clinical and management skills and specialist areas of interest to support the District Nurse as a more senior team member.
We have supported 5 staff to commence this programme and working with University Campus Suffolk, we will review and evaluate the programme.
We also recognise leadership support is required for our district nurses to meet the growing needs of our patients.
We have developed a new District Nursing Development lead post which commenced in March 2015, who is an experienced District Nurse and Team lead.
Through strong clinical leadership the District Nurse Practice
Development Nurse will support District Nurses to promote excellence in nursing care to maintain and improve clinical standards in the community. She will ensure that all patients are treated with compassion, dignity and respect and promote best practice in accordance with our policies and best practice guidelines, supporting teams with caseload management, District Nursing leadership and support, complex patient reviews and supporting District Nurses to manage their caseloads effectively.
Nationally the numbers of District Nurse Specialist Practice quali fi ed staff have fallen by more than 2,000 since
2010. We need to maintain numbers of specialist practice district nurses according to our predicted demand for the service. We also need to ensure equitable standards of DN leadership, knowledge and skills across Suffolk, providing the
Suffolk population with an appropriately skilled workforce.
Working with East of England Education and Suffolk CCGs we hav e fi ve full-time and seven part-time district nursing students, who all commenced the course in January 2015.
The feedback from students is very positive so far in that they are experiencing a much broader perspective on community nursing and understanding and contextualising the national , regional and local initiatives and debates.
Our community teams and mentors who are supporting these students are also bene fi ting from the objectives and initiatives the students are completing in practice.
From October 2015, all nurses who are registered with the
Nursing Midwifery Council (NMC) have to demonstrate they ar e fi t to practice and maintained their knowledge and skills every three years. This is to promote greater professionalism among nurses and midwives and also improves the quality
57

Suffolk Community Healthcare Quality Account 2014/15 of care that patients receive by encouraging re fl ection on nurses’ practice against the revised NMC Code and greater assurance that nurses on the register remain up to date and fi t to practice.
SCH will be obliged to ensure every registered nurse is compliant with revalidation in order for them to undertake a registered nurse role. In the months prior to October,
SCH will be developing processes to ensure our staff are compliant with this new requirement and that we can demonstrate all our registered nurses are fully revalidated to work.
We will also be supporting staff to develop portfolios of evidence of practice and CPD to ensure they are able to demonstrate to the NMC they are able to be revalidated.
Bank and agency staff will be included in this preparation and mechanisms to validate new members of staff will also be in place.
There has been an increasing recognition that appropriate clinical staf fi ng levels are needed to protect patient safety and provide effective, good quality, compassionate care, respecting patient dignity. Although the main focus on staf fi ng levels nationally has been on nursing services we at Suffolk Community Healthcare, recognise that patient care for many of our population requires multidisciplinary intervention.
As well as changing how therapists work to dissolve the arti fi cial barriers between prevention and treatment and physical and mental health we need to make sure that our community therapists possess a whole raft of rehabilitation skills to ensure that patients get the right treatment, at the right time.
To ensure that SCH is ready for the challenge we have been focussing on understanding the current skillset of our therapists. Earlier this year, with the help of UEA we
Workforce team apprentice Josh Dennington
Workforce team apprentice Charlie Ross conducted a ‘Therapy Skills Audit’. 79 therapists (approx.
87%) took part in our online survey which helped us determine what skills our therapists were co nfi dent in, and what skills we needed some additional training for. As a result we have been able to work with UEA and commission a bespoke training programme for our community therapists.
An initial review of our therapy services has been completed and has helped us identify our next steps for ensuring we have the most cost effective staf fi ng and skill mix to deliver reliable, evidence based, safe and consistent pathways of care.
We know we have to work differently in order to meet the demand of our increasing elderly population and the next steps of the therapy review will explore:
• Aligning therapy into the admission prevention service
• Ensuring that the appropriate level of therapy input can be available 7 days a week
• Using support staff to co-ordinate care, to ensure the right therapist is available at the right time to deliver appropriate interventions
• Developing a quality metrics matrix as a methodology for determining safe and effective staf fi ng levels for therapists, based on outcome measures for people who use our services.
In recent years we have been recruiting apprentices to work in various roles within SCH, with four young people currently supporting our quality and governance, and workforce teams. Charlie Ross and Josh Dennington are members of the workforce team.
I have worked with many different people in different roles and have learnt many things. I have learnt a lot about
58
Suffolk Community Healthcare Quality Account 2014/15

Suffolk Community Healthcare Quality Account 2014/15 Suffolk Community Healthcare Quality Account 2014/15 administration, making and taking telephone calls, e-mailing, preparing handouts for induction and much more. My job role also involves supporting administration of th e fl eet lease car process.
Apprenticeships are good for people that are not too sure what they would like to do for work and would like get hands on training to understand the job in more detail. Apprenticeships also bene fi t because you get paid for learning.
As an apprentice in the workforce team I work within central co-ordination. I work on different tasks involving pre-employment checks, collecting references from referees provided by new starters, checking to see if PIN registrations are up to date as well as checking to see whether leavers are on the system. I’m really enjoying it. After completing my apprenticeship I feel as though I would want to use the skills and experience gained to help me obtain a similar job.
Suffolk Community Healthcare has maintained its impetus to help staff develop healthy habits in the workplace. Working with Serco has provided further opportunities to develop our network of health and wellbeing champions. Champions now link each month with all Serco’s other health contracts across the UK, sharing information on healthy living, physical activity, disease and illness prevention, mental health awareness and healthy recipe sharing they can then disseminate within their teams.
Staff take part in the personal development review annual process when skills development needs are assessed.
Both mandatory and continued professional development programmes are provided each year to meet organisational and personal development needs to ensure our staff are equipped to provide saf e fi rst-class health care for patients. The programmes provided include a wide range of mandatory topics and clinical skills updates, apprenticeships, foundation degrees, diplomas, degrees and masters quali fi cations. Training is delivered within higher education institutions, on site or with “out of region” training providers.
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SCH continues to develop its pre-quali fi ed staff to provide an excellent service to staff and patients whilst providing support for the quali fi ed workforce.
Job roles within this group include essential clinical and non-clinical roles including administration, catering, cleaning, generic workers and assistant practitioners. Employed apprenticeship quali fi cations are made available to all pre-quali fi ed staff to give them the opportunity to earn a quali fi cation demonstrating their competence in their current role.
SCH recognises the need to ensure suf fi cient staff are being trained to replace those leaving due to either natural turnover or retirement. SCH is also working with Ipswich Hospital to encourage returners through the return to practice route.
We are equally committed to attracting new staff to ensure the employment of high calibre clinicians and health professionals so we have a workforce of excellence that can provide care in a rapidly changing health environment. To do this essential links with the public and local schools continue to be maintained. Additionally, the recruitment team are exploring other means
Facilities staff and their families took part in Aldeburgh Carnival
59

Suffolk Community Healthcare Quality Account 2014/15
We continue to attend careers fairs at local schools and colleges whenever the opportunity arises. This gives the opportunity to provide detailed information and discuss employment possibilities directly with those interested in a career in the health sector.
We regularly receive requests for work experience placements. These are well-supported by our staff who recognise the value of encouraging new interest into the organisations. All placements provide opportunities for our visitors to experience life within busy health teams in areas across Suffolk, working with nurses, physiotherapists and other healthcare professionals.
Many placements are provided for those of school age, for school leavers and for those requiring placements prior to being accepted on to undergraduate university programmes.
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One of the recommendations from the Mid Staffordshire
Enquiry into poor standards of care was a national review of training for Healthcare Support Workers (HCSW). This was undertaken by Camilla Cavendish, a Sunday Times reporter and resulted in the Cavendish Review. This review highlighted that standards of training varied greatly across the country and led to the further recommendation of the development of a National Certi fi cate of Fundamental Care, to be completed by all new health and social care support workers who directly care for patients.
From April 2015 all newly recruited HCSWs in Suffolk
Community Healthcare will undertake the Care Certi fi cate.
This will consist of a competency based induction programme that sets out explicitly the learning outcomes, competences and standards of behaviour that will be expected.
The certi fi cate will be achieved within th e fi rst 12 weeks of the start of employment and trainees will be supervised until
Staff support red nose day assessed as competent in each standard. Various assessment methods will be used but most will take place in practice.
Achieving the Care Certi fi cate will provide clear evidence to patients, people who receive care and support and to employers that the HCSW has been trained and developed to a speci fi c set of standards and has been assessed to have the skills, knowledge and behaviours to ensure that they are caring and provide compassionate, high quality care and support.
Those HCSWs who wish to develop further will be encouraged to follow a development pathway that could lead to professional nurse training.
If you have any questions or comments about this quality report please contact:
Christian Jenner (Communications Of fi cer)
Email at: christian.jenner@suffolkch.nhs.uk.
Telephone on 01284 718259.
Children from local schools devised a healthy menu for patients at Aldeburgh Hospital
60

Suffolk Community Healthcare Quality Account 2014/15
This table includes all services that SCH is responsible for, including Paediatric and Specialist services hosted by SEPT
Notes
Face to Face Activity
All Services
Apr - Mar
2014/15
Planned
Activity
510,770
Local Health Community Team -
Response Times to new referrals
2 hours
4 hours
72 hours
18 weeks
Target
100%
≥95%
≥95%
≥95%
Apr-Mar 2014/15
Actual Activity
533,130
Over/(Under)
Activity
23,091
Percentage
4.53%
Mar-15
100.00%
97.82%
97.39%
97.16%
Target is +- 10% of planned activity. SCH has met the annual activity target even though this target has increased year on year for the last 3 years
In March 2015, SCH responded to a total of 23 patients within
2hrs (23 referrals), 314 patients within 4hrs (out of 321) and we also responded to 2611 within 72hrs (out of 2681).
Delayed Transfers of Care
(DTOC)
All Services
12 mth Target
≤76
12 mth Actual
151
DToCs are where inpatients discharges have been delayed, this delay can be due to NHS or Social care reasons. 75 of our delays were due to Social care issues, and 76 of these delayed transfers were due to NHS reasosn. Of the NHS delays, 33 of these delays were due to medically fit patients choosing to stay in our care until there was a bed available for them in a residence of their
The latest data available for Outpatient NHS number usage at the time of reporting is Janaury data. SCH has been at 100% for all the months reported this year to date. Using NHS numbers minimizes errors in medicine management, treatments etc.
Data Completeness
NHS Number for Outpatients
Target
100%
Month 10
100%
Pledge 2 - 18wk RTT for non cons led services
Number of Services
18 Week RTT
Compliant
15
Non Compliant
0
Compliant in
March
Non Compliant in
March
Number of Services
Audiology
Diagnostics
3
Compliant
2
1
Non Compliant
0
Minor Injuries Unit (MIU)
Patients seen within 4hrs
Target
≥98%
2014/15
100%
Over the year SCH consultant led services treated 2482 patients, out of 2495, within 18weeks. (This is an annual average of
99.48%). This indicates good waiting list management and active control of the waiting list. One service, Paediatrics, had 5 children wait over 18 weeks in March.
There is a 6 week referral to test target for diagnostic services, none of our patients exceeded this target during 2014/15
SCH did not have a single patient (out of 5281 attendances) wait over 4 hours for discharge or transfer to Ipswich Hospital Trust in
2014/15.
All Services
DNAs
Length of Stay
Average Length of Stay
Target
≤6%
Month 12
23.44
Month 12
1.76%
2014/15 Average
23.54
A low Did Not Attend rate indicates an actively managed appointment schedule. DNAs are a waste of time and resources.
The Length of Stay in our community hospitals and commissioned beds has reduced over 2014/15 from a yearly average of 24.6 days to 23.54 days.

Suffolk Community Healthcare Quality Account 2014/15
th
Unit 12&13 Norfolk House, Williamsport Way, Needham Market,
Suffolk, IP6 8RW (01449 703949)

Suffolk Community Healthcare Quality Account 2014/15
The document reviewed was in draft form, it is quite readable, though long at some 98 pages. A dashboard is presented as an example of innovation which covers the first two months of 2015. Suffolk Community Healthcare make good use of IT and have achieved good results in achieving an improvement in patent facing time. There has been good work done on the Post-Acute Care Enablement Service (PACE) and shows a useful reduction in the number of bed days occupied by patients. Comments Received by
Healthwatch Suffolk from Patients are generally good.
Quality Improvement Priorities for 2015/16 lists 3 priorities (Patient Safety, Clinical
Effectiveness and Patient experience) and an explanation for why they have been chosen.
The reasons given are valid and are supported by clear explanations of what has so far been achieved. For Patient Safety: Falls prevention the ambitions for the future are clearly set out. As well as other Patient safety issues such as Pressure Ulcers. For Clinical
Effectiveness they focus on dementia Care, Community Cardiac Services, as well as Stoma
Care. Again explaining where they are and following this up with an explanation of what they are aiming to achieve. The section on Patient Experience is laid out in a similar manner to the preceding priorities.
The quality Account then goes on to a statement of assurance where they discuss their audits, both National and Local. Commissioning for Quality and Improvement for the coming year are set out and explained clearly. They also set out the results of any Care
Quality Commission (CQC) inspections which have been rated as Non-compliant in one area for Aldeburgh Community Hospital for which they have developed an action plan which has received the approval of the CQC. Suffolk Community Healthcare have adopted the practice of using Quality Evaluation teams to mimic a CQC audit and hence prepare them for future visits and giving them an opportunity to improve services. This is a welcome innovation. They discusses Information Governance and results have been satisfactory over the years shown, with stable results across the range of measures.
The Quality Account then reviews their progress in 2014/15 in respect of the priorities for that year. Priorities are the same as those adopted for 2015/16. For Patient Safety: They discuss improvements in the Community Equipment Service where good improvement has been shown, with good results shown in their patient surveys. They also discuss reviews of the levels of nursing staff in community hospitals. For Clinical Effectiveness: There is an account of achievements in monitoring services utilising balanced scorecards. The community Intervention Service is also discussed. The third priority Patient Experience: has a discussion around staff engagement, which has shown improvement by 19% although they say their overall score is still low. The improvement in Patient experience are discussed, with very good Friends and Family Test scores. They also demonstrate improvements in other services. Community services had no never events in the year
2014/15. Rates for infection control are showing improvement over the years. For services from their partners they discuss the services provided and these are achieving good results.
Healthwatch Suffolk is pleased to see that many improvement have been achieved over the past year and looks forward to working with Suffolk Community Healthcare in the coming year. The trust contract is soon to be let to a different organisation and
Healthwatch Suffolk will continue to monitor the patient experience to ensure that there is no detriment to services during the changeover period.
Unit 12&13 Norfolk House, Williamsport Way, Needham Market,
Suffolk, IP6 8RW (01449 703949)

Suffolk Community Healthcare Quality Account 2014/15
QUALITY ACCOUNTS
Ipswich and East Suffolk Clinical Commissioning Group, as the commissioning organisation for Suffolk
Community Healthcare (Serco), con fi rm that the Trust has consulted and invited comment regarding the Quality Account for 2014/2015. This has occurred within the agreed timeframe and the CCG is satis fi ed that the Quality Account incorporates all the mandated elements required.
The CCG has reviewed the Quality Account data to assess reliability and validity and to the best of our knowledge consider that the data is accurate. The information contained within the Quality
Account is re fl ective of both the challenges and achievements within the Trust over the previous 12 month period. The priorities identi fi ed within the account for the year ahead re fl ect and support local priorities.
Ipswich and East Suffolk Clinical Commissioning Group is currently working with clinicians and managers from the Trust and with local service users to continue to improve services to ensure quality, safety, clinical effectiveness and good patient/carer experience is delivered across the organisation.
This Quality Account demonstrates the commitment of the Trust to improve services. The Clinical
Commissioning Group endorses the publication of this account.
Barbara McLean
Chief Nursing Of fi cer

Suffolk Community Healthcare Quality Account 2014/15

Suffolk Community Healthcare Quality Account 2014/15
A
A&E
ACH
ACS
ADHD
AHP
APS
ASD
B
BDA
BBL
BSE
CDS
CG
CGA
CEO
CES
CHT
CIDS
CIS
C
CAMHS
CCC
CCG
CCNT
C-diff
CM
COPD
CPN
CPS
CQC
CQUIN
D
D&T
DN
DH/DoH
DRC
DVT
E
EAU
ED
EIT
86 SCH headquarters
86 Sandy Hill Lane, Ipswich
Accident and Emergency
Aldeburgh Community Hospital
Adult and Community Services
Attention De fi cit Hyperactivity Disorder
Allied Health Professional
Admission Prevention Service (now
Community Intervention Service)
Autistic Spectrum Disorder
British Dental Association
Bluebird Lodge
Bury St Edmunds
Child and Adolescent Mental Health
Services
Care Co-ordination Centre
Clinical Commissioning Group
Children’s Community Nursing Team
Clostridium Dif fi cile
Community Dental Service
Caldicott Guardian
Comprehensive Geriatric Assessment
Chief Executive Offi er
Community Equipment Service
Community Health Team
Community Intervention Data Set
Community Intervention Service
Community Matron
Chronic Obstructive Pulmonary Disease
Community Psychiatric Nurse
Community Paediatric Services
Care Quality Commission
Commissioning for Quality and
Innovation
Day and Treatment Team
District Nurse
Department of Health
Disability Resource Centre
Deep Vein Thrombosis
Emergency Admission Unit
Emergency Department
Early Intervention Team
J
JSF
K
KPI
I
IC
IHT
IT/IMT
IV
F
FCH
FFLS
FoI
G
GP
GW
H
HCA
HCAI
HCW
HCSW
HES
HR
HSC
HSE
L
LA
LAM
M
MDT
MIU
MM
MND
MRSA
Aureus
N
NAO
NCGC
NCH
NHS
NHS CfH
NICE
NMC
NPSA
NSFT
Felixstowe Community Hospital
Falls and Fractures Liaison Service
Freedom of Information
General Practitioner
Generic Worker
Health Care Assistant
Health Care Associated Infections
Health Care Worker
Health Care Support Worker
Hospital Episode Statistics
Human Resources
Health Scrutiny Committee
Health and Safety Executive
Infection Control
Ipswich Hospital Trust
Information Technology/Information
Management and Technology
Intravenous
Joint Staff Forum
Key Performance Indicator
Local Authority
Local Area Manager
Multidisciplinary team
Minor Injuries Unit
Modern Matron
Motor Neurone Disease
Methicillin-Resistant Staphylococcus
National Audit Offi e
National Clinical Guideline Centre
Newmarket Community Hospital
National Health Service
NHS Connecting for Health
National Institute for Health and Clinical
Excellence
Nursing and Midwifery Council
National Patient Safety Agency
Norfolk and Suffolk Foundation
Trust (Mental Health)

Suffolk Community Healthcare Quality Account 2014/15
U
UTI
V
VTE
W
WSH
S
SALT
SCC
SCH
SEPT
SHA
SI
SITREP
SLC
SMOC
T
ThA
TOM
TOR
TUPE
R
RAG
RCA
RCN
RCP
RCGP
RGN
RIDDOR
RMN
RN
RTT
O
OH
OT
P
PALS
PLACE
PN
PU
PPI
PT
Q
QIPP
Prevention
Occupational Health
Occupational Therapist
Patient Advice and Liaison Service
Patient-Led Assessments of the Care
Environment
Practice Nurse
Pressure Ulcer
Patient and Public Involvement
Physiotherapist
Quality, Innovation, Productivity and
Red, Amber, Green reporting
Root Cause Analysis
Royal College of Nursing
Royal College of Physicians
Royal College of General Practitioners
Registered General Nurse
Reporting of Injuries, Diseases and
Dangerous Occurrences Regulations
Registered Mental Nurse
Registered Nurse
Referral to Treatment
Speech and Language Therapy
Suffolk County Council
Suffolk Community Healthcare
South Essex University Partnership Trust
Strategic Health Authority
Signi fi cant/Serious Incident
Situation Report
Stow Lodge Centre
Senior Manager on Call
Therapy Assistant
Target Operating Model
Terms of Reference
Transfer of Undertaking (Protection of
Employment) Regulations
Urinary Tract Infection
Venous Thromboembolism
West Suffolk Hospital