Quality Accounts
2009-10
Contents
Page
1. Statement from the Chief Executive
3
2. Priorities for improvement
4
3. Review of quality improvement
10
4. What others say about us
18
5. Performance against key national indicators
21
2
1. Statement from the Chief Executive
Camden and Islington NHS Foundation Trust is proud of its achievements to
date in focusing on and improving a wide range of aspects of the quality of
care we deliver to our service users. The first of the Trust’s strategic goals is
to continually improve outcomes and enhance recovery for service users and
their families, and we have a detailed, five-year work programme in place to
support the fulfilment of that goal. This work programme is underpinned by
the Trust’s Clinical Strategy which sets out the principles of service delivery
and the structures governing care. It sets out for the Trust and stakeholders
the objectives and principles which drive our delivery of excellent mental
health and substance misuse services.
The development of quantitative outcome measures is an exciting
development to which the Trust is fully committed. From the development
work with our commissioning partners we look forward to being able to
measure real aspects of recovery and of experience and to learn from and
improve our performance as a result.
We had set an ambitious list of quality targets with our commissioners for
2009/10 and we are reporting our achievement against these in this year’s
Quality Accounts. Further regional and local quality indicators and targets
have been set for 2010/11 and we are committed to achieving good results
against these targets in the coming months. We will be working with our
service users, our commissioners and other partners to deliver the priorities
we have made a specific commitment to achieving this year.
In March 2009, the Parliament and Health Service Ombudsmen released Six
Lives: The provision of Public Services to people with Learning Disabilities, an
independent report based on six investigations bought to the public’s attention
by Mencap. This report outlines three key recommendations of reviewing
effectiveness and capacity of services for people with learning difficulties,
ensuring regulatory framework and performance monitoring of services with
respect to learning disabilities and guidance for the Department of Health to
monitor and ensure compliance and progress against the report’s
recommendations. This report has been a key driver within the Trust and in
partnership with local commissioners in ensuring adequate, effective and
accessible local services for those with a learning disability in Camden and
Islington.
The Board is satisfied that the data contained in these quality accounts are
accurate and representative.
3
2. Priorities for improvement
2.1
Detailed below are the Trust’s agreed priority areas for quality improvement.
The priority areas described below represent key issues for the Trust that are
of the highest importance across the three quality domains of safety,
effectiveness and patient experience. They are also areas for which the Trust
is committed to develop its performance in 2010/11 as the Trust views them
as having further scope for improvement. Each of these priority areas also
has quantifiable measures of performance against which progress can be
judged.
2.1.1
Priority area 1 - Service User Experience: key questions from CQC
survey – Patient Experience Tracker (PET) initiative
Rationale
This is a key priority for the CQC and our local stakeholders. Key ratings
from the annual CQC survey indicate that trusts in London score relatively
poorly for service user satisfaction compared to the national average.
Camden and Islington NHS Foundation Trust was the highest performing
mental health trust in London at the 2009 survey but results still indicated an
unsatisfactory level of satisfaction for some of our service users. The PET
initiative will allow us to monitor service user feedback much more
dynamically than the current reliance on the CQC annual survey can allow.
Commissioners have identified this area as a key priority for improved Trust
performance, including particular questions from the annual CQC survey as
indicators in the 2010/11 CQUIN list. The Trust’s Service User Focus
Working Group have also included improved performance in this area as high
in its list of priority concerns.
Key improvement initiatives
Previously, the Trust has relied on the annual CQC service user survey for a
structured patient feedback process. In 2010/11, the Trust is instigating the
Patient Experience Tracker (PET) initiative across all its services. Portable
electronic devices will be used by clinical staff to gauge service user
satisfaction across all services to allow for a more dynamic and frequent
surveying process. Facilities have been put in place to enable service users
to register their feedback at any time at Highgate Mental Health Centre and
this approach will be extended to other sites.
Key performance indicator
An audit will be undertaken in Q1 and Q3 of 2010/11 using the PET process
to monitor improvement against key satisfaction questions across inpatient
sites. In addition, the annual CQC survey will ask similar questions of users
of community services. The key questions are:




Overall, how would you rate the care you have received from mental
health services in the last 12 months?
Do you have enough say in decisions about your care and treatment?
Do you feel you have been treated with respect and dignity?
During your most recent stay, did you ever share a sleeping area, for
example a room or bay, with patients of the opposite sex?
4
These questions all figure in the Trust’s CQUIN measures and contractual
quality requirements for 2010/11.
How will progress be monitored and measured?
Progress will be monitored through the reporting processes for quality
indicators with the Trust Board and with commissioners. Information will be
provided after each round of surveying.
2.1.2
Priority area 2 - Safeguarding training
Rationale
This is a key priority nationally with performance against recognised
standards being keenly scrutinised across all relevant agencies. Audit of
training records had previously revealed a shortfall in the numbers of staff
complying with the required training. This has been addressed in 2009/10
with a major improvement in compliance being achieved and this will be
further progressed in 2010/11. Improved safeguarding compliance and
training is a priority area for the Trust’s local primary care and social care
partners.
Key improvement initiatives
A safeguarding training action plan has been designed to ensure staff receive
the appropriate level of safeguarding training. Safeguarding children and
young people training is in line with the national intercollegiate agreement and
all training corresponds to the Local Safeguarding Board requirements. Level
1 and 2 form part of the mandatory training matrix and this covers
safeguarding children and vulnerable adults. Level 1 training (basic
awareness) is included at staff induction and in the Safety Awareness
Workshops on a rolling programme. Level 2 is mandatory for staff who have
contact with patient/clients who are parents and for those who have a direct
public facing roll training .The level 2 programme was commenced in
February 2010 and is currently offered to staff as in-house training through a
rolling programme. Accurate records of numbers of staff who attend and fail
to attend are being maintained. This is included in the agreed Service
Development and Improvement Plan.
Key performance indicator
% of staff compliant with mandatory training requirement for safeguarding
How will progress be monitored and measured
Progress will be measured through the training records held by the Trust
Learning and Development Department and monitored through the quarterly
Trust Board Performance Reports.
2.1.3
Priority area 3 - Access to mental health services for Learning Disability
service users – Green-light toolkit
Rationale
This is another key national priority with agreed standards scrutinised by the
CQC. Achievement against the Green-light toolkit was the sole area within
which the Trust failed to receive a satisfactory score in the 2008/9 CQC
Annual Health-check. Much progress has been achieved since then but there
remained two indicators within the toolkit by the end of 2009/10 for which the
5
Trust received ‘amber’ rather than ‘green’ scores. This is included in the
agreed Service Development and Improvement Plan.
Key improvement initiatives
The interface between the Foundation Trust and Learning Disabilities
Partnership Services has been further reviewed and developed in 2009/10. A
Learning Disabilities and Mental Health Steering Group was instigated to
monitor and support the overall implementation of the standards in the Green
light Toolkit. These regular steering group meetings are chaired by an
Executive Director with participation from the Heads of Learning Disability
Partnership services.
This steering group implemented changes and
improvements to address some of the gaps which were identified in the
Green light toolkit. One of the key initiatives was the development of an
agreed interface protocol which will be launched in the summer of 2010. In
addition, an Executive Director and Assistant Director have been identified to
be the lead for Learning Disabilities in the Trust. These roles are to oversee
and improve the delivery of services as indicated in ‘Valuing People Now –
Department of Health 2009’.
Key performance indicator
90% of indicators on the Green-light Toolkit "green" at year-end
How will progress be monitored and measured
Progress will be measured through the agreed multi-agency responses to the
Green-light Toolkit and monitored through the Learning Disability Partnership
Board and through the Board Performance Reports.
2.1.3
Priority area 4 - Completion of Treatment Outcome Profiles for
substance misuse service users
Rationale
The development of treatment outcome indicators for Substance Misuse
Services is an important move to better understand and quantify the
effectiveness of our treatment. The information these profiles will provide will
guide service development. It is a key indicator for The National Treatment
Agency (NTA) and one for which the Trust is carefully monitored. Local
commissioners have also included completion of treatment outcome profiles
on its list of priorities for the Trust in its 2010/11 Service Improvement Plan.
Key improvement initiatives
There has been a significant amount of work carried out in the Trust drug
services to improve performance as this has been an area of national focus
for the National Treatment Agency. The start of the year saw performance at
53% in Islington Drug Services and 57% in Camden Drug Services against a
target of 80%. The initiatives taken in service have resulted in a Q3 position
of 95% for Islington and 78% for Camden. These initiatives included
reviewing case notes to ensure that any profiles completed with service users
had been entered on to the patient administration system and setting up
databases to alert staff when they had profiles due for completion and to
record that these had been completed.
This improvement work continues in the Trust alcohol service. The 80%
target for the Treatment Outcome Profile measure on the 2009/10 Service
Quality Improvement Plan included alcohol services but as the NTA’s
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attention was on drug services, efforts were focussed on those areas. This
meant that the 80% target for all substance misuse services was not
achieved. Substance Misuse Services will therefore be extending the focus
and lessons learnt from the improvements in the drug services to the alcohol
services in 2010/11.
Key performance indicator
Number of service users who have had at least 1 TOP during the last six
months as a proportion of the total number of service users treated
How will progress be monitored and measured
Progress will be monitored through the quarterly Trust Board Performance
Reports and with regular reports to the NTA.
2.2
Statements of assurance from the Board
The Board is able to provide the following statements of assurance:
2.2.1
Review of services
During 2009/10, Camden and Islington NHS Foundation Trust provided
and/or sub-contracted the following 4 NHS services:




Adult Mental Health
Mental Health Care of Older People
Substance Misuse
Learning Disability
Camden and Islington NHS Foundation Trust has reviewed all the data
available to it on the quality of care in all 4 of these NHS services
The income generated by the NHS services reviewed in 2009/10 represents
100% of the total income generated from the provision of NHS services by
Camden and Islington NHS Foundation Trust for 2009/10.
The Trust has been able to review data for each of these services in the
areas of patient safety and clinical effectiveness. It has also been able to
review data relating to patient experience for Adult Mental Health and Mental
Health Care of Older People. The Trust’s Patient Experience Tracking
programme in 2010/11 will allow it to review data for patient experience
across all Trust services.
2.2.2
Participation in clinical audits and national confidential enquiries
During 2009/10, no national clinical audits covered the NHS services that
Camden and Islington NHS Foundation Trust provides. One national
confidential enquiry covered NHS services that the Trust provides.
During 2009/10, Camden and Islington NHS Foundation Trust participated in
100% of the national confidential enquiries of which it was eligible to
participate in.
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The national clinical audits and national confidential enquiries that Camden
and Islington NHS Foundation was eligible to participate in during 2009/10
are as follows:

confidential enquiry into suicide and homicide by people with mental
illness (CISH)
The national clinical audits and national confidential enquiries that Camden
and Islington NHS Foundation Trust participated in during 2009/10 are as
follows:

confidential enquiry into suicide and homicide by people with mental
illness (CISH)
The national clinical audits and national confidential enquiries that Camden
and Islington NHS Foundation Trust participated in, and for which data
collection was completed during 2009/10, are listed below alongside the
number of cases submitted to each audit or enquiry as a percentage of the
number of registered cases required by the terms of that audit or enquiry.
National confidential enquiry into
suicide and homicide by people
with mental illness (CISH)
Cases submitted
10
% of cases required
100%
The reports of no national clinical audits were reviewed by the provider in
2009/10.
Results from the national clinical audit programme administered by the
Healthcare Quality Improvement Partnership (HQIP) are available at the
HQIP website:
http://www.hqip.org.uk/national-clinical-audit/
The reports of 260 local clinical audits were reviewed by the provider in
2009/10 and Camden and Islington NHS Foundation Trust intends to take the
following actions to improve the quality of healthcare provided (examples):





Work to an internal target of 72 hours for contact with service users
post-discharge,
Work with well-being champions across services to help service users
access smoking cessation services and advice,
Augment protocols on physical health assessment and monitoring
through routinely requesting primary care encounter records on
admission/allocation to Trust services,
Inpatient teams further improving provision of social activity groups for
service users,
Development of a men’s social and activity group for community
based service users.
The Trust has worked diligently in 2010/11 to further develop its programme
of clinical audit and augment clinician participation in this audit work. All
professions and disciplines contribute to clinical audit across all services
through the balanced scorecard programme and the healthy programme of
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local audit in both boroughs. Structures are in place locally in both boroughs
to encourage audit projects, monitor their progress and analyse and share
their results. The findings and information accrued by these local groups is
then shared with the Trust Clinical Governance Committee where the trustwide remit for centrally co-ordinating audit lies.
Since 2006, the Trust has organised biannual Audit Forums where clinicians
can present the findings of their audits to their peers. In 2010/11 a prize-fund
element was introduced to the two audit forums whereby the author of the
best audit presentation, as agreed by a judging panel, was awarded a grant of
£300 towards their personal professional development.
2.2.3
Participation in clinical research
The number of patients receiving NHS services provided or sub-contracted by
Camden and Islington NHS Foundation Trust that were recruited in 2009/10
to participate in clinical research approved by a research ethics committee)
was 617 (454 more than in 2008/9).
The Trust participated in 75 research projects in 2009/10. This is a significant
increase on the 31 active studies in which the Trust participated in 2008/9.
2.2.4
The CQUIN framework
A proportion of Camden and Islington NHS Foundation Trust’s income in
2009/10 was conditional upon achieving quality improvement and innovation
goals agreed between Camden and Islington NHS Foundation Trust and its
any person or body they entered into a contract, agreement or arrangement
with for the provision of NHS services, through the Service Quality
Improvement Plan (pre-curser to the Commissioning for Quality and
Innovation or CQUIN payment framework). Further details of the 2009/10
agreed goals and new goals agreed for 2010/11 are available on request from
the Trust Performance Manager, Ian Diley (ian.diley@candi.nhs.uk).
A list of seventeen service quality indicators and ten data quality indicators
were agreed between the Trust and its lead commissioner, NHS Islington, for
the Service Quality Improvement Plan in 2009/10. Five of these service
quality indicators were attached to financial incentives dependent on annual
targets being achieved.
The monetary total for the amount of income in 2009/10 conditional upon
achieving quality improvement and innovation goals was £397,703 of which
100% was accrued.
2.2.5
Registration with the Care Quality Commission (CQC)
The Trust is currently fully registered with the CQC and we have no
conditions on our registration.
The CQC has not taken enforcement action against us since the start of the
reporting year.
Camden and Islington NHS Foundation Trust is subject to periodic review by
the Care Quality Commission. The last review was the annual assessment in
9
2009 (results published September 2009). The CQC’s assessment of
Camden and Islington NHS Foundation Trust following that review was as
follows:
Quality of services – Excellent
Quality of financial management – Excellent
Camden and Islington NHS Foundation Trust has not participated in any
special reviews or investigations by the CQC during this reporting period.
The Trust successfully registered with the CQC in 2009/10 for meeting the
standards required of NHS trusts in relation to protection of service users,
workers and others from HCAIs.
2.2.6
Quality of data
Camden and Islington NHS Foundation Trust submitted records during
2009/10 to the Secondary Uses System (SUS) for inclusion in Hospital
Episode Statistics (HES) 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 97% for admitted
patient care.
which included the patient’s valid General Practitioner Registration
Code was 99.9% for admitted patient care.
Camden and Islington NHS Foundation Trust’s score for 2009/10 for
Information Quality and Records Management assessed using the
Information Governance Toolkit was 77% (59 out of 62 answered).
The Trust was not subject to the Payment by Results clinical coding audit
during the reporting period by the Audit Commission.
3. Review of quality improvement
3.1
The Quality Accounts process requires that trusts identify three key quality
performance indicators for each of three quality domains; safety,
effectiveness and patient experience. The Trust’s performance on each of
these indicators during the financial year (and in previous years where
available) is set out below, along with a description of the construction of the
indicator.
3.1.1
Safety
The Trust has selected the following three indicators to represent the safety
domain:
i.
ii.
iii.
the proportion of adult service users cared for under the Care
Programme Approach who are followed up within seven days of their
discharge from inpatient care;
the proportion of service users receiving physical health assessments
whilst in Trust inpatient care;
the proportion of service users admitted to mental health care of older
people wards who are screened for malnutrition.
10
i. 7 day follow-up
Reductions in the overall rate of death by suicide will be supported by
arrangements for securing provision by PCTs of appropriate care for all those
with mental ill health. This includes action to reduce risk and social exclusion
and improve care pathways, it includes action to follow up quickly all those on
the care programme approach (CPA) who are discharged from a spell of
inpatient care. Guidance to support best practice, including the mental health
national service framework and NHS plan is available to support local
planning and service delivery. Measures by mental health services to achieve
a reduced risk of suicide are also set out in the 'National suicide prevention
strategy for England' and 'Preventing suicide: A toolkit for mental health
services'.
Numerator:
The number of people under adult mental illness specialties on CPA receiving
follow up (by phone or face to face contact) within seven days of discharge
from psychiatric in-patient care.
Denominator:
The number of people under adult mental illness specialties on CPA*
discharged from psychiatric in-patient care.
Indicator:
The indicator is the numerator divided by the denominator, expressed as a
percentage.
Reporting: This is captured internally on the Foundation Trusts integrated
performance and governance system Performance Accelerator and reported
via Vital Signs Monitoring Return and the CQC special collection.
Performance Figures:
Target for 09/10
95%
2007/8
94.2%
2008/9
95.2%
2009/10
95.7%
ii. Physical health checks
The association between severe mental illness and physical health problems
is well established with the life expectancy of people with severe mental
illness being nine years less than that of the general population (Disability
Rights Commission 2006). Therefore people with a mental illness are at a
greater risk of premature mortality than the general population. The physical
health care needs of people with a mental illness are as important as the
individual’s mental health care and must be part of a holistic package of care.
The Trust has agreed policies and protocols for ensuring our service users
receive effective physical health assessment and the implementation of these
policies is measured through the balanced scorecard process. A measure is
also included in the CQUIN indicator set examining whether physical checks
have been conducted for inpatients during their period of admission.
Balanced Scorecard indicator,
Residential & Rehabilitation,
Numerator:
11
All current service users in Residential & Rehabilitation services at the time of
the (quarterly) audit with evidence of physical assessment being offered in the
preceding 12 months.
Denominator:
All service users in Residential & Rehabilitation services at the time of the
(quarterly) audit.
Indicator:
The indicator is the numerator divided by the denominator, expressed as a
percentage.
Reporting:
This is reported internally through the quarterly balanced scorecard process.
Performance Figures:
Q1
2007/08
2008/09
78%
2009/10
86%
2009/10 Target = 70%
Q2
Q3
Not reported in 07/08
73%
74%
91%
94%
Q4
93%
95%
Inpatient - Adult Mental Health & Mental Health Care of Older People,
Numerator:
All service users currently admitted to inpatient services at the time of the
(quarterly) audit receiving a physical assessment (or refusal noted) within 24
hours of admission.
Denominator:
All service users admitted to inpatient services at the time of the (quarterly)
audit.
Reporting:
This is reported internally through the quarterly balanced scorecard process.
Performance Figures:
Q1
2007/08
83%
2008/09
88%
2009/10
67%
2009/10 Target = 100%
Q2
95%
93%
73%
Q3
87%
80%
72%
Q4
88%
82%
84%
iii. Use of Malnutrition Universal Screening Tool (MUST) in inpatient
sites
The 'Malnutrition Universal Screening Tool' ('MUST') is a validated, evidence
based tool designed to identify individuals who are malnourished or at risk of
malnutrition (under-nutrition and obesity). The use of MUST is included in
NICE guidelines to tackle the issue of malnutrition and its use is particularly
important for services such as Older People Services (MHCOP). The Trust
has an agreed Balanced Scorecard and Service Quality Improvement Plan
measure for monitoring implementation of Trust policy in its application of the
MUST in inpatient sites.
12
Balanced scorecard and Service Quality Improvement Plan indicator,
Numerator:
All service users admitted to inpatient services at the time of the (quarterly)
audit receiving a MUST assessment within 72 hours of admission.
Denominator:
All service users admitted to inpatient services at the time of the (quarterly)
audit.
Reporting:
This is reported internally through the quarterly balanced scorecard process.
Performance Figures:
Q1
2007/08
2008/09
89%
2009/10
80%
2009/10 Target = 75%
3.1.2
Q2
Q3
Not reported in 07/08
89%
77%
76%
96%
Q4
95%
94%
Effectiveness
The Trust has selected the following three indicators to represent the safety
domain:
i.
ii.
iii.
the proportion of adult service users admitted to inpatient care whose
admission has been gate-kept by a Crisis Resolution Team;
the proportion of meetings about service users’ discharge from
inpatient care where the community care co-ordinator attends;
the proportion of inpatients where their care plan is reviewed weekly;
i. Access to Crisis Resolution Home Treatment (CRHT)
A crisis resolution team (sometimes called a crisis resolution home treatment
team) provides intensive support for people in mental health crises in their
own home: they stay involved until the problem is resolved. It is designed to
provide prompt and effective home treatment, including medication, in order
to prevent hospital admissions and give support to informal carers. The NHS
Plan target for crisis resolution teams was 335 teams by December 2004, but
teams were not required to meet all of the fidelity criteria. Meeting all of the
fidelity criteria, including being available to respond 24 hours a day, 7 days a
week, was required by December 2005. In 2009/10, trusts were required to
continue providing these services to the required level of fidelity while also
demonstrating that the teams in place are functioning properly as a gateway
to inpatient care and also facilitating early discharge of service users.
Numerator:
The number of admissions to the trust's acute wards (excluding admissions to
psychiatric intensive care units) that were gate-kept by the crisis resolution
home treatment teams.
Denominator:
The total number of admissions to the trust's acute wards (excluding
admissions to psychiatric intensive care units).
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Indicator:
The indicator is the numerator divided by the denominator, expressed as a
percentage.
Reporting:
This data is captured internally on a weekly basis and also reporting to the
CQC via the Adults and Older Persons service mapping website.
Performance Figures:
Target for 09/10
2007/8
90%
Not applicable
2008/9
94.8%
2009/10
94.4%
ii. Care co-ordinators attending inpatient discharge meetings
Care Programme Approach (CPA) care co-ordinators (usually based in
community services) should wherever possible attend the discharge meetings
of their service users from inpatient admissions. This is an indicator that has
been included in the balanced scorecard process for inpatient services as a
measure of the effectiveness processes to ensure continuity of care between
inpatient and community services. Please note that since Q3, a new
performance measure is being developed for this theme.
Numerator:
All inpatients discharged in the quarter on CPA where it is indicated on the
CPA care plan that the care co-ordinator attended the discharge meeting.
Denominator:
All inpatients discharged in the quarter on CPA.
Indicator:
The indicator is the numerator divided by the denominator, expressed as a
percentage.
Reporting:
This is reported internally through the quarterly balanced scorecard process.
Performance Figures:
Q1
2007/08
2008/09
47%
2009/10
93%
2009/10 Target = 80%
Q2
Q3
Not reported in 07/08
74%
78%
New measure
80%
Q4
95%
New measure
iii. Frequency of care plan reviews
It is important for services to react swiftly to changes in our service users’
mental and physical state and to their personal circumstances and we must
be quick to review and amend care plans to reflect these changes. The Trust
Care Programme Approach (CPA) Policy outlines the standards expected of
our care teams in this area. A measure to monitor this is included in the
balanced scorecard process for inpatient services.
14
Numerator:
All service users currently admitted to inpatient services at the time of audit
with evidence that their care plan has been reviewed in the seven days
preceding the audit.
Denominator:
All service users currently admitted to inpatient services at the time of audit.
Indicator:
The indicator is the numerator divided by the denominator, expressed as a
percentage.
Reporting:
This is reported internally through the quarterly balanced scorecard process.
Performance Figures:
Q1
2007/08
79%
2008/09
76%
2009/10
67%
2009/10 Target = 85%
3.1.3
Q2
81%
87%
61%
Q3
70%
77%
76%
Q4
68%
82%
76%
Patient experience
The Trust has selected the following three indicators to represent the patient
experience domain:
i.
ii.
iii.
the number of carers receiving advice or services following a carer’s
assessment;
the score from a question in the Service User Survey, asking service
users to rate the overall quality of care;
the proportion of complaints responded to within deadline;
i. Carers’ assessments
The needs of carers to Trust service users are of paramount importance.
Ensuring the well-being of carers is a significant factor in also ensuring the
well-being of the people for whom they care.
Numerator:
Number of carers receiving a ‘carer’s break’ or other specific carers service,
or advice or information, during the year following a carer’s assessment or
review.
Denominator:
The number of adults receiving a community- based service during the year.
Reporting:
This is reported to CQC via the Local Authority. Camden LA have a target
defined by whole numbers, Islington LA have a target defined as a
percentage.
Performance Figures:
Camden AMH 2008/09
Camden MHCOP 2008/09
Target
90 carers
16%*
Year-end score
93 carers
17.4%*
15
Islington AMH 2008/09
161 carers
Islington MHCOP 2008/09
15%*
Camden AMH 2009/10
272 carers
Camden MHCOP 2009/10
122 carers
Islington AMH 2009/10
23%*
Islington MHCOP 2009/10
23%*
* % of clients receiving a community based service
** As of end of February 2010
109 carers
16.8%*
281 carers
177 carers
13.4%**
19.3%**
ii. Service user rating of care
The Trust places great importance in service users’ views of the care they
receive. The CQC holds an annual survey for all NHS trusts and this quality
indicator looks at the response to questions concerning service user
perceptions of overall quality of care.
Data source:
Annual CQC service user survey question – “Overall, how would you rate the
care you have received from Mental Health Services in the last 12 months?
Reporting:
This is reported to the CQC through its annual service user survey.
Performance Figures:
2008
2009
2010
% answering “Excellent” or “Very
54%
43%
*
good”
Please note, the cohort requested to respond to the survey by the CQC has
changed year-on-year in this period between inpatient and community service
users so direct comparison is not possible.
* Results for 2010 not yet available
iii. Complaints response
The Trust Complaints Policy sets out in detail our expectations for how swiftly
the Complaints Manager and Trust staff respond to service user and carer
complaints. Performance information relating to this issue is regularly
reported to and monitored by the Service User Complaints and Incidents
Committee.
Numerator:
Number of complaints for each response rate category responded to within
deadline per quarter.
Denominator:
All complaints received for each response category per quarter.
Reporting:
This is reported internally through the quarterly Board Performance Report.
Performance Figures:
The new national process for complaints response was implemented in April
2009 so figures are only available from this period onwards.
Q1
Q2
Q3
Q4
2009/10
72%
86%
77%
67%
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3.1.4
Review of monitoring processes

Balanced Scorecard process
The Trust completed its eighth year of balanced scorecard service
improvement work.
The balanced scorecards for services are
developed on an annual basis with performance indicators being
amended to follow Trust and service need and targets being
stretched. Balanced scorecards are produced for the vast majority of
clinical teams with aggregated scorecards for service types and
boroughs providing an overall summary of Trust performance. The
measures chosen for inclusion reflect both national and local priority
and are categorised into four domains; service user outcomes, service
user processes, resources and lifelong learning. Many of the quality
indicators included in these Quality Accounts are monitored quarterly
through the balanced scorecard process. The completed scorecards
for each quarter are discussed at trust-wide and local forums and
action plans are produced at a team-level to address any concerns
raised in each report.

Service Quality Improvement Plan monitoring process
For 2009/10, the Trust agreed with its commissioners a service
improvement plan of 17 performance indicators including 5 financially
incentivised Service Quality Improvement Plan indicators.
A
monitoring and reporting process was developed to allow for internal
review of the 17 indicators and external reporting.
Quarterly
performance monitoring was conducted through use of Performance
Accelerator software with reporting at the Trust Performance
Committee and at local borough performance meetings. Progress
against these indicators was also reported as part of the quarterly
Board Performance Report. Results at borough level were reported to
commissioners through the lead commissioners in Islington. All 5
indicators were satisfactorily achieved by the Trust by year-end with
full financial incentive accrued.

Board Performance Report
2009/10 saw the further development of the Board Performance
Report. In close consultation with executive and non-executive Board
members, the report developed a new set of internally derived
performance indicators under the domains required by the Quality
Accounts to sit alongside the performance monitoring of national
indicators, locally delegated measures and CQUINs. The report
moved from being produced monthly to being produced quarterly but
will further develop in 2010/11 to become more dynamic and
responsive through the use of electronic dashboards with more
effective access to the base data held in the patient administration
system, RiO. While quarterly highlight reports will continue to be
produced, these will sit alongside dashboards with the facility to be
updated much more frequently.
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3.1.5
How do stakeholders and clinicians participate in analysis of quality
indicator performance?
The Trust’s key stakeholders are included in its processes for monitoring and
analysis of quality indicator performance throughout the annual reporting
cycle. Commissioners and local primary care partners receive reports on
performance at a trust-wide and borough-wide level on a quarterly basis for
all service improvement plan measures (including CQUIN indicators). An
expanded set of regional and local quality indicators has been agreed with
commissioners for 2010/11 and commissioners and local partners will be
included in the quarterly performance review programme. The Board
Performance Report (including information on the key quality indicators) will
be included in the papers for the open meeting of the Trust Board which all
stakeholders (including governors and service users) will be able to access.
The balanced scorecard process (from which much information for the quality
indicators is derived) is a work programme owned primarily by clinical staff.
The scorecards are shaped through its annual consultation by teams and
clinical staff themselves, the audits are undertaken by clinical staff with the
results being analysed and reflected upon at a local level by the teams
themselves. The Trust Performance Committee reviews balanced scorecard
results along with the overall CQUIN results report and the quarterly Board
Performance Report. This committee includes strong representation from
clinical and professional leads. Local performance forums in the boroughs
and service areas (including clinical representation) also regularly review
performance against all Trust performance indicators including the quality
indicators included in these Quality Accounts. Clinical and managerial
supervision of clinical staff is expected to utilise the results from Trust quality
indicators as a measure of team performance and a marker for national and
local priorities.
3.1.6
Action planning against quality indicator performance
The action planning process for the Trust’s quality indicators is co-ordinated
by the Board-level Performance Committee. Performance against the key
quality indicators is reviewed on a quarterly basis both in this central Trust
committee and also at a local level within borough management groups and
service areas. Action planning for the CQUIN indicators and the other quality
measures included in the service improvement plan is co-ordinated centrally
to ensure a consistent approach across all the relevant services but the
process is managed on a day to day basis by local performance management
teams. There is a quarterly action planning process for the balanced
scorecards that is co-ordinated by the Trust Clinical Governance Team but is
owned by the clinical teams themselves. This action planning has led to
improved results in balanced scorecard scores over the nine years that the
programme has been running.
4.
What others say about us
4.1
Statement from LINks
4.1.1
Islington
This year the Islington LINk has not carried out any specific work in relation to
the Trust and as such is unable to comment on the Quality Accounts for this
year.
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4.1.2
Camden
Camden LINk provided the Trust with the following comment on the 2009/10
Trust Quality Accounts:
Our comments stem from a ‘draft’ report submitted to the Camden LINk.
Allowing the Trust to choose its own performance indicators does not seem a
robust way of regulatory reporting or grading because the Trust will be
tempted to use areas whey they perform well, or least badly.
Some indicators not reported on which might give a broader view of quality
performance are: the number of patients, service user and public
involvement, suicide rates, re-admission rates, morbidity, levels of
medication, waiting list times, number of patients represented by an advocate
and serious incidents. We are aware that in the Camden health scrutiny
committee of 15 July 2009, suicide rates in Camden amongst older women
remains static.
Having to show ever improving quality and patient experience in order to do
well, the temptation for a mental health trust will be to provide fewer services
to fewer patients, making it easier to concentrate on providing quality to an
‘elite’ patient group and hit its targets. In order to reduce patient numbers,
managers can re-categorize patients, or raise the threshold at which care is
given because mental health needs are subjective and much of mental
healthcare is based on philosophy rather than evidence. We are concerned
that the recent cuts to staffing as reported in the local press and the plan to
further cut patient services with another Cost Improvement Programme will
further reduce the numbers of patients accessing care, or reduce treatment
episodes, even though those few who remain may continue to receive a
reasonable standard of care.
The new PET survey of inpatients where a clinician inputs patient responses
into a handheld device sounds innovative, but it appears to be retrograde.
The data collection will not be independent because the surveyor is not
impartial. The data is not anonymised so the person surveyed may feel under
duress and this will be particularly so for vulnerable people on a locked ward.
It would seem a way of ensuring positive feedback. Although this new
inpatient survey method is currently somewhat balanced by the paper based
community survey which is posted by and returned to an independent body,
we are concerned that the paper based survey will be undermined by the
rollout of PET to all Trust sites in the community.
We note that on page 5 the safeguarding training percentage target is
omitted.
The measure of inpatients admissions gate kept by the crisis team is not
necessarily a measure of quality or safety. The use of the crisis teams as
gatekeepers is controversial amongst patients. Arguably the crisis team can
be an obstacle to appropriate admission because the hospital clinician may
have a better view of the appropriateness of admission, where the crisis
teams may tend to want to keep patients out of hospital under their care and
so take more risks.
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The proportion of meetings about service users’ discharge from inpatient care
where the community care co-ordinator attends is not necessarily the same
as CPA meetings prior to discharge. The meetings being measured could be
internal meetings held after the discharge has already happened which may
not be of any help to patients and may only help statistics.
The measure of care plans reviewed weekly may be reflecting a mechanical
process. We do not know whether these reviews involve the patient at all –
they could be internal meetings. How the plan is reviewed is not indicated - it
could be a of clicking a box on a computer to mark the plan 'reviewed'.
The measure of complaints responded to within a given time limit does not
indicate quality. It does not reflect the number of complaints which can
indicate satisfaction levels, or the quality of the responses. For example, the
responses could be quite unsatisfactory or dismissive. A more useful
measure would be the number of complaints, the proportion upheld, or the
proportion where the complainant is satisfied with the response.
We found the table of figures on carers confusing. Percentages and real
numbers are mixed up, making comparisons between time periods and
boroughs difficult or impossible. It would be clearer to use either percentages
or real numbers throughout the table. We note that the numbers of carers
where given are tiny.
The LINk feel that the Trust needs to better understand the profile of carers in
mental health settings and how they might be useful to its objectives.
Although mentally ill patients are prone to isolation and so may avoid carers,
patients often care for other patients. Furthermore due to social problems,
the carer role may be more transitory than in other settings with the patient
moving from carer to carer, or the carer and patient may not be able to
identify or articulate what their roles are. We are concerned that in focusing
on reducing services, the Trust may inadvertently view carers as a threat
because carers will naturally advocate for more care for their friends and
loved ones, not less.
The Trust welcomes constructive comment from its stakeholders and will
work to address these concerns with Camden LINk and other stakeholders as
part of the development of the 2010/11 Quality Accounts.
4.2
Statement from Quality Accounts lead commissioner
As host commissioners of the Camden and Islington NHS Foundation Trust
contract, NHS Islington developed and agreed a quality improvement plan
with the provider for the 2009-10 contract. The plan contains 17 indicators;
achievement of five of these will attract an incentive payment of 0.5% of the
contract value. The plan is a pre-cursor to CQUIN and focuses on those
areas where there is either a real need for improvement in quality, or a need
to start recording performance in order to benchmark improvements in future.
Each indicator is linked to the Darzi themes of personal, effective and safe.
Examples include:

Personal - service user reported measures of satisfaction, reports of
dignity and respect and being involved in decisions made about care.
For example numbers of service users answering ‘excellent’ or ‘very
good’ to the question ‘how would you rate the care you received?’
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Electronic handheld devices are being implemented to improve the
way in which such information is captured.

Effective - an annual discussion to demonstrate consistency of
practitioner performance; protocol to establish ease of access for ILDP
service users to the full range of MH services, where appropriate.

Safe - number of safeguarding alerts and number of alerts leading to
investigation. Additionally all Serious Untoward Incidents (SUIs) are
to be reported to the commissioner. There was an issue earlier in the
year involving a substantial number of SUIs that were very overdue
and still ‘open’ according to NHS London; the cause was multifactorial and the issue has now been resolved. As host commissioner
for a Foundation Trust, NHS Islington is responsible for reviewing and
recommending for closure, all Camden and Islington NHS Foundation
Trust’s SUIs. The Foundation Trust is currently reviewing its
procedures for SUI investigation and are piloting a new reporting
method, which is likely to result in a new process later in the year. Todate investigation reports have been sent to NHS Islington as final
approved documents; therefore it has been requested consideration is
given to both the method and at what stage NHS Islington is best
engaged in the investigation/approval process to enable its assurance
responsibilities to be effectively discharged.
The plan is supported by a data improvement plan, which identifies areas for
improvement in data collection and reporting.
Monitoring Performance
Performance and quality are standing agenda items at quarterly SLA
meetings with the provider. Frequency of reporting varies depending on the
type of indicator. For example, consistency of practitioner performance is
monitored through an annual discussion between the NHS Islington’s Director
of Quality and Performance and the Foundation Trust’s Medical Director. The
three indicators on patient reported measures of satisfaction, respect and
dignity are reported annually through the patient survey. The number of
inpatients receiving a physical health check is reported on a quarterly basis.
NHS Islington, as lead commissioner, support this document as an accurate
reflection of the indicators agreed with the commissioner for 2009/10.
5.
Performance against key national indicators
The Trust is monitored against four key national performance indicators by
Monitor. The 2009/10 results for these indicators are provided below:
Indicator
% of Care Programme Approach (CPA)
patients receiving follow-up contact within
seven days of discharge from hospital
Admissions to inpatient services had access
to crisis resolution home treatment teams
Delayed transfers of care
Maintain level of crisis resolution teams
Target
95%
End of year performance
95.7%
90%
94.4%
<7.6%
100%
0.67%
100%
The Trust met each of the four targets for all four quarters in 2009/10.
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