Quality Report
2009 / 2010
Here for you
Statement on quality from
Stephen Dalton, Chief Executive
As Chief Executive I am pleased to present our
annual Quality Report which has been prepared
in line with the requirements of the National
Health Service Act 2009 and Monitor, the
independent regulator of foundation trusts. This
report fulfils the Foundation Trust’s duty to
publish a quality account which will increase the
visibility, accuracy and attainment of quality in
the services provided to the public.
It was proposed by High Quality Care for All, a
report produced by Lord Darzi in 2008, that all
providers of NHS services should produce a
quality account – an annual report to the public
about the quality of services delivered. Further
information about the requirement to produce a
quality account can be found on the Department
of Health website www.dh.gov.uk.
The Board of Directors confirms its commitment
to improving the quality of care provided by the
Foundation Trust through effective monitoring,
assurance and accountability. The Board of
Directors confirms that, as far as it is aware, the
information included in this report is accurate
and presents a balanced view of the quality of
services provided by the Foundation Trust.
The Foundation Trust aims to improve mental
health and wellbeing by delivering the best care
to the people of Cumbria. Improving the quality
of the services we offer to achieve this aim is a
key priority for the Foundation Trust as outlined
in our annual plan. During 2009/10 we have
improved the quality of services provided as
outlined in this report. Delivering quality
services to our members and the public is at the
heart of the Foundation Trust.
Our Board of Directors monitor quality in a
number of ways, including through specific
Board committees, including the Risk
Management Committee and Clinical
Governance Committee. Through scrutiny,
inspection, self assessment and feedback from
Signed:
people using our services we are aware and
informed on the qualitative issues that affect our
services. We celebrate and share good practice
and ensure action plans are in place where
quality improvements are required.
Specifically, the Foundation Trust established
some key priorities for quality in our 2009/10
annual plan:
• maximising the clinical time to care
• Patient Safety First campaign
• infection prevention and control
• the single equality scheme.
During 2009/10, the Annual Health Check
published by the Care Quality Commission
(previously the Healthcare Commission) assessed
the quality of services provided by the
Foundation Trust during 2008/09 as ‘weak’ in
that 5 of the 55 standards/targets monitored did
not meet the required level. The Board of
Directors has ensured that necessary
improvements have been made during 2009/10
and has secured full registration of all services
with the Care Quality Commission from April
2010 onwards.
This quality report has been compiled by the
Foundation Trust with input from:
• heads of clinical professions and senior nursing
staff within the Foundation Trust
• members of staff with specific responsibility
for quality improvement
• the Governors’ Council
• the Board of Directors.
To the best of my knowledge, I confirm that the
information contained in this report is accurate.
(Chief Executive)
Date:
28th May 2010
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61
Statement regarding the NHS
constitution
The Board of Directors has regard for the rights
and pledges in the NHS constitution. Important
initiatives for achieving the patient focussed
rights and pledges include our programme of
assurance around the requirements of core
Healthcare Standards (now superseded by
registration with the Care Quality Commission
under the Health and Social Care Act 2008) and
the assurance programmes of our Board of
Directors sub committees including Risk
Management and Clinical Governance
Committees. With regards to staff, our initiatives
include our constructive partnership working
relationship with staff representative
organisations and our programme for improving
staff wellbeing known as Workwell.
Part one:
Priorities for improvement and statements
of assurance from the Board of Directors
For the coming year, we have set the following
key priority areas which build on progress made
in 2009/10 and reflect greater attention to the
feedback from people using our services:
• maximising the clinical time to care (a priority
for 2009/10)
• patient safety first campaign (a priority for
2009/10)
• infection prevention and control (a priority for
2009/10)
• improving service user experience (a new
priority introduced for 2010/11).
These priorities have been identified through
discussion with senior nursing leaders and
leaders from other clinical professions within the
Foundation Trust. The priorities have been
recommended to the Board of Directors by our
Clinical Governance Committee. The priorities
have been discussed and approved by the
Governors’ Council in line with the Foundation
Trust’s annual planning process.
The following tables set out how progress
against these priorities is being/will be measured.
Table 5.1 Maximising clinical time to care
62
Rationale
2009/10 Performance
2010/11 Planned attainment
The NHS Institute for Innovation
and Improvement‘s Productive
Ward programme is designed to
help ward based staff spend
more time on direct patient
care. The Foundation Trust is
implementing the programme
across all inpatient services.
During 2009/10, we commenced
implementation of the 3
foundation modules:
• knowing how we are doing
During 2010/11, we plan to
complete the roll out of the 3
foundation modules in all 9 of
the relevant inpatient wards.
• patient status at a glance
• well organised wards.
Of the 9 relevant inpatient
wards within the Foundation
Trust, 5 completed
implementation of the first
module by the end of the year.
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Annual Report and Summary Financial Statements
Table 5.2 Patient Safety First campaign
Rationale
2009/10 Performance
2010/11 Planned attainment
The Patient Safety First
Campaign aims to improve
patient safety by reducing the
incidence of and potential for
adverse patient safety incidents
in the Foundation Trust. Patient
safety incidents are monitored
by the National Patient Safety
Agency (NPSA).
Information from the NPSA is
issued for every six month
period with the latest
information being published for
the six months to September
2009. The report shows that:
• the Foundation Trust has a
strong reporting culture
During 2010/11, we aim to:
• maintain our strong reporting
culture
• reduce incidents in falls,
nutrition and medication.
• the degree of harm reported is
generally lower than other
similar organisations.
In addition, the Patient Safety
Climate Survey was completed.
Table 5.3 Infection prevention and control
Rationale
2009/10 Performance
2010/11 Planned attainment
Infection prevention and control
is an essential basic requirement
of high quality services. The
Foundation Trust places great
emphasis on its ability to control
and prevent infection such as
healthcare acquired infections
(HCAI).
We introduced the following
metrics during 2009/10:
• number of reportable
infections (e.g. MRSA
bacteremia, clostridium
difficile, etc.)
During 2010/11, we aim to
review the effectiveness of these
metrics and introduce more
effective metrics where
required. We intend to increase
the monitoring of infection
prevention and control within
community services.
• proportion of inpatient wards
completing and returning
HCAI audits
• proportion of hand hygiene
audits returned scoring over
95% for inpatient areas.
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Table 5.4 Single Equality Scheme
Rationale
2009/10 Performance
2010/11 Planned attainment
Our Single Equality Scheme is a
three year scheme which sets
out the Foundation Trust’s
priorities in relation to the six
equality strands of age, gender,
disability, race, sexuality and
religion.
We introduced the following
metrics to monitor performance:
• the percentage of staff
receiving appropriate equality
and diversity training – we
achieved 96%
During 2010/11, we aim to
continue to monitor the
performance of existing metrics
and develop a Single Equality
Scheme covering the period
2011-14.
• the percentage of policies
where an Equality Impact
Assessment has been carried
out - we achieved 83%
• demographic information
relating to employees and
service users is fully monitored
and recorded - we achieved
the required levels of
recording.
Table 5.5 Improving service user experience
Rationale
2010/11 Planned attainment
Understanding and improving the experience of
people using our services has been identified as a
key area for priority for 2010/11. The Foundation
Trust already benefits from national patient survey
feedback and plans to introduce more robust
systems to measure and then improve the
experience of people when using our services.
This priority is included in the Foundation Trust’s
Commissioning for Quality and Innovation Scheme
as agreed with NHS Cumbria.
During 2010/11, we will introduce systematic
surveying of feedback from people using our
services. Specifically, this will include all people
discharged from inpatient wards and a valid
sample of people using our community services.
Metrics for this priority are:
• proportion of people discharged from inpatient
services offered a feedback survey (against a
target of 100%)
• proportion of people discharged from inpatient
services who return a completed survey
• number of people receiving community services
returning a completed survey (against minimum
monthly target of 100 per month).
Outcomes from these surveys will provide the
Foundation Trust with the ability to set relevant
patient experience improvement targets in future
years.
For each of these priorities, reports will be provided regularly throughout the year to the Foundation
Trust’s Clinical Governance Committee and Board of Directors. Update reports will be provided to the
Governors’ Council and PCT commissioners during the year.
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Part two:
Statements of assurance from the
Board of Directors
1. Statement of coverage
During 2009/10, the Foundation Trust provided
the following NHS services:
• organic mental health services (adults)
• functional mental health services (children and
adults)
• learning disability services (children and adults)
• acquired brain injury services (adults)
• drug and alcohol recovery services (children
and adults)
The Foundation Trust has reviewed all of the
data available to them on the quality of care in
these NHS services. The income generated by
these services was reviewed in 2009/10 and
represents 100% of the total income generated
from the provision of NHS services by the
Foundation Trust.
2. Participation in clinical audits and
national confidential inquiries
During 2009/10, four national clinical audits and
one national confidential inquiry covered NHS
services that the Foundation Trust provides.
During that period, we participated in 75%
national clinical audits and 100% national
confidential inquiries which we were eligible to
participate in. The national clinical audits and
national confidential inquiries that we were
eligible to participate in during 2009/10 are as
follows:
Audits
• Prescribing Observatory for Mental Health
(UK)
• National Audit of Continence Care
• National Health Promotion in Hospitals Audit
• National Accreditation Programme for
inpatient Learning Disability Units. RCPsych
AIMS Project.
Inquiries
• The National Confidential Inquiry into Suicide
and Homicide by People with Mental Illness
The Foundation Trust participated in all of the
above except for the National Health Promotions
in Hospital Audit.
The national clinical audits and national
confidential inquiries that we participated in,
and for which data collection was completed
during 2009/10, are listed in table 6.1 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.
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Table 6.1 Number of cases submitted to each audit
National audit/inquiry
Participating
Sample expected
by national audit
Actual number of
cases
Prescribing Observatory for Mental
Health (UK)
Yes
n/a
131
National Audit of Continence Care
Yes
80
5
National Accreditation Programme for
inpatient Learning Disability Units.
RCPsych AIMS Project
Yes
n/a
n/a
The National Confidential Inquiry into
Suicide and Homicide by People with
Mental Illness
Yes
n/a
99.1*
*The figure of 99.1% is the latest available figure and represents response rates to questionnaires sent
out between the 1st January 2003 and 1st January 2009, and returned by the 31st May 2009.
The report of the Prescribing Observatory for
Mental Health (UK) audit was reviewed by the
provider in 2009/10 and the Foundation Trust
intends to take the following actions to improve
the quality of healthcare provided and
implement the key lessons resulting from topic 6
re-audit of the side effects of depot
antipsychotics:
• the key lessons are being fed back to the
clinical networks via network clinical
governance meetings and included in training
sessions for junior doctors
• an awareness raising session will be provided
to team leaders with a further roll-out
planned for teams
• a protocol/procedure/pathway will be
developed for monitoring side effects of
psychotropic drugs
• information leaflets for patients will be either
purchased or developed.
The reports of 7 local clinical audits were
reviewed by the provider in 2009/10 and the
Foundation Trust intends to take the following
actions to improve the quality of healthcare
provided:
• MH030910 – in physiotherapy services in the
Ullswater Rehabilitation Centre, discharge
summaries are now being sent to all referrers
on completion of assessment/treatment to
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Quality
Annual Report and Summary Financial Statements
ensure that communication with the referral
sources is effective. Information from audit is
being used to develop the service to meet the
particular needs of the patient population and
ensure the service is evidenced based.
• MH120910 – in Yewdale Ward this audit has
led to improvements in the provision of
information on medications. Medication
advice leaflets are now being provided about
the medication that the patient has been
prescribed, firstly on admission, and then
further leaflets are provided if and when their
medication is changed during their stay in
hospital.
• CAMHS010910 – as a result of this audit of the
transition from Child and Adolescent Mental
Health Services to adult mental health services,
Foundation Trust policy is being amended to
ensure continuity of care, and to ensure that
young people are central to the transition
process and that this is clearly documented
within the policy.
• DART050910 – as a result of this morbidity
audit of drug related deaths, Drug and
Alcohol Recovery Services is reviewing the
prescribed and illicit use of benzodiazepines,
and overdose-related interventions. Actions
are being taken to ensure that the
communication systems which identify ‘hot
spots’ for drug use continue to be operational.
• TW150910 – this audit of the medicines
administration procedure in inpatient units led
to key points from the audit findings being
incorporated into the Foundation Trust’s
medicines management training and into the
consent policy. Further actions are planned to
raise ward staff awareness on the key points of
the audit, e.g. the importance of completing
the allergy box on documentation and the
roles of assistant practitioners and healthcare
assistants.
• MH230910 – the planned actions following
this audit of GP referrals for dementia against
the older adults team dementia care pathway
are: to raise awareness of the guidelines in GPs
and older adults teams; provide clarification
notes for the dementia care pathway; consider
GP training needs, e.g. with regard to
cognitive assessment tools and assessment of
social risk factors; and establish key contacts in
primary care services to maintain cohesive links
between older adults specialist memory
services and primary care providers.
• TW090910 – this audit of evidence-based
practice in Occupational Therapy has provided
a baseline of information on which to measure
practice change and has highlighted areas on
which to focus learning and development for
practitioners to ensure evidence-based
practice. Above all it highlighted that the
Foundation Trust’s occupational therapists are
fully supportive of the partnership with
UKCORE and are keen to develop their skills
and enhance their practice.
In addition to the above seven completed
reports, 57 audit projects were initiated in the
year that are either in progress or did not result
in specific actions plans. These audit programmes
are well estabished within clinical services rather
than as part of the Foundation Trust’s central
clinical audit department. Significant clinical
audit activity is undertaken within clinical
services in addition to the audits and audit
projects lised above.
3. Research
26 patients who were receiving NHS services
provided or sub-contracted by the Foundation
Trust in 2009/10 were recruited during that
period to participate in research approved by a
research ethics committee.
This number reflects patients recruited to studies
on the portfolio of the National Institute for
Health Research (NIHR). In addition to NIHR
portfolio studies, there is also a number of
student and staff projects taking place within the
Foundation Trust.
In 2008/09, the number of patients that were
recruited to participate in research approved by a
research ethics committee was 14 with the
number of studies that were given permission to
start being 9. The number of studies that were
given permission to start in 2009/10 was 16. We
have built close links with research networks and
local universities and increased our capacity to
deliver National Institute for Health Research
(NIHR) research by increasing our research
support staff to a total of 3.
This increasing level of participation in clinical
research demonstrates our commitment to
improving the quality of care we offer and to
making our contribution to wider health
improvement.
The Foundation Trust was involved in conducting
18 clinical research studies. (This number includes
16 studies approved in 2009/10 and 2 NIHR
studies approved in previous years which
recruited in this year). The Foundation Trust was
not the sponsor of these projects and so did not
monitor these against the relevant protocol
which includes monitoring of recruitment to the
studies.
We used national systems to manage the studies
in proportion to risk. Of the 16 studies given
permission to start, 100% were given permission
by an authorised person less than 30 days from
receipt of valid complete application. No studies
were sponsored by industry and therefore no
studies were established and managed under
national model agreements.
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100% of the 3 eligible research studies used a
Research Passport. Access arrangements for other
studies included 4 letters of access for researchers
with substantive NHS contracts and 1 letter of
access for an external researcher. In 2009/10 the
National Institute for Health Research (NIHR)
supported 11 of these studies through its
research networks. (These were 9 NIHR studies
approved this year and 2 NIHR studies approved
in previous years which recruited in this year).
In the last three years, staff with employment
contracts with the Foundation Trust have
published 89 academic papers and book
chapters. These publications are listed in Annex
2, on
pages
82-86.publications
None of these
publications
2.
None
of these
have
have resulted
our involvement
in NIHR
resulted
fromfrom
our involvement
in NIHR
research.
4. Goals agreed with commissioners
A proportion of the Foundation Trust income in
2009/10 was conditional on achieving quality
improvement and innovation goals agreed
between the Foundation Trust and any person or
body they entered into a contract, agreement or
arrangement with for the provision of NHS
services, through the Commissioning for Quality
and Innovation (CQUIN) payment framework.
Further details of the agreed goals for 2009/10
and for the following 12 month period are
available on request from the Foundation Trust.
During 2009/10, the Foundation Trust was
successful in meeting the requirements of the
CQUIN scheme and collected the payment in full
to the value of £278,369.
5. Registration with the Care Quality
Commission
The Foundation Trust is required to register with
the Care Quality Commission (CQC) and its
current registration status is ‘fully registered’.
The CQC has not taken enforcement action
against the Foundation Trust during 2009/10, nor
is the Foundation Trust subject to periodic
reviews by the CQC. The Foundation Trust has
not participated in any special reviews or
investigations by the CQC in the reporting
period.
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6. Data Quality
The Foundation Trust submitted records during
2009/10 to the Secondary Uses Service for
inclusion in 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:
• 99.76% for admitted patient care
• No data submitted for out-patient care (not
required)
The percentage of records in the published data
which included the patient’s valid General
Medical Practice Code was:
• 100% for admitted patient care
• No data submitted for out-patient care (not
required)
The Foundation Trust score for 2009/10 for
Information Quality and Records Management,
assessed using the Information Governance
Toolkit, was 82%.
The Foundation Trust was not subject to the
Payment By Results clinical coding audit during
2009/10 by the Audit Commission.
Part three:
Review of quality and other information
Review of quality key performance indicators
In reviewing the quality of services the Board of Directors monitor key areas of quality improvement.
Summary of the key quality indicators monitored by the Board during the year is given in the table 7.1
below.
Target
Apr 2009
May 2009
Jun 2009
Jul 2009
Aug 2009
Sept 2009
Oct 2009
Nov 2009
Dec 2009
Jan 2010
Feb 2010
Mar 2010
Domain
Table 7.1 Key quality indicators
3 or less
0
0
0
0
0
1
1
0
0
0
1
1
Proportion of wards
completing and returning
monthly HCAI audit
100%
66%
66%
75%
79%
87%
77%
83%
94%
92%
94%
98%
98%
Proportion of hand
hygiene audits returned
100%
50%
47%
57%
65%
83%
79%
90%
90%
88%
92%
98%
98%
Proportion of returned
hand hygiene audits
scoring 95%+
100%
28%
36%
45%
53%
66%
58%
77%
77%
83%
81%
88%
95%
% of people followed up
within seven days of
discharge
95%
99%
99%
98% 100% 98% 100% 95%
95%
97%
97%
98%
96%
% of people readmitted
within 28 days following
discharge from hospital
against all admissions
8% of
admissions
or less
2%
4%
8%
10%
3%
9%
7%
4%
6%
6%
6%
9%
Number of under 16s
admitted for more than
48 hours to an adult
inpatient bed
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Indicator
Clinical quality
Patient safety
Number of reportable
infections identified
% of new drug and
alcohol patients retained
in treatment for more
than 12 weeks (or subject
86% cumulative
74%
Patient experience
to a care planned discharge
within the first 12 weeks)
Number of complaints to
be investigated by the
Health Service
Ombudsman
0
Proportion of days lost
through delayed transfers
as a % of occupied bed
days
7.5%
Number of occasions
when planned respite has
been cancelled at Seacroft
(learning disability
facility)
0
1
0
0
0
3.4%
0
0
0
0
0
3.5%
0
0
0
5.9%
0
0
0
3.2%
0
0
0
Note: Performance below target is indicated by an orange box.
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Number of reportable
infections identified
Target
Mar 2010
Indicator
Mar 2009
Domain
Table 7.2 Comparisons with previous year
3 or less
1
1
% of Infection audits
completed with action
plans in place (12 month
100%
N/A
Patient safety
rolling figure)
Proportion of wards
completing and returning
monthly HCAI audit
Proportion of hand
hygiene audits returned
Clinical quality
Proportion of returned
hand hygiene audits
scoring 95%+
100%
100%
100%
N/A
N/A
N/A
98%
98%
95%
Sourced internally (number
of reportable infections identified)
This indicator was not
continued into 2009/10 as
three new indicators were
introduced giving a more
detailed view of performance.
Outcome of internal monitoring
(number of audits completed by
inpatient units)
New indicator
Outcome of internal monitoring
(proportion of inpatient units
completing
and returning monthly audit)
New indicator
Outcome of internal monitoring
(proportion of wards which have
returned the weekly hand hygiene
audit, averaged for the weeks within
each month)
New indicator
Outcome of internal monitoring
(proportion of wards which have
returned the weekly hand hygiene audit
scoring greater than equal to 95%,
averaged for the weeks within each
month)
Outcome of internal monitoring
(proportion of Mental Health inpatient
discharges which had a face to face or
telephone contact within seven days of
being discharged)
95%
% of people readmitted
within 28 days following
discharge from hospital
against all admissions
8% of
admissions
or less
3%
6%
Number of under 16s
admitted for more than
48 hours to an adult
inpatient bed
0
0
0
Sourced internally (number of patients
aged 16 and under who were admitted
to a Trust ward and had a length of stay
of 48 hours or more)
74%
86%
86%
Sourced from The National Drug
Treatment Monitoring System Mental
Health Trust - Retention Reports (PDUs)
Number of complaints to
be investigated by the
Health Service
Ombudsman
0
0
0
Sourced internally (number of
complaints to be investigated by Health
Service Ombudsman)
Proportion of days lost
through delayed transfers
as a % of occupied bed
days
7.5%
2.0%
3.1%
Outcome of internal monitoring
(number of days lost due to delays /
occupied bed number)
0
0
0
Sourced internally
98%
96%
to a care planned discharge
within the 1st 12 weeks)
Patient experience
Indicator description
and source
% of people followed up
within seven days of
discharge
% of new drug and
alcohol patients retained
in treatment for more
than 12 weeks (or subject
Number of occasions
when planned respite has
been cancelled at Seacroft
(learning disability facility)
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Quality
Annual Report and Summary Financial Statements
During 2008/09 the target was
exceeded in two months of the
12 month period. During
2009/10 the target was
exceeded in 3 months of the
12 month period.
Average of monthly percentages
The Board of Directors monitor quality indicators
(the above and other indicators) on a monthly
basis. Detailed scrutiny of key issues takes place
within Board committees – the Risk Management
Committee and Clinical Governance Committee.
The Foundation Trust has structures in place to
ensure that both local and trust-wide quality
issues are considered by all services through local
clinical governance processes and clinical
supervision systems.
Performance against key national priorities
and National Core Standards
During 2010/11, the Foundation Trust expects
performance against the key national priorities
as shown in table 7.3 below.
Table 7.3 Performance against key national priorities
National priority
Admissions to inpatient services have access to
crisis resolution home treatment teams
Target performance
Actual performance 2009/10
>=90%
95%
Self certification against compliance with
requirements regarding:
a)
access to healthcare for people with a learning
disability
Not yet published
22 points out of a possible 24
b)
best practice healthcare for people with a
learning disability
Not yet published
47 points out of a possible 48
100%
100%
>=95%
Not yet available
Not yet published
22 points out of a possible 24
<=7.5%
3.1%
Not yet published
87%
>=85%
Inpatients = 100%
Community = 94%
Learning disabilities - number of people with a
care plan
Care Programme Approach – number of people
receiving follow up contact within seven days of
discharge
Self certification against compliance with
requirements regarding Child and Adolescent
Mental Health Services
Minimising delayed transfers of care
Drug users in effective treatment
Ethnic coding
Mental health minimum dataset data quality
a) indicator 1
Not yet published
b) indicator 2 (Employment, HONoS, Diagnostic
Coding)
a) 99%
b) (74%, 4.3%, 98%)
Mental health minimum dataset patterns of care
Not yet published
96%
Patient experience
Not yet published
Outcome dependent upon
national staff survey results
Staff satisfaction
Not yet published
Outcome dependent upon
national staff survey results
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During the year the Foundation Trust declared non-compliance with the following National Core
table 7.4.
7.4.
Standards and rectified this compliance by the end of the year in full as set out in table
Table 7.4 Non-compliance with National Core Standards
Standard
Description
Start of period of
non-compliance
End of period of
non-compliance
C4b
All risks associated with the acquisition and use of
medical devices are minimised
November 2009
March 2010
C7a & c
Healthcare organisations:
a) apply the principles of sound clinical and
corporate governance
c) undertake systematic risk assessment and
risk management
September 2009
January 2010
C13b
Healthcare organisations have systems in place to
ensure that appropriate consent is obtained
when required, for all contacts with patients and
for the use of any confidential patient
information
November 2009
March 2010
During the year the Foundation Trust completed a patient safety climate survey. A large sample of over
80% of clinical staff surveyed and table 7.5 shows some of the results.
Table 7.5 Results of patient safety climate survey
Disagree
strongly
Disagree
slightly
Neutral
Agree
slightly
Agree
strongly
Not
Not
answered applicable
The senior leaders in my Trust
listen to me and care about my
concerns
16%
18%
21%
15%
19%
6%
5%
I am encouraged by my
colleagues to report any patient
safety concerns I may have
0%
2%
6%
19%
59%
6%
8%
I know the proper channels to
direct questions regarding
patient safety
1%
3%
7%
26%
52%
6%
5%
The team in this clinical area
take responsibility for patient
safety
1%
1%
8%
22%
45%
10%
14%
Members of the team
frequently disregard rules or
guidelines that are established
in this clinical area
44%
15%
9%
5%
4%
10%
13%
To aid the monitoring of quality the Foundation Trust initiated a detailed care quality audit of patient
records during 2009/10. This audit covered areas where the Foundation Trust sought evidence on
compliance with regulators requirements.
All 45 clinical teams took part in the audit including 11 inpatient and 34 community teams with a total of
348 records tested across 90 criteria.
Key findings from the audit are summarised in table 7.6 below.
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Table 7.6 Key findings from care quality audit of patient records
Areas where performance was high (over 80% of teams being compliant with the standard required by the audit)
Evidence in the clinical file that the benefits of medicines had been explained.
Evidence in the clinical file that a risk management plan was developed where required.
Evidence in the clinical file that the service user has an identified care coordinator/lead professional.
Evidence in the clinical file that the service user’s care has been reviewed in a timely manner.
All records evidence that assessments regarding employment/education have been carried out.
For inpatients only, the clinical record identifies that the service user had one-to-one sessions of 15 minutes or longer on at least 4
out of 7 days.
Where appropriate there was a 7 day follow-up by the CRHT.
Evidence in the clinical record that the service users response to medication is reviewed at annual review or Multi Disciplinary
meetings.
Evidence in the clinical record for prescriptions for antipsychotic medication that the script has been rewritten by an authorised
prescriber in the previous 6 months.
For inpatients only, that there is evidence in the clinical record indicating a full physical examination was completed on admission.
That all entries in the clinical record have the date the entry was made.
That all entries in the clinical record is signed by the person making the entry.
That the record is in an integrated green file.
That the file has a label referencing the NHS number.
That the NHS number is recorded on the most recent correspondence.
That ethnic status is recorded.
That marital status is recorded.
That post code is recorded.
For detained patients, that form 132 (Patients Rights) was completed and a copy retained in the clinical notes.
Evidence of involvement in care planning is included in the clinical notes.
For detained patient, evidence that all leave was authorised by the responsible clinician and recorded on a section 17 leave form
with a copy retained in the clinical notes.
Areas where performance was low (under 20% of teams being compliant with the standard required by the audit)
Evidence in clinical file that a referral to advocacy has been made if the individual lacked capacity,
Evidence in the clinical file that the individual was offered information about PALS.
Evidence in the clinical record that the service user’s BMI was recorded during the period of the audit.
Evidence in the clinical record that the individual was given appropriate advice with respect to sexual health, pregnancy and
contraception.
Evidence in the clinical record that the service user had been informed of their right to access the clinical record.
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73
Sustainability
Priorities and targets: going forward
Providing healthcare services to communities
results in environmental impacts, including
greenhouse gas (GHG) emissions that contribute
to climate change. Climate change impacts are
set to become a major health threat with global
temperatures expected to rise to a level that will
have a major effect on the environment and
societies worldwide. In recognition of this, the
UK Government has introduced the Climate
Change Act 2008, with a target to cut GHG
emissions by at least 80% on 1990 levels by 2050.
Addressing environmental impacts, alongside
economic and social issues, is central to the UK
Government’s sustainable development strategy.
The Foundation Trust commissioned a leading
environmental and energy research company
Briar Associates to identify its direct
environmental impacts through a measurement
programme and also develop a matrix for
potential carbon reduction opportunities.
As one of the world’s largest organisations, the
NHS has an important role to play in reducing
carbon emissions, a key cause of climate change.
Reducing carbon emissions will also save money
that can be reinvested directly into patient care
and contribute to the improved efficiency of the
NHS. Taking sustainability and carbon emissions
seriously is an integral part of providing a high
quality health service. The public will expect the
NHS to safeguard its ability to provide high
quality and sustainable healthcare while
managing environmental risks now and in the
future.
The Foundation Trust is seeking to develop
systems to comprehensively measure, understand
and report the environmental impacts of its
operations, as well as the carbon impacts of its
supply chain. We aim to develop and expand our
operating model in an environmentally friendly
way as part of our commitment to good
corporate citizenship. By measuring, reporting
and reducing our environmental impacts, the
Foundation Trust will position itself as a leader in
environmental disclosure and performance.
During 2009/10, we received a Gold Award from
the Cumbria Business Environment Network for
our commitment to environmental management,
in particular auditing, monitoring and measuring
performance against the criteria laid down in the
Environmental Policy. The Foundation Trust’s
recycling scheme has successfully reduced the
amount of waste going to landfill by 15% during
2009.
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Based on the analysis of the matrix, a detailed
action plan was developed outlining the key
steps to reduce GHG emissions and drive forward
opportunities for cost saving. The following key
steps will be prioritised during 2010:
• improve heating and lighting controls
• renew out of date lighting with energy
efficient replacements
• improve loft insulation and draught
prevention
• institute a building policy to upgrade to high
efficiency boilers
• introduce smart utility meters to provide
accurate consumption data
• maintain and improve current recycling
projects to reduce waste sent to landfill
• introduce and promote a car share scheme
• liaise closely with suppliers and contractors to
minimise the impact of their operations on the
environment.
The Department of Health have recently
introduced a Carbon Indicator (CI) that shows the
performance of water, sewage and waste
efficiency in relation to other NHS sites of the
same type. It is based upon a format that is now
commonly recognised for indicating the energy
efficiency of buildings (Energy Performance
Certificates and Display Energy Certificates) or
equipment such as white goods. It uses a similar
scale for energy efficiency, i.e. from A to G with
A being the most efficient and G the least. The
carbon indictor rating for the Foundation Trust is
B (a typical rating would be D) which indicates
that the Foundation Trust is efficient in its
management of the areas measured.
Table 8.1 Summary performance - sustainability
Area
Nonfinancial
data
2008/09
Waste
minimisation
and
management
for main
Carleton
Clinic Site
Finite
Resources
Trust wide
Nonfinancial
data
2009/10*
Financial
data
Financial
data
£000
£000
2008/09
2009/10*
29
23
Absolute
values for
total amount 202 T
of waste
produced
162 T
Expenditure
on waste
disposal
Water
19802 m3
16089 m3
Water
45
39
Electricity
8299 GJ
8462 GJ
Electricity
304
278
Gas
24712 GJ
22728 GJ
Gas
213
155
* Projected figures included for final quarter 2009/10.
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75
Equality and Diversity
We are committed to treating our staff and
service users with dignity and respect. Embracing
diversity is vital to the success of our business, the
delivery of effective services and achieving good
employment practices.
The Board of Directors has responsibility for
ensuring that the Foundation Trust is legally
compliant with equality and human rights
legislation. Our Equality and Diversity Steering
Group led by the Executive Nurse sets out the
strategic direction and monitors performance on
equality and diversity issues.
The Foundation Trust’s strategy incorporates a
Single Equality Scheme, which sets out
arrangements for meeting our statutory duties in
relation to race equality, disability equality and
gender equality as well as actions on age, sexual
orientation and spirituality. As a Foundation
Trust, our Governors’ Council represents
members and the local community. This delivers
our commitment to ensuring the Governors’
Council and Foundation Trust membership is
representative of Cumbria’s community profile.
Key priority area
Performance
Equality Impact Assessments
are carried out against all
Foundation Trust policies and
are in the public domain.
Fully met
Demographic information
relating to employees and
service users are monitored
and recorded: achieved for
employees.
Fully met
The number of staff and
managers receiving equality
and diversity training is
monitored.
Community engagement is
monitored.
Fully met
Fully met
Senior managers within the Foundation Trust are
responsible for maintaining equality as an
important issue and for promoting the Single
Equality Scheme.
Priorities and targets: going forward
During 2009/10, the Foundation Trust has
complied with the statutory publication duties by
publishing:
• expand the use of Equality Impact Assessments
to ensure they are carried out against key
strategic documents which in turn will be
published in the public domain
• the Single Equality Scheme for the period 2008
– 2011
• set new targets as result of evidence provided
by the demographic information to improve
the representation of service users, staff and
Foundation Trust membership
• the Single Equality Scheme annual reports
• annual monitoring of our workforce equality
data
• the results of our equality impact assessments.
All published information is available on the
Foundation Trust website with printed copies
available on request by calling 01228 603890.
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Table 9.1 Statement of key priority areas
(from last year’s report) and performance
Quality
Annual Report and Summary Financial Statements
In 2010/11, the Foundation Trust will:
• provide suitable training on equality and
diversity to staff and managers
• develop a new Single Equality Scheme and
action plan for a further 3 year period.
All priorities will be measured and monitored
through the Foundation Trust’s Equality and
Diversity Steering Group.
Table 9.2 Summary performance – workforce and membership statistics
Membership
(Public, service user and carer)
Staff
2008/09
%
2009/10
%
2008/09
%
2009/10
%
Age
0-16
0
0%
0
0%
3
0.04%
80
1.2%
17-21
10
0.7%
18
1.3%
59
0.96%
268
4.05%
22+
1411
99.3%
1415
98.7%
5570
90.7%
5641
84.87%
509
8.3%
657
9.88%
Not declared
Ethnicity
White
294
91.06%
1309
91.35%
4198*
78.8%
5508
82.8%
Mixed
4
0.28%
4
0.28%
2*
0.37%
11
0.1%
Asian or Asian British
18
1.27%
18
1.26%
15*
0.28%
23
0.3%
Black or Black British
4
0.28%
2
0.14%
0*
0%
0
0%
Other
101
7.11%
100
6.98%
4*
0.07%
13
0.2%
1108*
20.8%
1091
16.41%
Not declared
Gender
Male
334
23.5%
332
23.2%
2338
38%
2467
37%
Female
1087
76.5%
1101
76.8%
3803
62%
4179
63%
Trans-gender
0
0%
0
0%
0
0%
0
0%
37
2.6%
32
2.2%
Recorded
disability
Note: The Monitor requirements for 2008/09 only included ethnicity date for the public constituency.
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77
Staff Survey
Staff engagement
The Foundation Trust takes the engagement of
staff seriously and recognises the need for
continuous work within this area. Working
closely with staff and their representatives, we
will identify key areas of concern and the
necessary actions to address these together with
learning from areas of good practice. This work
focuses on key themes which are identified as
follows:
wellbeing issues. The wellbeing survey has been
endorsed by the Strategic Health Authority, NHS
North West.
Table 10.1 Staff survey response rate
2008/09 2009/10
Response
45%
rate
41%
Improvement/
Deterioration
4% decrease
• looking after staff/communication
• health and wellbeing
The areas where staff experience has improved
are:
• staff engagement.
To support the work of the national survey,
during 2009 the Foundation Trust undertook a
major health and wellbeing survey administered
by external specialists Robertson Cooper. This
enabled the development of an improvement
programme at both local and trust-wide level. In
addition to the programme, the Foundation
Trust has recruited an extra Union convenor who
will focus on staff wellbeing and engagement
over the next 12 months.
More about staff engagement can be found on
pages 23-25.
23-25 of the Annual Report.
Results of 2009/10 staff survey
Over the past 12 months, the Foundation Trust
has registered a small improvement in the results
of the survey with only one area deteriorating in
score. The actions developed as a result of our
work with Robertson Cooper will continue to be
developed and implemented throughout
2010/11. Whilst the Foundation Trust remains in
the bottom 20% nationally of mental health
trusts in some areas, it is anticipated that our
long term programme will lead to sustainable
improvements and change this position.
The number of staff responding to the staff
survey during 2009 decreased slightly by 4%
compared to 2008. This is due to the Foundation
Trust undertaking a major staff wellbeing survey
immediately prior to the release of the national
staff survey. The Foundation Trust’s response rate
for the internal wellbeing survey was more than
double that of the national staff survey,
providing the Foundation Trust with valuable
data on a wider range of staff engagement and
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Annual Report and Summary Financial Statements
• staff believing the Foundation Trust provides
equal opportunities for career progression or
promotion
• staff intention to leave jobs
• quality of job design
• staff job satisfaction.
The areas where staff experience has
deteriorated are:
• percentage of staff working longer hours.
Tables 10.2 and 10.3 show the top and bottom 4
ranking scores for the Foundation Trust.
Table 10.2 The top 4 ranking scores in the staff survey
2008/09
2009/10
Top 4 Ranking Scores
Foundation
Trust
National
Average
Foundation
Trust
National
Average
Foundation Trust
Improvement/
Deterioration
Staff appraised in the
last 12 months
82%
70%
86%
75%
4% improvement
Staff appraised with
personal development
plans in last 12 months
71%
62%
78%
67%
7% improvement
Staff experiencing
physical violence from
patients/relatives in last
12 months
14%
19%
14%
18%
No change
Staff suffering from work
related injury in last 12
months
10%
8%
6%
8%
4% improvement
Table 10.3 The bottom 4 ranking scores in the staff survey
2008/09
2009/10
Bottom 4 Ranking Scores
Foundation
Trust
National
Average
Foundation
Trust
National
Average
Foundation Trust
Improvement/
Deterioration
Staff agreeing their role
makes a difference to
patients
86%
89%
85%
90%
No change
Staff recommendation as
a place to work or receive N/A
treatment
N/A
3%
3%
Not calculated in
2008 survey
Staff agreeing they
understand their role and
where it fits in
26%
42%
32%
45%
6% improvement
Staff reporting good
communication between
senior management and
staff
18%
28%
19%
29%
1% improvement
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79
Regulatory ratings
The independent regulator of foundation trusts, Monitor, assesses the Foundation Trust against a
compliance framework on a quarterly basis. The compliance framework consists of financial, governance
and mandatory service risk. The financial risk rating uses a scoring system of 1 to 5 (1 is the worst score
and 5 is the best score) and the governance and mandatory service risk ratings use a red, amber and green
scoring system (red is the worst score and green is the best score).
Performance rating throughout 2008/09 and 2009/10
Tables 11.1 and 11.2 summarise the Foundation Trust’s performance rating against each of the three areas
of the compliance framework during the two periods.
Table 11.1 Performance for the year ended 31st March 2010
Annual Plan
2009/10
Q1 2009/10
Q2 2009/10
Q3 2009/10
Q4 2009/10
Financial risk
5
5
5
5
5
Governance risk
Green
Green
Amber
Amber
Green
Mandatory
service risk
Green
Green
Green
Green
Green
Table 11.2 Performance for the year ended 31st March 2009
Annual Plan
2008/09
Q1 2008/09
Q2 2008/09
Q3 2008/09
Q4 2008/09
Financial risk*
4
4
4
5
5
Governance risk
Amber
Amber
Green
Green
Green
Mandatory
service risk
Green
Green
Green
Green
Green
Note: During a foundation trust’s first year of authorisation it is only possible to achieve a maximum
financial risk rating of 4. Analysis of actual quarterly performance throughout 2009/10 compared with
expectation in the Annual Plan 2009/10.
The Foundation Trust was assigned an amber
governance risk rating in quarter 2 of 2009,
which reflects the weak rating for quality of
services in the 2008/09 Annual Health Check and
the associated concerns regarding the
Foundation Trust’s assurance systems.
The Foundation Trust commissioned an
independent review of the circumstances
surrounding the weak rating, its assurance
system, self-certification and governance
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Annual Report and Summary Financial Statements
shortfalls. This resulted in an action plan which
addressed the shortfalls highlighted and
implemented the recommendations that were
made by the auditor.
The action plan was completed in January 2010.
The Foundation Trust is able to confirm that the
action plan is fully implemented and full
registration was granted by the Care Quality
Commission with effect from 1st April 2010.
Annex 1
Comments on the Foundation Trust’s
Quality Report
Joint comments received from Cumbria
Health and Wellbeing Scrutiny Committee
and Cumbria LINk
“Thank you for your letter and attached draft
quality report. Members of the Cumbria Health
and Wellbeing Scrutiny Committee met with
members of Cumbria LINk on 21st May 2010 to
prepare a joint response. Members of both
organisations hope that these comments will
prove useful and look forward to receiving the
final report. It is further suggested that it would
help in future if an opportunity was given to
comment at an earlier stage in the process on
issues to be addressed in the draft quality
account.”
8 detailed comments were made, of which 5
have been addressed by the Foundation Trust in
the final report (these 8 comments are available
on request).
Comments received from NHS Cumbria
“Thank you for your letter inviting NHS Cumbria
to comment on your quality account. Overall the
presentation of the document fits with the
guidance for producing a quality account and we
recognise that this is the first year so will form a
baseline for future years. We would hope that
the Foundation Trust will be able to use the
Quality Sub Group of the Contract group to
inform the quality account next year. This should
be reflected in the document if possible so that
readers can understand the process. We hope
these comments are helpful. We will endeavour
to work with you to improve quality during this
year.”
16 further drafting comments were made (these
are available on request). As the response was
received after the deadline of the end of May,
the Foundation Trust was unable to make these
changes in the final report, but will take these
comments into consideration in future years.
Quality
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Annual Report and Summary Financial
Statements
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81
Annex 2
Cumbria Partnership NHS Foundation Trust
Research Publications
Foundation Trust staff indicated in Green.
2007
1. Atkin, T. (2007) Developing theories of
change in clinical psychology training,
Journal of Family Therapy, 29, pp 322-325
2. Bennett-Levy, J. & Thwaites, R. (2007) Self
and Self-Reflection in the Therapeutic
Relationship: A Conceptual Map and Practical
Strategies for the Training, Supervision and
Self-supervision of Interpersonal Skills, In P.
Gilbert & R. L. Leahy (Eds) The therapeutic
relationship in the cognitive-behavioural
psychotherapies, pp 255-281, London:
Routledge
3. Blacher, J. & Hatton, C. (2007). Families in
context. In S. Odom, R. Horner, M. Snell & J.
Blacher (Eds) Handbook on Developmental
Disabilities, pp 531-551, New York: Guilford
4. Dagnan, D. (2007) Psychosocial interventions
In: Bouras N, Holt G, (Eds) Psychiatric and
Behavioural Disorders in Intellectual and
Developmental Disabilities, Cambridge:
Cambridge University Press
5. Dagnan, D. (2007) Psychosocial interventions
for people with intellectual disabilities and
mental ill-health, Current Opinion in
Psychiatry, 5, pp 456-460
6. Dagnan, D. (2007) Psychosocial interventions
for people with learning disabilities,
Advances in Mental Health and Learning
Disabilities, 1, pp 3-7
7. Dagnan, D. (2007) Commentary on the
prevalence, incidence and factors predictive
of mental ill-health in adults with profound
intellectual disabilities, Prospective study,
Journal of Applied Research in Intellectual
Disabilities, 20, pp 502-504
8. Dagnan, D. Jahoda, A. and Stenfert Kroese, B.
(2007) Cognitive Behavioural Therapy and
People with intellectual Disabilities, In
O’Reilly, G., McEvoy, J. & Walsh, P. (Eds)
Handbook of Clinical Psychology and
Intellectual Disability Practice, Routledge.
9. Dagnan, D., Holloway, D., & Jones, S. (2007)
Helping staff teams tell us about the effects
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Annual Report and Summary Financial Statements
of challenging behaviour, Clinical Psychology
Forum, 179, pp 15-18
10. Dagnan, D., Jones, S., Hawkins, N. (2007) The
implementation and audit of a clinical
pathway for an assessment and treatment
unit for people with learning disabilities,
Clinical Psychology Forum, 180, pp 5-8
11. Emerson, E. & Hatton, C. (2007a) The
contribution of socioeconomic position to the
health status of children and adolescents
with intellectual disabilities in Britain,
American Journal on Mental Retardation,
112, pp 140-150
12. Emerson, E. & Hatton, C. (2007a) Reducing
the risks, Mental Health Today, May 2007, pp
23-25
13. Emerson, E. & Hatton, C. (2007b) Poverty,
socio-economic position, social capital and
the health of children and adolescents with
intellectual disabilities in Britain: a
replication, Journal of Intellectual Disability
Research, 51, pp 866-874
14. Emerson, E. & Hatton, C. (2007b) The mental
health of children and adolescents with
learning disabilities in Britain, Advances in
Mental Health and Learning Disabilities, 1, pp
62-63
15. Emerson, E. & Hatton, C. (2007c) The mental
health of children and adolescents with
intellectual disabilities in Britain, British
Journal of Psychiatry, 191, pp 493-499.
16. Emerson, E., Fujiura, G. & Hatton, C. (2007)
International perspectives, In S. Odom, R.
Horner, M. Snell & J. Blacher (Eds), Handbook
on Developmental Disabilities, pp 593-613,
New York: Guilford
17. Hatton, C. & Lobban, F. (2007) Staff
supporting people with intellectual
disabilities and mental health problems, In N.
Bouras & G. Holt (Eds) Psychiatric and
Behavioural Disorders in Intellectual and
Developmental Disabilities, 2nd edition, pp.
388-399, Cambridge: Cambridge University
Press
18. Hatton, C., Khan, N. & Oranu, N. (2007)
Meeting the needs of people from diverse
backgrounds through person centred
planning, pp 164-188, In J. Thompson, J.
Kilbane & H. Sanderson (Eds), Person Centred
Practice for Professionals, Milton Keynes:
Open University Press
19. Jones, S., Burrell-Hodgson, G. & Tate, G.
(2007) Relationships Between the Personality
Beliefs Questionnaire and Self-Rated
Personality Disorders, British Journal of
Clinical Psychology, 46, pp 247-251
20. Jones, S.H., Shams, M., Liversidge, T. (2007)
Approach goals, behavioural activation and
28. Robertson, J., Hatton, C., Emerson, E., Elliott,
J., McIntosh, B., Swift, P., Krinjen-Kemp, E.,
Towers, C., Romeo, R., Knapp, M., Sanderson,
H., Routledge, M., Oakes, P. & Joyce, T. (2007)
Reported barriers to the implementation of
person-centred planning for people with
intellectual disabilities in the UK, Journal of
Applied Research in Intellectual Disabilities,
20, pp 297-307
risk of hypomania, Personality and Individual
Differences, 43, pp 1366-1375
21. Knowles, R, Tai, S., Jones, S., Morriss, R. &
Bentall, R. P. (2007) Stability of Self-Esteem in
29. Samarasekera. N., Kingdon. D., Siddle, R.,
O’Carroll. M., Scott. JL., Sensky. T Barnes. TRE.
& Turkington D. (2007) Befriending patients
with medication resistant schizophrenia: Can
Bipolar Disorder: Comparison of Remitted
psychotic symptoms predict treatment
Bipolar Patients, Remitted Unipolar Patients
response, Psychology and Psychotherapy:
and Healthy Controls, Bipolar Disorders, 9, pp
Theory, Research & Practice, 80 (1), pp 97-106
490-495.
22. Popovic, M. (2007) Case report: A combined
30. Skirrow, P. & Hatton, C. (2007) ‘Burnout’
amongst direct care workers in services for
psychosexual treatment of a man with
adults with intellectual disabilities: a
erectile dysfunction and reluctance towards
systematic review of research findings and
couple therapy, Sexual & Relationship
Therapy Journal, 22 (3), pp 366-377.
23. Popovic, M. (2007) Establishing a new breed
of (sex) offenders; science or political control?
Sexual and Relationship Therapy Journal, 22
(2), pp 255-271.
24. Popovic, M. (2007) Review article: Treatment
of sexual offenders and survivors of sexual
abuse, Engrami, 29 (1-2), pp 45-52
25. Popovic, M., Milne, D. & Barrett, P. (2007)
Assessing clients’ satisfaction with
psychological services: Development of a
multidimensional Client Satisfaction Survey
Questionnaire, Counselling Psychology
Review, 22, pp 15-25
26. Robertson, J., Emerson, E., Elliott, J. & Hatton,
C. (2007) El impacto de la planificación
centrada en la persona en las personas con
discapacidad intelectual en Inglaterra: un
resumen de hallazgos, Siglo Cero, 38, pp 5-24.
27. Robertson, J., Emerson, E., Hatton, C., Elliott,
J., McIntosh, B., Swift, P., Krinjen-Kemp, E.,
Towers, C., Romeo, R., Knapp, M., Sanderson,
H., Routledge, M., Oakes, P., and Joyce, T.
(2007) Person Centred Planning: Factors
associated with successful outcomes for
people with intellectual disabilities, Journal
of Intellectual Disability Research, 51, pp 232243
initial normative data, Journal of Applied
Research in Intellectual Disabilities, 20, pp
131-144
31. Thwaites, R. & Bennett-Levy, J. (2007) Making
the implicit explicit: Conceptualising empathy
in cognitive behaviour therapy, Behavioural &
Cognitive Psychotherapy, 35, 5, pp 591-612
2008
1. Chadwick, P., Hember, M., Symes, J., Peters, E.,
Kuipers, E., & Dagnan, D. (2008) Responding
mindfully to unpleasant thoughts and
images: reliability and validity of the
southampton mindfulness questionnaire
(SMQ), British Journal of Clinical Psychology,
47, pp 451-455
2. Dagnan, D. (2008) Mental Health and
Emotional Wellbeing of People with
Intellectual Disabilities,Tizard Learning
Disability Review, 13, pp 3-9
3. Dagnan, D. (2008) Psychological assessment
with people with learning disabilities and
mental ill-health, Advances in Mental Health
and Learning Disability
4. Dagnan, D., Jahoda, A., McDowell, K.,
Masson, J., Banks, P. & Hare, D. (2008) The
psychometric properties of the hospital
anxiety and depressions scale adapted for use
with people with intellectual disabilities,
Quality
Report
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Statements
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