Devon Partnership
NHS Trust
Quality Account
2009/10
Contents
Page
Chief Executive’s Statement
3
Priorities for 2010/11
4
Improving Care Planning
Reducing Slips Trips and Falls
Improving the Patient Experience
Other Quality and Safety Initiatives
10
Performance and Compliance
12
Appendix 1
Schedule of Statements
As set out in The National Health Service (Quality Accounts) Regulations 2010
15
Appendix 2
Supporting Statements
22
Devon County Council’s Health Overview and Scrutiny Committee
NHS Devon
Devon and Torbay LINks
Engagement in Producing the Quality Account
Appendix 3
Services Good Enough for My Family 25
Devon Partnership NHS Trust
Chief Executive’s Statement
Devon Partnership NHS Trust has always had a strong commitment to providing high quality
services but, over the last year in particular, we have done a great deal to sharpen our focus on
safety, clinical effectiveness and the experience of people using our services.
We have expressed our ambition as a desire to provide services that are ‘good enough for my
family’, by which we mean services that are Safe, Timely, Personalised, Recovery-focused and
Sustainable. We made good progress towards achieving these objectives during 2009/10. Among the highlights
were further work to embed our safety culture across the organisation and our continued efforts
to put recovery-oriented practice at the heart of all we do. We also introduced a programme of
peer and walkaround audits, which has proved both informative and productive, and conducted
extensive work to improve our medicines management.
Importantly, we also laid the groundwork for some significant developments over the forthcoming
year. These include the introduction of a Clinical Directorate structure to improve our governance
arrangements; the launch of a simple ‘dashboard’ for teams to see where they are doing well and
where support is needed; the introduction of an electronic patient record system and new practice
quality standards for all clinicians.
We now commence each Board of Directors’ meeting by listening to someone’s personal story
about their mental health, care and treatment - or that of a loved one. Hearing about people’s
experiences in their own words has given all Board members an invaluable and often very moving
insight into frontline care, where it is working well and where we need to focus further attention. The introduction of a new system of registration by the Care Quality Commission will undoubtedly
help to identify those areas where further work is required. Our registration was conditional upon
improvements being made in the field of staff supervision and appraisal and I am pleased to say
that we have already made significant headway on this front.
As ever, our staff have been the key to making improvements and I would like to acknowledge
their unerring commitment and dedication to delivering better services. We must ensure that we
continue to develop a working environment in which they feel enabled to deliver safe, high quality
care – and to speak out with confidence where they have concerns or feel further improvements
can be made.
Iain Tulley
Chief Executive
3
Quality Account 2009/10
Priorities for 2010/11
The Trust has expressed its desire to provide
services that are ‘good enough for my family’
and the organisation’s long-term strategic
objectives are designed to support the
Safe Timely
attainment of this goal. In order for services to
be good enough for our own families the Trust
believes that they have to be:
Minimum risk of harm to people and best possible quality of care
Based on early intervention, available when people need them,
without unnecessary waiting
Personalised
Tailored to meet the needs of individuals, and planned with them
Recovery-
focused Emphasising hope, opportunity and the ability to exercise control over treatment and life choices
Sustainable
Making best use of our human and financial resources, building our reputation, establishing consistency and reducing our carbon
footprint
The key pieces of work aligned to each of these five objectives are attached at Appendix 3 and are
also available to view on the Trust’s website at: www.devonpartnership.nhs.uk
4
Devon Partnership NHS Trust
The Trust has identified three priorities as
quality improvement indicators for 2010/11.
The priorities are:
1. Improving Care Planning
2. Reducing Slips, Trips and Falls
3. Improving the Patient Experience
1. Improving Care Planning
A good, up-to-date personal care plan is a
key factor in providing a safe, high quality
service for people. The aim is to ensure that
every person using the Trust’s services has
a personal recovery plan that is reviewed
at least once every six months. This will
be measured by taking a regular, random
sample of personal recovery plans from
across the Trust.
The Trust will measure success by ensuring that:
• People who use services are satisfied with the service they have used
•
Care and treatment is delivered in accordance with agreed standards for being safe, timely, recovery-focused and personalised
• Clinical interventions are delivered according to evidence and recognised best practice.
Performance against the key practice standards
will be measured through another innovation
called the ‘quality dashboard’. This is being
introduced during 2010/11 to give teams a
monthly view of their performance in a number
of key areas and a clear indication of where
they are doing well and where they need to
review and improve their performance.
Electronic Patient Records
Steps that the Trust is taking to improve care
planning include:
Practice Standards
In 2011, the Trust is introducing a framework of
practice standards to support staff in delivering
consistent clinical standards across the Trust. The framework strives to ensure safe, high
quality services and sets out that everyone who
uses them will:
• Be supported to identify their desired personal outcomes
• Have a personal recovery plan which is based on their desired outcomes
• Receive the agreed interventions and supports to achieve those outcomes
• Regularly review, with their practitioner, their progress towards outcomes.
The Trust is introducing a new records system
during the year and an intensive programme of
staff training and preparation has been under
way since early 2009. The RiO care records
system is being implemented across the Trust
and will replace paper records and the existing
electronic recording system. The project is
part of a wider programme overseen by the
Strategic Health Authority to introduce RiO
to mental health trusts across the south of
England.
People who use our services will benefit from
improved quality of care and safer services as
the risk of losing paper records and duplicating
information is removed. All the information
relating to their care and treatment will be
readily available in one place, in a secure
online environment and clinicians will have
access to the most up-to-date information from
assessments and care plans whenever they
require it.
5
Quality Account 2009/10
Recovery Coordination
Nationally, the Trust is at the forefront of work
to embed the notion of personal recovery
and recovery practice at the heart of mental
healthcare. Much of the material that the
organisation has produced is endorsed by the
Royal College of Psychiatrists and is available on
its website. The Trust is committed to embedding the
principles of personal recovery into the
framework of the organisation and a lot has
been achieved in the last year through the
implementation of Recovery Coordination.
This work has included the development of
Recovery Coordination master classes and the
opportunity for staff to undertake a degree
module Understanding Recovery Principles and
their Application to Practice at the University
of Plymouth. The expectation that all staff
have appropriate recovery knowledge, skills
and qualities for their work is now in all job
descriptions.
The How well is life working out for you?
practice tool helps support the principle of
being more person-led and becoming much
more focused on how someone is doing, rather
than leading on what the service has to offer.
The implementation has involved working
with many people with a wide range of lived
experiences as well as partner organisations
and has seen the publication of Putting
recovery at the heart of all we do – what does
this mean in practice?.
It outlines the values, principles, practices
and standards that have been endorsed
by the Trust, the Devon and Torbay Local
Implementation Team and the joint
commissioners for Devon and Torbay.
6
A further publication Putting recovery at the
heart of who we are – a guide to mental and
emotional wellbeing is intended to be given
to people who come into contact with Trust
services as well as network partners. The guide
gives information about looking after your
wellbeing, explains what is meant by recovery
and details the Recovery Coordination process
and different forms that it takes. 2. Reducing Slips, Trips
and Falls
Although managing slips, trips and falls may
not seem an obvious priority for a mental
health Trust, the organisation is committed
to ensuring that every aspect of a person’s
care and treatment is safe and of a high
quality – including their physical care. A high
number of serious incidents of this kind can
also place additional pressure on the wider
health and social care system. The Trust’s
overall aim is to reduce the number of slips,
trips and falls suffered by the people in its
care. The organisation will be focusing, in
particular, on reducing the number of people
transferred to another hospital because of
a slip, trip or fall while using its inpatient
services, and on reducing the number of
incidents that cause harm.
Steps that the Trust is taking to reduce slips,
trips and falls include:
Falls Protocol
The Trust is introducing an evidence-based falls
protocol, based on evidence from the United
States and the National Patient Safety Agency,
to provide practical advice and support for staff
to help reduce the number of falls. Devon Partnership NHS Trust
Services for Older People
The Trust is currently reviewing its older
people’s mental health (OPMH) services across
the county, looking very closely at how and
where services are provided and what might
be done to improve their quality, safety and
accessibility. This work follows the launch of the
government’s first national dementia strategy
and a review of dementia services right across
the south west of England by the local Strategic
Health Authority, NHS South West. The Trust
has also been working closely with the CQC to
carry out a review of its OPMH services and this
review was concluded early in 2010. The Trust is
expecting the CQC’s report to be published later
in the year.
As part of its commitment to improve the
quality of older people’s services, the Trust’s
Board approved a £4.6m investment in older
people’s inpatient services at the start of 2010. This money will be used to provide muchneeded modernisation and refurbishment at
the units in Barnstaple, Exeter and Torbay and
the work is expected to be completed by the
summer of 2011. Considerable work has also
been undertaken to address issues around
single sex accommodation in older people’s
inpatient units (see opposite).
Peer Review and Executive
Walkaround Audits
As part of its plans to drive-up safety and
quality, and maintain an accurate picture
of frontline services, the Trust has initiated
a programme of regular Peer Review and
Executive Walkaround Audits.
Peer Review Audits are carried out by clinical
peers and feedback is immediately taken from
action into practice. This technique offers a
powerful tool for quality improvement and
patient safety. The structure of the visit is open
and informal and auditors are asked to use their
own judgment in deciding which aspects of care
should constitute the focus of the audit. Executive Walkaround Audits are conducted
by executive and non-executive directors with
executive coaching skills trained in the use of
the audit tool. The walkarounds are scheduled
to take place every three months. Verbal
feedback and recommendations for action are
given to the local team immediately after the
walkaround, and in writing as soon as possible.
3. Improving the Patient
Experience
What people say about their experience
of the service, or that of a family member,
is one of the most important indicators of
quality and whether the Trust is getting the
basics right. The aim is for people who have
experienced services to say that they would
recommend them to a family member
or friend. This will be measured through
a questionnaire to a random sample of
people who are using or have recently used
our services. Steps that the Trust is taking to improve the
experience of people using its services include:
Single Sex Accommodation
In line with best practice and national guidance,
mixed sex accommodation has been virtually
eliminated in all of the Trust’s inpatient
services. Every person using these services
has the right to receive high quality care that
is safe, effective and respectful of their privacy
and dignity. Devon Partnership NHS Trust is
committed to providing everyone with same sex
accommodation, because it helps to safeguard
their privacy and dignity when they are often at
their most vulnerable. 7
Quality Account 2009/10
People who are admitted to any of the Trust’s
inpatient services will only share the room
where they sleep with members of the same
sex, and same sex toilets and bathrooms will
be close to their bed area. In most inpatient
services the sleeping and bathing areas for
men and women are in clearly separated areas.
However, there are certain circumstances
where, for reasons of clinical need, this is not
the case.
In general, people can expect the following
when they use the Trust’s inpatient services:
• The room where their bed is will only have people of the same sex as them
• Their toilet and bathroom will be for people of their sex only, and will be close to their bedroom •
There will be both men and women on the ward, but they will not share sleeping areas. People may have to cross a ward corridor to reach their bathroom, but they will not have to walk through opposite-sex areas
•
Most communal space, such as day rooms or dining rooms, will be used by both men and women but there will be a sitting room reserved for women only
• It is probable that both male and female nurses, doctors and other staff will need to come into people’s bed area on occasion
•
8
If people need help to use the toilet or take a bath (for example to use a hoist or special bath) then they may be taken to a “unisex” bathroom used by both men and women, but a member of staff will be present, and other people will not be in the bathroom at the same time.
The Board of Directors will closely monitor the
delivery of same sex accommodation and the
Trust will seek feedback from people who use
services through questionnaires, a programme
of independent ward visiting and comments
made through the Patient Experience Team.
Talking and Listening to People
A strategy and work plan are in place to ensure
that the Trust talks and listens to people who
use its services, their families and the wider
community. This includes key stakeholders,
such as Local Involvement Networks (LINks) and
local authority Health Overview and Scrutiny
Committees.
The aim is to encourage people to seek
information, comment, raise concerns or make
a complaint on an individual or representative
basis. This can be through contacting the
Patient Experience Team, completing a
comment card, participating in a survey or
attending an open meeting or focus group to
hear about developments and provide views. Many people are involved in sharing their
personal experience and opinions at specific
meetings to plan or monitor services. Others
are involved in activities such as visiting wards
to meet with people using services, working in
partnership to recruit staff or specific activities
such as creating training DVDs for staff. In recent years, feedback from all sources
has revealed that the attitude of staff and the
need for good communication are amongst
the top priorities for people. As a result, a
number of programmes have been introduced
where people who have personal experience
of services are involved in staff learning and
development. This includes revised and
improved monthly staff induction sessions and
In My Shoes training.
Devon Partnership NHS Trust
These activities provide a rich source of
feedback to the Trust. Much of this activity is
captured through the Patient Experience Team,
which provides advice and support, handles
enquiries, complaints and patient and public
involvement. The Patient Experience Team
reports on a quarterly basis to the Quality
and Safety Committee. These reports provide
examples of feedback received, arising themes
and action taken.
Plans for 2010/11 include:
•
The re-launch of the Network Action Groups. These are public meetings held in each part
of the county to inform people about developments and encourage feedback
• Further development of the training programme for people involved in delivering staff learning and development
• Raising staff awareness of the support available for families, including delivering ‘Real Lives’ workshops.
Infection Prevention and Control
The Trust has developed a proactive approach
to infection prevention and control. Each year
the Trust develops an annual work programme
which is approved by the Board of Directors. This is monitored through the work of the Trust
Infection Control Committee which, in addition,
provides assurance reports to the Quality and
Safety Committee after each of its meetings.
The Board of Directors receives monthly
statistics against MRSA bacteraemia and
also Clostridium difficile, which provides an
additional alert to the Board of any developing
patterns or concerns.
The Trust has identified a Non-executive
Director as a champion for infection control
and also has a number of identified Link
Practitioners who help promote best practice in
infection prevention and control.
The Trust has registered with the CQC as having
appropriate arrangements in place for the
prevention and control of healthcare associated
infections with the exception of Exeter Prison,
where concerns were declared against outcome
8 of the CQC regulations. The Trust is working
in partnership with Her Majesty’s Prison
Service, which owns the buildings and provides
cleaning services, to undertake the necessary
improvements to comply with the standards. Mental Health Act
The Trust has 19 Hospital Managers, who
ensure that the Mental Heath Act is applied
appropriately and fairly, and that hearings,
appeals and reviews and other activities are
conducted in accordance with the legislation.
To help improve the quality of services, and
enhance the experience of the people who
use them, annual training seminars have now
been established for all Hospital Managers. Additional training is now provided for those
Hospital Managers who Chair Mental Health
Act hearings appeals and reviews. Formal
arrangements have also been introduced
to provide support for Hospital Managers
who may be facing particularly difficult or
challenging cases. Procedures for visits to wards
and units have been reviewed and amended to
ensure that they are consistent with the Trust’s
recently-introduced executive walkaround and
peer review audits.
9
Quality Account 2009/10
Other Quality and Safety Initiatives
Patient Safety Programme
The theme of patient safety has been at the
heart of much of the Trust’s work during the
past few years and will continue into 2010/11
and beyond. The organisation has invested in
leading-edge Patient Safety Officer training with
the Institute of Health Improvement for several
of its key staff and Leadership for Patient Safety
training for some of its other senior staff.
Working with the Health Foundation, the
organisation is one of just four pilot sites in the
country leading on the safety improvement
agenda within mental health. The work at
Devon Partnership NHS Trust has three key
strands to it:
•
Leadership – establishing a baseline for staff’s perception of safety within the organisation through a ‘climate survey’; introducing peer review and executive walkaround audits (see separate section); delivering a one-day safety training programme for all staff and a three-day programme for safety and improvement leads within teams.
• Medicines Management – improving safety
around the prescription and administration of medicines.
•
10
Communication – improving communication at key points in people’s care such as ward rounds, admission and discharge; enhancing the quality of patient notes; introducing learning logs; improving verbal briefings within teams and developing new accident and incident forms.
to the arrangements for assuring the safe,
effective and appropriate use of medicines
across the Trust. Of particular note is the
work that is carried out by the newly-formed
Medicines Governance Group and the crossagency Mental Health and Learning Disabilities
Prescribing Forum, which is led by the Trust. A comprehensive range of policies, procedures
and training programmes has been developed
and introduced - aided in practice by the
Medicines Management Team and its new
network of ward-based medicines management
link practitioners. Later in 2010, a medicines
management annual report will also be
submitted to the Trust’s Board of Directors for
consideration.
Clinical Audit
The Clinical Audit Programme is now led by
one of the Trust’s Co-Medical Directors. The
programme will continue to integrate quality
improvement and mainstream clinical audit
work. This reflects the wider organisational
shift towards an increased emphasis on service
improvement, safety and the quality of people’s
experience of services. The work programme
is based on the Trust’s priorities for quality
improvement and clinical audit activity and also
reflects both national and local priorities in the
field of mental health. The Trust’s current priority areas for clinical
audit include:
• Depression
• Medicines Management
Medicines Management
• Older People’s Mental Health
Better and safer medicines management
continues to be one of the key priorities for
the Trust. Building on the progress that has
been made over the last couple of years,
2009/10 saw further recruitment of pharmacy
staff and sustained improvement in relation
• Schizophrenia
• Suicide.
The clinical audit improvement programme is
currently being reviewed with a view to setting
new priorities for the next few years.
Devon Partnership NHS Trust
Research and Innovation
Devon Partnership NHS Trust is committed
to increasing its participation in research and
contributing to better health outcomes for
the people using its services. In 2009/10, the
number of people recruited to research projects
approved by a research ethics committee was
150. The organisation is currently involved
in conducting 33 clinical studies, of which 18
are supported within the National Institute of
Health Research portfolio.
The Trust collaborates with the Peninsula
Medical School and co-hosts its Mental Health
Research Group. It has close links with the
West Hub of the UK Mental Health Research
Network and the South West Dementia and
Neurodegenerative Diseases Network.
Data Quality
The quality and accuracy of data is a key factor
in monitoring and improving performance
across all services. The Trust has made
significant strides forward in improving both
the completeness and validity of the data
that is captured. Opportunities to further
improve data quality are routinely identified
and the Trust’s Performance Team sets clear
priorities every month for development and
improvement. Clinical Directorates
One of the key projects to improve the Trust’s
management, governance and delivery
of services is the introduction of a Clinical
Directorate structure. The decision to adopt this
model, which is used successfully in most acute
hospitals, is based on feedback from a number
of sources within the Trust and is also informed
by our safety improvement programme and
the work we have been doing with the CQC to
review older people’s services.
Clinical Directorates will deliver stronger links
between managers and clinicians; clearer lines
of responsibility and accountability; better
measurement of performance against agreed
standards and stronger clinical leadership. The
key appointments in this new structure will be
made from April 2010 onwards.
11
Quality Account 2009/10
Performance and Compliance
Standards for Better Health
In the 2008/09 Annual Health Check ratings
published by the Care Quality Commission
(CQC), Devon Partnership NHS Trust was rated
as ‘fair’ for its overall quality of service and
‘good’ for its use of financial resources. In the
previous year, the Trust was rated ‘excellent’
and ‘good’ respectively. With effect from 1 April 2010, Standards for
Better Health has been replaced by the CQC’s
registration process At the end of 2009/10,
the Trust declared compliance with all
relevant Standards for Better Health, with the
exception of:
12
Standard C5b – Clinical Supervision
The Trust implemented an online system for
recording supervision during the year but it
was unable to demonstrate the necessary
level of uptake and compliance for clinical
supervision across the organisation.
Standard C5c – Updating Clinical Skills and
Techniques
This standard is linked directly to the noncompliance with standard C5b (above), and
relates to keeping the skills and techniques of
clinical staff up-to-date. An assurance action
plan has been produced, which includes a
range of measures to improve performance
in these areas (see Care Quality Commission
Registration).
Devon Partnership NHS Trust
Results of Periodic Review 2009/10
Each year, the CQC conducts a review of key
performance data for all Trusts. The assessment
period for the latest Periodic Review was 1 April
2009 to 31 March 2010. The Trust’s position at
the end of March 2010 is set out below:
Indicator
08/09 result
08/09
national
average
09/10
expected result
1
Access to Crisis Resolution Services
98%
94.1%
99%
Å
2
CPA 7 day follow up
98%
96.9%
97%
Ä
3
Data quality on ethnic groups
94%
N/A
94%
=
4
Delayed transfers of care
9.5%
N/A
4.5%
Å
5
Drug users in effective treatment
91%
N/A
93%
Å
6
Completeness of mental health minimum data set (MHMDS)
99%
98.3%
99%
=
7
Patterns of Care in the MHMDS
82%
90.7%
97%
Å
8
Access to healthcare for people with a learning disability (reported, not assessed)
N/A
N/A
79%
N/A
9
Best practice in mental health services for people with a learning disability
64%
N/A
97%
Å
10
Experience of people who use services
Satisfactory
(top score)
N/A
*
11
Staff satisfaction
Satisfactory (top score)
N/A
*
12
Learning Disability Care Plans
100%
N/A
100%
=
* Please note that items 10 and 11 have been marked as amber as it is not possible to estimate the
outcome with the same degree of confidence as the other indicators.
13
Quality Account 2009/10
Care Quality Commission Registration
From 1 April 2010, the Care Quality Commission
(CQC) put in place a new system for enforcing
essential standards of quality and safety across
the NHS. The new system replaces the National
Minimum Standards and Standards for Better
Health.
For some trusts, registration is conditional on
taking further action to meet outcomes. Devon
Partnership NHS Trust has one condition placed
upon its registration. The Trust has declared
itself to be non-compliant against Outcome 14
– supporting workers (Regulation 23) which
concerns staff supervision and appraisal.
The Trust has now introduced a number
of measures to increase levels of staff
supervision and appraisal. These include
the standardisation and simplification of
paperwork, the roll-out of an extensive training
programme and the introduction of a webbased recording system which is quick and easy
to use. These initiatives are steadily delivering
results and the latest figures show that 60%
of staff received an appraisal last year (source:
2009 staff survey) and 61% of staff have
recorded supervision on the new web-based
system (as at May 2010).
14
Four other areas were identified as requiring
further work. However, these were not made
the subject of conditions because the CQC was
satisfied with the Trust’s plans for improving
performance. Commissioning for Quality and
Innovation (CQUIN)
The CQUIN payment framework is a national
initiative that makes a proportion of income
(1.5%) available to those Trusts providing
services if they meet certain quality and
innovation targets agreed with their local
commissioning organisations. For its 2010/11 CQUIN scheme, Devon
Partnership NHS Trust has agreed a total of
15 indicators with its local commissioners and
these include targets related to dementia,
physical health checks, individual health
budgets, discharge arrangements, supporting
people’s recovery, crisis and home treatment
services and the involvement of people using
services. In addition to these, the Trust must
also meet all of the existing indicators carried
over from 2009/10, as agreed in the standard
contract for delivering mental health and
learning disability services.
Devon Partnership NHS Trust
Appendix 1
The National Health Service (Quality Accounts) Regulations 2010 require the following schedule of
statements to be included in the Quality Account.
Prescribed Information
1.0
Form of statement (words in italics indicate
information which must be inserted by the
provider)
The number of different types of NHS services
During 2009/10 the Trust provided and/or provided or sub-contracted by the provider
sub-contracted four NHS services.
during the reporting period, as determined in
accordance with the categorisation of services—
(a) specified under the contracts, agreements or
arrangements under which those services are
provided; or
1.1
1.2
2.0
2.1
2.2
(b) in the case of an NHS body providing services
other than under a contract, agreement or
arrangements, adopted by the provider.
The number of NHS services identified under
entry 1 in relation to which the provider has reviewed all data available to them on the quality
of care provided during the reporting period.
The percentage the income generated by the
NHS services reviewed by the provider, as
identified under entry 1.1, represents of the
total income for the provider for the reporting
period under all contracts, agreements and
arrangements held by the provider for the
provision of, or sub-contracting of, NHS services.
The number of national clinical audits and
national confidential enquiries which collected
data during the reporting period and which
covered the NHS services that the provider
provides or sub-contracts
The number, as a percentage, of national clinical
audits and national confidential enquiries,
identified under entry 2, that the provider
participated in during the reporting period.
A list of the national clinical audits and national
confidential enquires identified under entry 2
that the provider was eligible to participate in.
The Trust has reviewed all the data available to
them on the quality of care in all 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 the Trust for 2009/10.
During 2009/10, no national clinical audits and
one national confidential enquiry covered NHS
services that the Trust provides.
During that period the Trust participated in
100% of national clinical audits and national
confidential enquiries which it was eligible to
participate in.
The national clinical audits and national
confidential enquiries that the Trust was eligible
to participate in during 2009/10 are as follows:
The National Confidential Inquiry into Suicide
and Homicide by People with Mental Illness.
15
Quality Account 2009/10
2.3
2.4
A list of the national clinical audits and national
confidential enquiries, identified under entry 2.1, that the provider participated in.
The national clinical audits and national
confidential enquiries that the Trust
participated in during 2009/10 are as follows:
The National Confidential Inquiry into Suicide
and Homicide by People with Mental Illness.
Data collection was completed during 2009/10
In relation to the National Confidential Inquiry
into Suicide and Homicide by People with
Mental Illness.
A list of each national clinical audit and
national confidential enquiry that the provider
participated in, and which data collection was
completed for during the reporting period,
alongside the number of cases submitted to each
In respect of suicide the data is requested
audit, as a percentage of the number required by
directly from the consultant psychiatrist
the terms of the audit or enquiry.
responsible for the person concerned and
these figures are not available centrally. It
should be noted that data requested in respect
of this inquiry follows on from a verdict of
suicide, or an open verdict, being recorded at
the end of a Coroner’s inquest.
Inquests are usually concluded in the period
six months to two years following a person’s
death, so data requests do not in any way
correlate with the incidence of unexpected
deaths in the reporting period, for which data
would be available. Typically one would expect
in the region of 40 cases per annum where
death is recorded as suicide/open verdict in
those who are in contact with Trust services,
or who have been in the year preceding their
death.
In respect of homicide, a less frequent
occurrence by far, there were no incidents
recorded in 2009/10 and no convictions in
respect of earlier cases. 16
2.5
The number of national clinical audit reports
published during the reporting period that were
reviewed by the provider during the reporting
period.
2.6
A description of the action the provider intends
to take to improve the quality of healthcare
following the review of reports identified under
entry 2.5.
Typically one would expect an average of one
case per annum where a person in contact
with Trust services, or who has been in the
year preceding their offence, is convicted of
homicide. No national clinical audit reports were
reviewed by the provider in 2009/10.
The reports of 48 local clinical audits were
reviewed by the provider in 2009/10 and the
Trust intends to take the following actions to
improve the quality of healthcare provided:
The Trust records specific action points
following clinical audits which are monitored
on a monthly basis by the relevant governance
groups in all the localities and specialities
across the Trust.
Devon Partnership NHS Trust
2.7
The number of local clinical audit reports that
were reviewed by the provider during the
reporting period.
2.8
A description of the action the provider intends
to take to improve the quality of healthcare
following the review of reports identified under
entry 2.7.
The number of patients receiving NHS services
provided or sub-contracted by the provider
during the reporting period that were recruited
during that period to participate in research
approved by a research ethics committee within
the National Research Ethics Service.
3.0
4.0
Whether or not a proportion of the provider’s
income during the reporting period was
conditional on achieving quality improvement
and innovation goals under the Commissioning
for Quality and Innovation payment framework
agreed between the provider and any person
or body they have entered into a contract,
agreement or arrangement with for the provision
of NHS services.
4.1
If a proportion of the provider’s income during
the reporting period was not conditional on
achieving quality improvement and innovation
goals through the Commissioning for Quality and
Innovation payment framework the reason for
this.
4.2
If a proportion of the provider’s income during
the reporting period was conditional on achieving
quality improvement and innovation goals
through the Commissioning for Quality and
Innovation payment framework, where further
details of the agreed goals for the reporting
period and the following 12 month period can be
obtained.
Whether or not the provider is required to
register with the Care Quality Commission (CQC)
under section 10 of the Health and Social Care
Act 2008.
5.0
The Clinical Effectiveness Group is informed
of key issues and any risks identified as a
result of an audit are brought to the attention
of the Risk Management Team. The Clinical
Effectiveness Group also formally reports to
the Quality and Safety Committee within the
Trust’s governance reporting structure.
The number of people receiving NHS services
provided or sub-contracted by the Trust in
2009/10 that were recruited during that
period to participate in research approved by a
research ethics committee was 150.
A proportion of the Trust’s income in
2009/10 was conditional on achieving quality
improvement and innovation goals agreed
between the 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 payment framework.
Further details of the agreed goals for 2009/10
and for the following 12 month period are
available on request from the Trust.
The Trust is required to register with the
Care Quality Commission and its current
registration status is ‘Registered’. The Trust has
the following conditions on registration. The
registered provider must ensure that there
are systems in place by 31 March 2010 for the
supervision and appraisal of staff and for the
keeping of proper records of that supervision
and appraisal.
17
Quality Account 2009/10
5.1
If the provider is required to register with the
CQC—
(a) whether at end of the reporting period the
provider is—
(i) registered with the CQC with no conditions
attached to registration,
(ii) registered with the CQC with conditions
attached to registration, or
(iii) not registered with the CQC;
(b) if the provider’s registration with the CQC is
subject to conditions what those conditions are;
and
Evidence must be available to demonstrate
this from 1 April 2010.
The Care Quality Commission has not taken
enforcement action against the Trust during
2009/10.
(c) whether the Care Quality Commission has
taken enforcement action against the provider
during the reporting period.
6.0
Whether or not the provider is subject to
periodic reviews by the CQC under section 46 of
the Health and Social Care Act 2008.
The Trust is subject to periodic reviews by the
Care Quality Commission and the last review
was on 31 March 2009. The CQC’s assessment
of the Trust following that review was Good for
Quality of Financial Management and Fair for
Quality of Services.
6.1
If the provider is subject to periodic reviews by
the CQC—
The Trust took action to improve compliance
with core standards in medicines management,
clinical supervision, updating clinical skills,
governance, records management, mandatory
training, dignity and respect.
(a) the date of the most recent review,
(b) the assessment made by the CQC following
the review,
(c) the action the provider intends to take to
address the points made in that assessment by
the CQC, and
(d) any progress the provider has made in taking
the action identified under paragraph (c) prior to
the end of the reporting period.
Full details of the actions are available
on the CQC website: http://2009ratings.
cqc.org.uk/findcareservices/
informationabouthealthcareservices/
overallperformance/searchfororganisation.
cfm?widCall1=customWidgets.content_view_
1&cit_id=RWV&element=CSA
The Trust had made the following progress
by 31st March 2010 in taking such action:
Improvements have been made and the
required performance levels have been
achieved in all areas except for core standards
on clinical supervision and updating clinical
skills.
The Trust has participated in an investigation
by the Care Quality Commission during
2009/10 the terms of reference for this review
were given in April 2009 and are as follows:
Terms of reference for the Care Quality
Commission’s investigation into services for
18
Devon Partnership NHS Trust
7.0
7.1
Whether or not the provider has taken part in
any special reviews or investigations by the CQC
under section 48 of the Health and Social Care
Act 2008 during the reporting period.
If the provider has participated in a special
review or investigation by the CQC—
(a) the subject matter of any review or
investigation,
(b) the conclusions or requirements reported by
the CQC following any review or investigation,
(c) the action the provider intends to take
to address the conclusions or requirements
reported by the CQC, and
(d) any progress the provider has made in
taking the action identified under paragraph (c)
prior to the end of the reporting period.
patients in older persons’ mental health units
at Devon Partnership NHS Trust.
The Trust raised concerns with the Care
Quality Commission about some aspects of
care in its older people’s units. Concerns were
raised in relation to recovery, palliative and
end of life care, the provision of pharmacy
services and the issue and use of controlled
drugs, its governance arrangements and
its management and clinical supervision
arrangements, particularly in relation to
individual older persons’ mental health units.
The Care Quality Commission conducted
an investigation to establish whether these
concerns had any foundation and what action
might be required to improve services for
older people requiring mental health care.
The investigation included an examination of:
a) the allegations of poor care at the unit
where the concerns were first raised and a
review of standards of care at other similar
units
b) the adequacy of the Trust’s model of
service provision of care for older people
requiring mental health care and in relation
to referral, assessment, recovery, palliative or
end of life care, including care pathways
c) the culture of the Trust’s older persons’
mental health service and the extent of
engagement with service users, their carers
and families
d) the Trust’s clinical governance, clinical
supervision and management arrangements,
including the arrangements at strategic and
local level to assure the safety of people and
the quality of care
e) the Trust’s recent and present provision
of pharmacy services, clinical pharmacy
support, and the extent of clinical supervision
in relation to the issue and prescribing of
controlled drugs
19
Quality Account 2009/10
f) any other matters which the Care Quality
Commission considered arose out of, or were
connected with, the above.
Additional Information
The investigation was conducted by the Care
Quality Commission using the Care Quality
Commission’s powers under Section 48 of the
Health and Social Care Act 2008.
The Care Quality Commission had early
discussions with the South West Strategic
Health Authority and Devon and Cornwall
Police and was satisfied that current multiagency patient safeguarding arrangements
were in place at the Trust.
The Care Quality Commission will publish a
report on the findings of the investigation
and will make recommendations as
appropriate to the Trust and other relevant
bodies.
The Care Quality Commission’s detailed
review of the Trust’s Older Persons’ Mental
Health Services is complete and a report is
expected in June 2010.
The Trust is also currently conducting its
own review of OPMH services to determine
how these services might best be provided. The Board has approved plans for a capital
investment of £4.6m in three of the Trust’s
inpatient units and will be developing and
testing different ways of working and new
models of care to inform the long-term plans
to place a greater emphasis on community
services and reduced reliance on inpatient
facilities. Both of these review processes will inform
service provision and positively impact
upon the quality of the treatment, care and
support received. 20
Devon Partnership NHS Trust
8.0
8.1
Whether or not during the reporting period the
provider submitted records to the Secondary
Uses service for inclusion in the Hospital Episode
Statistics which are included in the latest version
of those Statistics published prior to publication
of the relevant document by the provider.
If the provider submitted records to the
Secondary Uses service for inclusion in the
Hospital Episodes Statistics which are included in
the latest published data:
The Trust submitted records during 2009/10 to
the Secondary Uses service for inclusion in the
Hospital Episode Statistics which are included
in the latest published data. The percentage of
records in the published data:
— which included the person’s valid NHS
number was:
98% for admitted patient care;
No records were submitted for outpatient
care; and
(a) the percentage of records relating to admitted No records were submitted for accident and
patient care which include the patient’s —
emergency care.
(i) valid NHS number; and
— which included the person’s valid General
(ii) General Medical Practice Code;
Medical Practice Code was:
(b) the percentage of records relating to out
100% for admitted patient care;
patient care which included the patient’s—
No records were submitted for outpatient
(i) valid NHS number; and
care; and
(ii) General Medical Practice Code;
No records were submitted for accident and
(c) the percentage of records relating to accident emergency care.
and emergency care which included the
patient’s—
(i) valid NHS number; and
(ii) General Medical Practice Code.
9.0
The provider’s score for the reporting period, as a
percentage, for Information Quality and Records
Management, assessed using the Information
Governance Toolkit published by the Audit
Commission.
The Trust’s score for 2009/10 for Information
Quality and Records Management, assessed
using the Information Governance Toolkit, was
83%.
10.0
Whether or not the provider was subject to the
Payment by Results clinical coding audit at any
time during the reporting period by the Audit
Commission.
The Trust was not subject to the Payment by
Results clinical coding audit during 2009/10 by
the Audit Commission.
10.1
If the provider was subject to the Payment
by Results clinical coding audit by the Audit
Commission at any time during the reporting
period, the error rates, as percentages, for
clinical diagnosis coding and clinical treatment
coding reported by the Audit Commission in any
audit published in relation to the provider for
the reporting period prior to publication of the
relevant document by the provider.
21
Quality Account 2009/10
Appendix 2
Prior to publication, the Trust complied with the
requirement to share its Quality Account for
2009/10 with:
• NHS Devon (the commissioning Primary Care Trust)
• Devon and Torbay LINks
• Devon County Council’s Health Overview and Scrutiny Committee (OSC).
The Trust ensured that NHS Devon met its
legal obligation to review and comment on the
publication, and that the OSC and LINks were
offered the opportunity to comment on it.
A range of stakeholders was also given the
opportunity to contribute to the report (see
below). Supporting Statements
Prior to publication, the Trust complied with the
requirement to share its Quality Account for
2009/10 with:
• NHS Devon (the main commissioning Primary Care Trust)
• Devon and Torbay LINks
• Devon County Council’s Health and Adults’ Services Scrutiny Committee.
The Trust ensured that NHS Devon met its
legal obligation to review and comment on the
publication, and that the OSC and LINks were
offered the opportunity to comment on it. A
range of other stakeholders were also given the
opportunity to contribute to the report. Commentary by NHS Devon NHS Devon agrees that the Quality Account
for Devon Partnership NHS Trust contains
information that is consistent with data
received throughout the year in question. The
Trust is has faced a number of challenges during
2009/10 that arose from concerns regarding
quality of care within older people’s mental
health units which have been reflected within
22
the Quality Account. NHS Devon has worked in
partnership with the Trust to identify, manage
and respond to these concerns and whilst there
is further work to be completed the trust has
invested time and resources in ensuring that
a culture of quality and safety improvement is
embedded within the organisation.
The priorities identified by the Trust are in
alignment with the commissioning intentions
of NHS Devon and in addition are consistent
with the principles of quality identified within
the contract which focus on improving the
experience of patients, working to increase
reliability and productivity, ensuring patient
safety and forwarding clinical excellence. This
will be achieved through ensuring that the
building blocks of high quality care are in place
from ward to board and has been informed in
light of learning from the challenges faced by
the Trust.
Devon Partnership NHS Trust has undertaken
a significant programme of work to ensure
that it has virtually eliminated mixed sex
accommodation and as such has undertaken
a programme of work to comply with new
national guidance to ensure that the dignity and
privacy of patients is enhanced. This has been
supported by work to further improve patient
experience of care throughout its services.
Although the Trust has performed well against
most of its quality indicators it is recognised
that there are areas where improvement has
been slower than expected for example delayed
discharges, access to therapies and dementia.
The PCT and Trust will work together to address
these issues during 2010/11.
The Trust has declared areas of non-compliance
with the CQC assessment in relation to a
number of areas, action plans are in place
and being monitored by the CQC who have
indicated that they are satisfied with the plans
submitted.
Devon Partnership NHS Trust
The Trust has a conditional registration with the
CQC for clinical supervision, significant progress
has been made and it is our understanding that
the Trust has properly addressed all issues.
on the knowledge the SC has of DPT. The SC
would like to highlight, however, the following
concerns about service areas which it considers
need additional consideration.
CQUIN indicators which demonstrate the Trust’s
commitment to quality have been agreed.
Included in this scheme is developmental
work to improve the experience of patients,
to support recovery based care and the use
of dashboards within clinical teams. The Trust
is keen to ensure that the CQUIN indicators
represent stretch targets and that they will
be used to incentivise towards further real
improvements in patient safety, patient
experience and effective care.
In 2010/11, DPT it is carrying out a £4.6m
improvement programme for its inpatient
services for older people in Exeter, Torbay and
Barnstaple. Recently, the SC carried out a subgroup review of older people’s mental health
services and found evidence that community
services, including mental health teams and
inpatient beds, require further development
which DPT readily acknowledges.
NHS Devon has been able to verify the
accuracy of data provided within this Quality
Account and considers that it contains
accurate information in relation to the services
provided. We, as commissioner, look forward to
continuing the close working relationships with
Devon Partnership NHS Trust that will enable
the health community to deliver high quality
care for all.
Commentary by Devon County Council’s
Health and Adults’ Services Scrutiny
Committee Devon County Council’s Health and Adults’
Services Scrutiny Committee (SC) determined
to comment on the Devon Partnership NHS
Trust’s (DPT) Quality Account 2010/11. All
references in this commentary relate to the
reporting period 1 April 2009 to the date of
this statement and pertain only to the DPT’s
relationship with the SC. The DPT has been
engaging regularly with the SC throughout the
reporting period.
The SC believes that the Quality Account
2010/11 is a fair reflection of the services
provided by DPT and gives a comprehensive
coverage of the provider’s services, based
After older people’s specialist mental health
inpatient units have closed in the past,
community care has not always significantly
improved and the SC recognises the importance
of establishing adequate community cover
before the closure of units in order to
manage a seamless transition and to improve
preventative services. Resources from the acute
sector could not be withdrawn for reinvestment
in community services until these were
equipped to cope with the increasing demand.
The SC is working with DPT to address the
challenging issue of achieving the right balance
between inpatient and community services and
is particularly keen to ensure that people do not
have to travel long distances for treatment.
Inappropriate admissions and delayed transfers
of care create serious knock-on effects in
many areas of the NHS as patients cannot
access treatment if beds are not available in
both acute and community settings or while
units remained suspended. In the absence of
specialist units, patients from across Devon
are admitted into the acute hospitals. More
cooperation between NHS trusts and the
County Council is necessary in order to avoid
unilateral decisions and this point, too, is
readily accepted by the DPT.
23
Quality Account 2009/10
The SC believes that the limited number of
specialist units for older people with mental
health needs has meant a growing demand on
general acute wards. Past closures of specialist
units have not delivered savings for the NHS
due to knock-on effects and resulting pressures
on other services, especially as the demand
on these services is increasing. No additional
funding was allocated for the transition from
acute to community services within the
current redesign of older people’s mental
health services and the implementation of the
National Dementia Strategy.
The DPT is also currently introducing a new
electronic patient records system and the
SC is keen to receive assurance about the
compatibility of IT and patient record systems
across NHS trusts and adult services.
Commentary by Devon LINk
Due to time constraints, Devon LINk did not
submit a formal response to the Quality
Account for 2009/10. However, the draft
document was circulated to its Strategic
Planning Group and the organisation is keen to
ensure greater involvement next year. Devon
LINk also confirmed its agreement and support
for the response submitted by Devon County
Council’s Health and Adults’ Services Scrutiny
Committee.
24
Commentary by Torbay LINk
Due to time constraints and the restructuring
of the organisation, Torbay LINK did not submit
a formal response to the Quality Account
for 2009/10. The draft document was not
circulated to its Stewardship Group. However,
the newly established Steering Group will be
keen to ensure greater involvement next year.
Engagement in Producing the Quality
Account
The Trust sought ideas and suggestions for
inclusion in the Quality Account from all of its
key stakeholder groups, including the people
using services and their carers and families. The Quality Account was also discussed with
shadow governors at the Trust’s shadow Council
of Governors’ meeting on 22 April 2010.
Appendix 3
Services Good Enough for my Family
How will we achieve this?
By delivering services
that are:
What should people
using our services
experience?
NHS Trust
What should our
staff experience?
üEasily accessible
clinical records
üAll compulsory
training completed
üDevelop single clinical
record through RiO
üAll clinical records
up-to-date and
accurate
üMeasure perfomance against
standards (dashboard)
üConfidence in
reporting and learning
from incidents
üIntroduce Clinical Directorates
üMonthly feedback on
team performance
üDelivery of consistent
clinical standards
üExtend peer audits and
executive walkarounds
üGreater support from
peers and executives
üTimely assessments
üFewer delayed
discharges
üReview workloads to ensure
enough capacity to meet
demand
üCare and treatment
when and where
people need it
üFollow-up of all
discharges within 7 days
ü Ensure timely flow through
the system
üCompliance with
waiting time standards
ü Increase time available to spend
with people using services
PERSONALISED
üCare that is tailored
to people’s needs
regardless of
their age and
circumstances
üAgree personal
recovery plans with
everyone
üProvide support and
supervision for person-centred
approaches to care
üMore time to spend
with people using
services
RECOVERYFOCUSED
üA sense of hope,
opportunity, choice
and control
üImplementation of
recovery standards
and recovery
coordination
üExtend staff learning,
training and peer review
in recovery coordination
and practice
üGreater ability to
support people to
live independently
and meet their own
goals
SAFE
üConfidence in quality
üImproved mental
health and wellbeing
üMinimum risk of
harm
TIMELY
SUSTAINABLE
üNo unnecessary
waiting
üBetter experience of
services
üGreater involvement
in service planning
and development
üSkilled, trained workforce
üMore manageable
workloads
üReduced bureaucracy
üBetter job satisfaction
üHealthy financial
position
üEnsure adequate human
and financial resources
üOpportunity for
greater autonomy
üDevelopment and
expansion of services
üReduce business travel and
energy consumption
üGovernance, safety
and quality of services
measurably improved
üReduced carbon footprint
What will be achieved?
üExtend safety & medicines
management programmes
Services Good Enough for my Family
Services Good Enough for my Family
How will we support this
to happen?
üAll staff regularly
supervised
üSafer services
What is our goal?
What are our priorities
for 2010?
Devon Partnership
25
Devon Partnership NHS Trust
Wonford House Hospital
Dryden Road
Exeter
EX2 5AF
Tel: 01392 403433
www.devonpartnership.nhs.uk