QUALITY ACCOUNTS - 2010/11
East London NHS Foundation Trust
Contents:
Executive Summary……………………………………………………………... 4
Part 1. Statement from Chief Executive……………………………….……...5
Part 2. Priorities for Improvement…………………………………………...…6
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2.1 Review of services
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2.2 Participation in Clinical Audits
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2.3 Research & Innovation
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2.4 Goals agreed with commissioners
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2.5 What others say about the Trust
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2.6 Data quality
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2.6 (i) Information Governance Toolkit attainment levels
2.7 ELNHSFT Priorities for 2010/11
Part 3. Review of Quality performance…………………………….……..…..16
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3.1 Quality Management Systems
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3.2 An explanation of which stakeholders have been involved
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3.3 Statement from lead commissioning PCT
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3.4 Statement from LINks
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3.5 Statement from OSCs
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3.6 An explanation of any changes made to Quality Accounts report
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3.7 Feedback
Glossary…………………………………………………………………………….26
2
Executive Summary
High-quality care for all (The ‘Darzi Review’) introduces Quality Accounts as a mechanism
for public reporting on quality. These reports will be available to the public from April 2010
and provide information across all service provision; looking at safety, experience and
outcomes.
The Trust has identified key areas for improvement and has in place plans to monitor and
report on progress. The suggested priorities for the 2010/11 Quality Accounts Report focus
attention and resources on achieving a maximum of quality improvement within a one year
period. There is one priority each for four major areas of service delivery in the Trust: inpatient care in general adult psychiatry, out-patient care of the same group, Child and
Adolescents Mental Health Care and Old Age Mental Health Care. All of these priorities are
intended to improve clinical effectiveness, patient experience and patient safety.
The priorities address the initial processes and experiences, and follow a similar rationale:
•
•
•
•
An emphasis on initial phases of care allows a focus of quality improvement
activities on confined processes.
Care processes that are high quality from the very beginning are more likely to
continue well.
It is easier to get processes right from the start than to rectify them later.
There is sound research evidence showing that a more positive experience of
treatment is associated with better clinical and social outcomes in the medium and
long term.
For each priority, indicators have been suggested which will simplify the assessment of
whether sufficient improvements have been achieved or not. Quality Accounts also offers
an opportunity to reflect on the quality of service provision for the identified areas of priority
for the previous year.
The rationale and details for each priority were developed in co-ordination with senior
clinical and management staff across each of the service delivery areas. The proposed
priority areas were considered and appraised by the Trust’s Members Council which
consists of service users, carers, Trust staff and lay members of the local community.
These discussions form part of an ongoing dialogue about the quality of our services and
are intended to make the Quality Accounts process as practicable as possible, whilst
allowing for the realities of good practice.
3
Part 1.
Statement on Quality from Dr Robert Dolan, Chief Executive
This is the second Quality Account report produced by the Trust and is an opportunity for
us to demonstrate how we are working to improve the quality of our services with regard to
patient safety, clinical effectiveness and patient experience.
Each of the priorities identified in our Quality Accounts have been developed with senior
clinical and management staff across each of our service delivery areas. The proposed
priority areas were considered and appraised by the Trust’s Members Council which
consists of service users, carers, Trust staff and lay members of the local community.
These discussions are part of our ongoing dialogue about the quality of our services and
are intended to make the Quality Accounts process an integral part of the work of the Trust.
The report has been presented to our Trust Board and their recommendations included.
These priorities have also been discussed with our Commissioners.
The information contained in this report is, to the best of my knowledge, an accurate
reflection of the Trust’s position.
The suggested priorities for the 2010/11 Quality Accounts Report focus attention and
resources on achieving a maximum of quality improvement within a one year period. We
know that care processes that are high quality from the very beginning are more likely to
continue well and that it is easier to get processes right from the start than to rectify them
later. There is sound research evidence showing that a more positive experience of
treatment is associated with better clinical and social outcomes in the medium and long
term. By focusing on the initial phases of care, we can concentrate our efforts on quality
improvement activities on specific processes. Our priorities are:
Acute Adult Inpatient Services: Improving the adult patient experience within the first 7
days of an acute admission to hospital with a specific focus on contact with staff and
information provision.
Community Adults Services: Improve the adult patient experience of assessment and
brief treatment within the first 28 days of referral to the Trust’s community mental health
teams (CMHT).
Older Adults Services: Improving the older adult patient experience of assessment and
brief treatment within the first 28 days of referral to the Trust’s services for both dementia
and functional mental health.
Child and Adolescent Services: To introduce and support the implementation of a
common model of routine outcome evaluation across all community CAMHS.
Throughout 2009/10 we have faced significant challenges which are not formally reported
as part of the Quality Account. These include a high bed occupancy rate, a staff survey that
we would wish to improve on, and the introduction of a new CPA policy. All these issues
are reported as part of our monthly performance management meetings with our Primary
Care Trust colleagues and are subject to significant actions outside of the Quality Account.
4
The Trust currently has a ‘Good’ rating for the quality of our services. We know we have
much to do to ensure that service users and their carers get the best standard of care and
we will strive to raise our standards to make this a reality in all areas.
Dr Robert Dolan - Chief Executive
Part 2.
Priorities for improvement
2.1 Review of services:
East London NHS Foundation Trust provides a wide range of community and inpatient
mental health services to the City of London, Hackney, Newham and Tower Hamlets.
Forensic Services are also provided to Barking & Dagenham, Havering, Redbridge and
Waltham Forest.
During 2009/10 East London NHS Foundation Trust provided and/ or sub-contracted one
NHS service. The Trust has reviewed all the data available to them on the quality of care in
this service.
The income generated by the NHS services reviewed in 2009/10 represents less than one
per cent of the total income generated from the provision of NHS services by the Trust for
this period.
2.2 Participation in clinical audits
During 2009/10, eight national clinical audits and one national confidential enquiry
covered NHS services that East London Foundation Trust provides.
During that period East London Foundation Trust participated in 50% of national clinical
audits and 100% of national confidential enquiries of the national clinical audits and
national confidential enquiries which it was eligible to participate in.
The national clinical audits and national confidential enquiries that East London NHS
Foundation Trust participated in during 2009/10 are as follows:
•
•
•
•
•
•
•
•
National Confidential Inquiry (NCI) into Suicide and Homicide by People with Mental
Illness (NCI/NCISH)
National Audit of Psychological Therapies (pilot)
National Falls and Bone Health Audit
National Audit of Continence Care
POMH-UK: Prescribing high dose and combined antipsychotics on adult acute and
psychiatric intensive care wards
POMH-UK: Screening for metabolic side effects of antipsychotic drugs in patients
treated by assertive outreach teams
POMH-UK: Assessment of side effects of anti-psychotic medication
POMH-UK: Medicines Reconciliation
5
•
POMHUK: Use of anti-psychotic medicine in people with Learning Disabilities
The national clinical audits and national confidential enquiries that East London NHS
Foundation Trust participated in, and for which data collection was completed during
2009/10 are listed below alongside the number of cases submitted to each audit or enquiry
as a percentage of the number of registered cases required by the terms of that audit or
enquiry.
•
•
•
•
•
National Confidential Inquiry (NCI) into Suicide and Homicide by People with Mental
Illness (NCI/NCISH): (state time frame of data collection)
POMH-UK: Prescribing high dose and combined antipsychotics on adult acute and
psychiatric intensive care wards: Time Frame-Yearly (May 2009) Sample Size100% All Adult Wards and PICU / Also carried out as a Quarterly Benchmarking
Exercise
POMH-UK: Screening for metabolic side effects of antipsychotic drugs in patients
treated by assertive outreach teams: Time Frame: Yearly (July 2009) Sample SizeChosen by local teams
POMH-UK: Medicines Reconciliation: Time Frame-Yearly (May 2009) Sample Size100% All Wards across the Trust
POMHUK: Use of anti-psychotic medicine in people with Learning Disabilities: Time
Frame-Yearly (September 2009) Sample Size-Chosen by relevant teams
The reports of four national clinical audits were reviewed by the Trust in 2009/10 and East
London NHS Foundation Trust intends to take the following actions to improve the quality
of healthcare provided.
Each national report was considered at the Trust wide Medicines Committee where
recommendations are discussed. Work has been carried out to raise awareness at Trust
induction. Reports have also been discussed at local healthcare governance committees
for relevant directorates.
2.3 Research & Innovation
Being ‘a centre of excellence for mental health research’ is one of the core objectives in the
strategy of East London NHS Foundation Trust. To achieve this, the Trust collaborates
closely with academic partners, in particular Queen Mary University of London and City
University, and focuses on research that improves the delivery of mental health care in
East London, strengthens the Trust’s profile and underpins its business development.
6
Currently, the Trust’s research focus is on forensic psychiatry, psychiatric nursing, and
social and community psychiatry and on a social sciences perspective. There are several
reasons for this emphasis:
•
These three areas are linked to core areas of service delivery in the Trust and
therefore underpin the major business activities.
•
There are three strong research groups on these areas that are already linked to
and working in the Trust and have an excellent reputation and track record. Thus,
focussing on these areas plays to the existing strengths in East London.
•
The Trust is one of very few organisations focussing on these areas, which helps
maintain competitiveness and profile.
•
Other research within East London that is relevant to mental health care (e.g. in
public health and primary care) links well with these areas.
The research groups across the Trust generated significant amounts of external income
which will fund important research activities over the coming years. The new grants that will
be administered by the Trust include three Programme Grants for Applied Research funded
by the NIHR, and three studies funded by the Research for Patient Benefit Programme of
the NIHR. Additionally, the research groups in the Trust generated grants for studies that
will be administered by academic partners, e.g. a large trial funded by the Health
Technology Assessment Programme of the NIHR, and a PhD studentship funded by the
Medical Research Council.
The number of patients receiving NHS services provided or subcontracted by East London
NHS Foundation Trust in 2009/10 that were recruited during that period to participate in
research included on the NIHR Portfolio was 180 (includes recruitment reported through 28
February 2010).
In calendar year 2007, 108 publications resulted from our involvement in research, in 2008
there were 112 and in 2009 over 100, helping to improve patient outcomes and experience
across the NHS.
2.4 Goals agreed with commissioners
A proportion of the East London NHS Foundation Trust income in 2009/10 was conditional
on achieving quality improvement and innovation goals agreed between the Trust and the
East London PCTs (City & Hackney, Newham and Tower Hamlets) 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 the Trust website: http://www.eastlondon.nhs.uk/ or on request from Trust
Board Secretary (see section 3.7).
2.5 What others say about the Trust
East London NHS Foundation Trust is required to register with the Care Quality
Commission (CQC) and its current registration status is ‘registered’. The Trust has no
conditions attached to its registration.
The Care Quality Commission has not taken enforcement action against East London NHS
Foundation Trust during 2009/10.
7
East London NHS Foundation Trust has not been subject to periodic reviews by the Care
Quality Commission in 2009/10.
At the end of the year, the Trust was fully compliant with all the core standards for better
health. The Trust has met all targets set out in Monitor’s Compliance Framework.
Over the last three years the CQC ‘Annual Health Check’ (shown in the table below) has
been consistently positive.
Quality of Services
2006/07
Excellent
2007/08
Excellent
2008/09
Good
Use of Resources
Good
Excellent
Good
However, the Trust’s score for Quality of services was affected by four areas of underperformance:
•
•
•
•
Non-compliance with the Safeguarding Children Core Standard for Better Health,
due to levels of training compliance and CRB checks.
A “below average” score for the National Inpatient Survey, which covered the period
1 July – 31 December 2008.
“Under achievement” of targets relating to the collection of information (the Mental
Health Minimum Data Set).
“Under achievement” of a self-assessment against standards for Learning Disability
services (the Green Light toolkit).
Action plans were put in place in response to each area. By January 2010, the Trust was
able to declare compliance with the Safeguarding Children standard. The quality of
inpatient services remains a priority for the Trust to address, and the development of
Quality Accounts has enabled sharper focus to be brought to this area. The key quality
priorities and measures are set out in the Quality Accounts Report, and will be monitored
closely by the Trust Board in 2010/11.
2.6 Data quality
The Trusts Information Governance (IG) framework, including Data Quality (or ‘Information
Quality Assurance’) policy, responsibilities/management arrangements are embedded in
the Trust’s Information Governance and Information Management &Technology Security
Policy.
Information Quality Assurance:
•
The Trust established and maintains policies and procedures for information quality
assurance and the effective management of records
•
The Trust undertakes or commissions annual assessments and audits of its
information quality and records management arrangements
•
Data standards are set through clear and consistent definition of data items, in
accordance with national standards.
8
•
The Trust promotes information quality and effective records management through
policies, procedures/user manuals and training
The Trust’s Commissioners, Trust Board and Information Governance Steering group
receive regular reports on Data Quality/Completion rates against agreed targets. The IG
Steering group receive and review performance on Data Quality benchmarked across
London and nationally – including use of the national data quality dashboard.
To support action and improvement
plans,
Directorate
Management
Teams receive a range of cumulative
and snapshot data quality reports
from
the
Trust’s
Information
Management team – these show
missing or invalid data at Ward,
Team and down to individual patient
level. Data Validity and Accreditation
checks are undertaken annually
(often more frequently) in line with
the IG Toolkit national requirements
and an annual audit of Clinical
Coding is undertaken in line with the
IG Toolkit national requirements.
East London NHS Foundation 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 patient’s valid NHS number was: 93% for admitted patient care,
and 99.1% for out patient care.
•
which included the patient’s valid General Medical Practice Code was: 100% for
admitted patient care, and 100% for out patient care.
*Figures presented are for the year 2009/10 up to February as complete annual figures are
not available until May 2010.
2.6 (i) Information Governance Toolkit attainment levels
East London NHS Foundation Trust score for 2009/10 for Information Quality and Records
Management assessed using the Information Governance Toolkit was 91% which
constitutes a ‘Green’ rating.
East London NHS Foundation Trust was not subject to the Payment by Results clinical
coding audit during 2009/10 by the Audit Commission. However, an internal coding quality
audit has been undertaken.
2.7 East London NHS Foundation Trust Priorities 2010/11
The Trust has identified key areas for improvement and has in place plans to monitor and
report on progress. The suggested priorities for the 2010/11 Quality Accounts Report focus
attention and resources on achieving a maximum of quality improvement within a one year
period. There is one priority each for four major areas of service delivery in the Trust:
9
inpatient care in general adult psychiatry, out-patient care of the same group, Child and
Adolescents Mental Health Care and Old Age Mental Health Care. All of these priorities are
intended to improve clinical effectiveness, patient experience and patient safety.
The priorities address the initial processes and experiences, and follow a similar rationale:
•
An emphasis on initial phases of care allows a focus of quality improvement
activities on confined processes.
•
Care processes that are high quality from the very beginning are more likely to
continue well.
•
It is easier to get processes right from the start than to rectify them later.
•
There is sound research evidence showing that a more positive experience of
treatment is associated with better clinical and social outcomes in the medium and
long term.
For each priority, indicators have been suggested which will simplify the assessment of
whether sufficient improvements have been achieved or not.
2.7 (i) Priority One – Acute Inpatient Adults Services
Improving the adult patient experience within the first 7 days of an acute admission to
hospital with a specific focus on contact with staff and information provision.
Rationale for the use of this priority
What patients feel and say about the treatment at initial stages of treatment is an important
predictor of outcome. This is consistent across a number of different types of psychiatric
treatments and applies to voluntary and involuntary patients.
I feel like I matter especially when the staff listened to what I have to say Service User in Hackney
How will the improvement be achieved, i.e. the process(es)
1. Each patient to have a physical health-check undertaken within the initial 24
hours of admission to a ward.
2. Each patient to have a one-to-one with nursing staff on at least 5 of the first 7
days of admission during which patient views are actively elicited and recorded.
3. A multi-disciplinary team (MDT) meeting which involves the patient to be held in
the first 7 days of admission and a care plan developed in conjunction with the
patient.
4. A brief introductory leaflet to be provided to each new admission. This form will
contain essential information and signpost patients towards the welcome pack.
Suggested process measures
1. Data regarding physical health-checks and one-to-one contact with nurses are
recorded in patient case notes.
2. Information regarding MDT care meetings and the development of care plans
will be recorded using a standardised ‘Ward Round’ form.
10
3. Patients to complete the Client’s Assessment of Treatment (CAT) questionnaire.
4. Service User Led Audit questions specifically relating to the receipt of
information at admission to a ward.
How and when this progress will be reported:
1. Data for items 1-3 are currently collected as part of the ‘Case note audit’ on a
quarterly basis.
2. A random sample of patients admitted to wards across the Trust will be asked to
record their satisfaction with treatment on the Client’s Assessment of Treatment
(CAT) questionnaire, which consists of 7 items on different aspects of hospital
treatment. Findings to be reported at the end of the year.
3. Service User Led Audits are conducted each quarter in co-ordination with Trust
People Participation leads.
Target:
1. 95% of all patients to undergo a baseline physical examination within the first 7
days of admission.
2. During the first seven days of admission, 95% of all patients to have five one-toone sessions with nursing staff.
3. A MDT care meeting is held in the first seven days for 95% of all admissions.
4. 95% of all patients surveyed report receiving an information leaflet within the
first seven days of admission.
2.7 (ii) Priority Two – Community Adults Services
Improve the adult patient experience of assessment and brief treatment within the first 28
days of referral to the Trust’s community mental health teams (CMHT).
Rationale for the use of this priority
Following a review of community services, the Trust has recently strengthened its
assessment and brief treatment processes across East London, in line with good clinical
practice.
Timely and high quality expert assessment will ensure that the service user receives the
most appropriate and clinically effective treatment as soon as possible. It will also ensure
that, where the Trust’s services are not appropriate, the service user is promptly signposted
to the most appropriate service.
It is important that the service user’s experience of this assessment and brief treatment
process is positive since this will affect their levels of satisfaction, clinical outcomes and
their first experience of using the Trust’s community services.
How will the improvement be achieved, i.e. the process(es)
1. Initial assessment to be carried out by a doctor as part of the Assessment and
Brief Treatment (ABT) team, who is able to formulate a meaningful care plan
and level of service within the first 28 days of contact.
Suggested process measures
1. Data regarding initial CPA assessment and initiation to be entered onto Rio.
11
2. Patients to be sent a service satisfaction questionnaire – undertaken by Quality
Health.
How and when this progress will be reported
1. Assessment and CPA data on Rio to be monitored on a quarterly basis.
2. Annual collation and reporting of service satisfaction data via Quality Health.
Target:
1. 95% of all patients to undergo an initial assessment within the first 28 days of
contact.
2.7 (iii) Priority Three – Older Adult Services
Improving the older adult patient experience of assessment and brief treatment within the
first 28 days of referral to the Trust’s services for both dementia and functional mental
health.
Rationale for the use of this priority
In line with national local drivers such as New Horizons, the National Dementia Strategy
and borough specific Joint Strategic Needs Assessments, the Trust recognises the
importance of the:
•
•
•
•
Availability of pertinent, good quality information
Improving access to specialist services
Early identification and treatment of mental health problems
On-going contact and support from specialist services.
In line with this and a strategic review of MHCOP services the Trust has recently
strengthened its assessment and brief treatment services as well as systems for providing
on-going support to users and carers across East London as evidenced by the
establishment of specialist Intermediate Care Services, community dementia and memory
services in two boroughs.
The early availability of information, ease of access and the availability of timely and high
quality expert assessment will ensure that interventions and on-gong care are planned,
crisis situations are avoided and that the service user receives the most appropriate and
clinically effective treatment as soon as possible or their carer is supported in this respect .
It will also ensure that, where the Trust’s services are not appropriate, the service user is
promptly sign-posted/transferred to the most appropriate service with support from trust
staff to access these services.
It is important that the service user and carer experience of Mental Health Care of Older
People (MHCOP) services is positive and beneficial since this will affect their levels of
satisfaction, clinical outcomes and their on-going contact with the Trust’s community
services.
How will the improvement be achieved, i.e. the process
1. Initial assessment to be carried out by a doctor as part of the Assessment and
Brief Treatment (ABT) team, who is able to formulate a meaningful care plan
12
and level of service within the first 28 days of contact.
Suggested process measures
1. Data regarding initial assessment and initiation of the CPA to be entered onto
Rio.
2. Patients to be sent a service satisfaction questionnaire – undertaken by Quality
Health.
How and when this progress will be reported
1. Assessment and CPA data on Rio to be monitored on a quarterly basis.
2. Annual collation and reporting of service satisfaction data via Quality Health.
Target:
1. 95% of all patients to undergo an initial assessment within the first 28 days of
contact.
2.7 (iv) Priority Four – Children and Adolescents
To introduce and support the implementation of a common model of routine outcome
evaluation across all community Child and Adolescent Mental Health Services (CAMHS).
Rationale for the use of this priority
As of 2009/10 the Trust is part of the national CORC (CAMHS Outcome Research
Consortium) process. CORC utilises a range of measures which assess clinical outcomes
from the perspective of users, carers and clinicians, as well as patient needs and
experience. These measures constitute indicators of quality which form part of an existing
nationally collected data set. CORC is currently suggesting a particular core set of
measures to cover three perspectives; child, practitioner and parent views.
How will the improvement be achieved, i.e. the plan
We propose to implement a complete roll-out of CORC measures across all community
CAMHS.
By looking at the information at individual client, team, service and national levels, the
services can see whether clients are improving with the treatment they receive and also
how they experienced the service. This information can then be used to inform decision
making and help improve the service, both in terms of the care they receive and facilities. It
is also useful information for the clinician about each client’s problems.
Suggested process measures
1. Data on the patients’ mental health problems are collected at the very first
session, as a means of assessing levels of difficulties.
2. Measures are then collected at 6-month and 12-month intervals and then
annually after this, as well as at case closure, so that they can be compared
with the previous information to see whether the clients’ problems are
improving.
13
How and when this progress will be reported
1. Data are collected by the clinicians in contact with the patient and family.
2. Data are collated every quarter as part of the Trust Board Report.
Target:
1. The data collection process to be initiated with 95% of all CAMHS patients.
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Part 3.
3.1 Quality Management Systems
1. Service Users
The Trust continues to keep service users at the heart of what we do. An example of this
was the launch of Florid, a user led and run website which was supported by the Trust and
launched in January 2009. The website provides a comprehensive directory of statutory
and voluntary services in East London in addition to other resources for service users,
parents and carers which include a moderated blog/chat room where information and ideas
can be exchanged. Professionals are invited to join the blog as guest speakers. This
exciting and innovative development has been led by the Trust’s public participation
programme and also provides paid employment and training opportunities for service
users.
It has definitely given me hope that the opinions and needs of service users might be taken into consideration more seriously, or more effectively, in the much nearer future in Tower Hamlets. Service User in Tower Hamlets
Similarly, the Trust Members Council has also made a very positive contribution. The
Members Council, the wider membership and the Trusts’ service user groups have been
integral to the development of the 2009/10 Annual Plan and our priorities for the year
ahead.
The Trust also engages with the Local Involvement Networks (LINks). For example, the
Tower Hamlets LINK (THINk) will provide comments received from their members on
mental health provision to the Trust on a quarterly basis together with any
recommendations or requests for information. LINks obtain user comment through a range
of mechanisms including Enter and View visits to inpatient and community services,
Discovery Interviews with users, User Service Assessors (users who provide more detailed
feedback on their experience of services against a set of guidelines) and through outreach
to events and user groups.
2. Staff
The HR department has
proposed and implemented
several initiatives over the
past year. The aim is for the
Trust to improve the level of
engagement
with
its
workforce, enabling it to
become an Employer of
Choice and to meet the
Investors in People (IIP)
standards
15
The initiatives that have been rolled out in the past 12 months include:
•
•
•
•
•
•
•
Implementing and communicating the actions taken from the internal employee
engagement survey
Appointment of bullying & harassment advisors
Setting up a reward and recognition scheme (employee of the month)
Introduction of a survey of new starters to understand what drives people to want to
join the Trust
Introduction of a mediation service
Piloting the succession planning project in John Howard Centre
Introduction of a web based tool for staff to access their total remuneration
information
The Trust has remained committed to taking a proactive approach to providing high
standards of Health & Well-Being for staff. The Trust has begun the process of
implementing the recommendations from the Boorman Report. Other initiatives/benefits are
in place to support staff e.g. Childcare Voucher Scheme, Subsidised Nursery Provisions,
40% subsidy towards holiday play-schemes, Cycle to Work Scheme, Eye Care Vouchers,
staff benefits booklet, NHS Reward Scheme, Employee of the Month Awards, Health &
Well-being Courses.
The Trust has made immense changes in the delivery of our Workforce Information and
ESR system. We have conducted a comprehensive validation exercise of all personal
information and at the same time proceeded to budgetary establishment so that both sides
of the system were realigned and accurate. We are in the process of realigning our
systems again by liaising regularly with Finance and our budget holders as we are into a
new financial year.
There is regular reporting to the Trust Board on workforce issues, and an annual Equality
and Diversity Report will be presented at the May Trust Board. The Trust has also been
implementing an extensive Organisational Development Strategy.
3. Systems
There have been a number of improvements made to the information and workforce
systems over the past year. Improvements to information systems include:
•
•
•
Rio upgrade to version 5
Upgrade to new email & storage system
Upgrade of remote access to enable increased productivity efficiency via off-site
working
More detailed information is available in section 2.6.
Priorities for 2009/10
The overall focus of the 2009/10 Annual Plan was to build on the quality and service
improvements made in 2008/09 and improve the service user experience and the
services we provide for service users and their carers and families. The priorities outlined
in the 2009/10 Annual Plan did this through improving Quality and Safety. Within this
broad area, there were 10 priority areas which were supported by the existing enabling
strategies and plans. Six of which focused on quality and build on the themes of clinical
effectiveness, patient experience and patient safety. These priorities are outlined below.
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To ensure that these key priorities and target areas were delivered, the Board of
Directors regularly reviewed and monitored delivery. The delivery of these priorities was
also the key 2009/10 personal objectives for the Executive Team, Corporate and DMT
staff. The key priorities and targets for the 2009/10 Annual Plan are detailed below.
Progress on delivery of the six key priorities as at the end of March is summarised below.
Due to the change over in RiO systems, tables relying on RiO data do not include year-end
data but indicate whether or not plan achievement is on course.
Priority One:
Older Adult Services
New investment in services for people with dementia has been achieved in all the
boroughs. A public consultation on the inpatient changes is planned immediately following
the General Election. Following the consultation it is anticipated that in-patient services will
begin to change in the autumn 2010.
In recognition of wider developments in the older adult services across ELNFT, NHS Tower
Hamlets has indicated that they will fund an older adult liaison service at the London
Hospital beginning mid-year in 2010/11. An interagency steering group has been
established to lead this work.
The older adult wards in C&H have seen significant capital investment resulting in an
improved environment for users, carers and staff. The quality of these clinical areas
received positive comments during a recent AIMS review.
Plans are being developed to undertake a major refurbishment of Robinson Ward and
environmental improvements at the Green. It is anticipated that these works will be
completed by October 2010.
Priority Two:
Inpatient Services
Delivery of improvement plans, in line with the Care Quality Commission’s quality
measures and standards
The audit of the quality standards covering the period (i.e. Aug-Oct 2009) was reported to
the Trust Board in January 2010. Action Plans are being implemented. The next audit will
report in June 2010 and significant improvement is expected.
Continued development of and implementation of AIMS for adults and older adults and the
Quality Network for CAMHS
The Quality Network for CAMHS inpatient units' inspection of the Coborn Unit has been
undertaken with an action plan to address the areas needing development.
In relation to Adult wards, in City & Hackney, Connolly ward has been accredited and the
AIMS accreditation process will recommence in May 2010 for Gardner, Brett & Joshua
wards.
In Newham all 4 acute and the 2 older adult wards have been accredited and graded as
‘Excellent’.
In Tower Hamlets - three wards (Brick Lane, Lea and Roman Ward) have been accredited
and one ward (Globe) is awaiting accreditation. An action plan has been implemented for
Globe ward and the accreditation application is to be resubmitted in May. Brick Lane and
Lea wards are in the second phase of accreditation. Staff are following the self-assessment
process to focus on improvement action plans.
17
Four of the six older adult admission wards across the Trust have been AIMS reviewed –
all have been successful with, as indicated above, two rated ‘Excellent’. The two remaining
wards were reviewed in March 2010, and the outcome of this review in expected in June
2010. It is expected that these wards will also achieve AIMS accreditation.
Development of gender specific inpatient services
The provision of single gender wards will be established in City & Hackney as of May 2010
as a pilot for the Trust. This will be evaluated and a report submitted to the Trust Board
after 6 months.
All the older adult inpatient sites now offer gender segregated areas including separate
lounge areas if required and the Trust is compliant with the Delivering Single Sex
Accommodation requirements. The capital works on Robinson ward noted above and the
single gender wards in City & Hackney will further enhance the quality of these
environments.
Introduction of service user older adult surveys
Older adult admission wards have been included in in-patient surveys for the last two
quarters of 09/10. The results from these have been positive. The older adult directorate is
seeking to recruit more users and carers to undertake this work, and is also considering
how to improve user feedback systems for patients with advanced dementia.
Case note audit
The Trust wide case note audit (based on the Healthcare Commission standards from the
Acute Mental Health Inpatient Review 2007) was undertaken in Nov 2009. The report
compares results from previous years. The Service Delivery Board identified key priorities
from the audit standards devised by the Healthcare Commission, for which results can now
also be compared. The Director of Operations oversees the work to enable service
improvement and ensure better compliance with standards. The five standards are detailed
in the table below:
Audit findings
Standard
Achieved (%)
Nov 2009
1. That all service users on admission as part of their medical
assessment will receive a physical health check and the outcome will be
recorded.
88
2. That all services will hold a multi-disciplinary team meeting/ward
round within 7 days of admission to discuss the care of the service user
and this will be recorded.
94
3. That the community care co-ordinator for service users known to the
service will attend and provide input into the first multidisciplinary team
care review meeting and their attendance will be recorded.
65
4. Within the first 7 days of admission, formal one to one sessions to
discuss the nursing care plan with nursing staff must be recorded at
least five times in the first week and thereafter weekly.
71
5. That service users’ views on their inpatient care plans will be
recorded as part of the 1-1 sessions and following the first reviews.
84
18
Indicators used as part of the case note audit, thought to be crucial in understanding the
initial phase of contact, have been selected for the Quality Account priorities for 2010/11.
Service User-led Standards Audit
The service user-led standards audit collects information across ten service user defined
standards by asking two questions per standard. The standards cover four themes; Health
Professionals/Staff attitudes, Quality of Care and Treatment, Meaningful Activities
Provision, and Quality of Information/Guidance. Over the last year (09/10) 684 service
users from across the Trust completed the survey.
Standard
Trust Total
Q1*
Trust Total
Q2*
Trust Total
Q3
Trust Total
Q4
Annual
(09/10)
1
2
3
4
5
6
7
8
9
10
Ward
mean
3.4
3.3
3.4
3
2.9
3.6
2.8
2.8
3.3
2.5
3.1
3.7
3.6
3.4
3.1
3
3.7
2.9
3
3.4
2.5
3.2
3.7
3.6
3.8
3.5
3
3.8
2.9
3.2
3.6
2.8
3.4
3.9
3.5
3.7
3.2
2.8
3.9
3
3.2
2.8
2.5
3.3
3.7
3.5
3.6
3.2
2.9
3.8
2.9
3.1
3.3
2.6
3.3
* Trust Totals for Quarters 1 and 2 are for Adult Acute wards only.
The focus of the audit overlap with the priorities developed for the Quality Accounts, as
such, the Trust is determined to improve the way service users perceive their care and
treatment.
Priority Three: Adult Community Services
Improvements in clinical leadership, responsiveness and timeliness of assessment
and brief treatment interventions, through delivery of the community review’s
implementation plans.
Overall, the Trust is achieving 91.5% assessments of new referrals to Trust community
teams (CMHTs) within 28 days, against a challenging 95% target.
% of Patients referred receiving an assessment within 28 days 1
Directorate
City and
Hackney
Tower
Hamlets
Newham
Q2
Target
Adult Services
Q1
Adult Services
Q2
Adult Services
Q3
Adult
Services
Q4 Estimate
95%
88.4%
80.8%
82.0%
83%
95%
87.2%
69.2%
77.0%
83%
95%
98.8%
96.2%
95.1%
97%
The Trust finds these levels unacceptable. Consequently, improvement plans have been
put in place to address target performance and are monitored on a monthly basis. This
priority has been retained for the 2010/11 Quality Accounts.
1
PCT KPI Reference 114
19
Adult Community Review
The London Borough of Tower Hamlets has only recently agreed the new arrangements.
However, the Trust began implementation to create the new teams and these were in place
by the end of January 2010.
Improve the implementation and quality of adult CPA
Assessment of care plans in date takes place monthly and is audited every six months to
assess compliance with policy, with the last audit undertaken in November. Overall
performance across the Trust is estimated to be just below the 95% target.
% of NEW CPA CMHT patients having care plan within date
(Snapshot at Quarter/Period End - Target 95%)
Target
2009/10
Q1
2009/10
Q2
2009/10
Q3
2009/10
Q4 Estimate
95%
91.3%
96.3%
90.1%
91%
95%
92.3%
94.2%
91.8%
95%
Newham
95%
92.6%
95.8%
97.5%
97%
Trust Total
95%
92.1%
95.4%
93.3%
94%
Directorate
City and
Hackney
Tower
Hamlets
Introduction of service user community surveys
To date Newham community care forums has agreed and is currently piloting a service
user satisfaction survey of community services. Community care forums have yet to be
established in the other localities. A paper to discuss the use of an Electronic Audit Tool to
capture and process the survey data will be submitted to the Service Delivery Board
shortly. This is likely to include a similar approach to the recording of inpatient views.
Priority Four:
Physical Healthcare
As part of the Trust’s Physical
Healthcare and Wellbeing Strategy, we
have
employed
three
physical
healthcare nurses during the year
however, on review by the Service
Delivery Board we will be employing
GPs with special interest in mental
health to provide two clinical sessions
per week on wards in each borough. A
similar service already exists in the
Trust’s Forensic service. This service
will be provided by the GP and Primary
Care Leads within the Newham
Community and Health services and
will start within the first Quarter of this
year.
20
Priority Five:
Carers Services
Implementation of the Trust’s Carers’ Plan, in conjunction with the Carers’ Network,
continues, with identified carers being recorded on the RiO IT system and provided with an
information leaflet and letter outlining their rights for an assessment and the local services
within each borough.
In addition, the three locality services have undertaken significant work on offering
assessments for carers to achieve the target of a 30% increase in the number of
assessments.
Carers’ assessments –
Total number of carers’
assessments carried out
Mar 2010 YTD Target
City &
Hackney
Newham
Tower
Hamlets
TRUST
TOTAL
139
499
663
1301
Mar 2010 YTD Estimates
170
240
635
1045
Total above/(below) target
31
(259)
(28)
256
Priority Six: Learning from Incidents, SUIs, Homicides and Serious Case Reviews
(SCRs)
Improved management of SUIs, SCRs and action planning
The Trust continues actively to manage the SUI process, to discover the facts in serious
incidents, why these occur and what can be done to prevent the recurrence of similar
events in future. The Trust implements action plans drawn from recommendations and
shares the lessons to be learnt via local and Trust wide seminars.
The Assurance Department continues to work on the DATIX reporting system to simplify its
use for reporters. The system has now been programmed to send notifications to
consultants whenever an incident relating to their patient is reported. The consultant can
then view the details of the report and put remedial measures in place accordingly.
Regular reviews and audit to ensure that learning is embedded within clinical
practice
There are a number of work streams in place, i.e.:
•
The Trust has a quarterly ‘Lesson learning’ seminar. In December 2009, the
seminar was attended by over 50 staff across all professions. Focusing on
Safeguarding Children and Serious Case Reviews, presenters included the
Independent Chair for Newham LSCB, Consultant Psychiatrist-CAMHS, the
Associate Director for Safeguarding Children and members of the Trust Board. In
March 2010, a seminar was held specifically for medical staff and over 40
consultant psychiatrists attended this event. The next ‘Lesson learning’ seminar
with East London PCTs is scheduled for June 2010.
•
The Trust Lead Nurse for SUI and Quality Assurance attends all level 1a post
investigation feedback sessions, to ensure effective sharing of investigation
outcomes.
•
The monthly Trust SUI update is made available to East London PCTs and the
Trust presents incident themes at the quarterly joint meeting. The PCTs intend
also to set up a dedicated regular meeting to assist progress reporting and
dissemination of learning.
21
Ensure that levels of violence and aggression amongst patients and staff are
minimised
There was an increase in violence and aggression incidents from 185 at the end
of February to 211 in March 2010. The Assurance Department provides a weekly report on
violence and aggression related incidents to the working group.
In Quarter 4, 708 frontline inpatient staff were trained in the prevention and management of
violence and aggression [PMVA], more than double the number from the previous quarter
(Q3, 344).
At the time of reporting, 60% of frontline staff had attended an appropriate level of PMVA
training. In relation to inpatient wards, this represents 47% for Adults, 36% for Mental
Health Care of Older People, 64% for Forensic and 45% for the Centre for Adolescent
Health Care (Coborn Unit).
The Trust continues to review this and is setting up a working group to look at more
innovative ways of tackling this.
3.2 An explanation of which stakeholders have been involved
The rationale and details for each priority were developed in co-ordination with senior
clinical and management staff across each of the service delivery areas. The proposed
priority areas were also reviewed and appraised by the Trust Members Council and Service
User groups. These discussions form part of an ongoing dialogue about the quality of our
services and are intended to make the Quality Accounts process as practicable as
possible, whilst allowing for the realities of good practice.
3.3 Statements from lead commissioning PCT – Tower
Hamlets
East London and the City Alliance (NHS Tower Hamlets, NHS Newham and NHS City and
Hackney) welcomes the opportunity to provide this statement on East London NHS
Foundation Trust’s Quality Account. We confirm that we have reviewed the information
contained with in the Account and checked this against data sources where this is available
to us as part of existing contract/performance monitoring discussions and is accurate in
relation to the services provided.
We have reviewed the content of the Account and
confirm that this complies with the prescribed information, form and content as set out by
the Department of Health. We believe that the Account represents a fair, representative
and balanced overview of the quality of care at East London NHS Foundation Trust. We
have discussed the development of this Quality Account with East London NHS Foundation
Trust over the year and have been able to contribute our views on consultation and
content. This Account has been reviewed within East London and the City Alliance by
colleagues in sector commissioning, clinicians, public health, as well as specialists in
infection control and safeguarding. As the lead commissioner for mental health services
across the East London Sector, NHS Tower Hamlets has coordinated the responses. We
confirm that this Account has also been shared with our local LINks and they have had the
opportunity to comment. NHS Tower Hamlets has formally presented the Account and this
supporting statement at their Commissioning Executive Committee.
NHS Tower Hamlets has been implementing a model of quality assurance over the last
year, this has included a process for reviewing quality as well as developing a range of
22
metrics across four domains of quality; patient experience, safety, effectiveness and
organisational integrity. We have complimented this approach with quality assurance visits
to East London NHS Foundation Trust over the last year. The visits have offered a more
interactive and engaged approach to quality assurance for both the commissioner and
provider, observation of the care environment and the patient experience is a very useful,
practical and visual method of triangulating the evidence and giving assurance that
standards are being met.
Overall we welcome the vision described with the Quality Account, agree on the priority
areas and will continue to work with East London NHS Foundation Trust to continually
improve the quality of services provided to patients.
3.4 Statements from Tower Hamlets Local Involvement
Network (on behalf of East London Local Involvement
Networks)
Priorities
LINKs agree that priorities targeted at improving the first contact period with users are key
to improving user experience. However this focus must set in place the mechanisms and
support to drive quality improvements throughout the whole patient experience. LINks will
use the results of the service user audits and feedback to assess improvements over the
duration of a users contact with Trust service.
Staff
Users feel there is a high staff turnover and a high use of bank staff. Staff are not given
enough guidance and support and there is lack of, or poor quality, supervision. We’d like to
see better processes for user input into staff performance and easier systems for
dismissing poor performing staff.
Will administrative support to clinical staff be improved to ensure it does not compromise
their ability to function?
The lack of activities for patients is still a problem perhaps contributing to a rise in
aggressive incidents as boredom creates tension between patients. There is some sense
that activities are available but there are barriers to attendance e.g. doctors using rooms,
nurses not having the time to escort patients to activities.
Users
Service users need to be given more involvement in setting targets not simply monitoring.
We would like to see user groups supported to understand and contribute to the Quality
Accounts next year starting with the publication of this document. Community Care Forums
are not operating effectively across all boroughs and need more commitment and
resources from the Trust.
Care Plan Approach (CPA)
We are pleased to see that CPA is firmly embedded in the Trust. Some service-users do
not understand when they should have a care plan, what it is, and do not feel adequately
involved in the CPA process. There is concern that some people from black and ethnic
minority (BME) communities do not understand their Care Plans due to the unavailability of
interpreters who can explain the issues.
Data, Targets and performance progress
23
Statistical data needs to be augmented and disaggregated for all boroughs. More
information is needed on how targets will be met. Will this involve an increase in staffing or
a decrease in patients seen and services provided? Where the required level of service has
not been met, information is required on the penalties in place, or incentives offered to
improve performance. Waiting periods are too long and targets too low for Community
Adults Services and Older Adult Services. One in five patients are not seen within 28 days.
Targets are being set to improve the amount of data gathered as opposed to improve
service performance. Clear progress needs to be demonstrated in providing access to
talking therapies. There is no mention of the psycho-trauma department at Barts.
There is potential overlap and debate around the most valid data collection method. Leads
for each audit process should come together to agree comparative question formats and
priority areas. BME communities may not respond to CAT surveys ethnicity data should be
monitored.
Integrated Care
We would like to see a more integrated care approach to treatment linked to housing,
employment, social needs, benefits and physical health.
3.5 Statements from Tower Hamlets Overview and Scrutiny
Committee
No statement was received at the time of finalising the Quality Accounts.
3.6 An explanation of any changes made
The feedback from the various stakeholders has been positive. There was a general
agreement of the overall focus and that the priorities for improvement are the right ones. As
a consequence of the review process the Quality Accounts Report has been modified to
include additional contextual information which the stakeholders felt would enhance the
readability of the document, and the emphasis on service user and carer involvement in the
appraisal of quality assessment. The Trust welcomes this feedback, and, as a result of the
process, new ideas and opportunities for collaboration have been developed. We will work
with our commissioners, Local Involvement Networks and other stakeholders in order to
further develop and improve our Quality Accounts over the coming year.
3.7 Feedback
If you would like to provide feedback on the report or make suggestions for the content of
future reports, please contact the Trust Secretary, Mr Mason Fitzgerald on 0207 655 4000.
GLOSSARY
24
Term
Admission
Assessment
Definition
The point at which a person begins an episode of care, e.g. arriving at an
inpatient ward.
Assessment happens when a person first comes into contact with health
services. Information is collected in order to identify the person’s needs
and plan treatment.
Black and minority
ethnic (BME)
People with a cultural heritage distinct from the majority population.
Boorman Review
The review recognises that in order to provide high quality care, the NHS
needs healthy staff and high quality workplaces.
Care Co-ordinator
A care co-ordinator is the person responsible for making sure that a
patient gets the care that they need. Once a patient has been assessed as
needing care under the Care Programme Approach they will be told who
their care co-ordinator is. The care co-ordinator is likely to be community
mental health nurse, social worker or occupational therapist.
Care pathway
A pre-determined plan of care for patients with a specific condition
Care plan
A care plan is a written plan that describes the care and support staff will
give a service user. Service users should be fully involved in developing
and agreeing the care plan, sign it and keep a copy (see Care Programme
Approach).
Care Programme
Approach (CPA)
The Care Programme Approach is a standardised way of planning a
person’s care. It is a multidisciplinary (see definition) approach that
includes the service user, and, where appropriate, their carer, to develop
an appropriate package of care that is acceptable to health professionals,
social services and the service user. The care plan and care co-ordinator
are important parts of this (see Care Plan and Care Co-ordinator).
Care Quality
Commission (CQC)
The Care Quality Commission is the independent regulator of health and
social care in England. They regulate care provided by the NHS, local
authorities, private companies and voluntary organisations.
Case Note Audit
An audit of patient case notes conducted across the Trust based on the
specific audit criteria outlined by CQC.
Child & Adolescent
Mental Health
Services (CAMHS)
CAMHS is a term used to refer to mental health services for children and
adolescents. CAMHS are usually multidisciplinary teams including
psychiatrists, psychologists, nurses, social workers and others.
CAMHS Outcome
Research
Consortium (CORC)
CORC aims to foster the effective and routine use of outcome measures
in work with children and young people (and their families and carers) who
experience mental health and emotional wellbeing difficulties.
Client Assessment
of Treatment (CAT)
The CAT is a widely used and validated questionnaire assessing different
aspects of hospital treatment. Each item is rated from 0, not at all, to 10,
yes entirely; mean score of all items used.
Community care
Community Care aims to provide health and social care services in the
community to enable people to live as independently as possible in their
own homes or in other accommodation in the community.
Community mental
health team (CMHT)
Darzi Review
A multidisciplinary team offering specialist assessment, treatment and
care to people in their own homes and the community.
The Darzi ‘NHS Next Stage’ Review sets out the government’s plans for
NHS reform in England over the next 10 years. Its principal focus is on
driving up the standards of quality in health care and putting clinicians at
the heart of change.
25
Discharge
The point at which a person formally leaves services. On discharge from
hospital the multidisciplinary team and the service user will develop a care
plan. (see Care plan)
East London NHS
Foundation Trust
(ELFT)
East London NHS Foundation Trust provides a wide range of community
and inpatient mental health services to the City of London, Hackney,
Newham and Tower Hamlets. Forensic Services are also provided to
Barking & Dagenham, Havering, Redbridge and Waltham Forest.
General practitioner
(GP)
A family doctor who works from a local surgery to provide medical advice
and treatment to patients registered on their list
Info & feedback form
Brief introductory form containing essential information for each newly
admitted patient. The form will also direct patients to the Welcome Pack
(see below) and have a brief feedback section which can be completed by
the patient.
Multidisciplinary
Multidisciplinary denotes an approach to care that involves more than one
discipline. Typically this will mean that doctors, nurses, psychologists and
occupational therapists are involved.
Named Nurse
This is a ward nurse who will have a special responsibility for a patient
while they are in hospital.
National Institute of
Health Research
(NIHR)
The goal of the NIHR is to create a health research system in which the
NHS supports outstanding individuals, working in world class facilities,
conducting leading edge research focused on the needs of patients and
the public.
(NCI / NCISH)
The National Confidential Inquiry into Suicide and Homicide by People
with Mental Illness (NCI / NCISH) is a research project which examines all
incidences of suicide and homicide by people in contact with mental health
services in the UK.
Patient Advice and
Liaison Service
(PALS)
Prescribing
Observatory for
Mental Health
(POMH-UK)
The Patient Advice and Liaison Service offers patients information, advice,
and a solution of problems or access to the complaints procedure.
POMH-UK is an independent review process which helps specialist
mental health services improve prescribing practice.
Primary Care
Collective term for all services which are people’s first point of contact with
the NHS. GPs, and other health-care professionals, such as opticians,
dentists, and pharmacists provide primary care, as they are often the first
point of contact for patients
Primary Care Trust
(PCT)
Statutory NHS bodies with responsibility for delivering healthcare and
health improvements to their local areas. They commission or directly
provide a range of community health services as part of their functions
Quality accounts
RiO
Service user
Welcome Pack
Quality Accounts aim to enhance accountability to the public and engage
the leaders of an organisation in their quality improvement agenda.
The electronic patient record system which holds information about
referrals, appointments and clinical information.
This is someone who uses health services. Other common terms are
patient, service survivor and client. Different people prefer different terms.
The patient Welcome Pack is a document designed at providing
information around a range of issues including the service, staff,
medication and legal matters.
26