Humber
NHS Foundation Trust
Humber Mental Health
Teaching NHS Trust
Humber NHS Foundation Trust
(Foundation Trust status awarded 1st February 2010)
QUALITY REPORT
2009-10
Contents
Quality Statement
4
Our Trust Values
5
Q.1 Trust Quality Assessment
6
Q.1.1 Historic and current view of the Trust’s position
for delivering high quality care
6
Q.1.2 Overview of governance arrangements
7
Q.1.3 How we have prioritised our quality
improvement initiatives
7
Q.1.4 Our 2009/10 selected priorities and proposed
initiatives updates
8
Priority 1: Same Sex Accommodation
9
Priority 2: PEAT (cleaning, food and infection control)
10
Priority 3: 7 Day Follow-up
11
Priority 4: Delayed Discharges
12
Priority 5: Gatekeeping/Single Point of Access
13
Q.1.5 How did we review our services
14
Comments from our Commissioners and
other key stakeholders
19
Example Quotes from patients and carers
22
Q.1.6 Looking forward 2010/11
23
Glossary
28
Quality Statement
During 2009/10 Humber NHS Foundation Trust provided mental health,
learning disability and addiction services for children, adults and older
people across the City of Hull and the East Riding of Yorkshire. We also
provided forensic services to patients from the wider Yorkshire and Humber
area. Our income in 2009/10 was £83.9 million and as at 31 March 2010 we
had 1611.94 whole time equivalent staff in post.
During 2009/10 monthly reports on the Trusts
performance against national and local quality
indicators were reported to the Trust Board, these
public reports provided the Trust Board with up
to date and accurate information on the quality
of care delivery across our services.
These Board level reports are part of a three tier
performance management system which runs
from “Ward to Board” and ensures that high
quality care is at the heart of all we do.
We also recognise that, in order to offer assurance
to patients that we provide high-quality care, we
must be able to demonstrate, through quality
reporting, that we have high levels of reported
patient satisfaction, services that are as safe as
possible, and clinical outcomes that are higher
than the national average.
In 2008/09 the Trust published its first quality
accounts and set five priorities for quality
improvement for 2009/10 and has been reporting
progress monthly to the Trust Board.
These quality accounts represent our achievements
for 2009/10 and following consultation with
stakeholders, set our priorities for 2010/11.
The Trust was successful in gaining Foundation
Trust status on the 1st February 2010 and
therefore this document represents our final quality
account as a NHS Trust and our first Quality Report
as a Foundation Trust.
• That we are proud that feedback from patients
tells us that they are largely satisfied with our
services.
• That we rank highly in national league tables,
for example patient and staff experience.
• That over the past year, we have made some
significant quality improvements: successfully
improving privacy and dignity for our patients.
• That we have also made great progress in the
prevention and control of healthcare-associated
infections.
Along with improving the quality of care for our
patients, we also want to be an organisation
where staff feel recognised and rewarded. We
want staff to work within an environment where
they are able to provide the highest quality of care
possible.
We recognise that there will always be challenges
to meet and will continue to strive for the highest
quality in all care provided, putting our patients
at the heart of everything we do.
The information contained in this document has
been subject to robust internal review and, where
applicable external verification. Therefore, to the
best of my knowledge these accounts are a true
and accurate reflection of the quality of care we
deliver to the communities we serve.
The document outlines:
• Increased accountability to the public for quality,
explaining the quality of the care we offer and
how we are seeking to improve and engage the
Trust Board in leading the quality agenda.
4
QUALITY REPORT 2009 to 2010
Humber Mental Health Teaching Trust • Humber NHS Foundation Trust
David Snowdon
Chief Executive
June 2010
Our Trust Values
Underpinning all of our work with patients and carers is the commitment
to uphold the values and principles of the NHS.
These are:
VALUE
IMPACT
Compassion
We will make sure we take the time to listen and
understand
Respect and Dignity
We will ensure people are treated as individuals, in
environments where their dignity is maintained
Commitment to the
quality of care
By getting the basics right we will maintain and improve
the quality of care
Improving lives
We will strive to deliver continuous quality improvement,
improving peoples' health and wellbeing. We will
promote activities that make a positive impact on the
'work life balance' of our staff
Working together for
patients
We will work with partners across organisational
boundaries to improve user and carer experience
Everyone counts
We will maintain clear focus on people as well as services
All of the above support delivery of our vision to improve the health and wellbeing of the communities we serve.
Humber Mental Health Teaching Trust • Humber NHS Foundation Trust
QUALITY REPORT 2009 to 2010
5
Q.1 Trust Quality Assessment
Q.1.1
Historic and current view of Trust’s position for delivering high quality care
The Care Quality Commission (CQC), formerly the
Healthcare Commission, undertakes an annual
health check.
This quality account has reviewed the CQC
assessment 2008/09 results and has compared
with previous years and with other mental health
trusts in the Yorkshire and the Humber Strategic
Health Authority.
Our Trust was rated ‘excellent’ for quality of
services and ‘good’ for the use of resources for
the second year running based on performance
in 2008/09.
These results place our Trust alongside the best
performers locally, regionally and nationally.
6
QUALITY REPORT 2009 to 2010
As part of the East Coast Audit Consortium’s
2009/10 annual plan for the Humber NHS
Foundation Trust, a review has been performed
to ensure that the Trust has a robust system for
demonstrating compliance with the Standards for
Better Health, and that there are effective reporting
mechanisms in place to fully evidence the midyear declaration for 2009/10.
The East Coast Audit Consortium have offered
significant assurance that the Trust has developed
and implemented a robust system for
demonstrating compliance with the Standards for
Better Health, and has a clearly auditable and
linked process. The East Coast Audit Consortium
sample testing of seven standards indicated that
within the Trust there is a sufficient body of
documentary evidence to support the Trust’s fully
met annual declaration for 2009/10.
Humber Mental Health Teaching Trust • Humber NHS Foundation Trust
Q.1 Trust Quality Assessment
Q.1.2
Overview of governance
arrangements
Q.1.3
How we have prioritised our quality
improvement initiatives
The keys to effective governance within the Trust
are robust integrated committee structures and
management processes, which give the Board of
Directors confidence that all risks are being
effectively controlled and managed and that
attention is focused on the core business of the
organisation to care for and treat patients.
To determine these priorities, we reviewed our
clinical performance against Key Performance
Indicators for the year. Through a series of reviews
we assessed each initiative in terms of:
The Board committee structure is evaluated for
effectiveness on an ongoing basis by the Board
of Directors and committee members.
• impact on improving quality through considering
the likely improvement in safety, clinical outcomes
and experience
• feasibility, in terms of the ease of
implementation, resources required and likely
time to completion or delivery
Clinical Governance Strategy
We have an established Clinical Governance
strategy supporting high quality care, which is
underpinned by compliance with the Health Care
Standards. This strategy provides a vision for the
strategic development of Clinical Governance
throughout the Trust and helps demonstrate its
direction in the next three years towards the
delivery of excellent mental health and learning
disability services for both our patients and carers.
Humber Mental Health Teaching Trust • Humber NHS Foundation Trust
QUALITY REPORT 2009 to 2010
7
Q.1 Trust Quality Assessment
Q.1.4
Our 2009/10 selected priorities and proposed initiatives updates
Our Trust uses a “Traffic Light” system to report
on performance and on the quality of services,
e.g. Green = Good, Amber = Fair and Red = Weak.
This is translated to reflect the organisation’s
performance on the selected priorities and
initiatives.
To achieve quality performance our traffic light
system has allowed our Trust to:
Priority 1:
Single Sex Accommodation
Priority 2:
PEAT (cleaning, food and infection control)
Priority 3:
• monitor critical clinical processes and activities
using metrics of clinical and corporate
performance that trigger alerts when potential
problems arise
7 day follow-ups to patients following discharge
from an inpatient stay
• analyse the root cause of problems by exploring
relevant and timely information from multiple
perspectives and at various levels of detail
Priority 5:
• manage people and processes to improve
decisions, optimise performance, and steer the
organisation in the right direction.
8
The following were the priorities and updates for
2009/10
QUALITY REPORT 2009 to 2010
Priority 4:
To prevent delays in discharge from inpatient stays
Gatekeeping/Single Point of Access to ensure a
multi-disciplinary Approach to admission to an
inpatient ward
Humber Mental Health Teaching Trust • Humber NHS Foundation Trust
Priority 1:
Single Sex Accommodation
Description of issue and rationale for
prioritising:
Further information on our work to
deliver same sex accommodation
All Trusts must be compliant with the same sex
accommodation requirements by 2010 including
the Department of Health minimum standards of:
Every patient has the right to receive high quality
care that is safe, effective and respects their privacy
and dignity. The Humber NHS Foundation Trust
is committed to providing every service user who
is receiving services within our inpatient units with
same sex accommodation, because it helps to
safeguard their privacy and dignity when they are
often at their most vulnerable.
• no shared sleeping accommodation
• no shared toilets
• patients do not have to pass through opposite
sex facilities to access their own
Aim/Goal:
To ensure that our Trust is compliant by 2010.
The majority of our inpatient services are provided
within single bedded rooms. Where patients have
to share a room this will be with members of the
same sex, and same sex toilets and bathrooms
will be close to their bed area.
Position as at 31/03/2010
Lounges for ‘women only’ use are available on all
of our inpatient units on request.
All our inpatient units are fully compliant. However,
the Trust not only wants to meet the target, but
to exceed it, therefore it acknowledges that further
work is required at Townend Court to enhance
the facilities provided to our learning disability
inpatients.
Looking back to 2009/10, how have we
measured success?
By seeking the views of people who have used
Humber NHS Foundation Trust inpatient services.
The Trust carried out regular patient surveys to
ensure that the standards have been maintained.
We have regularly updated the Trust Board on
how our inpatient services are viewed by patients
in terms of privacy and dignity issues. These reports
have been published on our website.
Humber Mental Health Teaching Trust • Humber NHS Foundation Trust
QUALITY REPORT 2009 to 2010
9
Priority 2:
PEAT (cleaning, food and infection control)
Description of issue and rationale for
prioritising:
The Clean Hospitals Programme has been
implemented and monitored by the Patient
Environment Action Team (PEAT) and involves
patients and carers. For this year the programme
has been adapted to reflect the changing
expectations of patients, the way the NHS is
organised and to ensure that the results of the
programme provide an accurate picture of the
standards that should be achieved.
Aim/Goal:
To maintain and improve on previous PEAT scores.
Position as at 31/03/2010
Our focus in 2009/10 was on cleanliness. Although
this was not a mandatory requirement, the Trust
completed 90% of deep cleans, excluding the
forensic units. Within the forensic units, a limited
deep clean has taken place due to building works.
We have undertaken a full analysis of all PEAT
assessments. The data gathered guides the Trust
in producing 2009/10’s “Clean Hospital
Programme”.
To support this programme, the total capital
allocation awarded to address Privacy and Dignity
standards, including same sex accommodation,
was £253,500.
At December 2009, the Trust was reporting two
units which were attaining unacceptable overall
scores. Following proactive activity, we can now
confirm that one of these units is reported as
“very good” with a PEAT score of 95% and the
other unit reported as “acceptable” with a PEAT
score of 90% ensuring that the Trust is fully
compliant with the Clean Hospital Programme.
Looking back to 2009/10, how have we
measured success?
By seeking the views of people who use Humber
NHS Foundation Trust inpatient services.
The Trust has regularly surveyed the patients of
inpatient units to ensure that the standards of
food and cleanliness are maintained or improved.
10
QUALITY REPORT 2009 to 2010
Humber Mental Health Teaching Trust • Humber NHS Foundation Trust
Priority 3:
7 Day Follow-up
Description of issue and rationale for
prioritising:
Position as at 31/03/2010
Supported by the evidence set out in the National
Suicide Prevention Strategy for England (Professor
Louis Appleby 2002), it is recognised that anybody
being discharged from inpatient care should be
contacted by a mental health professional, either
face to face or by telephone, within seven days
of that discharge.
For Quarter 4 the 7 day follow up rate Trustwide
was 100%. The graph below shows that the Trust
has achieved a 100% follow up rate for seven
months of the last financial year (09/10) and has
consistently achieved or been above the national
target of 95% for the other five months.
Looking back to 2009/10, how have we
measured success?
Aim/Goal:
To ensure that everyone who is discharged from
our inpatient care is followed up within the required
criteria.
Exceptions to this are:
• people who die within seven days of discharge
• where legal precedence has forced the removal
of a patient from the country
• patients discharged or transferred to other NHS
hospital for psychiatric treatment
In July 2009 the Performance Team implemented
a more robust pro-active process for the tracking
of discharges and 7 day follow-ups. This, along
with the standard that all patients should be seen
face to face within seven days of discharge and
that telephone contact should only be used as last
resort, has had a positive impact by increasing the
Trustwide average 7 day follow-up rate from
95.02% (April 08 to March 09), 0.02% above the
national target, to 98.73% (April 2009 to March
2010) which is 3.73% above the national target.
Trustwide Figures for 7 Day Follow-up
2008/09 - 2009/10
102%
100%
98%
96%
94%
92%
90%
88%
86%
84%
82%
Apr-09 May-09 Jun-09 July-09 Aug-09 Sept-09 Oct-09 Nov-09 Dec-09 Jan-10
Feb-10 Mar-10
Target
95%
95%
95%
95%
95%
95%
95%
95%
95%
95%
95%
95%
2008/09
98%
89%
94%
95%
93%
96%
96%
96%
97%
96%
96%
95%
2009/10
100%
95%
96%
97%
100%
98%
100% 100%
98%
100% 100% 100%
Humber Mental Health Teaching Trust • Humber NHS Foundation Trust
QUALITY REPORT 2009 to 2010
11
Priority 4:
Delayed Discharges
Description of issue and rationale for
prioritising:
In the last quarter of 2008/9 our Trust was 2%
above the national measure of 7.5%. Our traffic
light rating for this period was weak and there
was an expectation that delays in discharges would
be kept to a minimum.
Aim/Goal:
To reduce the number of delayed discharges in
the Trust below the national key performance
indicator set of 7.5%.
Position as at 31/03/2010
In Quarter 4 of 2009-10 our Trust had an overall
delayed discharge rate of 6.16%, this being a
favourable 1.34% below the national target of
7.5%.
As Care Quality Commission only examines delayed
discharges where NHS provision is the delaying
factor, this reduced the figure significantly to show
the Trust as being a favourable 3.98% below the
national measure of 7.5%.
Looking back to 2009/10, how have we
measured success?
As part of a transition programme, over 2009/10
Humber NHS Foundation Trust has worked in
collaboration with a local private provider who
offers long term care for older people and for
patients no longer requiring treatment within an
NHS hospital.
Four patients in our older people’s services who
were classified as "Delayed Discharges” have now
been successfully transferred to more suitable
accommodation. As a Trust we are still working
collaboratively with the private sector to maintain
high quality of care.
Delayed Discharge Figures 2009/10
12%
10%
8%
6%
4%
Target
2%
0%
Apr-09 May-09 Jun-09 July-09 Aug-09 Sept-09 Oct-09 Nov-09 Dec-09 Jan-10
12
QUALITY REPORT 2009 to 2010
Humber Mental Health Teaching Trust • Humber NHS Foundation Trust
Feb-10 Mar-10
Priority 5:
Gatekeeping/Single Point of Access
Description of issue and rationale for
prioritising:
To comply with Mental Health Policy
implementation guidance Crisis Resolution Home
Treatment (CRHT) must ensure that all admissions
to an inpatient unit have a Gatekeeping assessment
(an admission has been gate kept when a multidisciplinary decision includes CRHT staff agreeing
that home treatment is not a suitable alternative).
Aim/Goal:
90%
Gatekeeping Assessments
This is the role CRHT teams play in deciding who
needs to be treated in hospital and who can be
treated at home. In the initial assessment by the
team, additional information is sought, with patient
permission, from family and friends to gain a full
picture of how mentally ill the person is and the
risk they present to themselves and/or others.
Following assessment, the community services
then review where best that patient’s needs can
be met.
Looking back to 2009/10, how have we
measured success?
Position as at 31/03/2010
We have looked at performance data from the
existing Single Point of Access Service in Hull with
a view to implementing this model in the East
Riding Business Unit.
100%
Single Point of Access
This service is accessed by patients at the start of
their mental health journey (ease of access) and
quickly refers callers to the most appropriate NHS
resource. In such circumstances “appropriate”
means the service best able to clinically meet
patient needs in a timely manner.
Gatekeeping Figures 2009/10
102%
100%
98%
96%
94%
92%
90%
88%
Apr-09 May-09 Jun-09 July-09 Aug-09 Sept-09 Oct-09 Nov-09 Dec-09 Jan-10
Feb-10 Mar-10
Humber Mental Health Teaching Trust • Humber NHS Foundation Trust
QUALITY REPORT 2009 to 2010
13
Q.1 Trust Quality Assessment
Q.1.5
How did we review our services
The Trust provides services for Mental Health,
Learning Disability and Addictions specialties/areas.
For 2009/10 the Trust has undertaken 29 service
reviews. The data from these audits has been
presented and discussed at relevant committees,
clinical networks and clinical teams who have
reviewed the available data on the quality of care
in their sections of these specialties/areas.
The Trust has undertaken specific reviews in the
following areas;
Working Age Adult
8
Older People
2
Addictions
5
Children’s
5
Learning Disability
2
All Service Areas
7
TOTAL
29
The relevant committees and clinical networks
have used the results of these reviews to develop
plans for improving the quality of the Trust’s
services.
The Trust has robust governance arrangements in
place to manage any adverse incidents. For this
reporting period we have undertaken 30 serious
untoward incident (SUIs) investigations and 14
management reviews. Outcomes found during
these investigations have been shared with all
relevant parties and any lessons learnt are acted
upon.
Information on participation in
clinical audits
The Trust was eligible to participate in three national
clinical audits and related clinical quality data
collection programmes, such as national
confidential enquiries, covering services it provides.
The full list of potential audits and those the Trust
participated in can be provided on request.
In relation to the Trust’s participation:
• The Trust participated in two out of three of the
national clinical audits for which it was eligible.
• The Trust undertakes a programme of local audit
on clinical performance which is reported to the
Trust Board.
14
QUALITY REPORT 2009 to 2010
Humber Mental Health Teaching Trust • Humber NHS Foundation Trust
Q.1 Trust Quality Assessment
Information on participation in
clinical research
The number of patients recruited in the previous
year to clinical research (that is, research approved
by a Research Ethics Committee) was 501. 66
were recruited to National Institute for Health
Research (NIHR) Projects. 435 were recruited to
studies conducted by Psychology Students
employed by the Trust.
The Trust has an ongoing programme of care
review activity for 2010/11, and the Trust has
commissioned a programme of themed reviews
covering all speciality areas, which will be reported
on in our next Quality Accounts.
Information on what others say
about our Trust
The following is an overview of the quality and
resources provided by our Trust based on
performance in 2008/9 against the Care Quality
Commission indicators (CQC).
Historic & Current view of Trust’s position
for delivering high quality care
Financial
Year
HCC
Quality
HCC
Resources
2005/06
Fair
Fair
2006/07
Fair
Good
2007/08
Excellent
Good
2008/09
Excellent
Good
2009/10
Pending
Pending
(October 2010)
(October 2010)
Humber NHS Foundation Trust is required to
register with the Care Quality Commission and its
current registration status is fully compliant. The
Care Quality Commission has not taken
enforcement action against Humber NHS
Foundation Trust during 2009/10.
The most recent periodic review carried out by
the CQC made the following conclusions for the
second year running our Trust was rated
“excellent” for quality of services and “good” for
the use of resources.
Humber NHS Foundation Trust has not participated
in any special reviews or investigations by the CQC
during the reporting period.
These results place our Trust alongside the best
performers locally, regionally and nationally.
Humber Mental Health Teaching Trust • Humber NHS Foundation Trust
QUALITY REPORT 2009 to 2010
15
Q.1 Trust Quality Assessment
16
Information on the National Patient
Survey
Information on the quality of data
The National Patient Survey enables Trusts to
benchmark themselves against other mental health
trusts. The data in the following table, as published
in our Integrated Business Plan for Foundation
Trust status, was constructed from the National
Patient Survey question regarding rating of the
care received within the national parameters which
are “Excellent”, “Very Good”, “Good”, “Fair”,
“Poor” and “Very poor”. The table shows our
Trust as being the best performing mental health
trust in the Yorkshire and Humber Strategic Health
Authority in 2008. The results for 2009 will be
made available to the Trust in July/August 2010.
In 2009/10 the Trust submitted 1380 records to
the Secondary Uses System (SUS) service for
inclusion in the Hospital Episode Statistics (HES)
which are included in the latest published data.
The percentage of records which included the
patient’s valid NHS Number was 99.8%. The Trust’s
rate for clinical coding (for diagnosis) was 76.8%
and the percentage of records which included the
patient’s valid General Practitioner Registration
Code was 100%.
SHA
Comparators
2005/6
rating
2006/7
rating
2007/8
rating
2008/9
rating
Humber
Mental
Health
75
70
77
75
Bradford
Care Trust
71
71
66
70
Rotherham,
Doncaster,
S Humber FT
74
71
71
74
Leeds
Partnership FT
69
72
72
73
Sheffield Health
and Social
Care FT
67
65
72
68
QUALITY REPORT 2009 to 2010
Work is being undertaken in the coming year to
develop a more robust process for the managing
of corporate records with the implementation of
a Trust Information Management and Lifecycle
Policy.
Humber Mental Health Teaching Trust • Humber NHS Foundation Trust
Q.1 Trust Quality Assessment
The Information Governance Toolkit
Achievement Against Requirements
There is a mandatory requirement for the Trust to
submit an annual central return measuring its
performance in the following areas of information
governance:
The requirements in each initiative are assigned
to a lead officer. They have assessed the level of
attainment against their requirements, giving any
supporting evidence for these scores and describing
improvement plans to move to the next higher
level. The following table shows the Trust’s
performance against the requirements:
• Information Governance Management
• Confidentiality and Data Protection Assurance
• Information Security Assurance
• Clinical Information Assurance
• Secondary Use Assurance
Initiative
• Corporate Information Assurance
There are a total of sixty requirements across the
six areas of information governance (plus two that
have been deemed not relevant to this Trust) and
each requirement is rated from zero for no
compliance, to three for full compliance.
Performance is traffic lighted according to the
percentage achieved in each initiative as follows:
0 to 39%
RED
40% to 69% AMBER
70%+
GREEN
Results 2009/2010
Information Governance
Management
86%
(Green)
Confidentiality and Data
Protection Assurance
85%
(Green)
Information Security
Assurance
95%
(Green)
Clinical Information
Assurance
75%
(Amber)
Secondary Use
Assurance
53%
(Amber)
Corporate Information
Assurance
66%
(Green)
TOTAL
80%
(Green)
Humber Mental Health Teaching Trust • Humber NHS Foundation Trust
QUALITY REPORT 2009 to 2010
17
Q.1 Trust Quality Assessment
Commissioning for Quality and
Innovation (CQUIN)
CQUIN are measures which determine whether
we achieve quality goals or an element of the
quality goal. These achievements are on the basis
of which CQUIN payments are made.
2009/10 was the first year in which CQUIN was
implemented for mental health trusts, in this first
year the Trust was required to demonstrate its
ability to report on quality improvement and
innovation goals which were agreed between the
Provider and its Commissioners through the CQUIN
payment framework.
18
QUALITY REPORT 2009 to 2010
The Trust achieved this and was awarded a
maximum quality payment of £314,749, this is
broken down as follows:-
Commissioner
NHS Hull
Final CQUIN payments 2009/10
£149,987
Commissioner
NHS East Riding of
Yorkshire
Final CQUIN payments 2009/10
£117,772
Commissioner
NHS Barnsley
Final CQUIN payments 2009/10
£47,000
Humber Mental Health Teaching Trust • Humber NHS Foundation Trust
Comments from our Commissioners
and other key stakeholders
NHS Hull
I welcome the opportunity to review and comment
on the Draft Quality Report 2009-10 for Humber
NHS Foundation Trust.
I can confirm that, to the best of my knowledge
the report is a true and accurate reflection of the
quality of care delivered by Humber NHS
Foundation Trust and that the data and information
contained in the report is accurate.
Our joint commitment to continuous quality
improvement and learning lessons has led us to
restructure our formal contracting process so there
is a specific focus on quality. This allows us to
scrutinise issues of quality and outcomes with the
same rigour that contracting has previously
afforded to finance and performance.
The development of local scrutiny of serious and
untoward incidents allows us to monitor action
plans locally, collect evidence of lessons learnt and
revise specifications and services if necessary.
During the period covered by this report Humber
NHS Foundation Trust, NHS Hull and NHS East
Riding of Yorkshire accepted the findings of a joint
Independent Inquiry (SUI Reference 2005/95 and
SUI Reference 2003/1578) commissioned by
Yorkshire and the Humber Strategic Health
Authority. An action plan was produced which
addressed the recommendations from the
Independent Inquiry reports, and has been
thoroughly implemented.
As commissioners and provider we have had
significant input into the shaping of both regional
and local CQUIN schemes mentioned in the report
and will continue to set challenging targets in
order to provide incentives to improve services
and service user experience.
experience
Chris Long
Chief Executive
NHS Hull
Humber Mental Health Teaching Trust • Humber NHS Foundation Trust
QUALITY REPORT 2009 to 2010
19
Comments from our Commissioners
and other key stakeholders
NHS East Riding of Yorkshire
We would like to see a continuation of the positive
working between Humber NHS Foundation Trust
and NHS East Riding of Yorkshire to deliver
improved quality of patient care and the patient
experience.
It is encouraging to see local quality standards
(CQUINS) reflecting commissioner priorities within
the Quality Account. We would welcome further
developments in capturing the patient experience
to inform service delivery and how some of the
targets identified translate into improved outcomes
for patients.
Ivan Ellul
Chief Executive
NHS East Riding of Yorkshire
20
QUALITY REPORT 2009 to 2010
Humber Mental Health Teaching Trust • Humber NHS Foundation Trust
Comments from our Commissioners
and other key stakeholders
Hull Local Involvement Network (LINk)
Hull LINk welcomes the opportunity to comment
on the Trust’s Quality Accounts.
Since the LINk was set up a very constructive
relationship has been built up with the Trust,
enabling us to engage with the service to deliver
our key aim of improved services for patients.
In our view the document is representative and
provides comprehensive coverage of the Trust’s
services. It is encouraging that the Trust is meeting
the same sex accommodation requirements for
inpatients and also the seven day follow up for
discharged patients. We also welcome the progress
made in reducing delayed discharges. The
introduction of the Single Point of Access has been
a key development in the past year and we are
encouraged that the system is helping patients
reach the most appropriate NHS resource.
A major item on our work plan this year was our
enquiry into mental health services for young
people. This involved gathering information and
feedback from groups supporting young people
and a survey of people with experience of services.
Over 100 people and groups had their say on this
issue. Our resulting report included
recommendations around: improving transition
between children’s and adult’s services; involving
young people in how services are designed; and
improving publicity and awareness of services.
In response the Trust committed to formalise
protocols regarding transition between services,
including the single point of access services, interagency link team and the child and adolescent
mental health service. The Trust was able to highlight
a lot of activity to engage young people and made
us aware of a forthcoming overall service evaluation.
Jonathan Appleton
LINk Team Leader
Hull Local Involvement Network (LINk)
Humber Mental Health Teaching Trust • Humber NHS Foundation Trust
QUALITY REPORT 2009 to 2010
21
Our patients and carers say ...
Thank you for all your
support. I’ve reached the
light at the end of the
tunnel; you played a part
in that too.
A special thank you for the
support and reassurance
you have given to us.
Thanks for all your help and
support. My future is a lot
brighter now thanks to you.
Many, many thanks for all
of your help and support
whilst I was going through
a very difficult time.
22
QUALITY REPORT 2009 to 2010
Thank you so much for all
the care and support you
have given to R over the
last five years. We have
appreciated your hard work
and commitment as his key
worker and particularly
thank you for your efforts
in planning his transition.
I just wanted to write and
thank you for all of your
help when I came to see
you earlier last year. Before
speaking to you I had no
idea what was going on
inside of my head and no
clear image of who I was.
Through talking to you I
found myself and started
to love myself in a way that
I don’t feel many people
every get the luxury of.
Humber Mental Health Teaching Trust • Humber NHS Foundation Trust
Q.1 Trust Quality Assessment
Q.1.6
Looking forward 2010/11
Agreed quality performance 2010/11,
including:
An overview of the quality of care provided by
our Trust will be based on our performance in
2010/11 against the following indicators agreed
by the Trust Board following consultation with
key stakeholders.
Our indicator set includes:
Patient safety
Infection control
To ensure that all patients who are undergoing
any treatment or intervention in an inpatient or
outpatient setting are protected from the potential
and actual acquisition of healthcare associated
infections (HCAI).
Same sex accommodation
Clinical effectiveness
All Trusts must be compliant with same sex
accommodation requirements set out by the
Department of Health 2010 minimum standards.
Physical Health and Wellbeing
7 day follow-up
This is supported by evidence set out in the
National Suicide Prevention Strategy and it is
recognised that anyone being discharged from
inpatient care will be contacted within seven days.
To ensure that we as a Trust have clinical
performance procedures in place to ensure we
meet the physical health needs of those with
mental health needs and learning disabilities.
Access
To ensure all patients and carers have a clear
pathway in to services in the right time to meet
the right person to assess and treat identified
need.
Delayed discharges
Any identified patient who no longer requires
inpatient treatment with no alternative
accommodation will be registered or reported as
a delayed discharge. Each of these patients will
have an action plan to signpost them to suitable
accommodation as quickly as practicable.
Humber Mental Health Teaching Trust • Humber NHS Foundation Trust
QUALITY REPORT 2009 to 2010
23
Q.1 Trust Quality Assessment
Patient experience
Key national priorities
Assessment of food and cleanliness
• Meeting Early Intervention in Psychosis new
cases target
This is an element of the Department of Health’s
“Clean Hospitals” programme and is monitored
by the Patient Environment Action Team (PEAT).
• Meeting Vital Signs targets
• Meeting Crisis resolution targets
Carer Experience
To co-ordinate and capture the experience of
carers who have access to and work within our
services.
• Admissions to adult in patient units for people
aged 16 or 17
Pathways for Learning Disability
To improve care pathways for Learning Disabled
patients’ ensuring that safe and effective care is
given.
24
QUALITY REPORT 2009 to 2010
Humber Mental Health Teaching Trust • Humber NHS Foundation Trust
Q.1 Trust Quality Assessment
Commissioning for Quality and Innovation (CQUIN) 2010/11
Yorkshire and the Humber have worked to develop the regional indicators
below for the 2010/11 CQUIN scheme.
Regional
1 Improving the proportion of patients who
receive rapid face to face response
EXPECTED OUTCOME
To improve the proportion of patients in crisis
who receive rapid face to face response will
improve patient experience and reduce
inappropriate bed use.
2 Improvement of the number of referrals
being seen and treatment commencing
within eight weeks
EXPECTED OUTCOME
To allow progress towards a ‘no waits’ culture
in mental health services.
3 Improving the experience of black and
minority ethnic (BME) patients by ensuring
that safe and effective care is given
EXPECTED OUTCOME
To improve BME patients’ experience by
ensuring that safe and effective care is given.
5 Improving in pressure ulcer prevention and
management in line with the Essence of
care
EXPECTED OUTCOME
To improve pressure ulcer prevention and
management.
6 Development and implementation of care
pathways for all patients with learning
disability requiring mental health services
EXPECTED OUTCOME
To improve the experience of mental health
services for patients who have a learning
disability by ensuring that safe and effective
care is given. This is also aligned to the Green
light toolkit.
7 Development and implementation of an
integrated Dementia pathway across
mental health and Learning Disability
services
EXPECTED OUTCOME
4 Improving the focus on the care of patients
in line with the essence of care
EXPECTED OUTCOME
To ensure the physical wellbeing of inpatients
on older people’s mental health wards.
To improve the experience of patients with
dementia by ensuring that safe and effective
care is given, communication channels are clear,
and cross boundary working is achieved across
mental health, community and acute sectors.
Humber Mental Health Teaching Trust • Humber NHS Foundation Trust
QUALITY REPORT 2009 to 2010
25
Q.1 Trust Quality Assessment
Local CQUIN indicators have been produced with the three primary care trusts for
which we provide services and have been included within the national CQUIN
template before being submitted to the SHA for assurance.
Local
1 Improving access for people experiencing
problems that require an urgent response
EXPECTED OUTCOME
To improve the proportion of patients in crisis
who receive rapid face to face response will
improve patient experience and reduce
inappropriate bed use.
2 Patient satisfaction
EXPECTED OUTCOME
Patient views of whether they have been treated
with dignity and respect is the biggest indicator
of their broader experience of care. The Care
Quality Commission annual inpatient survey
2009 demonstrated that our Trust’s performance
needed to be improved in this area.
5 Patient transfers
EXPECTED OUTCOME
To have collaborative working with local PCTs
for agreement for repatriation of our patients
currently in out of area treatment.
6 Co-morbid condition
EXPECTED OUTCOME
For every practitioner to have skills and
knowledge on how to improve the assessment
and management of patients with a mental
health problem and other identified co-morbid
conditions.
3 Violence and aggression
EXPECTED OUTCOME
To reduce adverse incidents when dealing with
disturbed or violent behaviour by any individual
in an in-patient setting, who poses a serious
risk.
4 Improving care experience
EXPECTED OUTCOME
To increase in the number of carers reporting
satisfaction.
26
QUALITY REPORT 2009 to 2010
Humber Mental Health Teaching Trust • Humber NHS Foundation Trust
Q.1 Trust Quality Assessment
Local CQUIN Values
It was agreed following discussion at the PCT
Chief Executives’ meeting in January 2010 that
the allocation of CQUIN money will be broken
down for Mental Health and Community into
0.5% Regional determination and 1.0% for Local
determination. Below, subject to confirmation,
are the values of our scheme.
Commissioner
NHS Hull
Financial value of Scheme
£311,126
Commissioner
NHS East Riding of
Yorkshire
£240,000*
Financial value of Scheme
Payments will be made according to the following
schedule:
• 50% of financial value of scheme paid in
advance, in monthly instalments
• Reconciliation against performance in months
3, 6 and 9
• Year end reconciliation against performance and
gateway within six weeks of 2010-2011 year
end.
*subject to confirmation
Commissioner
NHS Barnsley
Financial value of Scheme
£143,296
Humber Mental Health Teaching Trust • Humber NHS Foundation Trust
QUALITY REPORT 2009 to 2010
27
Glossary
BME
Black and Minority Ethnic people
The National Service Framework emphasises the need to improve mental health services
for black and minority ethnic people. The Department of Health has published ‘Delivering
Race Equality in Mental Health Care’, a five-year action plan for tackling discrimination
and achieving equality in services for black and minority ethnic patients and communities.
CQC
Care Quality Commission
The independent regulator of health and social care in England, aiming to make sure
better care is provided for everyone in hospitals, care homes and people’s own homes.
CQUIN
Commissioning for Quality and Innovation
Measures which determine whether we achieve quality goals or an element of the quality
goal. These achievements are on the basis of which CQUIN payments are made.
Co-morbid Co-morbid condition
The presence of one or more disorders in addition to a primary disorder, for example,
dementia and diabetes.
CRHT
Crisis Resolution Home Treatment teams
Provide intensive support for people in mental health crises in their own home: they stay
involved until the problem is resolved. Designed to provide prompt and effective home
treatment, including medication, in order to prevent hospital admissions and give support
to informal carers.
HES
Hospital Episode Statistics
The national statistical data warehouse for England of the care provided by the NHS. It
is the data source for a wide range of healthcare analysis for the NHS, government and
many other organisations and individuals.
LINk
Local Involvement Network
A network of local people and community groups who want to improve social care and
healthcare in their local area.
NIHR
National Institute for Health Research
Commissions and funds research
28
QUALITY REPORT 2009 to 2010
Humber Mental Health Teaching Trust • Humber NHS Foundation Trust
Glossary
PCT
Primary Care Trust
Primary care is the care provided by people you normally see when you first have a health
problem. It might be a visit to a doctor or a dentist, an optician for an eye test or a trip
to a pharmacist to buy cough mixture. NHS walk-in centres and the NHS Direct telephone
service are also part of primary care. All of these services are managed the local primary
care trust (PCT).
PEAT
Patient Environment Action Teams
An annual assessment of inpatient healthcare sites in England that have more than 10
beds. It is a benchmarking tool to ensure improvements are made in the non-clinical
aspects of patient care, such as cleanliness, food and infection control.
SUS
Secondary Uses System
A single source of comprehensive data to enable a range of reporting and analysis.
SUI
Serious Untoward Incident
An out of the ordinary or unexpected event (not exclusively clinical issues) that occurs on
NHS premises or in the provision of an NHS or a commissioned service, with the potential
to cause serious harm.
SHA
Strategic Health Authority
Manages the NHS locally and provides an important link between the Department of
Health and the NHS.
Humber Mental Health Teaching Trust • Humber NHS Foundation Trust
QUALITY REPORT 2009 to 2010
29
and finally ...
We look forward to working with our patients, carers, staff and
other key stakeholders to continue to strive to improve the health
and wellbeing of the communities we serve.
David Snowdon
Chief Executive
June 2010
30
QUALITY REPORT 2009 to 2010
Humber Mental Health Teaching Trust • Humber NHS Foundation Trust
Humber
NHS Foundation Trust
For further copies of this report or more information please contact:
Julie Wilson
Corporate Assurance
Trust Headquarters
Humber NHS Foundation Trust
Willerby Hill • Beverley Road
Willerby • HU10 6ED
01482 389135
Jules.Wilson@humber.nhs.uk
www.humber.nhs.uk
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