Quality Account 2009/10
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Part 1: Statement on quality from the Chief Executive
The purpose of this report is to provide a fair and representative overview of the
quality of services in Lancashire Care NHS Foundation Trust. The Trust Board
has approved this account as a representative picture of the status of quality of
services within the organisation and the Council of Governors has been actively
involved in the process. The focus is on three key components of quality, the
safety and effectiveness of services and the impact these have on the experience
of people who use services. As will be seen from this document the Trust has
made progress in the development of its services and there are many examples
of excellent practice. The challenge is to make this best practice evident in all
areas of service provision.
In developing the account the focus has been on established programmes of
work and to ensure that the process is as inclusive as possible. Underpinning the
approach has been a commitment to a set of values and goals which guides the
organisation on a day to day basis. There has been a commitment to taking into
the account the views of both service users and staff when making decisions and
setting priorities but this is an area the Trust will focus on increasingly over the
next twelve months. The ongoing production of the account gives an opportunity
to engage with local communities and to give them the opportunity to hold the
Trust to account for the services it provides.
This has again been a challenging year as the Trust continues to work hard to
provide the best possible care for service users and carers in Lancashire. The
focus has been on continuously improving the Trust’s performance and ensuring
consistently high standards in all service areas. The Annual Report describes a
number of such initiatives. During the last year preparations took place for
registration with the Care Quality Commission and the Trust was successfully
registered without any conditions. In 2009/10 the implementation of the Quality
Improvement Strategy commenced. This emphasises a range of quality initiatives
and focuses on the safety, experience and outcomes for all service users and
carers who come into contact with services. The strategy forms the basis for this
Quality Account and the information used is drawn from the monthly quality
reports that are submitted to the Trust Board. Whilst much of the Quality Account
reports on and is based on the quality strategy, it also reflects work that is being
progressed through other strategies such as workforce development and
leadership. The account covers the full range of services across the Trust and
the information is accurate, to the best of my knowledge.
During 2009/10 the Trust has worked hard to coordinate all activities in an
integrated way through a more robust approach to planning and the introduction
of a quarterly review process. This considers performance against a range of
indicators. Involving frontline staff has been important and to this end a set of
core values have been agreed that express the ethos as an organisation and
promote the type of behaviours which Trust staff should demonstrate in pursuit of
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excellence in service delivery. The Trust has developed six values through
discussion with staff and the Council of Governors that are thought to represent
what Lancashire Care should be all about.
These values are:
Teamwork
Compassion
Integrity
Respect
Excellence
Accountability
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The behaviour of all staff should always fit in with and reinforce these values.
Going forwards work with staff to translate these values into behaviours will be
undertaken and there will need to be challenge to make sure that the Trust’s
services and the behaviours of staff towards each other and everyone with whom
they come into contact, consistently reflect these values. Underpinning these
values is a commitment to quality.
The next year will continue to be challenging, in an increasingly tight financial
environment efficiency and effectiveness will be paramount. However, the focus
on quality will continue as the services provided to the people of Lancashire
improve and meet the needs of the diverse local communities. This report will
now outline the priorities for improvement and how the Trust has performed
against them in 2009/10. It will then provide an overview of performance against
quality. The priorities and approach to quality are based on the Trust’s Quality
Improvement Strategy which forms the basis for the Quality Account. The
measurement and monitoring of standards is through the quality review process
supported by visits to clinical teams and their environments by senior managers,
non-executive directors and governors, and clinical audit.
Professor Heather Tierney-Moore
Chief Executive
Part 2: Priorities for improvement, performance against
2009/10 priorities and statements of assurance from the
board
Priorities for improvement
Lord Darzi in his report “High Quality Care for All” argued that information on the
quality of services needed to be published. This quality account has been
produced with the aim of providing information on the quality of care the Trust
provides and the indicators used have been guided by the following principles:
1. Metrics which focus on the three domains of quality as outlined by Lord Darzi –
safety, effectiveness and patient experience will be used.
2. All quality measures on which the Trust is assessed as part of the Annual
Health Check or other national requirements.
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3. The focus will be on measures that can be benchmarked both internally and
externally, allowing a comparison with similar organisations (wherever possible)
4. Wherever possible there will be a focus on outcomes rather than processes
and will reflect the views of stakeholders, staff, service users and carers about
priorities for improvement.
5. Metrics that link to the Quality Strategy will be chosen.
Darzi
Safety
Effectiveness
Patient Experience
National Requirements
Annual Health Check
Benchmarking
Priorities for Improvement
Focus on Outcomes
Views of Stakeholders
Quality Strategy
Quality Metrics
The metrics described in the next section reflect the application of the above
principles and have formed the basis of the Trust’s Quality Account for the year
2009/10. All metrics are cross referenced with the priorities in the Quality
Strategy (QS).
The Quality Strategy approved by the Board in February 2009 outlined the
following as key quality priorities for the organisation during a 3-5 year time
frame:
• Priority 1 - Standards of clinical supervision
• Priority 2 - Performance of community mental health teams
• Priority 3 - Standards on in-patient units
• Priority 4 - Leadership development
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•
•
Priority 5 - Ensuring National Institute for Health & Clinical Excellence
(NICE) compliance
Priority 6 - Developing care pathways
The aim is to see improvements in practice in all these areas and this report
outlines the progress so far. The Trust has been very clear about the reason for
choosing these priorities. First, all services must be delivered through care
pathways based on the most up-to-date evidence. Second, work nationally and
experience locally, demonstrates the need to focus attention on the work of
Community Mental Health Teams and inpatient units. This is particularly
important given the “New Ways of Working” initiative and the need to be able to
demonstrate that the whole system of care functions in an integrated and
coordinated way. Third, research has demonstrated how the experience of staff
has a significant impact on the experience of service users and the quality of care
provided. For this reason there has been a focus on supervision as an integral
part of the improvement work. It is important that the process of clinical
supervision is improved to deliver high quality services. These priorities continue
to underpin the work of each clinical team who also have the freedom to focus on
local quality initiatives. During 2009/10 there has been the identification of two
additional priorities:
• Clinical risk assessment
• Access to therapeutic activity
Regular reviews of performance and learning from serious incidents that have
occurred during the year led to clinical risk assessment being identified as one
new priority, work is underway to review the clinical risk assessment and make
improvements. Feedback from service users on ways to improve the service
identified access to therapeutic activity as a second new priority. Measures will
be developed, implemented and reported to ensure improvements are made.
During 2010/11 the Trust hopes to have a new clinical risk assessment process
in place and to have collated information on levels of therapeutic activity. The
latter, through clinical audit.
During 2009/10 the workstream on leadership development has been reviewed
and the Trust has invested additional resources to support this programme of
work. As it now has a more Trust-wide rather than clinical focus, it is not a
specific priority for the quality improvement strategy and has been taken out of
the priorities for 2010/11. The progress of the Leadership Strategy led by the
Director of Workforce and Organisational Development will be monitored via the
Trust’s annual plan during 2010/11.
In making improvements across such a range of priorities the Trust understands
it is setting itself significant challenges. However, the areas identified will have a
significant impact on the quality of service provided and are fundamental to the
implementation of the Quality Improvement Strategy. This strategy provides the
overriding framework for the Trust’s approach to quality management and
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improvement and can be accessed at
http://www.lancashirecare.nhs.uk/publications.php.
Performance against 2009/10 priorities
The Trust delivers services primarily through four Networks:
• Adult Services
• Older Adult Services
• Secure Services
• Child and Adolescent Mental Health Services, Early Intervention Services,
Substance Misuse Services.
Each Network has a monthly Governance meeting. These are supported by a
cascade of information to and from teams and this is upwards to a Trust-wide
Executive Management Team Governance Meeting. A Sub-Committee of the
Board is attended by Executive Directors, senior managers and professional
leads. This structure gives the Trust the opportunity to cascade information to all
levels and seek assurance regarding standards. In addition the Trust has a
dashboard system in place, accessible to all staff through the intranet. These
systems cover both national and local indicators.
During 2009/10, the Trust has spent considerable effort in intensifying the focus
on the recording, reporting and use of information. Data quality has improved
across a number of key indicators and Networks regularly consider reports on
activity and quality of performance, as well as on data quality. The Trust has
engaged in the Audit Commission Mental Health Benchmarking and the
Foundation Trust Network Psychological Services benchmarking to help us to
improve further. The Trust’s Information Department is looking at systems to
provide real-time data to managers and teams through a ‘self-service’ model.
Aligned with this, the Trust is upgrading its systems to better integrate operational
and clinical data.
To ensure the full engagement of clinicians, a number of key structural changes
have been instituted: a Health Informatics Cabinet chaired by the Chief
Executive; a Quality Strategy Board co-chaired by the Director of Nursing and
Medical Director; and a Clinical Systems Development Board chaired by a
Network Director. At a local level the Trust is embedding these changes through
the implementation of the Quality Strategy which ensures that information is
considered in some depth and supported by visits to clinical teams and their
environments by senior managers, non-executive directors and governors. It is
anticipated that the development of the Quality Strategy and of Payment by
Results in the coming year will continue to reinforce and advance these
developments. In addition the need to ensure there is the right diagnostic
information available to enable the data to confirm that service users are on the
right pathways. This will be monitored using clinical audit.
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Priority 1 - Standards of Clinical Supervision (Patient Safety)
During 2009/10 a re-audit of clinical supervision was undertaken measuring the
practice against standards set out in the Trust’s clinical supervision policy.
Inpatient staff have previously been audited. This was the first time community
staff had been audited so therefore there is no data to compare from previous
years.
Clinical Supervision – Staff Audit
Standard
Community
Staff
2009/10
%
All staff have a right to regular
formal supervision
Supervision will take place in line
with professional codes conduct
Supervision meetings will be made
in advance and prioritised and held
in a suitable private room free from
interruptions
A record of each session will be
held confidentially in line with local
supervision protocols
All supervisory relationships will be
governed by the supervision
contract
Allocating/prioritising work during
managerial supervision
Identifying & acknowledging good
practice during managerial
supervision
Source – LCFT internal data collection.
Inpatient Staff
2008/09
%
2009/10
%
Increase /
Decrease
85
81
86
(5%)
43
82
89
(7%)
86
95
88
(7%)
80
86
76
(10%)
46
76
60
(16%)
81
64
77
(13%)
79
75
79
(4%)
An action plan has been developed and is being implemented to address the
outstanding issues e.g. supervisory contract and the development of professional
specific procedures. A re-audit will be undertaken during 2010/11 to ensure
improvements have been made following implementation of the actions.
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Priority 2 - Performance of Community Mental Health Teams and Priority 3 Standards on Inpatient Units
Healthcare Acquired Infections (HCAIs) (Patient Safety)
The graph below identifies the number of patients who are colonised with MRSA
(MRSA present on the patient’s skin without causing an infection). The Trust has
not had any cases of MRSA bacteraemia.
Number of Patients with colonised MRSA
50
45
40
35
30
25
20
15
10
5
0
43
28
21
35%
Reduction
2007/08
On
2007/08
25%
Reduction
On
2008/09
2008/09
2009/10
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Number of Patients C.difficile Positive
18
17
16
14
12
9
10
8
47%
Reduction
On
2007/08
6
4
8
11%
Reduction
On
2008/09
2
0
2007/08
2008/09
2009/10
Source – LCFT internal data collection.
Infections are a high priority from a patient safety perspective and graphs
demonstrate a year on year reduction in infections. The rates will continue to be
monitored via the Board report during 2010/11.
In last year’s quality account the figures reported for 2008/09 infections were
inaccurate due to problems relating to the transfer of data from a paper based
system to an electronic system. The accurate figures have been included in the
graphs above.
Falls resulting in fracture (Patient Safety)
The falls resulting in a fracture are older adult service users who have a higher
risk of falling compared to other service users in the Trust.
There has been an
Falls Resulting in Fracture
increase in the
number of falls
2007/08
2008/09
2009/10
resulting in a
Number of Falls
10
4
11
fractured neck of
Source – LCFT internal data collection.
femur reported over
the last 12 months.
These have been reviewed and there is no evidence of any trends or clusters
which would indicate there are any service delivery issues. It has been agreed
that this type of fracture will be investigated as a full Post Incident Review (PIR)
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in line with national recommendation. Previously some fractures may have been
subject to a management review rather than a full PIR investigation.
The Older Adults Network undertakes a six monthly detailed analysis of all types
of falls which highlights number of falls by ward and occupied bed days. The data
suggests there has been a relative improvement in reducing the number of
falls. Detailed analysis of departments with high rates of falls takes place which
includes working with staff to identify where falls are taking place. One example
was a cluster of falls around a certain part of a corridor, chairs were positioned in
the corridor and as a result there has been a significant reduction in falls in that
area. The Trust, as part of its approach to reducing falls, has invested
significantly in purchasing new beds which are adjustable and all wards have a
number of beds that actually go down to the floor for patients at the highest risk
of falling at night. The falls re-audit will continue to be a priority of the Trust in
2010/11.
Inpatient Surveys (Patient Experience)
The internal survey commenced in May 2009 and is a questionnaire given to all
older and adult in-patients on discharge. A questionnaire is also given to carers
of older adults, however, the results have not been included below as the
numbers returned were so small. Results are in percentages (%).
The Trust was disappointed with the national survey results given the amount of
work that has gone into improving the in-patient units. The results were reviewed
in detail and it was felt that due to the timing of the national data collection, the
results were not reflective of this work programme. The Trust internal survey
shows better results and this is also supported by the recent quality review
assessments in all the adult in-patient units.
Adult & Older Adult Inpatient
Surveys
LCFT Internal
Survey
2009/10
The ward was clean
Always/
Mostly
I could get a hot drink
whenever I wanted
Always/
Mostly
My privacy was
respected
Always/
Mostly
80
Yes
82
The Ward felt a safe
place to be a patient in
94
76
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National
Survey
Results
(LCFT)
2009/10
National
Survey
Results (All
MH/LD
Trusts)
2009/10
78
92
-
-
65
87
65
84
I experienced
discrimination on the
ward
I got as much
information as I wanted
about my treatment
I was satisfied with
how I was involved in
my assessment and
care planning
I was satisfied in how I
was involved in
planning my discharge
I knew how to make a
complaint if I needed to
No
89
-
-
Yes
74
-
-
Yes
80
-
-
Yes
81
-
-
Yes
68
41
48
Surveys for other services including Substance Misuse Services, Secure Services and
Community Services have all been developed. The findings from these surveys will be
reported on during 2010/11 in the monthly quality board report.
The data from the internal survey provides useful information which is used in the quality
review of services. The response rate has been disappointing and to increase the rate is a
key challenge. The questions have been reviewed and reduced the number of questions in
the survey. Alternative ways of disseminating the survey e.g. through inpatient ward
meetings and advocacy is also being undertaken.
Source – LCFT internal data collection and CQC national Inpatient survey.
National Patient Survey (Community Services)
National Patient Survey (Community
2007 2008 2009
All
Services)
%
%
%
%
Patients receiving a copy of their Care Plan
61
63
74
46
Patients who definitely had the purpose of
66
61
66
67
medications explained
Patients who felt they were treated with
88
87
83
86
dignity & respect.
‘All’ - shows the results from all the Trusts with Mental Health Services surveyed
by Quality Health in 2009.
Source – CQC national community patient survey.
The national community survey results are varied. There has been an
improvement year on year for patients receiving a copy of their care plan and this
is nearly 30% above the national average. There has been an improvement from
last year on the number of patients who definitely had the purpose of the
medications explained which is similar to the national average. The percentage of
patients who felt they were treated with dignity and respect has decreased for the
second year and is also 3% below the national average. The work being
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undertaken on Trust values (mentioned in part 1) will help address this.
Improvements will be monitored through the quality reviews supported by visits to
clinical teams and their environments by senior managers, non-executive
directors and governors.
Priority 4 - Leadership Development (Patient Safety)
TARGET
75%
Staff with up-to-date appraisal – 63%
Source–Staff Survey
TARGET
Staff in receipt of mandatory training -
67%
75%
Source – LCFT internal system (OLM)
The staff appraisal figure is taken from the CQC staff survey 2008/09 and the
mandatory training figure is from the internal database on 31st March 2010.
A large scale Leadership Programme will be launched in Summer 2010
concentrating on the development of current leaders to grow talent and improve
quality. Plans are in place with a partner identified to support this work. This will
be supported with management development programmes to train current and
future leaders in the management skills necessary to live the values and develop
the behaviours. Robust performance management programmes are being
introduced to assess the talent within the organisation, empowering individuals to
progress though a sound understanding of their roles, objectives and overall
organisational strategy linked to Personal Development Plans (PDPs). The
Trust’s appraisal programme is being reviewed and the Trust’s values have been
included as part of the process.
The Trust is concerned about the rates for mandatory training and on reviewing
performance have realized that a number of training initiatives classed as
mandatory would be better termed as ‘essential’ and are not for all staff. As a
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result 5 areas have been identified which will be mandatory and the Trust will be
aiming to have 100% compliance in these areas.
Priority 5 - Ensuring NICE compliance (Patient Safety)
Prescribing Observatory for Mental Health – UK (POMH-UK)
Prescribing Observatory for Mental Health (POMH) UK Clinical Audit &
Quality Improvement Interventions
Topic (Published Date)
Rank
Medicines Reconciliation Audit (May 09)
10/80
Depo Injection Re-audit (Feb 10)
2/35
Source – POMH-UK.
POMH-UK enables the Trust to benchmark its performance against national data.
A key local priority identified in the quality strategy was ensuring the
implementation of NICE guidance. Work on the development of care pathways
has contributed to this and the appointment of a dedicated 12 month post (NICE
Implementation Lead) has and will further strengthen this area.
Priority 6 - Developing Care Pathways (Effectiveness)
As part of the Trust’s service transformation programme a clinical care pathways
project has been undertaken to develop care pathways for use in clinical practice
across the Trust.
Achieved
Develop 20 Care Pathways
100%
All of the 20 pathways (100%), which cover 80% of the conditions treated by the
Trust, were successfully developed in line with regulatory requirements and NICE
guidance. They seek to ensure that the level of care delivered is of a very high
quality and consistent across the Trust by providing a reference tool for clinicians
that is evidence based and promotes best practice. They do not replace clinical
judgment and are flexible and responsive to the needs of individuals. Pathways
for the remaining 20% conditions e.g. dual diagnosis will be developed as part of
the ongoing development of services.
Clinicians and service users from across the Trust were involved in creating the
pathways, drawing on their experience and knowledge to ensure that the
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pathways were holistic and person centred. Now that the pathways have been
approved and rolled out, the next phase of this project during 2010/11 will focus
on ensuring that they are embedded within clinical practice. A method of
reviewing and evaluating the effectiveness of the pathways is also being
developed in order to ensure that they are responsive to change and continuous
improvement.
Statements of assurance from the Board
This section includes a number of nationally mandated statements from the Trust
Board which relate strongly to the drive for quality improvement. The aim of these
statements is to offer assurance to the reader that the Trust is:
• Performing to essential standards e.g. meeting CQC registration
• Measuring clinical processes and performance via participation in national
clinical audits
• Involved in cross-cutting projects and initiatives aimed at improving quality
such as recruitment of service users to clinical research trials.
Review of services
During 2009/10 Lancashire Care NHS Foundation Trust provided one NHS
service (mental health), reviewed all the data available on the quality of care in
this service and the income generated by this service represented 100% of the
total income generated from the provision of this NHS service.
The Board’s approach to the management of quality and the collation of data is
based on the Quality Improvement Strategy and the Trust’s performance
management framework. Data is provided on a monthly basis through the
performance and quality report and clinical audit which covers the 3 main
dimensions of quality i.e. safety, effectiveness and experience. The clinical audit
programme is reviewed in detail by the Audit Committee on a quarterly basis.
Participation in clinical audits
During 2009/10 Lancashire Care NHS Foundation Trust participated in all
national clinical audits and national confidential enquiries that it was eligible for.
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National Clinical Audits
LCFT Participation
Prescribing Observatory for Mental Health – UK
(POMH-UK)
Yes
Continence
Yes
Falls and Bone Health in Older People - Round 2
Organisational Audit
Psychological Therapies for Anxiety & Depression –
registering for 2010/11
Yes
Registered
Applicable to Acute
Trusts only
Dementia
National Confidential Enquiries
Suicide and Homicide by People with Mental Illness
(NCI/NCISH)
LCFT Participation
Yes
The national audits and national confidential enquiries that the 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 that audit or enquiry.
Prescribing Observatory for Mental Health – UK
(POMH-UK)
Cases submitted as a
percentage of the
number of registered
cases
Prescribing of high dose antipsychotics on
adult acute and intensive care wards baseline
audit
100%
Medicines reconciliation baseline audit
100%
Screening for metabolic side effects of
antipsychotic drugs in patients treated by
assertive outreach teams baseline audit
100%
Assessment of side effects of depot
antipsychotics re-audit
100%
Benchmarking of high dose and combined
antipsychotics on acute wards
Not Applicable
Use of antipsychotics on people with learning
disability
Not Applicable
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Sections Completed (100%)
National Audits of Falls and Bone Health in
Older People
100%
National Audit Continence – the Trust contributed to the pilot study and made a
number of recommendations around the structure of the audit in relation to a
mental health setting. The Trust began data collection, but identified a concern
regarding the suitability of the audit for mental health. The decision was taken by
the Trust to withdraw from the audit.
The table below identifies the number of cases the Trust was required to submit
for each of the relevant national confidential enquiries. The number the Trust
actually submitted is expressed as a percentage.
Suicide and Homicide by People with Mental
Illness Confidential Inquiries
(NCI/NCISH)
Number required to submit
(% submitted)
Suicide
33 (73%)
Homicide
5 (100%)
One of the reasons for the low response rate could be that some of the
questionnaires had only recently been sent out to the Trust so were being
completed when this data was extracted. In addition some of them have turned
out not to fall within the scope of the Inquiry so should not really count in the
figures.
Additional Participation in National Audit
The Trust also took part in a National Health Promotion Audit (NHPA) which
provided baseline information on health promotion and areas for improvement
within the Trust as well as comparable data with other Trusts. The national audit
required data from 100 service users and the Trust submitted data for 100
service users (100%).
The reports of the 3 national clinical audits were reviewed by the Trust in 2009/10
and a number of actions are being implemented including:
• Changes to the electronic patient system to enable capture of health
promotion and physical health information
• Improving access to walking aids where applicable
• Review of the Trust policy on falls to support practice development
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The reports of local audits included 19 Trust priority and 24 network priority
audits which were reviewed by the Trust and as a result a number of actions are
being taken including:
• Development and implementation of a handover protocol for all inpatient
wards
• Raising awareness amongst staff in relation to the identification and
support for young carers
• Quarterly spot checks of resuscitation equipment
• Review of Trust policies including observation policy, resuscitation policy
and discharge policy to support practice development
• Development and implementation of local protocols for
specialist/professional supervision and potential ligatures
• Amendments to Mental Health Act documentation to ensure consistency
of recording
• Specialist Occupational Therapists to work with multidisciplinary teams to
assist them in better identifying service users occupational need in order
to make appropriate referral for specialist Occupational Therapy advice
and input
Participation in clinical research
The number of service users receiving NHS services provided or sub-contracted
by the Trust in 2009/10 that were recruited during that period to participate in
research approved by a research ethics committee was 701. This increasing
level of participation in clinical research demonstrates Lancashire Care NHS
Foundation Trust’s commitment to improving the quality of care the Trust offers
and to making a contribution to wider health improvement.
In 2009/10 Lancashire Care:
• was actively involved in a total of 55 research projects of which 32 were UK
Clinical Research Network (UKCRN) portfolio studies. 18 were student
projects and the remaining 6 studies were Trust funded pilot projects.
• worked closely with the Cumbria and Lancashire, Comprehensive Local
Research Network (CLRN) to implement the National Institute for Health
Research (NIHR) Central System for Permissions (CSP) and has a 14 days
median approval time.
• had the quickest approval time for any exemplar study and was the first Trust
in the programme to approve a study, and the first site globally for that trial to
recruit a service user
• has subsequently presented as a good practice study at the joint
NIHR/Strategic Health Authority (SHA) North West event held on 16th October
2009
• has worked closely with the CLRN, Mental Health Research Network, and the
Dementias and Neurodegenerative Diseases Network (DeNDRoN) to lead
and host an increased number of portfolio and NIHR funded projects.
• the Trust currently leads 1 programme grant, 1 Research for Patient Benefit
Grant (RfPB)
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•
been awarded a further 2 Research for Patient Benefit grants, and is a key
applicant on a recent award for a programme grant
Goals agreed with commissioners - Use of the CQUIN payment framework
A proportion of Lancashire Care NHS Foundation Trust’s income in 2009/10 was
conditional on achieving quality improvement and innovation goals agreed
between Lancashire Care NHS Foundation Trust and Commissioning
PCTs/North West Specialist Commissioning Group through the Commissioning
for Quality and Innovation (CQUIN) payment framework.
The amount for 2009/10 was £800,000 with targets for quarters 1, 2, 3 and 4
achieved.
The Trust has worked to CQUIN indicators which are in line with Lord Darzi’s
Next Stage Review “High Quality Care for All”. The indicators focused on
improving the information collected and reported relating to the key areas of
Patient Safety, Patient Experience and Effectiveness. The indicators are listed
below and impacted on all of the Trust’s Networks:
•
•
•
•
•
•
•
•
CQUIN Indicators
The development and implementation of the Quality Strategy and
related measures of quality and effectiveness
The number of Health Care Acquired Infections
The number of falls resulting in a fracture
Plans for improving the Trust’s safety culture and, specifically, for
reporting and investigating serious untoward incidents (SUIs) in a
timely manner
Staff training and supervision
The provision of single sex accommodation service user views on
privacy and dignity
The development of services for young people
Access to psychological therapies for inpatients in Secure Services
These indicators have been included in the quality account.
The Board Performance Report was amended for the second half of the year to
include these indicators and they were therefore subject to scrutiny by the Board
and by Commissioners as well as through the Trust’s own internal review
mechanisms.
Further details of the agreed goals for 2009/10 and for the following 12 month
period are available on request from Sarah Jones, Associate Director
Communications and Corporate Affairs (sarah.l.jones@lancashirecare.nhs.uk).
Page 19 of 38
What others say about the provider - Statements from the Care Quality
Commission
Lancashire Care NHS Foundation Trust is required to register with the CQC and
its current registration status is registered without conditions.
The CQC has not taken enforcement action against Lancashire Care NHS
Foundation Trust during 2009/10.
Lancashire Care NHS
Foundation Trust is subject to
periodic reviews by the CQC
and the last review was a
random visit on 3rd June 2009.
The CQC reviewed evidence for
four standards:
•
•
•
•
CQC Standards
C2 (safeguarding children)
C4a (infection control)
C4b (medical devices)
C20b (privacy and dignity of
environment)
The CQC’s assessment of Lancashire Care NHS Foundation Trust following the
review was that there was insufficient evidence to support a declaration of full
compliance on standard C4b relating to medical devices and qualified the Trust
on this one standard.
Lancashire Care NHS Foundation Trust is taking the following actions to address
the points made in the CQC’s assessment:
• A review and update of the medical device inventory which will make use
of the DATIX system to ensure it can be updated constantly
• A review of the procurement arrangements and the development of a
Trust list of preferred models of equipment. Medical devices not on the list
will not be approved for purchase
• Checking each clinical area has an updated inventory of equipment and
maintenance records
• An annual programme of random audits is being introduced that focuses
on repair and maintenance
• The service level agreements are being reviewed and will specify: the
schedule of maintenance and repair, system to obtain feedback on the
repair and maintenance service, evidence available to demonstrate that
staff undertaking maintenance and repair are competent
The Trust has made significant progress by 31st March 2010 in relation to:
• The policy framework
• The systems and processes in place to support the management of
medical devices
• Movement towards a principal supplier of medical devices support
However, further work is required to confirm that the relevant outcomes have
been met to ensure full compliance with the new regulatory framework, which will
Page 20 of 38
support registration with the CQC. The problems with the management of
medical devices have had no significant impact on the clinical care provision to
service users.
Lancashire Care NHS Foundation Trust has not participated in any special
reviews or investigations by the CQC during the reporting period.
Data Quality
NHS Number and General Medical Practice Code Validity
The Trust submitted records during 2009/10 to the Secondary Users service for
inclusion in the Hospital Episode Statistics which are included in the latest
published data.
NHS Number and General Medical Practice Code Validity
2009/10
In-Patient
%
Outpatient
%
Valid NHS Number
99.6
100
Valid GP Practice Code
100
100
Information Governance Toolkit attainment levels
Lancashire Care NHS Foundation Trust score for 2009/10 for Information Quality
and Records Management, assessed using the Information Governance Toolkit
was 88%.
Clinical Coding Accuracy
Lancashire Care NHS Foundation Trust was subject to the Payment by Results
clinical coding audit during 2009/10 by the Audit Commission and the accuracy
rates reported in the latest published audit for that period for diagnosis and
treatment coding (clinical coding) were as follows:
Coding Field
The results should not be
extrapolated further than the actual
sample audited and the services
reviewed in the sample included
Adult, Older Adult, Secure Services
and CAMHS.
Accuracy %
Primary diagnosis
78.38
Secondary diagnosis
53.45
Primary procedure
100
Secondary procedure
100
Page 21 of 38
Part 3: Review of Quality Performance
This section of the report will provide an overview of the Trust’s performance in
relation to a series of quality standards. The indicators were used as they
address significant quality issues and provide us with data on which to judge
performance in relation to the key components of quality as defined by Darzi
(patient safety, effectiveness and patient experience). These indicators have a
direct or indirect link with the improvement priorities identified in part 2 and were
chosen as part of the work programme supporting the delivery of the Quality
Improvement Strategy. Implementation of the quality strategy during 2010/11,
development of new metrics to measure quality improvement and regular
reporting will ensure improvements to the quality of care continues. They
include:•
•
•
Patient Safety
o Serious Untoward Incidents
o Improved safety culture
o Violence against staff
o Staff appraisal
Effectiveness
o Peer review
o Medium & low secure health checks
o Accredited services
o Psychological therapies
Patient Experience
o Single sex accommodation
o Patient complaints
o Age appropriate services
Page 22 of 38
Patient Safety
Serious Untoward Incidents (SUIs)
TARGET
SUIs reported within 2 working days – 71%
80%
TARGET
SUIs reviews completed (45 working days) -
68%
80%
Source – LCFT internal data collection.
A significant amount of work has been undertaken in relation to the SUI metrics
during 2009/10, however, further work is being undertaken to ensure the target of
80% is achieved during 2010/11.
Page 23 of 38
Improved Safety Culture
Percentage of staff witnessing potentially harmful errors, near misses or incidents
in last month (the lower the score the better)
Trust Score 2007
28%
Trust Score 2008
32%
Trust Score 2009
27%
National 2009 Average for Mental
Health/Learning Disability Trusts
29%
Source - CQC national staff survey.
27% of staff at the Trust said that, in the previous month, they had witnessed at
least one error, near miss or incident which could have hurt staff, patients or
service users which is slightly below the national average.
Violence against Staff (Data for 2009/10 not yet available)
Violent Incidents per 1000 staff
200
180
160
140
120
100
80
60
40
20
0
184
157
2006/07
2007/08
Year
Source – security management service.
Page 24 of 38
146
2008/09
The number of violent incidents against staff has decreased for the second year
reflecting the work undertaken within the Trust to implement the violence
strategy.
The Trust aims to monitor more closely the ratio of violent incidents against
service users by service users. This was outlined in last year’s quality report. The
appropriate methodology is still in development to ensure valid and reliable data
on this issue. This metric will form part of next year’s account.
Staff Appraisal
Percentage of staff appraised in last 12 months (the higher the score the better)
Trust Sc ore 2007
Trust Sc ore 2008
Trust Sc ore 2009
National 2009 Average for Mental
H ealth/Learning Dis ability T rusts
61%
67%
63%
75%
Source - CQC national staff survey.
63% of staff at the Trust said that they had received an appraisal, performance
development review, Knowledge and Skills Framework (KSF) development
review or other such review in the last 12 months.
The Trust is disappointed with this issue and has undertaken a detailed review of
why the uptake is so low. A sustainable programme of work over the next 12
months will result in an improved rate for 2010/11. The aim is to exceed the
national average for mental health/learning disability Trusts.
Attention continues to be focused on the development of two areas noted in last
year’s report. Which are drug safety incidents and carers assessments.
Employment of two medicines management nurses has helped progress with the
first one and data will be available during 2010/11. The implementation of the
carers’ strategy should start to demonstrate some true benefits during 2010/11
and measures will be developed.
Page 25 of 38
Effectiveness
Royal College of Psychiatrists Peer Review
The secure unit at Guild Lodge took part in the Royal College of Psychiatrists
peer review which allows the Trust to benchmark services against other
organisations in order to identify areas for improvement.
Guild Lodge was fully compliant with 146/167 (87%) of the criteria including 13
out of the 19 standards for women. The service was noted to score highly in a
number of areas, indeed it was found that over 80% of the criteria were fully met
in as many as seven of the sections, and 100% of the criteria were met in the
following three areas: Serious and Untoward Incidents, Safeguarding Children
and Visiting Policy and Accessible and Responsive Care.
Review Area
Safety and Security
Criteria met by Trust %
1. Physical Security
91
2. Procedural Security
92
3. Relational Security
83
4. Serious and Untoward Incidents
100
5. Safeguarding Children and Visiting policy
100
Clinical and Cost Effectiveness
92
Governance
93
Patient Focus
69
Accessible and Responsive Care
100
Environment and Amenities
85
Public Health
83
Source – Royal College of Psychiatrists forensic mental health service quality
improvement network.
The lowest scoring criteria was patient focus and the areas which require further
work included a strategy to ensure carers are consulted and involved, more
involvement of service users in care planning, privacy of phone calls and level of
engagement of carers through feedback structures. An action plan is being
developed and implemented to address these areas and other areas identified in
the review.
Page 26 of 38
Medium and Low Secure Health Checks
During 2009/10 medium secure services based at Guild Lodge achieved fullcompliance against the Department of Health’s best practice guidance for adult
medium secure services.
Low secure services based at Guild Lodge and the Lonsdale Unit also underwent
the first ever low secure health check. There were two wards eligible to
participate and both scored highly with one of the wards (Fairoak) achieving the
highest scores in the North West.
The network is also piloting a range of clinical outcome measures in order to
monitor the overall effectiveness of the services provided.
Advancing Quality
The advancing quality project is being led by the NHS North West and includes 2
projects (memory assessment and early onset psychosis). The Trust via the
Medical Director is leading on the implementation of the memory assessment
clinics project for the North West. The metrics have been agreed and discussions
are being held in relation to how the baseline data will be collected. The second
project is on early treatment of psychosis and the Trust is participating in the
development of metrics and then in the collection of baseline data in the autumn.
Accredited Services
Lancaster and Morecambe Memory Assessment Service is one of only two
services to be awarded an Excellence Accreditation by the Memory Service
National Accreditation Programme (MSNAP) which assesses standards in
memory services for people with dementia.
All of the Trust’s Electro-Convulsive Therapy (ECT) services are nationally
accredited through the Electro-Convulsive Accreditation Service (ECTAS) to
assure and improve the quality of the administration of ECT.
Psychological Therapies
Psychological Therapies can be offered by the Trust to service users following
their initial assessment as an effective addition to their treatment plan.
Service User Category
Secure Services
Older Adult (over 65)
Source – LCFT internal data collection.
Page 27 of 38
2009/10 Cases
86
638
Patient Experience
Quality Initiatives
Lancashire Care is well positioned to respond to the challenges laid down by the
Darzi report in this area. These include:
• New Ways of Working (change management programme launched in
2006 in Adult Services with the aim of creating a more integrated
approach to service delivery)
• Mental Health Matters (the Trust’s overall Vision and Mission for
transforming healthcare services across Lancashire and delivering on this
Vision of providing mental health care with well being at its heart. Includes
the new inpatient reconfiguration and the service transformation
programme)
• The Quality Improvement Strategy (The strategy is all about how the Trust
promotes a quality based approach to the management of services,
particularly how the vision for person centred care as set out in the Next
Stage Review by Lord Darzi is delivered)
• User Participation Strategy (The Trust’s approach to public and service
user involvement which sets out how the Trust is going to involve the
public in the development of its services)
• Service transformation including care pathway development
• Service users/carers members of recruitment panels
• Information sharing
• Carers booklet
• Early Intervention Services website
• Staff and service users have been involved in all aspects of the
development for the ‘Platform’, an inpatient facility for 16 and 17 year olds
• Record of success in delivering person centre care:
o CAHMS and the Junction’s philosophy of young consultants
o Older Adults – Dignity in Care Programme
o Secure – SEED programme and Service User Champions
• Lancashire Care has significant expertise in creating new services and
responding to service users needs
• Growing clarity of where the challenges lie and what the priorities are:
o Inpatient Environment – particularly the Adult setting
o Setting common standards of service across all settings
o Bring service users into the heart of the organisation
Service User Experience
The Trust has also invested in a series of initiatives to gather qualitative feedback
on the service user experience. This has included developing a Service User
Experience Strategy and looking into innovative ways of gathering and
responding to Service User Feedback. The Trust has appointed a Volunteer Co-
Page 28 of 38
ordinator who commenced in April 2010 and will develop a Trust-wide strategy
for volunteering, including establishing a Friends of Lancashire Care model.
One of these initiatives has involved a pilot with the North West Mental Health
Improvement Programme, using a video booth to generate original service user
feedback on an Inpatient Ward. Around fifteen service users, including two
service users from the Psychiatric Intensive Care Unit (PICU) and a carer went
into the booth and were asked five basic questions about their experiences.
These included:
• “What do you feel the team is getting wrong for you or need to work harder
on?”
• “If there was one thing you could change about the service what would it
be?”
The main themes that emerged from the feedback were:
Communication: Attitude of staff, Bank and
permanent; barriers to engagement through perceived
lack of staff or staff being too busy; lack of
communication with carers; difficult to initiate
communication with staff.
Workforce: Staff not spending enough quality time with
service users; occasional poor attitude towards service
users; staff appearing to spend more time on paperwork
than with service users; perceived difference in quality
of experience between Bank and permanent staff.
Freedom of
movement:
Restrictions around
access to move on
and off the ward; not
getting out enough or
long enough;
feelings of having to
ask permission to
use facilities; not
enough exercise/lack
of activities.
On the positive side service users felt overall they were well cared for and there
was a genuine commitment towards treating them with dignity, respect and
kindness. One of the comments said:
“I got the feeling ten or twelve years ago I was just treated like a number
instead of an individual which whilst I was here………I was treated like an
individual all the time.”
One former service user travelled on two buses to record his experience of being
treated at the inpatient unit and this was mainly to tell us about how caring the
staff had been.
Page 29 of 38
The feedback was edited into a 10 minute DVD and this was shown as part of
service improvement workshop involving around 30 staff, governors, nonexecutive directors and service users. From the workshop a local experience
programme is being developed with the input of frontline staff and those service
users who took part in the Video Diary pilot.
The Trust is now looking at more initiatives where social reporting techniques will
be used to interview service users about their experiences and work with frontline
staff on how these insights can be turned into tangible improvements in service
quality.
Single Sex Accommodation
Single Sex Accommodation
Single Gender
Accommodation
Adult
Yes
Older Adult
Yes
Child Adolescent
Mental Health
Yes
Services (CAMHS)
Substance Misuse
Yes
Secure Services
Yes
Source – LCFT internal data collection.
Number of
women only
wards
9 - inc. PICU
12
Women only
day areas
Yes
Yes
1
Yes
1
4 inc. Cottages
No
Yes
Every service user has the right to receive high quality care that is safe, effective
and respects their privacy and dignity. Lancashire Care NHS Foundation Trust is
committed to providing every service user with same sex accommodation
because it helps to safeguard their privacy and dignity when they are often at
their most vulnerable. The Trust can confirm that mixed sex accommodation has
been virtually eliminated. Service users who are admitted to any of the hospitals
will only share the room where they sleep with members of the same sex, and
same sex toilets and bathrooms will be close to their bed area. These areas are
not accessible to individuals of the opposite sex. A self assessment exercise has
been undertaken and the declaration is supported by the Trust Board. Work
which is being undertaken through the in-patient reconfiguration will ensure that
new in-patient units will not be mixed sex accommodation.
Page 30 of 38
Patient Complaints
Patient Complaints
No of patients who had their complaint
referred to the Ombudsman
Source – LCFT internal data collection.
2007/08
2008/09
2009/10
5
2
13
The Healthcare Commission ceased to deal with requests for independent reviews from
complainants on 31 March 2009 if the complainant remains dissatisfied with the Trust’s
response. Complainants are now referred to the Parliamentary and Health Service
Ombudsman (HSO). This change from a two stage process may be a reason for the
increase. During this financial year the Trust has received 13 requests from the HSO in
relation to complaints, five await a decision by the HSO, five are with the Trust for further
local resolution, one has been resolved by the Trust, another does not relate to Trust
services and one complaint was reviewed by the HSO who decided not to investigate.
Quarterly monitoring will continue to be undertaken during 2010/11 via the Board report.
Age Appropriate Services
The Mental Health Act of (2007) requires that services have age appropriate
facilities for young people in place by April 2010.
Age Appropriate Services
Young People admissions to adult inpatient
units
Source – LCFT internal data collection.
2007/08
2008/09
2009/10
17
28
29
A new young person’s inpatient unit (The Platform) for 16 and 17 year olds has
been developed during 2009/10 involving staff and service users in all aspects.
The facility opened April 2010 to ensure young people are not admitted to adult
wards and has been highlighted as an exemplar by the Mental Health
Development Unit. Young people have initially presented their experiences on
adult wards to the Board. They were then actively involved in the development of
the new unit to ensure it met the needs of young people.
The Trust has received national recognition for the work undertaken in meeting
the requirements of Pushed into the Shadows in relation to young people.
Page 31 of 38
Staff and Quality
To achieve high quality care there is a need to ensure the Trust has a high
quality workforce who are engaged and committed to their work and improving
quality and are supported and provided with the appropriate training. This next
section outlines key areas which relate to the workforce and improving quality.
Planning and Developing the Workforce
Lancashire Care Foundation Trust is transforming its Human Resource
Department and part of this transformation is the redesign of how data is
accessed and analysed, the development of robust systems and realigning the
workforce plans. The Trust has already recruited a Workforce and Information
Manager who commenced employment on 1st April 2010. This will be followed by
a Workforce Information Analyst and Workforce Information Assistant.
Staff Experience
The Board is committed to improving the health of the workforce and is signing
the Charter for membership of The Mindful Employer and is about to launch the
Open your Mind Campaign across the Trust. An Intelligent Working Policy will
also be launched in line with results from the national staff survey with reference
to flexible working to improve the work-life balance of employees.
The staff survey results show improvements in the commitment to work-life
balance, feeling less pressured and working fewer hours than in the previous
year. With higher than average scores in personal satisfaction with work
standards and employees feeling valued and supported by their managers this
will ensure the delivery of better services to service users via an engaged
workforce.
Lean initiatives throughout the organisation but particularly within human
resources have led to many quality improvements with the recruitment
department giving enhanced customer service and improved turnaround on
vacancies.
A strategy for health and well-being is being developed and will be implemented
via an enhanced Occupational Health Service providing pro-active treatments.
This service will be fully operational across the region in July 2010. Managers are
also invited to take part in the Beyond Blue training, a training course that invites
managers with non mental health backgrounds to understand the triggers of
stress, anxiety and depression, looking for the early warning signs and therefore
initiate early intervention procedures in order to manage and reduce sickness
absence.
Page 32 of 38
Staff Engagement - Engage Events
Overall staff engagement scores have been calculated this year for the first time
and the Trust has scored 3.67 which is higher than the national average for
mental health Trusts (3.63). A number of ‘Engage’ events have taken place
quarterly, involving the senior leadership team, both managerial and clinical. This
is the forum where the senior leadership team can discuss with the Executives
the Trust’s vision for the future and describe the plans for the next 12 months.
Engage events are linked into the planning cycle.
Staff Engagement - Staff Awards
During 2009/10 the Trust launched its first annual Staff Awards to recognise the
contributions of staff from across the Trust. Nominations were invited for five
awards – the team or individual who have done the most to:
• Demonstrate teamwork
• Enhance the service user experience
• Enhance the carer experience
• Provide compassionate care
• Provide a well-being focus
The Executive team shortlisted four nominations for each category and staff were
invited to vote for the winners.
In addition, a number of awards linked to the executive portfolio areas were
presented, which senior managers made nominations for. These were for the
team or individual who have done the most to:
• Demonstrate leadership
• Improve performance
• Make best use of resources
• Improve quality
• Demonstrate innovation
There was a Chief Executive Overall Achievement Award and a Chair’s Unsung
Hero Award.
Page 33 of 38
Performance against key Mental Health Indicators
Performance
Mental Health Indicator
100% enhanced Care programme
Approach (CPA) patients receiving
follow-up contact within seven days of
hospital discharge.
Threshold
95%
95%
Minimising delayed transfers of care
No more than 7.5%
3%
Admissions to inpatient services had
access to Crisis Resolution Home
Treatment teams
90%
98%
8
8
Maintain level of Crisis Resolution Teams
set in the March 2005 planning round.
Figures quoted are currently in validation and are yet to be confirmed.
Core Standards
The Trust declared compliance with all of the CQC’s core standards with the
exception of medical devices. A declaration of ‘insufficient assurance’ was
provided and this was due to the reasons outlined in part 2. Further information
can be obtained from the CQC website.
CORE STANDARDS
43 out of 44 Standards Compliant
Page 34 of 38
43/44
Medical Devices
Insufficient
Assurance
Quality Overview
Quality Measures Reported
2007/08
2008/09
2009/10
Trend
Patients with colonized MRSA
43
28
21
Improved
Patients with C.difficile
17
9
8
Improved
SUI reported in 2 days
-
-
71%
-
SUI completed in 45 days
-
-
68%
-
Falls resulting in fracture
10
4
11
61%
67%
63%
-
-
53%
5
2
13
17
28
29
28%
32%
27%
Improved
157
146
N/A
Improved
Staff with up-to-date appraisal
Staff received mandatory
training
Complaints referred to
Ombudsman
Young People admitted to adult
units
Improving Safety Culture (lower
score the better)
Violent incidents against staff
Page 35 of 38
Improvement
planned
Improvement
planned
Improvement
planned
Improvement
planned
Statements from Local Involvement Networks, Overview and
Scrutiny Committees and Lead Primary Care Trust
Following submission of a copy of the draft quality account to the LINks, OSCs
and Lead PCT a number of changes have been made. These changes are
intended to further improve the quality account and are as a result of comments
made by the Council of Governors, external auditors and members of the Trust
Board. The key changes are in the following areas:• Layout
• Formatting
• Detail of data sources
• Rewording of some sentences
• Mandatory training figure changed from 53% to 67% - more up-to-date
figure taken
• Physical health figure changed on peer review table from 87% to 91%
Blackburn with Darwen Local Involvement Network Statement
The LINk has little evidence to support comment in areas other than User/Carer
Engagement. Informal feedback we have received indicates that Trust
engagement within areas of Lancashire is very good and positive. Also the
introduction of video booths for recording user and carer views is welcomed
though we do question if this will be suitable for many service as we do have
experience of users who feel vulnerable and wish to remain anonymous when
they are commenting on services.
The Trust has been very communicative with the LINk particularly in relation to it
plans for the new build at Burnley Bridge.
In terms of Blackburn with Darwen we have asked the Trust on several occasions
about plans for developing Service User and Carer Forums in the area. In
November 2009 the BwD Mental Health Task Group were informed that ‘the
adult network is appointing a lead person for service user and carer involvement
for their service area and re-establishing the group will be one of this person’s
tasks, once in post. In the mean time there are other service user and carer
groups in existence, not run by the Trust’.
While a Care Trust Forum meets in Nelson, East Lancashire, this is many miles
away from Blackburn and is difficult and costly to access by public transport from
the area.
It remains the case that there are no Service Users and Carers Forums in
Blackburn with Darwen organised by the Trust by which people feel they can
influence Trust Service provision. The LINk has yet to see a copy of the Trust
Service User Strategy mentioned in the Quality Accounts and the Task group
was informed last November that this was being re-written.
Page 36 of 38
Blackpool Local Involvement Network Statement
Blackpool LINk welcomes the publication of this report and sees it as a positive
step forward. For the first time, Blackpool LINk is able to read some
comprehensive information on the quality of care provided. Please see some
recommendations for next year’s report: Recommendations
•
•
•
•
•
•
To clearly state that targets being achieved are patient-led rather than
organisation-led
Request that actual numbers, rather than percentages be used, thus giving
a clearer picture of what has been achieved
From the information provided throughout the document, it would have been
useful to have seen a clear action plan with the statistics provided and a
clear explanation given
We are concerned that the targets are not stretching enough. i.e. 47% of
staff have not received mandatory training. We are concerned as this
training is required for their day to day job and a clear action plan is
required
The report is largely ‘jargon-free’. However, as this document is being
made available to the general public, an explanation of some of the terms is
required
Taking the information provided as a baseline, Blackpool LINk will look to
receive information showing how the trust has improved on it objectives, so
that a more comprehensive response can be given next year
We look forward to receiving the official report in due course.
Lancashire Local Involvement Network Statement
Lancashire LINk board has taken the decision not to comment this year but is
intending to do so in future years.
Blackpool Overview & Scrutiny Committee
The Committee members agreed that they would prefer not to be asked to
provide comments on draft Quality Accounts. They were concerned as to
whether they would be sufficiently well informed to ‘sign off’ a report and
effectively provide a level of assurance in relation to its content. If this were to
occur and a complaint in relation to Trust performance was later brought to the
attention of the Committee, a potential conflict of interest might arise. The
Committee considered that it would prefer to focus its time on providing feedback
to the Care Quality Commission in relation to the performance of NHS Trusts
Page 37 of 38
(excerpt from 8th December 2009 meeting minutes in relation to the Quality
Account information).
Quality Account: Assurance from the Coordinating
Commissioner - NHS Blackburn with Darwen Care Trust Plus
NHS Blackburn with Darwen is the organisation responsible for coordinating the
commissioning of services provided by Lancashire Care NHS Foundation Trust.
The Care Trust Plus commissions (buys) services from Lancashire Care
Foundation Trust on behalf of the people living within Blackburn with Darwen, as
well as coordinating the commissioning of services on behalf of other Primary
Care Trusts (who are known as associate commissioners), for people who live
within the areas served by:
• Blackpool PCT
• Central Lancashire PCT
• East Lancashire PCT
• North Lancashire PCT
The Quality Account must provide an accurate and unbiased account of how well
Lancashire Care NHS Foundation Trust is doing in terms of:
• Where improvements in service quality are needed, how these are
reviewed and where improvements have been made;
• What their priorities are for the forthcoming year and;
• How involved service users, staff and others with an interest in the
organisation were determining those priorities for improvement
Under the Regulations contained within the Health Act 2009, the Quality Account
must be reviewed by the commissioners. This has been carried out, led by NHS
Blackburn with Darwen in collaboration with the associate commissioners (as
listed above). Although the commissioning organisations were not fully engaged
in the production of the Quality Account, opportunities to consider and debate
quality issues are available at the monthly contract and performance meetings.
NHS Blackburn with Darwen can confirm that the data contained within the
account is accurate in relation to the services provided. It is the view of the
commissioners that the quality of the services as reported in the account is
representative of those provided. In those areas where performance has been
identified as requiring strengthening, the commissioning organisations have seen
evidence of action plans to address these areas. One example of this is in the
delivery of single sex accommodation.
We look forward to seeing the improvements to the quality of services provided
as outlined in this Quality Account, and we feel confident that Lancashire Care
Foundation Trust will continue to build on their achievements, and deliver
successfully against the priorities they have identified.
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