Manchester Mental Health
and Social Care Trust
Quality Account
2009/2010
Together we are better
www.mhsc.nhs.uk
1 1. Quality Narrative “Quality is our Operating Principle” Welcome to Manchester Mental and Health and Social Care Trust’s first Quality Account. There is a commitment throughout the Trust from the Trust Board that our strategy for the Trust is based on quality and safety so that there are continued improvements to the patient experience. The Trust will publish a Quality Account on an annual basis to assure our service users, commissioners and the wider public of our commitment to quality improvements. The aim of this Quality Account is to enhance the Trust’s public accountability, to consider where the organisation is doing well, reflect on where improvements are required and to decide on the priorities for the coming year. We aim to involve service users, staff and those with an interest in the organisation in determining regular quality improvement initiatives. We are ambitious in our drive to ensure high quality safe services and are progressing through the Foundation Trust application process to enable greater financial freedoms and accountability for patient experience. As part of that journey we will be ensuring that the Trust has a sound quality governance framework which is transparent to service users, staff and key partners in the drive to continually improve. We are continuing to review our service in light of service users’ experience; we do this through our governance processes which routinely consider incidents, compliments and complaints. We use information gathered from our Patients Advice Liaison Service (PALS) and through a range of user and carer involvement activities to learn and improve how services are delivered. The Trust has embarked on a Transformational Work Programme (TWP) to improve the efficiency, effectiveness and quality of the services delivered and ensure that they meet service user needs. The TWP will deliver a strategic approach to the redesign of the Trust's services through a programme of interconnected work streams and projects to ensure:  Our service users and carers get the right service in the right place at the right time, every time.  Our services are equitable and responsive to the differential needs of the varied population that we serve.  The 'style' of care we provide is recovery focused and needs led. The underpinning principle of the TWP will be to promote continuous quality improvement across the organisation. This quality account provides information about areas for improvement over the coming year. The progress made against these initiatives will be reported to the Quality Board of the Trust on a regular basis to ensure there will be an ongoing focus on quality. The Trust Board are confident that this account presents an accurate reflection of quality across Manchester Mental Health and Social Care Trust. As Chief Executive of Manchester Mental Health and Social Care Trust, to the best of my knowledge the information in this document is accurate. Signed…………………………………………………………………. Jackie Daniel Chief Executive 2 2. Review of 2009/2010 The Trust has continued to improve its performance against existing quality measures, such as Standards for Better Health Core Standards which resulted in a rating of Good for Quality of Services in 2009. The Trust has responded to new requirements including the recent registration of the Hygiene Code for 2009. As part of this work the Trust established a rigorous system to ensure compliance against the Core Standards through a process of regular challenge meetings with Non‐Executive Directors, checks against data collection and Directorate meetings. In 2009/10 the Trust specifically focused on ensuring that it was meeting its national targets including that all service users on the Care Programme Approach (CPA) are followed up within 7 days. Service user and carer engagement Service user and carer engagement is an area which is rapidly developing at the Care Trust. An appointment was made to the post of an Associate Director for Service User and Carer Engagement towards the end of 2009, since that point, service users, carers and public stakeholders have become more meaningfully involved in a wide range of quality initiatives. This includes the following examples:  Service user and carer involvement in corporate induction  Service user and carer involvement in staff recruitment and selection  Service user and carer involvement in the developing recovery agenda  Involvement within the privacy and dignity agenda  Service user and carer involvement in Trust service communications The Trust has a service user/carer engagement forum which acts as an important interface between the Trust and local stakeholders. This forum also monitors the quality and uptake of service user involvement within the Trust’s care groups including how service users and carers are involved in key trust developments. The Trust has introduced a Patient Experience Committee which operates within our new Governance arrangements. This committee assures the Trust’s Quality Board that appropriate processes are in place to give confidence that all aspects of patient experience are monitored effectively and that appropriate actions are taken to address any deviation from accepted standards. This committee considers a wide range of key areas including Service User Experience, Carer Experience, Complaints, Claims, Litigation, PALS, Service User and Carer Engagement, Privacy and Dignity and Equality and Diversity. Patient Safety The Trust continues to put patient safety as a key quality marker in its core business. A key area is to improve safety in medicines management. The Trust was delighted to win first prize in the National Patient Safety Awards 2010 in the ‘Improving medicines safety in healthcare organisations’ category. The project, 'How to Improve Medication Safety Using Pharmacists Interventions' demonstrated how the Medicines Management Team learnt from medication error reporting. 3 The National Patient Safety Agency (NPSA) stated that this is evidence of good practice and that the high level of prescribing errors reported show excellent pharmacy services as all types of errors are being noted. Learning from the improved medication error reporting has led to a new medicine kardex, education sessions for prescribers and a programme of competency assessment for staff making medication errors. The team are able to identify the highest risk medicines, procedures and most common errors and these are fed back each month to care services. On winning the award the team were congratulated on a sustainable, system wide change in practice that was truly improving patient safety. Effectiveness The Effectiveness team have continued to provide a range of education and updated effectiveness days over the course of 2009/10 focusing on key areas of evidence based research and practice in service improvements. Examples of which include events focusing on Schizophrenia, Deprivation of Liberty Standards, Sharing Best Practice in the North West and most recently ‘Get Fit, Get Well’, to celebrate world health day. Values Over the last year the Board have approved a set of core values to support our key operating principles. These values underpin our service delivery and are threaded through our operating principles and business planning processes:  Respect and Dignity  Commitment to Quality of Care  Compassion  Improving lives  Working Together  Everyone counts. During 2009 ‐2010 Manchester Mental Health and Social Care Trust provided NHS services in the following specialist areas: Adult Mental Health Older Peoples Mental Health Prison Mental Health Services Specialist Mother and Baby Unit The Trust Board and Governance Committees have reviewed all the data available to them on the quality of care in all of these areas. The income generated by the NHS services reviewed in 2009/10 represents 100% of the total income generated from the provision of NHS services by Manchester Mental Health and Social Care Trust. The Trust Board has used the results of these reviews to develop a plan for improving the quality of the Trust services. 4 Clinical Audit The Trust has a full programme of clinical audit which is reported to the Trust Board. During 2009/10 the Trust participated in 3 national clinical audits and 2 national confidential enquires covering services that Manchester Mental Health and Social Care Trust provides. The national clinical audits and national confidential enquiries that the Trust were eligible to participate in during 2009/10 are as follows National Audits National Health Promotion in Hospitals Audit National Audit of Continence Care Prescribing Observatory for Mental Health Services (POMH) Number of POMH Topic Number of service users enrolled by the service Trust Users nationally Screening for metabolic syndrome in community patients on anti ‐psychotics 30 2866 Benchmarking of high dose and combined antipsychotics on acute wards 39 1292 Assessment of side effects of depot antipsychotics 53 5037 Medicines reconciliation 45 1790 National Confidential Enquiries Suicide and Homicide by people with a mental illness Maternal and child health Local Audits The reports of 48 local clinical audits were reviewed by the provider during 2009‐2010. Manchester Mental Health and Social Care Trust intend to take the following actions to improve the quality of health care provided: Audit Title Re‐Audit of Documentation Prison In reach case notes Improvements Identified 
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MHIT must ensure that all Prisoners have a full initial assessment undertaken using the MMHSCT risk assessment form MHIT must ensure that all Prisoners have a care plan detailing the care they will receive from the mental health prison in reach team – only 23% of prisoners had a care plan 5 Audit Title Improvements Identified 
Physical Health Audit 
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Training will be delivered to the prison in reach team on completing the risk assessment form. Admission template was introduced to record all baseline parameters A further protocol for further monitoring at suggested intervals was introduced Measurement of BMI and waist circumference was introduced alongside the existing weight charts Attempts to improve liaison/communication with laboratories etc so results don’t go ‘missing’ Re‐audit in approximately 1 years time Audit Of Liaison Referrals To Old Age Psychiatry Department From General Hospital (Manchester Royal Infirmary Hospital Site) 
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Audit of the use of Atypical Antipsychotics in Patients with Dementia 
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Do people seen by liaison psychiatrist whilst at North Manchester General Hospital attend for OP appointments following discharge? 
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To Re‐format the consultation request form for patients of 65 years of age or older in the light of this audit To request the Acute Trust to make the new consultation request form available on all the wards. To take other measures including educating staff about providing the relevant information on consultation requests. To Re‐audit this project again after a period of time to see any improvement. A “Dementia Treatment Pack” to be introduced as this would better enable prescribing to be standardised. When behaviours are being described, a standard should be used. An example used in the “Dementia Treatment Pack” is the Neuropsychiatric Inventory (NPI). The reasons for specific prescribing of medications should be documented in the notes’ Reminders to be sent to patients and their relatives or nursing home personally by telephone/email/letter to improve attendance. Both clinic appointments to see psychiatrist and physical clinic to be arranged on the same day (preferably in the same morning/afternoon) for patients with dementia. Therefore, when these patients do attend, they would attend both clinics which would improve attendance rate. Accuracy of patient details in psychotherapy case notes 
System needed to ensure that service obtains ORF for all waiting list patients. A system for obtaining updated contact details from patients more frequently and systematically should be introduced. 6 Audit Title Improvements Identified 
Clinicians who record updated contact details for patients should flag up these changes to admin staff so that AMIGOS can be updated, thereby generating an accurate front sheet. 
Documentation in the following areas has improved since 2007 • Patients NHS Number • Special requirements where appropriate • Leaflet/ tape provided • Contact details of the clinic • Patient dated the signature on the consent form Ensure all clients have a consent form completed filed in the notes Ensure NHS number is recorded on all consent forms Ensure patients date the form when they have signed to consent. Ensure that risks are recorded on the consent form. Re audit of consent to acupuncture treatment 
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Standards of Physical Health in a Mental Health Unit. Adequate equipment to perform physical examination. 
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Checklists of medical equipment to be established on wards where this has not already been done, with one member of staff responsible for checking this. A regular check by staff to ensure equipment is working. Ensure all wards have tape measures in view of monitoring weight/waist circumference. Audit of Rapid Tranquilisation 
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All staff to attend Rapid Tranquilisation Update Training every 3 years as per mandatory training policy Physical Observation document has been developed which provides reminders to nursing staff re: policy requirements Re‐audit in 2 years Audit of Seclusion 
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Audit of Trust Risk Assessment Tool 
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The number of times seclusion was used during the audit time period was relatively small. 15 minute observation of service user in seclusion was well documented. The Trust policy on reviews at set intervals, 2hrs, 4 hours, 8 hours etc were well documented. Seclusion incidents on the ward should be documented electronically. Secondary care teams should complete risk assessment forms when seeing clients even if they are already under a CMHT) The Risk Matrix remains the most widely used risk 7 Audit Title Improvements Identified 
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assessment tool, as some teams do not get risk assessment copy referral The inpatient units across the Trust continue to successfully implement the risk assessment tool for all new clients included in the audit. Where risk assessments are being completed and filed in the medical notes, the assessments are not held by the team in question, but move with the patient around the Trust. Some citywide and community based teams are more likely to complete a risk assessment recorded on AMIGOS than using the paper forms. However, it was evident that further training was needed in terms of the navigability of the risk assessment form on Amigos. Review of need to audit NICE clinical guideline 52 and TA 114 methadone and buprenorphine. The audit highlights that Manchester Drug Service are leading the prescribing of opiates to MMHSCT service users and that in the majority of cases MMHSCT have documented being able to check the dose on admission. However there is a need to review 
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Audit of transfer policy from Adult Services to Old Age Services 
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Communication of information between the services pertinent to both individuals and around general alerts. possible service level agreements for services provided with subsequent review of these. Communication between Accountable Officers A letter be sent to all local GPs re‐emphasising the need for a blood screen to be conducted on all patients before being referred to the department. An ‘investigation’ front sheet developed and placed at the front of all new patients’ notes.. For all patients and relatives to be asked at the initial assessment if they wish to have their CT scan and ECG on the same day or different days. If the same then they should be given a completed ECG request card to take to the department on the day of their CT scan appointment. To ask the CT department about the feasibility of having a copy of patient’s CT appointment letter sent to the Old Age Psychiatry department. All consultant secretaries to have an ‘Investigation Diary’ to put in the dates that patients are having CT scans. The patients should be reminded of the test the week before and, if a result has not been received 2 weeks after the test, the CT department 8 Audit Title Improvements Identified should be rung to request it. Safe and Secure Handling of Medicines in community teams (DUTHIE re‐audit) 
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Suicide audit Audit of Hand Washing 
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Team leaders to work with pharmacists and technicians to further improve the standards of medicines management in their teams On‐line BNF available to all as BNF numbers too small to provide new copies to each practitioner. Work to change risperidone cold chain and delivery on‐going with start date in April. Fridge storage needs addressing Depot review project producing standard procedures for depot charts however teams must ensure correct cards used and prescriptions reviewed on time. Team leaders to urgently review instances of nurse dispensing Standard operating procedures in production by pharmacists Risk Assessment/Summary to be improved. Crisis Plans must be available in all case plans. Re audit in 3 months and then 6 months to assess impact of the campaign Launch the new national audit tools for hand hygiene in January Expand the patient questionnaire to include staff hand hygiene Include hand hygiene and light box training on induction Audit the facilities provided for staff to perform hand hygiene Audit of completion of physical health pro‐forma for all patients admitted to Cavendish Ward over a three month period 
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The existence of the pro‐forma and the importance of its completion should be emphasised to all new trainees at the time of their induction. This could be attained by including a copy of the pro‐forma in the induction manual given to all trainees. It should be emphasised that a statement such as “physical examination‐ NAD” is not sufficient and could have medico‐legal implications. Sufficient pro‐formas should be made available on all wards at all times, and staff should be made aware of their location. The current pro‐forma could be altered to highlight the sections where bloods and tests are taken/requested. If night time admissions make performing a physical examination or taking bloods impractical this should 9 Audit Title Improvements Identified 
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Audit on Service Users who were brought in by the police to the A&E department without being detained under Section 135/136 of the Mental Health Act 
Locally agreed arrangements on the involvement of the police should include a joint risk assessment tool to help determine the level of risk (possibly to adapt a new protocol) 
Timely assessment in safe and appropriate settings 
Some guidance on how to deal with people who are also under the effects of alcohol or drugs; or people who are behaving, or have behaved, violently 
Medico‐legal need to improve record keeping and monitoring 
Audit of practice against new standards and new protocol 
The depot card needs to be updated to reflect current practices. Data must be included on all key aspects of patient information, on the depot form and on AMIGOS. An audit of the use of long‐
acting neuroleptics ‐ Clinical Practice be documented in the ward diary by the admitting doctor to ensure this is done by the patient’s team at the earliest opportunity. Transportable scales should be available on Cavendish Ward. If a full physical examination and blood tests have been done by another department e.g A+E, a copy of this should be taken and filed in the patient’s notes. It is not sufficient to state “completed in A+E”. If a patient is transferred from a general ward where they have been for a period of greater than 24 hours a repeat physical examination and blood tests should be performed. If a complete physical examination and blood tests have been performed within 24 hours of a patient being transferred, the findings should be copied into the patient’s psychiatric notes. The guidelines regarding the use of a chaperone during a physical examination should be made clear by the appropriate body. A standard admission set of blood tests should be defined and highlighted on the admission pro‐forma. At the weekly MDT held on Cavendish Ward it should be ensured that any new patients admitted in the last 7 days has had a full physical examination performed and appropriate tests done/requested. The completion of physical health pro‐formas should be re‐audited in 12 months to ensure recommendations have been put in place. 
10 Audit Title Improvements Identified 
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Doctors must inform clinic nurses of any changes to depot injections both personally and by copying them into letters to the GP. A number of patients are prescribed depots above standard guidance. There must be a clear indication of discussion with the patient and/or carer on the risks and benefits of such practice. Generic prescribing of depots remains a difficult area. Medicines management needs to explore whether the prescribing of brand names is acceptable practice. It would be advantageous to have electronic prescription cards only instead of the confusion of having both depot cards and keeping electronic records. Further work needs to be done on ascertaining patient satisfaction of the service and also on the physical health of patients who receive long term depot medication. National Audits The reports of 7 national audits were reviewed by the provider in 2009/10 and Manchester Mental Health and Social Care Trust intends to take the following action to improve the quality of health care provided. Name of Audit Actions to be taken National Health Promotion in Hospitals Audit The findings from the report have been shared and discussed with members of the Northwest Mental Health Audit Group as well as MMHSCT’s Physical Health Group. MMHSCT Wellbeing nurses are currently undertaking an audit of Smoking Cessation on inpatient wards. National Audit of Continence Care The RCP National Audit of Continence Care has been completed and results from the Organisational Audit have only just been received.. The RCP has included the Audit in the DoH Quality Accounts 2009/10. Prescribing Observatory for Mental Health Services Pomh reports have been extensively presented at local audit meetings, 2 conferences and at a consultant cpd 11 event on 2 occasions. National Audit of Falls Training has been introduced for staff re falls. We participated in the first round of this but opted out of National Audit of Depression Detection and Management of the second NHS staff on long‐term sickness by Occupational Health Services National Audit of Violence Outcomes were presented at MMHSCT Effectiveness Day National Confidential Enquiry into Homicide and Suicide / MASH Project (self harm) Both have been presented at Effectiveness Days and fed back into MMHSCT’s Suicide Prevention Group Quality Improvement Projects and Improvement Networks The Trust also participated in a number of National Quality Improvement projects managed by the Royal College of Psychiatrists Centre for Quality Improvement. These included the Memory Service, Perinatal services (Anderson Ward), ECT suite and Grafton Ward. Participation in Clinical Research Research is an important driver for improving the quality of care. The Trust is a key partner in the Manchester Academic Health Science Centre (MAHSC), with the University of Manchester and the six most research active NHS organisations in Greater Manchester. The Trust is pleased to have four staff who are Senior Investigators for the National Institute for Health Research (NIHR) which recognises their outstanding contribution to health and social care research. The number of service users receiving services provided by Manchester Mental Health & Social Care Trust that were recruited to participate in research approved by the research ethics committee was 331. Use of Commissioning for Quality and Innovation (CQUINN) payment framework The CQUIN payment framework makes a proportion of providers' income conditional on quality and innovation. Its aim is to support the vision set out in High Quality Care for All (2008), a report by Lord Darzi which set out a vision for the NHS with the goal of putting quality at the heart of the NHS so that it becomes the organising principle. The framework was launched in April 2009 and helps ensure quality is part of the commissioner‐provider discussion everywhere. The Trust has agreed a CQUIN scheme with its lead commissioners. Further details of the agreed goals for 2010/2011 are available on request from Manchester Mental Health and Social Care Trust, Chorlton House, Manchester Road, Chorlton, Manchester M21 9UN. 12 Registration Status All NHS Trusts were required to formally register with the Care Quality Commission (CQC) in January 2010 against a set of requirements on infection control and Health Care Acquired Infections (HCAI). Manchester Mental Health & Social Care Trust were registered without conditions. Work has continued within the Trust to ensure that it remains compliant with all requirements. Manchester Mental Health & Social Care Trust is required to register with the Care Quality Commission and its current status is that it is registered without any conditions from 1/4/2010. The Trust, as part of a new process, submitted a registration compliance with 15 of the 16 regulations and non‐compliance with regulation 16 that focuses on safety and suitability of equipment. An action plan is in place, to ensure compliance is achieved for this regulation and associated outcome, this will be delivered by April 2010. Data Quality The Trust is committed to ensuring that the data the Trust is using to measure performance is accurate. The following statements highlight the progress made in delivering good data quality. Manchester Mental Health & Social Care Trust submitted records during 2009/10 to the Secondary Uses services for inclusion in the Hospital Episode Statistics. The percentage of records in the published data which included the patient’s valid NHS number was:  98.9% for in patient care  100% for outpatient care  The percentage of records in the published data which included the patients valid General Medical Practice Code was  99.6% for inpatient care  99.6% for outpatient care Manchester Mental Health & Social Care Trust score for the 2009/2010 Information and Quality Records Management assessed using the Information Governance Tool Kit was : Results (based on requirements version 7 ) Initiative Clinical Information Assurance 76% (GREEN) Confidentiality and Data Protection Assurance 88% (GREEN) Corporate Information Assurance 58% (AMBER) Information Governance Management 88% (GREEN) Information Security Assurance 90% (GREEN) Secondary Use Assurance 63% (AMBER) 13 The Information Governance Toolkit, ensures necessary safeguards for and appropriate use of confidential information. The Trust was not subject to a Payment by Results Clinical Coding audit during 2009/10 by the Audit Commission 3. Plans for 2010/2011 Under the new arrangements for regulation, the Trust has been registered with the CQC without conditions. The Trust has already agreed a range of quality measures through its standard contract and through the CQUIN Scheme with NHS Manchester, its key commissioner. The Trust Board has recently reviewed and improved its governance arrangements in relation to the quality of care it provides. It has established a Quality Board that is chaired by a Non Executive Director and three committees that enable assurance on the three key dimensions of quality; effectiveness, enhancing safety and service user experience. 14 This new assurance framework enables the connectivity of all the workings of the Trust, from patient experience through to the Trust Board. The Quality Board will ensure that there is a focus on quality throughout the organisation and a process for continuous improvement and review. The diagram below illustrates the new assurance arrangements:
Council of Governors Chair: Trust Chair Board of Directors Chair: Trust Chair Executive Management Team Chair: CEO Operational Management Team Chair: COO
Audit Committee Chair: NED Patient Experience Committee Chair: Director of Nursing and Therapies
Finance Committee Chair: NED Remuneration Committee Chair: NED Clinical Governance Committee Chair: Medical Director Quality Board Chair: NED Risk Committee Chair: Director of Nursing and Therapies
Management Board Chair: CEO IM&T Committee Chair: Director of Performance Psychological Therapies Management Group Adult Mental Health Care Group Workforce & Organisational Development Committee Chair: D. of W&OD Later Life Care Group Academic Research & Development Committee Chair: Medical Director
Social Inclusion Care Group Estates Committee Chair: Director of Finance Key Trust Committee Structure: Green Committees of the Trust that establish and monitor strategy Red Sub‐committees of the Trust Board authorised to make decisions on behalf of the organisation Blue Committees reporting to sub‐committees of the Trust Board that provide assurance regarding the management and delivery of all Trust activity Yellow Committees that manage the day to day provision of care services NED: Non‐Executive Director
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Patient Experience For 2010/2011 as part of the Annual Business Planning process the Trust has identified three key areas where we seek to make improvements to the patient’s experience. These improvements have been identified from the Trust results of the annual patient surveys. 1. Overall experience:  Ensuring that privacy and dignity is embraced throughout our patient care by enabling the provision of same sex sleeping, washing and toilet accommodation across all in patient ward areas.  Ensuring that our staff explain the purposes as well as the side effects of medications to service users and their carers.  Ensuring that service users receive information and an explanation of their rights in a way they can understand if they have been detained under the Mental Health Act. 2. Care Programme Approach (CPA):  To ensure that service users who have a CPA have received a review of their care plan within 12 months. 3. A and E waiting times:  To ensure that any patient with mental ill health presenting to an A and E department does not wait over 4 hours to be seen. Effectiveness The key areas for improvements in effectiveness are: 1. To ensure that all service care models have been assessed against recovery orientated model standards:  To deliver care processes that reflect wellness and recovery.  All care models have been reviewed to include patient experience. 2. To establish agreed outcomes for each care team in the Trust that reflect:  Patient experience and satisfaction.  Clinical improvements. 3. Clinical Audit Programme linked to the agreed emergency care pathways to test its effectiveness. Safety The following areas have been identified as areas to focus on in terms of Patient Safety: 1. To develop an Incident Observatory building on the existing work of the DATIX incident reporting system to:  Encourage increased incident reporting against National Patient Safety Agency (NPSA) reporting measures.  Provide information to teams in a timely way.  Support learning and patient safety improvements. 2. To establish 3 Patient Safety campaigns over the year to address themes and trends identified from the DATIX incident reporting system. 3. To review our clinical risk management processes including:  The Risk Management Assessment Tool.  Integration of risk management into recovery orientated pathway.  Making clinical risk information available to teams. 4. Partnership Working As part of our assurance system and to ensure strong partnership working with our key stakeholders we have asked our Local Involvement Networks, Overview and Scrutiny Committee and Primary Care Trust to make a comment on our Quality Account. Manchester Local Involvement Network The Quality Account was sent to Manchester Local Involvement Network who stated that: In view of the relatively short time scale that the Quality Account process has allowed in its first year for responses from other bodies (such as the LINk), the LINk Steering Group has agreed that the LINk will not be commenting on this year’s Quality Account submissions from its relevant NHS trusts. However, Manchester LINk intends to take part in the Quality Account process in future and is developing protocols for this. Manchester Overview and Scrutiny Committee The Quality Account was sent to Manchester Overview and Scrutiny Committee who stated that: On this occasion, the Health and Wellbeing Overview and Scrutiny Committee is not able to provide a detailed statement on the Quality Accounts due to the limited time we have available to comment for all of the NHS Trusts in Manchester. We have made representations to CQC and MONITOR about the timetable for Quality Accounts and to ask them to take account of election purdah periods to allow sufficient time for the Committee to comment in the future. At its meeting on 24 June 2010, the Committee reviewed the commentary provided by Manchester Mental Health & Social Care Trust and we support the comments contained within that statement about the quality of the service provided and the accuracy of the data. The Committee looks forward to doing a detailed piece of work around how commissioners and providers ensure the quality of services for Manchester residents in preparation for next year's Quality Accounts. NHS Manchester We welcome the opportunity to provide a statement for MMHSCT’s first Quality Account. For this purpose, we have reviewed information available to us and also consulted with associated Commissioners. We have checked the accuracy of the information and as far as we are able to we can confirm the accuracy of the information in the document. We regularly review publically available information on the quality of our main provider NHS Trusts. Judged against this information, one may have expected to see a mention of the Trust’s work in reducing length of stay in acute adult settings and work around development of care pathways including the subsequent delayed discharges of care caused by blockages within the treatment system. Presently a collaborative piece of work is under way to identify and develop an action plan in relation to this. Through our Quality reviews of the Trust we have worked with MMHSCT, in reducing the number of mental health assessments allowed to lapse within the community. This is seen as a key area to reduce clinical risk but is not reflected in the document. NHS Manchester would commend the trust for identifying within the Annual Business Planning process the key areas around reduction in mixed sex accommodation, and improving access to A&E mental health assessment as these are seen as key improvement areas also within the Quality agenda. The document describes that both MMHSCT Trust Board and Governance Committee have reviewed data in relation to the quality of care in Adult Mental Health Services, Older People Mental Health, Prison Mental Health and Specialist Mother and Baby Unit provision. We would hope to see these findings in future quality accounts. The Trust has undertaken a programme of clinical audit/non clinical audit, and confidential enquiries and has provided and identified an extensive list of improvements that will result from these. Whilst identifying these quality and service improvements in the core text NHS Manchester would hope to see improvement targets or goals in relation to these in future quality accounts. MMHSCT has set out a comprehensive Quality Campaign that the Trust is undertaking. NHS Manchester feel there should be more detailed plans in year; specifically it would be helpful to show how related improvements will be demonstrated and reported publically next year. Quality Accounts are an important tool for open reporting on quality priorities, and we would like to see them being used increasingly to provide more information publically. NHS Manchester welcomes the extensive service user and carer engagement agenda and the development of a local forum that acts as an interface between the trust and local stakeholders. It is unclear what improvements have resulted from this forum and how the subsequent actions from this agenda have impacted on quality and patient experience. It is felt that the reader may wish to be informed of these. As commissioner, we have specified quality requirements in the contract with MMHSCT through CQUIN. This is the first year that the trust has been involved in this scheme and has agreed a series of ambitious targets. Throughout 2010/11 we will endeavour to support the Trust’s quality initiatives programme, and identify future areas that may be incorporated into the subsequent years CQUIN programme. NHS Manchester will monitor the Trust’s progress through regular review at the joint quality improvement meetings where we will review information from Quality Accounts, audits, reviews, serious incidents, patient feedback or complaints. Readers should be able to check our assessment through the reports we make to the PCT Board also.