North East London NHS Foundation Trust Quality Accounts 2009/10 2 Quality Accounts 2009/10 Content Foreword Introduction Part 1 – About us An overview of the Trust, our vision and our values Our vision Our mission Our values Engaging with service users, staff, our partners and the public What we are doing well Improvement in service quality Part 2 – Improvement priorities 2010/11 Our plans for quality improvement in the coming year Service User Experience Clinical Effectiveness Patient Safety Agreed future goals with our commissioners 2010/11 – CQUINS Statements relating to quality of NHS services provided Clinical Audit Research Statement from the Care Quality Commission Data Quality Information Governance Toolkit attainment levels Clinical coding error rate Part 3 – Reviewing our performance An overview of our performance in 2009/10 Service user Experience Clinical Effectiveness Patient Safety Goals agreed with our Commissioners for 2009/10 Workforce Development and Leadership Development of the Staff Charter What our Staff are Saying – Staff Survey 2009 The NHS Constitution and NELFT – how we are doing Statement from the Overview and Scrutiny Committee Statement from PCT commissioners Statement from Barking and Dagenham LINks Statement from Service User Reference Group Appendix 1 – Service user feedback form Appendix 2 ‐ NELFT Assuring the Quality of Medical Appraisal for Revalidation (AQMAR) Action Plan Glossary 4 5 6‐10 11‐20 21‐32 34 35 36 37 40 41 42 3 Quality Accounts 2009/10 Foreword 4 Welcome to the North East London NHS Foundation Trust Quality Accounts 2009/10. This is an opportunity for us to share with you what our organisation is doing well, where we need to make improvements and how we intend to involve others in enhancing the quality of our services. We have a strong track record of involving the people who use our services in the development and monitoring of quality standards. Quality Accounts present us with an opportunity to inform you of our plans and progress. Although this is our first Quality Account report, our journey to improve the quality of our services is long established. In 2007 a set of service user defined standards were developed and introduced. Today these standards are shaping and informing what we do across our services. We are confident that you will find something of interest in this report, and some encouragement in our determination to bring about improvements and ensure that they are embedded and maintained. John Brouder Chief Executive Quality Accounts 2009/10 The ‘excellent’ score we achieved for quality of services last year from the Care Quality Commission is a tribute to the hard work and dedication of our staff and to the considerable contribution made by service users and Governors to ensuring that we concentrate on improving the quality of our services. While progress has been made, we know that we still have a way to go to ensure uniform quality across all of our services, and driving up quality will be an increasing challenge as resources become tighter in the year ahead. Our service users play an important role, through the Service User Reference Group (SURG) which reports directly to the Trust Board and through the User Quality Action Teams which monitor the Service User Standards. So too does the Council of Governors which worked with the Trust Board and the SURG to determine the priorities for the year ahead. Jane Atkinson Chair Introduction The final report of Lord Darzi’s NHS next stage review, High Quality Care for All, (DOH 2008) sets out a vision for an NHS with ‘quality at its heart‘. The report stated that Trusts should be required to publish Quality Accounts in the same way as they are required to publish financial accounts. This vision is consistent with our own. We too are driven by a strong desire to ensure the delivery of high quality services and so we welcome the opportunity to publish our first Quality Account Report. Our key priorities include improving the experience of our service users and staff and developing a forward‐looking, learning organisation, which delivers modern services. Quality improvement is a major priority at all levels of the organisation, and central to how we deliver services. We are proud of our achievements to date but recognise there are significant local and national challenges ahead. As a provider of both Mental Health Services (MHS) and Barking and Dagenham Community Health Services (CHS) under hosting arrangements, we are not formally required to include CHS in this report; but have decided to share with you the CHS CQUIN (Commissioning for Quality and Innovation) targets for the previous and coming year. Plans for developing our Quality Accounts 2011/12 Our Trust Board is ultimately accountable for the quality of services we deliver. We aim to embed Quality Accounts into our Governance arrangements so that discussion about them becomes business as usual rather than an annual exercise. However we thrive on involving and being shaped by staff, service users and carers, partner organisations and our Commissioners. All have a part to play in developing the content and priorities for our next Quality Accounts. In the coming year we will involve staff, services users and carers by listening to their views on how we are doing and what needs to improve. We will work with Local Involvement Networks (LINks) and the Overview and Scrutiny Committee, as well as our Governors, members, local stakeholders and other interested parties. What our service users have told us…… “I am now enjoying being a mum for the first time and that is because of the help the Perinatal Service has given me.” “The Willows and Brookside have really helped me to feel confident again and I can now identify the issues which may trigger depression” “The sensory room is helping me towards reaching my goal of living the life I want to live” (Victor Hugo Unit) “The idea that NELFT listens to service users is good” (UQAT) “It was a good opportunity to meet other people who stammer. The course helped me build confidence in different speaking situations, including visiting local shops” (Speech and Language Therapy) “It’s made such a difference to my life, being able to get the help I need at home, at anytime of day or night. It enables me to lead as normal life I can.” (Rapid Response Team) 5 Quality Accounts 2009/10 Part 1 An overview of the Trust, our vision and our values ‘Helping you live the life you want’ About Us North East London NHS Foundation Trust (NELFT) provides mental health services in the London Boroughs of Barking & Dagenham, Havering, Redbridge and Waltham Forest, and community health services in Barking & Dagenham, and, to a lesser extent, in Havering. We serve a population of almost one million. The extensive range of specialist services we provide include hospital based services and services in the community. Our vision To have in place a sustainable, people driven service system of care which is ‘best in class’. Our mission Helping you live the life you want. Our values Valuing and respecting individuals We will listen to the views of others Individualised evidence based care Hope inspiring environments Choice and socially inclusive opportunities Effective communication Service users at the heart of everything we do Embracing diversity Empowerment and choice Engaging with Governors, service users, staff, our partners and the public Engagement with our Governors has been a focus this year. They now receive details of Board decisions and issues specific to each Borough. Governors approved a new Engagement Strategy, and a group of Governors now meet monthly with Board members to discuss quality, governance, performance and strategy. This has improved information flow and allows Governors a real insight into the way the Trust is managed and the quality of our services. We realise that there is more work to do in engaging our public members. We have established a quarterly newsletter and launched a new website, and will continue to look at new ways to encourage their participation. We have developed a Service User Reference Group (SURG), which reports directly to the Trust Board on service user issues. The SURG also receives reports from the User Quality Action Team (UQAT), who monitor the implementation of the Service User Standards. Both the SURG and UQAT are recruited from the Trust’s service user community. The establishment of these groups has ensured that service user concerns, and suggestions for quality improvement, can directly influence our plans and strategy. We are committed to hearing the views and voices of our staff so that they can shape and feel a part of this thriving organisation. Our Senior Leaders Forum allows for networking and discussion on current issues. Engagement with the four borough LINks is conducted at local and Trust‐wide level through regular attendance at LINk meetings and joint ventures around training and public involvement. A joint meeting between all four LINKs and the NELFT Chief Executive takes place every two months. This facilitates collaborative working across all organisations. Information shared so far includes Productive Ward and Star Wards, mapping of dementia services with mock site and view visits. 7 Quality Accounts 2009/10 What we are doing well The hard work and commitment of our staff to deliver an excellent service, and investment in our facilities, contributed to the Trust being awarded an ‘excellent’ rating from the Care Quality Commission in 2009. Some of the things we are doing well and are proud of include: Perinatal Mental Health Service Our Perinatal Mental Health Service was launched in 2009 for women who experience mental health problems during and after pregnancy. The service works in partnership with Whipps Cross, Queens and King George Hospitals. We are very fortunate to be one of the few Trusts in the United Kingdom to secure funding for this type of service. Development of Carer Standards We have been working with carers, and carer organisations, to develop Carer Standards that set out what carers can expect from our services. Implementation of the standards began in August 2009, and there is an on‐going process of implementation and review. 8 Quality Accounts 2009/10 Development of Learning Disability Standards Learning Disability Service User Standards have been developed in collaboration with service users and Barking and Dagenham MENCAP. Forums and consultations were held to develop the standards in line with our Service User Standards, and in a format and language that is easily accessible to our service users with a learning disability. We launched these standards in 2010. Dementia In the past year a number of services have been introduced for people with dementia. Memory clinics have been established and Admiral Nurses have been recruited in each Borough. NHS Barking and Dagenham have funded an Accident & Emergency mental health liaison service for older people at Queens Hospital. Joint memory assessment services for young people with dementia have been developed across Havering and Barking & Dagenham, and a very successful Alzheimer’s café has been established in Havering in collaboration with the Alzheimer’s Society. Adult Acute Ward Transformational Programme Our nine adult acute wards have been involved in far‐reaching improvement programmes aimed at enhancing the inpatient experience for both service users and staff. The Star Wards programme has resulted in each ward setting its own unique improvement goals, Patient Protected Time, Patient Protected Meal Times and service user informed activity programmes. The Productive Ward programme has lead to a welcomed increase in the amount of time staff spend with service users. Sensory Room Our first sensory room, opened in Victor Hugo Unit, has proved so successful that Tate Modern has visited to get tips for its adult learning programme. The room is an environment where sensory experiences can be controlled, providing the service user with a space to relax, focus attention and develop an awareness of self, others and the environment. Investing in new facilities Excellent progress is being made in the building of a new, state of the art, inpatient facility at Goodmayes. Due to be completed in December 2010, the new Unit is purpose built to house a range of mental health inpatient services. Key features of the development will include individual bedrooms with en‐suite facilities, roof terraces and spacious dining rooms and lounges. Rapid Response Team Our Rapid Response Team has grown from strength to strength in 2009/10. This service provides intensive 72 hour support for patients in their own home or in nursing homes, to prevent the need for patients to be admitted to an acute hospital for treatment. The service has made a significant contribution to reducing the demand for beds within both Queen’s and King George’s Hospital. Integrated Diabetes Team Our integrated diabetes team brings together all the services that diabetic patients require in the community under one roof, within the Porters Avenue Health Centre in Dagenham. The service integrates GP input with nursing care, dietetic advice, podiatry care and psychology services into one appointment, providing seamless care for patients. 9 Quality Accounts 2009/10 Improvement in service quality We fully acknowledge that there is still a lot of work to do to deliver the high quality services we aspire to. Through working in partnership we intend to make significant improvements in the priority areas out‐
lined below, as these are the areas where we need to make improvements. Our priorities for improvement in the coming year: Service User Experience Improve patient satisfaction with treat‐
ment received Improve carer satisfaction Improve information on medication Increase Employment Education and Training (EET) opportunities Improving end of life care provision Clinical Effectiveness Improve physical health care Implement the Productive Series in the community Prescribing anti‐psychotics for people with dementia Increase Access to Psychological Therapies (IAPT) Improve HoNOS PbR (Health of the Nation Outcome Scores, Payment by Results) data collection and reporting Improve uptake of the Common Assessment Framework amongst CHS staff 10 Quality Accounts 2009/10 Patient Safety Increase reporting of medication errors Increase take up in smoking cessation programme Thereafter, helping ex‐smokers to stay off tobacco Suicide prevention Compliance with the hygiene code Compliance with safeguarding children with adults policies and procedures These priorities are explained in further detail in Part 2. Two of the common themes emerging from complaints received are, staff attitude and communication. We aim to address this through the implementation of our staff charter (see page 30) and the staff survey action plan. Part 2 Our plans for quality improvement in the coming year ‘Looking forward to the future with hope and optimism – our improvement priorities ’ We are committed to improving the experience of the people who use our services, in a real and meaningful way, because this is what matters to us. This section of our Quality Account sets out our plans for improving the effectiveness, safety and experience of our services. Under the three components of quality: service user experience clinical effectiveness and patient safety we have identified below a number of areas for improvement and why we believe they are important. Service User Experience We know that if we are going to transform services, then acting on what really matters to service users, carers and staff is essential. Through the following measures we aim to deliver services which respond to individual needs and lead to an improved experiences for those involved:‐ Service User Experience Area for quality improvement Improve patient satisfaction – please see CQUIN (Commissioning for Quality and Innovation) on page 16 Improve carer satisfaction Improve information about medication Why this is important To ensure that carers are identified and their needs addressed so that they are supported. To support delivery of the national carer strategy and local carer standards. To promote service user/
carer understanding, informed decision‐making and choice. The improvement we expect to see All carers will be offered an assessment and their needs addressed. Improved awareness of medication issues. Increase Employment To support service users to Education and Training fulfil vocational aspirations (EET) while encouraging social inclusion and recovery. More service users being asked about their needs. More service users in EET Improve end of life care provision (see CQUIN information on page 16) 12 Quality Accounts 2009/10 How we will achieve this Team Information Leads will ensure information leaflets are available to carers. Staff will receive training and support in carer’s assessments. Number of carers assessments monitored each month. We will subscribe to the website www.choiceandmedication.org as a resource for staff and service users. Monitoring by inpatient questionnaire. EET to be included in assessment of service users needs. Clear EET pathways to be developed with partner agencies Provide support to service users currently in employment, to retain their jobs. Additional employment support worker recruited (Barking & Dagenham). Clinical Effectiveness We want to ensure that the most effective and high quality care is available to the people who use our service. Clinical effectiveness is about making sure that the clinical treatment and care we provide is effective. We aim to ensure that all our activities are evidence based, and that our clinical audit programme provides proper feedback on effectiveness. Clinical Effectiveness Area for quality improvement Improve physical health care (see CQUIN information on page 16) Why this is important The improvement we expect to see How we will achieve this Increase direct care time for service users in the community by participating in the Productive Community Programme To increase the amount of time staff spend with service users. To roll out the benefits of the Productive Ward programme to community teams. Increase in direct care time spent with service users. Pilot the Productive Community series with two Community Mental Health Teams (CMHTs). Practice Improvement Practitioners (PIPs) to support CMHT staff with reviewing their systems and processes and making improvements. Share the learning and improvements from the pilot across all CMHTs. Roll out the Productive Community series to all CMHTs. Prescribing anti‐
psychotics for people with dementia (see CQUIN information on page 16) Increase Access to Psychological Therapies – (IAPT) courses To ensure service users have access to effective psychological therapies in a primary care setting. Increased numbers of individuals accessing the service. IAPT trainees to join specific IAPT teams to ensure the service is provided. Improve data collection and reporting of HoNOS PGR. (See CQUIN information on page 16) Improve uptake of the Common Assessment Framework. (See CQUIN information on page 16) 13 Quality Accounts 2009/10 Patient Safety We recognise that providing health care will always involve risks, but these risks can be reduced by analysing the root causes of incidents and addressing them. We are working with our staff to promote an open and transparent culture where things are reported when they go wrong, where lessons are learned and improvements made. We aim to further ensure patient safety through the following measures: Patient Safety Area for quality improvement Increase the reporting of medication errors Increase the take up of smoking cessation programmes Audit the number of ex smokers still not smoking after six months (see CQUIN information on page 16) Suicide Prevention 14 Quality Accounts 2009/10 Why this is important More medicine reporting correlates with increased safety. To improve the physical health and well‐being of service users. Supports the delivery of our Healthy Lifestyle Strategy. Local authority targets. To support NHS Barking and Dagenham’s goal to improve mortality rates for Cardiovascular Disease and Cancer. To help improve the health and well being of its staff. To ensure a safe environment where health and well‐being is the prime concern. The improvement we expect to see Improved percentage of management actions completed on the Datix Web recording systems. Reduction in medication related incidents. Increased numbers of service users on smoking cessation programme. Baseline assessment of the numbers of ex smokers still not smok‐
ing after 6 months of quitting Audit of the Increased numbers of service users on smoking cessation programme. Reduced suicide rates. How we will achieve this Team managers to follow‐up on recommendations on Datix Web, to ensure that actions are implemented. Fifty staff to be trained in smoking cessation to advise and support service users. A planned project between CHS & MHS to provide smoking cessation advice and guidance to Barking & Dagenham mental health inpatients, on how to reduce or stop smoking. Ex smokers smoking status will be followed up by post through either home testing or appointment. Use NPSA (National Patient Safety Agency) 2009 suicide prevention toolkit checklist to undertake an audit on each adult acute ward on a quarterly basis. Trust wide annual audits, performance data and action plans to inform future suicide prevention strategy developments. Patient Safety Area for quality improvement To be compliant with the hygiene code To ensure compliance with safeguarding children and adults, policies and procedures Why this is important Infection prevention and control is a key component of the patient safety agenda. To ensure a safe environment for children and adults. The improvement we expect to see Clear transparent systems put in place for the monitoring and improvement of infection control. Increased levels of referrals to safeguarding team. Increased staff awareness through training programme. Increased staff awareness of policy and legislation. How we will achieve this Recruitment of Infection Control Nurse. Monthly decontamination of equipment audits. CHS to provide training to MHS staff. Hygiene audit programme ensuring results lead to improvements in practice. Trust‐wide named nurse in place to co‐ordinate improvements. Safeguarding link workers in all clinical teams. 15 Quality Accounts 2009/10 Agreed future goals with our commissioners 2010/11 – CQUINs The document ‘High Quality Care’ for All (Department of Health 2008) included a commitment to make a proportion of health service provider’s income in 2010/11 conditional on quality and innovation ‐ through the Commissioning for Quality and Innovation (CQUIN) payment framework. This means that some of the Trusts income is dependant on us achieving specific goals agreed with the organisations that commission our services. CQUIN Targets Area for quality improvement Improve patient satisfaction with treatment received Development of clinical Quality Assessment Framework and processes (CHS) End of life care provision 16 Quality Accounts 2009/10 Why this is important Ensuring high quality care and improved experience for all service users. The Care Quality Commission annual inpatient survey 2009 demonstrated that per‐
formance could be improved. The National Strategy for End of Life Care (2008), identified that a need for be a significant improvement in the provision of services. Locally, this has led to a commitment to increasing the opportunity for patients to exercise their preferred location to die. The improvement we expect to see 5% improvement on previous questionnaire results. Increase in the number of patients on the Liverpool Care Pathway (which focuses on the last 48 hours of life) Increase in the % patients who die at their preferred place of death. Increase in the number of staff trained on LCP. How we will achieve this Practice Improvement Practitioners (PIPs) to support and work with clinical teams to improve identified areas. Action plan which demonstrates how 100% of services will be reported on. Training plan implemented for all CHS staff Developing Information Systems to permit recording, and thereafter training staff to ensure this is recorded CQUIN Targets Area for quality improvement Improve physical health care. Increase awareness of service user longer term conditions. Ensure access to routine physical health checks. Why this is important Identify and reduce health inequalities. To ensure patient safety as per NICE (National Institute for Clinical Excellence) guidelines and Royal College of Psychiatry Physical Health standards. To improve communication between primary and secondary care. The improvement we expect to see a) 80% RiO recording. b) Undertake audit prior to setting target. How we will achieve this Physical health assessment completed on admission for all inpatients by June 2010. Standardisation of physical health and emergency equipment. Venepuncture training for identified staff. Staff training in fitness and exercise to support delivery on inpatient wards. Trust‐wide Physical Health lead to co‐ordinate improvements. Prescribing anti‐
psychotics for people with dementia. Anti‐psychotics have limited impact on challenging behaviour in dementia and can be associated with severe side‐
effects in the long term. Undertake audit prior to setting target/action planning. Trust wide audit will be undertaken, concluding in December 2010. Improve uptake of the Common Assessment Framework (CAF) All vulnerable children should have a CAF assessment. CAFs help all local agencies to provide a co‐ordinated service for vulnerable children 200 CAFs to be completed by March 2011 Training will be provided to all CHS who may be in a position to initiate a CAF Champions will be identified to encourage uptake Health Visitor recruitment plan will help support this work Improve data collection and reporting of HoNOS PbR. (Health of Nation Outcome Score, Payment by Results) To ensure we can monitor the effectiveness of our services. HoNOS assessments are to become mandatory. 100% data recording. New quarterly HoNOS RiO reporting to capture data. Staff to have protected time to complete HoNOS entries. All staff to receive HoNOS training. 17 Quality Accounts 2009/10 Statements—Quality of NHS Services provided The following information has been provided in the format required by regulation Clinical Audit During 2009/10 ten national clinical audits and one national confidential enquiry covered NHS services that North East London NHS Foundation Trust provides. During that period North East London NHS Foundation Trust participated in 80% of the national clinical audits and 100% of the national confidential enquiries that it was eligible to participate in. The national clinical audits and national confidential enquiries that North East London NHS Foundation Trust was eligible to participate in during 2009/10 are as follows: National audit of Dementia National Falls and Bone Health Audit National Continence Care Audit POMH: prescribing topics in mental health services (x4) NAPTAD: Anxiety and Depression (pilot phase) National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCI/NCISH) 18 Quality Accounts 2009/10 The national clinical audits and national confidential enquiries that North East London NHS Foundation Trust participated in during 2009/10 are as follows: POMH: prescribing topics in mental health services Topic 1d: Prescribing of high dose and combination antipsychotics on adult and acute intensive wards‐ supplementary au‐
dit (March 2009) Topic 6b: Assessment of the side effects of depot antipsychotics: re‐audit (2009) Topic 7: Monitoring of patients prescribed lithium (Jan 2009) Topic 8: Medicines Reconciliation (May 2009) National Falls and Bone Health Audit National Continence Care Audit National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCI/NCISH) The national clinical audits and national confidential enquiries that North East London NHS Foundation Trust participated in, and for which data collection was completed during 2009/10 are listed below alongside the number of cases submitted to each audit or enquiry as a percentage of the number of registered cases required by the terms of that audit or enquiry. National Continence Care Audit ‐ 52% The report of National Falls and Bone Health Audit was reviewed in 2009/10 and North East London NHS Foundation Trust intends to take the following actions: Form a steering group to take forward delivery against Trust action plan Screening assessment tool to include assessment of fragility Produce guidance on actions to be taken after a patient experiences a fall Access to walking aids within 24hrs of admission The reports of local clinical audits were reviewed in 2009/10 and North East London NHS Foundation Trust intends to take the following actions: Reports from local clinical audits are reported to the Integrated Governance Committee quarterly. Recommendations are prioritised and actions are monitored by the Clinical Audit Department. Emerging themes are identified and disseminated through focussed clinical audit learning sessions. Examples of changes in practice as a result of internal audit include: Audit of Service User Involvement in the development and review of care plans in Victor Hugo Unit Audit identified that the current care plan did not enable service user ownership as it was not in an accessible format for learning disability clients. This has resulted in a number of changes including: Using new computer software, an easy read care plan package and easy read information leaflets (e.g. Medication information, Rights ‐ Mental Health Act, Complaints) have been developed, as has improved signage. Learning disabilities staff training package has been developed with City University. Learning Disability Service User Standards developed and launched in collaboration with MENCAP. Audit of Quality of Documentation of psychiatric history in Havering Home Treatment Team Audit identified that for the majority of patients there was insufficient documentation of psychiatric assessment. An action plan was developed to improve the standard of assessment information. This resulted in the introduction of a new Home Treatment Team Assessment form, which is completed during assessment and uploaded to RiO. In addition an assessment training/education programme has been developed. All recommendations were discussed and agreed at team meetings, and have now been implemented. They will be re‐audited to ensure effectiveness. Healthcare Quality Improvement Partnership National Clinical Audit Award NELFT Practice Improvement Directorate together with the NELFT User Quality Action Team were finalists in the Healthcare Quality Improvement Partnership National Clinical Audit Award 2010. NELFT were placed in the final three out of over 100 applicants nationwide. This was in recognition of ongoing Service User involvement in Clinical Audit. 19 Quality Accounts 2009/10 Research Commitment to research as a driver for improving the quality of care and patient experience The number of patients receiving NHS services provided or sub‐contracted by NELFT in 2009/10 that were recruited during that period to participate in research approved by a research ethics committee was 237. Clinical trials include: Support at home – interventions to enhance life in dementia (SHIELD), reminiscence groups for people with dementia and family care givers (REMCARE), understanding the sequence of conflict and containment events (CONSEQ), and Cognitive mechanisms of change in delusions. This increasing level of participation in clinical research demonstrates our commitment to improving the quality of care we offer and to wider health improvement. North East London NHS Foundation Trust was involved in conducting eight Department of Health or National charity funded clinical research studies. We used national systems to manage the studies in proportion to risk. All of the studies were established and managed under national model agreements. The Research Passport system was implemented in June 2009 and all researchers involved in studies are required to adhere to the research passport policy endorsed by the Trust. The National Institute for Health Research (NIHR) supported all of these research studies. We also had 29 own account research studies registered, which were all non‐NIHR funded studies, but they were governed by NELFT research governance guidelines. In the last three years 112 publications have resulted from our involvement in NIHR research, helping to improve patient outcomes and experience across the NHS. 20 Quality Accounts 2009/10 Statement from the Care Quality Commission North East London NHS Foundation Trust is required to register with the Care Quality Commission and its current registration status is compliant for all its registered activities at each of its associated locations. North East London NHS Foundation Trust is subject to periodic reviews by the Care Quality Commission. Data Quality North East London NHS Foundation Trust submitted records during 2009/10 to the Secondary Uses service for inclusion in the Hospital Episode Statistics, which are included in the latest published data. The percentage of records in the published data which included the patient’s valid NHS number was: 97.33% for admitted patient care 99.78% for outpatient care Information Governance Toolkit Attainment Levels North East London NHS Foundation Trust score for 2009/10 for Information Quality and Records Management, assessed using the Information Governance toolkit, was 87% for mental health services. Information for Barking and Dagenham Community Health Services is in the process of being disaggregated from NHS Barking and Dagenham figures. Clinical Coding Error Rate North East London NHS Foundation Trust was not subject to the Payment by Results clinical coding audit during 2009/10 by the Audit Commission. Part 3 An overview of our performance in 2009/10 ‘Reviewing our quality performance with a realistic eye’ Service User Experience Indicator: Ward to Board Service User Feedback The Service User Reference Group (SURG) ensure that service users can monitor, influence and evaluate our services. Core functions of the SURG include: Monitoring the performance of the Trust in relation to the User Led Quality Standards. Monitoring the performance of the Trust in relation to the Service User Strategy. Monitoring and advising the Trust in developing and increasing user involvement. Advising the Trust in the development of services that provide care, treatment and support to reflect a user‐led recovery and well‐being agenda. Key recommendations from the SURG: The Trust to develop a strategy to sup‐
port the service user employment agenda. More support for user and carer involvement at Directorate level. Improve information given to service users. Improved engagement with service user groups and the volunteering sector 22 Quality Accounts 2009/10 Response to SURG recommendations: A draft employment strategy has been developed by the Trust’s Social Inclusion Lead. The strategy includes sustaining employment for those using services, and targeting service users for internal and external appointments. We need to agree and plan how we intend to pursue user and carer involvement. The Trust’s Service User Information Group (SUIG) is looking at ways to improve access to, and availability of, appropriate and up to date information. All clinical teams have a member of staff who is the information lead. Personal Information folders are being considered by the SUIG as a way of providing essential information to service users and carers. The Trust is currently working towards achieving the NHS information standard. Indicator: Improve information provided to Service Users In 2007, we developed a set of user defined quality standards, with nine core themes. One of the themes is improving ‘Information and Care Planning’, which has 21 standards. Clinical teams are supported by Practice Improvement Practitioner’s (PIPs) to deliver these standards and to ensure continued self‐monitoring and improvement. Sixty‐seven clinical teams have been evaluated on the Information and Care Planning Standards, by the User Quality Action Team (UQAT), a group of service users trained in evaluation, who talk directly to service users about their experience of the standards. Figure 2 illustrates that Barking & Dagenham have made significant improvements from March 2009 to February 2010 in delivering the Standards. The other three Directorates however Date Directorates Havering Redbridge Mar‐09 Barking & Dagenham 46% 54% 69% Waltham Forest 48% Jun‐09 51% 53% 67% 53% Oct‐09 41% 54% 53% 49% Feb‐10 60% 47% 56% 45% [Figure 2, How each Directorate performed delivering the Information and Care Planning standards] Our aim is that each Directorate will achieve 100% when assessed on their delivery of the information and care planning standards. The results in figure 2 shows how each of the Directorates have performed in relation to this aim during the assessment periods from March 2009 to February 2010. have not been able to make sustained improvements and further focus and action is required. The Information and care planning Standards where improvements are required include: Top three Standards requiring Improvement Improvement Strategies All users to be provided with the opportunity to complete and have in place an advanced statement. A catalogue of Trust information should be readily available. Information will be given on how to be involved in Trust activities. All staff will be provided with training and support in advanced statements. A revised catalogue will be developed and circulated to all clinical teams with clear guidance. A Trust involvement pack is being developed. Indicator: Improve Supervision Standards Effective supervision practice, systems and structures are essential to supporting and developing staff, and to the quality of care provided. Supervision has been a key priority because it helps staff to reflect on and develop their knowledge and skills. All staff are expected to receive monthly supervision and monthly auditing is conducted to monitor that supervision is taking place. We aim to ensure that 100% of our staff are receiving monthly supervision. Figure 3 illustrates the Trusts’ performance in relation to the monthly supervision audits. We have seen significant improvements in our supervision rates particularly on inpatient wards. The ‘trend’ line shows an [Figure 3, Trust‐wide Supervision Audit] Figure 3 shows percentage each month, and trend. improvement from an average of 62% of staff supervised in February 2009, to 83% in January 2010. We continue to support the delivery and monitoring of supervision at all levels of the organisation. 23 Quality Accounts 2009/10 Clinical Effectiveness Indicator: Releasing Time to Care Implementation of the Productive Ward The Productive Mental Health Ward Programme empowers frontline staff to analyse and review ward processes and make improvements to ensure they are safer, more efficient and free up more staff time to spend with service users. A tool called the ‘Activity Follow’ is used to measure released time. Figure 4 illustrates the percentage of released time across the four show‐case Productive Wards. [Figure 4, Percentage of Direct Patient Contact Time] 24 Quality Accounts 2009/10 The wards have made steady progress in releasing time by redesigning their processes. This increase in direct patient contact time is being used to: Engage in patient protected time and patient protected meal times. Provide therapeutic groups and activities, on the wards. Enable staff supervision. Develop staff and practice improvement initiatives. The Productive Ward programme will now be rolled out to all inpatient wards, with support from the PIPs to ensure the benefits are spread and embedded. Staff from the four show‐case wards will be supporting the roll out and developing their leadership skills. Patient Safety Indicator: Reduce number of inpatient Incidents We continue to focus on reporting, investigating and learning from incidents. We aim to build on good practice and make incident reporting and analysis easier. By maintaining good levels of reporting and addressing the most frequent issues that cause incidents, a significant reduction in adult acute ward incidents has been achieved. The types of incidents commonly encountered include slips, trips and falls, absconding and issues relating to medication. Figure 5 shows that in January 2009 there was an average of 17 incidents on each ward. In January 2010 this had reduced to an average of seven incidents per ward each month, on average. [Figure 5, Average monthly incidents on adult acute wards] The Productive Ward programme has brought major benefits in terms of the identification and management of ward incidents and we have been able to share the learning across all wards. 25 Quality Accounts 2009/10 Goals agreed with our Commissioners for 2009/10 A proportion of NELFT income in 2009/10 was conditional on achieving quality improvements and innovation goals agreed between the Trust and Primary Care Trust Commissioners. These were to achieve improvement in: Safety – to improve the % of service users who have a risk assessment. Service User Experience – to improve the experience of care to people admitted to hospital. Social Inclusion – to improve the % of service users who have had the opportunity to develop a recovery and well‐being action plan. We have made significant improvements with our CQUINs and have achieved all targets set. It is acknowledged however that sustained effort and improvement is still required beyond 2010. Areas requiring further action have been incorporated in our forward plans (please see Part 2 of this report). Our performance ‐ CQUIN targets 2009/10 Indicator: Risk Assessments Undertaken We aim to improve the quality and delivery of risk assessments for people with severe mental illness, so that the safety of service users and staff is improved and their needs addressed. We have a systematic approach to risk assessment and management at an individual practitioner, team and organisational level. Our expectation is that we will achieve an average of 90% risk assessments completed in each Directorate. As can be seen in figure 6 only one of the Directorates is currently achieving this target, however the position of the others is improving. The Trusts Operational Performance group is working to identify ways to improve performance, and support staff in achieving this. [Figure 6, Percentage of completed Risk Assessments for each Directorate] 26 Quality Accounts 2009/10 Indicator: Improve patient satisfaction with treatment received We are working in partnership with Redbridge Concern for Mental Health and Psychiatric Systems Survivors Together to get direct feedback from service users and carers about the quality of care during their inpatient stay. The survey is conducted face to face on all inpatient wards. The questions asked in the service user survey can be found in Appendix 1. Responses ‘always’ or ‘most of the time’ indicate a positive reaction to the questions asked. Figure 7 illustrates that while significant progress was made particularly in [Figure 7, Patient survey responses that were ‘always’ and ‘most of the time’] November 2009, there has been a decline in performance during the following months. Actions to address this decline are outlined in Part 2 of this report. Indicator: Improve Social Inclusion Outcomes‐audit of Wellness and Recovery Plans We aim to deliver services that are focused Waltham Forest
on well‐being and recovery, based around Redbridge
self‐determination and self‐management. A recovery and well‐being booklet, devised Havering
by service users, is one of the key Care Planning Standards: “All users to be given Barking&
the opportunity to develop a recovery and Dagenham
well‐being action plan which includes pre‐
0%
20%
40%
venting or managing relapse” Standard 14. [Figure 8, Delivering Care Planning Standard 14] Delivery of this standard is monitored by Performance in February 2010 the UQAT, who ask service users about their experiences. Performance in January 2009 We are pleased with the overall improvement illustrated in Figure 8 as many more service users now have the opportunity to complete a recovery and well‐being plan. 60%
80%
27 Quality Accounts 2009/10 Indicator: Common Assessment Framework (CHS) All vulnerable children should have a Common Assessment Framework (CAF) assessment. It is a key part of delivering frontline services that are focused around the needs of children and young people, and integrated with other local services. Services need to demonstrate participation in the CAF to show they work in a co‐ordinated way with others, to ensure the best care for vulnerable children. All local partners see this tool as key to supporting early intervention and the work of the Children’s Centres and multi‐disciplinary locality teams. The 2009/10 target was to provide training in CAF assessments for appropriate staff, which was achieved. Next year, payment will be based on ensuring that 200 CAFs have been undertaken by March 2011. Indicator: Ensure compliance against the 18‐week pathway (CHS) The Department of Health Operating Framework 20010/11 stated that all Allied Health Professional (AHP) services will be mandated to report on performance against the 18 week Referral To Treatment (RTT) target from April 2011. This indicator has been established to incentivise community service to establish systems for earlier collection of data, and to make service improvements where performance is poor. The following systems are in place to support the delivery of this target: Services using a blank template to input data. Team based data collection methods. New VIPER data base, to support waiting time monitoring 28 Quality Accounts 2009/10 By the end of March 2010, all affected services were able to report progress against the 18 week target, and there were no breaches of this target. Indicator: Patient surveys (CHS) CHS were given a CQUIN target for services to complete two patient surveys each for 2009 / 2010. The surveys were to cover the four categories of access and waiting, quality of care, communication and dignity of patients. Monitor Compliance Targets Monitor, who are the Foundation Trust regulators, have identified three mandatory performance indicators for mental health Foundation trusts as follows: 100% enhanced Care Programme Approach (CPA) patients receiving follow‐up contact within seven days of discharge from hospital; Minimising delayed transfers of care; Admissions to inpatient services had access to crisis resolution home treatment teams. Our performance is set out in the table below: Indicator Suicide prevention measured through the % of people who receive an intervention within seven days of discharge from hospital. Appropriate and timely discharge from Hospital measured through the % of people whose discharge was delayed. Providing alternatives to admission measured through the % of people who receive an intervention from the Home Treatment Service before admission. Target Trust Achievement 95% 98.0% 7.5% 5.1% 90% 93% 29 Quality Accounts 2009/10 Workforce Development and Leadership We have a programme of organisational development activities to support service improvement and to ensure we have managers and professional leaders who are capable of providing good leadership and a focus on the needs of service users. We have already achieved NHS Litigation Authority NHSLA level 2. We will be running an accredited Leadership Development Programme in conjunction with London South Bank University. We have a shadowing scheme in place for Assistant Operational Directors and will be developing a mentoring scheme. We are encouraging staff to apply for the Breaking Through Programme for Black and Minority Ethnic (BME) staff. We are developing a programme of Equality and Diversity training. We have an action plan assuring Quality of Medical Appraisal and Revalidation (AQMAR) – see Appendix 2. 30 Quality Accounts 2009/10 Development of the Staff Charter We aim to deliver the highest care in an environment where staff feel valued and supported. To achieve this, each member of staff is expected to put service user and carer needs first, maintaining high standards of personal conduct. Our new Staff Charter for Mental Health services sets out expected values and behaviours of our employees. It is designed to provide staff with clarity and a shared understanding of what is expected at work, to ensure that we deliver user‐focused care of the highest quality. The organisation will only achieve its objectives and vision when all staff are working towards shared standards of practice and behaviour, underpinned by strong values. Service users have communicated and described very clearly – as part of the Acute Ward Transformational Programme – what constitutes good care and how they would like to be treated. This information, as well as feedback from carers and staff, has been used to inform the development of the Staff Charter. The Charter also includes a list of manager’s commitments to their staff. We plan to develop the charter further with staff and service users so that we are all working collectively to achieve the same outcomes. What our staff are saying Staff Survey 2009 The Care Quality Commission (CQC) requires that the national staff survey be carried out annually by all NHS Trusts. Because the core format has been largely the same for five years, we can compare our results year on year, and with other mental health Trusts. 343 out of 790 staff surveyed randomly returned the questionnaire. The return rate of 43.4% is sufficient for the sample to be representative of the views of all employees, had they been surveyed. The good news is that NELFT staff, now including Barking and Dagenham Community Health Services (CHS) staff, give the Trust an overall job satisfaction rating in the top 20% of all mental health Trusts. This is unchanged from 2008. Staff have also placed the Trust in the top 20% for staff engagement, with above average scores in three key measures. High staff engagement is widely linked to the achievement of a range of positive quality of service and care measures. The following is an overview of the Key Findings (KFs): The top four ranking scores where the Trust compares most favourably with others are: KF5 Quality of job design (job content, feedback and staff involvement) KF37 Staff motivation at work KF2 % of staff agreeing that their role makes a difference to patients KF16 Support from immediate managers The bottom four ranking scores are: KF10 % of staff using flexible working options KF38 % of staff having equality and diversity training in last 12 months KF22 % of staff reporting errors, near misses or incidents witnessed in the last month KF12 % of staff receiving job‐relevant training, learning or development in last 12 months Where staff experience has improved since 2008: KF19 % of staff suffering work‐related stress in last 12 months KF16 support from immediate managers KF20 % of staff saying hand wash materials are always available KF14 % of staff having well structured appraisals in last 12 months Where staff experience has deteriorated since 2008 KF38 % of staff having Equality & Diversity training in last 12 months We plan to ensure improvements by: Consulting with staff around the difficulties with flexible working and make flexible working more available. Improving uptake of Equality & Diversity training by ensuring staff are easily released. CHS staff to commence using Datix web to record errors, misses or incidents. Increasing the use of formal Personal Development Plans linking development needs to training. 31 Quality Accounts 2009/10 The NHS Constitution and NELFT Current Performance and Improvement Actions Current Performance – Based on the Staff Survey 2009 Pledge 1: The NHS commits to The Trust is very high scoring in this area, provide all staff with clear roles and being in the top 20% of all mental health responsibilities and rewarding jobs Trusts in the questions concerning job for teams and individuals that make design, team environment and work a difference to patients, their pressure, and below average only on the families and carers communities. use of flexible working. The Trust was in the best 20% for staff Pledge 2: The NHS commits to provide all staff with personal feeling there are good opportunities to development, access to develop their potential at work and for appropriate training for their jobs support in development from immediate and line management support to managers. Yet they also report lower levels of job‐relevant training and succeed. appraisal in this period. Pledge 3: The NHS commits to provide support and opportunities for staff to maintain their health, well‐being and safety. 32 In 2009 significant progress has been made but is still below average in several areas. This is the one area where the inclusion of Barking and Dagenham CHS for the first time has contributed weak scores. Pledge 4: The NHS commits to The Trust again performs exceptionally engage staff in decisions that affect well in this area, and is in the top 20% for them and the services they provide, senior management communication, individually, through representative understanding roles and contributing to organisations and through local improvement. partnership working arrangements. All staff will be empowered to put forward ways to deliver better and safer services for patients and their families. Quality Accounts 2009/10 Improvement Actions Waltham Forest MHS operational directorate has the lowest overall score on flexible working at 59% so will be the focus for this work. The Trust commissioned an internal audit of performance management in 2009 and has agreed an action plan that puts the national knowledge and skills framework at the centre of these processes and manages these by the national web based e‐ksf system. Local action within directorates will also be required, particularly in Redbridge MHS, and Barking and Dagenham CHS. In 2010 local action will be needed within directorates e.g Barking and Dagenham CHS on work related injury and hygiene, and Redbridge on using the new DATIX incident reporting system. Specific actions will be needed to further improve communication between medical staff and senior management across the Trust; and in Redbridge where there is a gap between senior management and staff (this is likely to relate to significant team management changes in the last 12 months). Statements Statement from Overview and Scrutiny Committee
Ian Buckmaster
Manager of Committee and
Overview & Scrutiny Support
OVERVIEW AND SCRUTINY TEAM
London Borough of Havering
Town Hall Main Road
Romford RM1 3BD
Please contact:
Telephone:
Anthony Clements
01708 433065
Fax:
01708 432424
email: anthony.clements@havering.gov.uk
TO:
Stephanie Dawe
Chief Operating Officer and Chief Nurse
North East London NHS Foundation Trust
Trust Head Office
Goodmayes Hospital
Barley Lane
Ilford
Essex IG3 8XJ
Date: 21 June 2010
Your Reference:
Our Reference:
AC
Dear Stephanie
NELFT Quality Account
I am writing on behalf of the Outer North East London Joint Health Overview and Scrutiny Committee. The Committee wishes to thank you for the opportunity to comment on the NELFT Quality Account but I am sure you will appreciate that, given the proximity of the Council elections, this has
not proved possible at the current time. As such, I have been asked to confirm to you that the Joint
Committee has no comments to make on the NELFT Quality Account on this occasion. The Committee wishes to have the opportunity to make comments on the Quality Account in the future and
looks forward to discussing next year’s Account with NELFT officers at the appropriate time.
Yours sincerely
Anthony Clements
Principal Committee Officer
CC:
34 Quality Accounts 2009/10 Statement from Primary Care Trust Commissioners
Stephanie Dawe
Chief Operating Officer and Chief Nurse
North East London NHS Foundation Trust
12th May 2010
Dear Stephanie
NELFT Quality Account 2010
I write on behalf of the four primary health care trusts, Outer North East London, that commission mental health
services from North East London NHS Foundation Trust. These commissioning PCTs have had the opportunity to
review a draft copy of NELFT’s Quality Account 2009/10 and wish to provide the following statement.
“A score of ‘excellent’, awarded to North East London NHS Foundation Trust for quality of services and quality of
financial management by the Care Quality Commission in 2009, provides commissioners with a measure of
confidence in the programme of quality improvements undertaken by the Trust in 2009/10 and an indication of
sustained improvement over a three year period. The Trust has moved from a score of ‘Fair’ in 2005/06 to ‘Excellent’
in 2007/08.
In contrast to the above rating, the Trust’s performance against hospital services for adults with acute mental health
problems (Healthcare Commission 2006/07) was rated as ‘weak’ (16.4% of trusts were rated as weak as compared
to 43.3% rated as ‘fair’, 29.9% rated as ‘good’ and 10.4% rated as ‘excellent’). Particularly poor performance was
noted against service user involvement in planning their own care and helping to improve services, and ward based
processes to ensure patient, staff and visitor safety. Against this backdrop work undertaken to engage and mobilise
service users in developing user led quality standards and monitoring performance against these, and the
introduction of Star Ward and Productive Ward programmes to improve ward processes, is commendable.
Measures to control hospital acquired infections are of equal importance in mental health as they are in general
hospital care. In 2008/09, the Healthcare Commission inspected mental health trusts for compliance with the
hygiene code. NELFT was found to be in breach of one sub section of the code, namely that relating to ‘effective
arrangements for the appropriate decontamination of instruments and other equipment’. An action plan to rectify
performance was immediately implemented and monitored via the Outer North East London Co Commissioning
Group. All actions have been completed and approved by the Commission.
Three quality improvement targets were set by commissioners as part of contractual requirements in 2009/10. These
concerned improving safety through an agreed risk assessment and risk management tool, improving patient
experience, and promoting social inclusion through the development of recovery and well being plans. The Trust
performed well against the targets set. Nonetheless, there remain challenges in ensuring and demonstrating high
levels of patient satisfaction against the range of measures set by the Care Quality Commission. Commissioners
have set a further challenge for the Trust in 2010/11, requiring improvements in particular areas of inpatient
experience. These include the availability of ward based activities and information available to patients.
The four Outer North East London primary care trusts purchase mental health services from North East London NHS
Foundation Trust on behalf of their local populations and require high quality information about the services provided.
This will be of particular significance with the introduction of new contracting tools such as Payment by Results in the
next few years. The introduction of improved information systems within NELFT over the past few years has assured
greater confidence in consistency and accuracy of information but there remains room for improvement and to this
end commissioners have agreed data quality improvement plans with the Trust in 2009/10 and 2010/11.
The attached Quality Account is the first provided by North East London NHS Foundation Trust and establishes a
basis for demonstrating how services are putting quality at the heart of everything the local NHS does. The four
Outer North East London primary care trusts are satisfied that the information contained in this first Account is
accurate”.
Yours sincerely
Pam Lloyd, Assistant Director Mental Health
35 Quality Accounts 2009/10 36 Quality Accounts 2009/10 Statement from Service User Reference Group
Dear Stephanie,
“Thank you for giving SURG an opportunity to comment on the Draft Quality Accounts
and for involving members in the various activities aimed at improving the quality of
services. SURG were particularly pleased to have a joint meeting with Governor
Colleagues to discuss the Quality Accounts and are planning further joint workshops on
issues such as social inclusion, employment and older people’s services.
SURG continue to influence decisions through individual membership of the Change
Management Board, the Change Steering Group and the various sub groups. Many
service users, both SURG members and individuals, are engaged in getting direct
feedback on the quality of services from service users. For example, through evaluation
of the User Led Quality Standards, the Inpatient Satisfaction Feedback Project, the
Employment, Training and Education Telephone Survey and the Productive Wards
programme.
A SURG priority for this year is to increase user involvement capacity and ensure
representation is equitable and diverse. SURG are currently looking at ways to engage
with service users from the Barking & Dagenham Community Health Services who are
also managed by NELFT. “
Kind regards
Neil Collins
37 Quality Accounts 2009/10 38 Quality Accounts 2009/10 Appendices Appendix 1‐ Service User Feedback Service User and Nominated Person Satisfaction Feedback Project 40 The following questions are asked to find out service user views about the quality of care they received during their stay in hospital. Participation in the survey is voluntary, and feedback is confidential. Q1. Are the staff friendly and sensitive to your needs? Always Most of the time Sometimes Seldom Q2. Are the staff quick to respond to your needs? Always Most of the time Sometimes Seldom Q3. Are the staff quick to respond to your carer’s needs? Always Most of the time Sometimes Seldom Q4. Is your privacy and dignity respected? Always Most of the time Sometimes Seldom Q5. Are you kept informed about your condition/treatment? Always Most of the time Sometimes Seldom Q6. Are your family/carer kept informed about your condition/treatment? Always Most of the time Sometimes Seldom Q7. Has the service met your expectations? Always Most of the time Sometimes Seldom Q8. Does your consultant spend enough time listening to your concerns? Always Most of the time Sometimes Quality Accounts 2009/10 Appendix 2—Assuring Quality of Medical Appraisal and Revalidation 41 Quality Accounts 2009/10 Glossary Acronym Details B&D BME CAF CHS CMHT CPN CQC CRT DAT DNA DoH/DH EET EMT HTT/OAHTT HoNOS IAPT IGC KPI LD LINKS LSP MENCAP MHA MHS NED NICE NHSLA NPSA OT PCT PDP PIP RiO R&D SUI SUIG SURG UQAT Barking and Dagenham Black and Minority Ethnic Common Assessment Framework Community Health Services Community Mental Health Team Community Psychiatric Nurse Care Quality Commission Community Recovery Team Drug & Alcohol Team Did not attend Department of Health Employment Education and Training Executive Management Team Home Treatment Team/Older Adults Home Treatment Team Health of the Nation Outcome Scores Increase Access to Psychological Therapies Integrated Governance Committee Key Performance Indicators Learning Disability Local Involvement Networks Local Strategic Partnership The National Society for Mentally Handicapped Children Mental Health Act Mental Health Services Non Executive Director National Institute for Clinical Excellence NHS Litigation Authority National Patient Safety Agency Occupational Therapy Primary Care Trust Personal Development Plan Practice Improvement Practitioner Computer System used to collect patient information Research & Development Serious Untoward Incident Ser User Information Group Service User Reference Group User Quality Action Team 42 Quality Accounts 2009/10 43 Quality Accounts 2009/10