Nottinghamshire Healthcare
NHS
NHS Trust
Positive about mental health and learning disability
Quality Account
2008/09
contents
3 · Report Introduction
4 · Quality Summary Overview
6 · Priority 1
Improving Patient Experience
9 · Priority 2
Managing and Reducing Violence
12 · Priority 3
Prevention and Control of Infection
13 · Ensuring Quality in the Future
15 · Conclusion
Our quality
strategy is a
primary focus for
us and shows our
commitment to
high quality costeffective care for
people who use
our services.
2·
Quality Account 2008/09
welcome
to the first Quality Account
for Nottinghamshire Healthcare.
This report covers the financial year from April 2008 to March 2009. We are producing
a Quality Account this year to build on the progress since last year when we published
the Trust’s first Risk Management Report for 2007/08.
This report focuses on the
quality of the services we
deliver to patients. Here we
focus on the main priorities
for quality improvement and
whether we are involving and
engaging with our staff and
patients to make these
improvements. The Trust is
keen to be seen as
transparent about the risks we
face, delivering the very wide
range of services we do, and
where we can minimise those
risks and provide services in a
safe setting.
The report is structured to
focus on the three measures
set out here:
This year the Trust has focused
on developing measures of
quality for the services we
provide and the environment
in which these services are
provided. Our quality strategy
is a primary focus for us and
shows our commitment to
high quality cost-effective care
for people who use our
services. The highlights from
the year are:
Priority 1: Improving the
experience of our patients
which will be reflected in
internal and national
patient surveys
• We are in the top 20% of
Trusts for 7 areas of our care
with 84% of people rating our
care as good, very good or
excellent – an 8 % rise from
2007/08.
• We have set rigorous targets
to drive improvements to
ensure people receive an
appointment quickly following
referral to our services. We aim
to see 90% of service users
within 8 weeks and at the end
of March 2009 we achieved
92.1% of people referred for
general appointments seen
within this time.
• The Trust achieved a level of
93% of Forensic service users
being admitted within 3
months from referral and all
Forensic service users being
discharged within 3 months
from agreement to discharge
at the end of March 2009.
violent incidents by 12.2%.
• NHS East Midlands
commented that the Trust:
“…has one of the best closure
rates across the region for
Serious Untoward Incidents
within 60 working days (46%).
The quality of reports
submitted is generally of a
good standard.” Whilst
welcoming this positive
comment the Trust is
committed to improving
performance for this important
process.
Priority 3: Prevention and
control of infection; to
ensure compliance with the
Health Act 2006
• We were awarded an
unconditional Registration
from the Care Quality
Commission for the Hygiene
Code.
Priority 2: Managing and
reducing violence
• We have comprehensive
plans in place for the
prevention and management
of Pandemic influenza and
achieved this by December
2008, well in advance of
requirements.
• We have decreased the
number of patient on patient
• The Patient Environment
Action Teams assessed 81% of
our facilities as Good or
Excellent against a set of
standards that reviews
· Privacy & Dignity
· Cleanliness
· Provision of food.
We are also assessed by
external organisations. During
the year the Healthcare
Commission gave us a score of
‘Excellent’ for the quality of
our clinical services and a score
of “Good” for how we carry
out and manage our business.
NHS Internal Audit commented
that the Trust has a “proactive
approach for identifying areas
for improvement…”and that
there is “a culture and
approach to addressing
weaknesses and ensuring
continuous improvement.”
In November 2007 the Trust
was successful in achieving the
Level 1 Standards of the
National Health Service
Litigation Authority (NHSLA)
Pilot Mental Health and
Learning Disability Standards.
The Trust is now working
towards achieving the Level 2
Standards with a planned
assessment in November 2009.
We recognise that the 2008/09
Quality Account is only the first
stage in the development of
our quality measures and will
be a priority for 2009/10. We
hope you find the report
informative and interesting.
This report should be read in
conjunction with the Trust’s
Annual Report and our
Involvement Report to obtain a
full picture of Nottinghamshire
Healthcare.
Mike Cooke
Chief Executive
Dr Peter Miller
Executive Medical Director
Report Introduction · 3
Quality Summary Overview
Our Steps On
The Quality Journey
Quality Measures are one of the most exciting
developments to have emerged for the NHS from the
Department of Health within the last decade; signalling a
shift from top down performance indicators and targets to a
bottom up approach; empowering teams to develop and
utilise more clinically appropriate quality indicators. Some
indicators will continue to be chosen nationally, some by the
Strategic Health Authority and some by local commissioners.
We have developed our quality measures around 3 key
components of quality; Patient Experience, Patient Safety and
Clinical Effectiveness.
Improving our
organisation
through better
quality measures
and outcomes
Nationally, a list of possible
quality measures was
published in late 2008 for a
period of consultation.
Regionally, 3 quality
measures have been agreed.
We will use these measures
to benchmark ourselves
across the East Midlands.
These are:
• A set of clinical outcome
scores i.e. Health of Nation
Outcome Scores (HONoS)
and its derivatives, which
measures the severity and
changing pattern of a
number of behaviours.
• 7 day follow up after
discharge from in-patient
care.
• Measures derived from the
National Patient Survey.
Locally the Trust has
established a Quality
Oversight Group which has
defined quality measures to
be included in both this
2008/09 Quality Account
and how we will build on
these measures for 2009/10.
In addition all clinical teams
are working to identify
locally relevant quality
measures.
Improving the patient experience
Gaining a better, more localised impression of the patient
experience has been a priority for the Trust and the Involvement
Team has devised a useful new tool to develop a systematic
way of collected feedback from service users and carers. The
Involvement Team has launched a simple, regular survey to gain
service user and carer views on their experience of its services.
The survey has initially been issued to people accessing the
Trust’s Adult Mental Health Services, Mental Health Services for
Older People, Substance Misuse Services and Psychological
Therapies, but will soon roll out across other services and areas.
The survey contains five simple questions to find out how
people rate the service, whether they were treated well and if
they believe it has made a difference to their lives. There is also
an opportunity for people to comment on what they would
most like to be improved and the best thing about the service.
Innovation
and Research
During the year
Nottinghamshire Healthcare
and the University of
Nottingham successfully led a
bid for £17.4m to develop a
new research centre to help
improve patient care across
the region.
The Collaborative Leadership in
Applied Health Research and
Care (CLAHRC) in the East
Midlands, one of only nine
in the country, is a five
year partnership
between progressive NHS
organisations, the
University of Nottingham
and both Nottingham
City and Nottinghamshire
County Councils.
The CLAHRC will
develop new
approaches
4·
Quality Account 2008/09
to healthcare research and
enable more research studies
to be carried out.
It will also ensure that
research is focused on
patients' needs and that
findings can be put into
practice more quickly to
improve the care that
patients receive.
Research areas already
identified include mental
health, primary care, stroke
and younger people. These
are local and national
healthcare priorities, as
outlined in Lord Darzi's NHS
Next Stage Review 'High
Quality Care for All'.
In addition there will be two
further areas of research;
firstly, research and
education; evaluating current
healthcare practices and
performance, areas of
From minimum requirements to a culture change
The NHS Next Stage
Review: “High Quality Care
for All” demands quality
improvements from Trusts.
The minimum standard for
quality will be that which
meets the regulatory standard
i.e. “Regulatory Quality”. As a
Trust we wish to exceed this
and expect high performance
on quality benchmarking in
improvement i.e. “Performance
Quality” together with
“Innovative Quality”.
Quality
The aim of our Integrated
Business Plan is to deliver
‘world class’ services – aiming
for innovative quality. We are
engaging our staff in a
collaborative ‘bottom up’
approach, individualising
quality accounts down to team
and individual leads, with
quality measures relevant to
their day to day practice.
The report outlines the priority
measures we have used to
Innovation
analyse our quality
performance in the areas of:
• Patient Experience
• Patient Safety
• Clinical Effectiveness
These have been agreed and
reviewed by our Trust Board
with regular reports on
progress through our Trust
Board Performance Reports
and Risk Management Reports.
Performance
Regulatory
Time
Effectiveness/safety/experience
innovation and their
implementation, and
educational support;
secondly, stakeholder
engagement; listening to the
views and experiences of
patients and partner agencies
to enhance the delivery of
healthcare services.
The development of a local
CLAHRC will have a positive
impact on patients by
accelerating the translation
of research evidence into
practical service
improvements, resulting in
better care and patient
experience within the NHS in
the East Midlands.
The successful bid has been
awarded by the National
Institute for Health Research,
which will provide half of the
funding for the CLAHRC with
the remaining half (matched
funding) raised by the
organisations involved.
Priorities for the
coming year
Throughout 2008 we have identified
and developed programmes to assure
our quality targets are being met. We
have identified key priorities for the areas
of Patient Experience, Patient Safety and
Clinical Effectiveness. In selecting our
priorities we have taken into account the
national and local picture and the views of
our service users. The top three priorities
have been identified as:
Priority 1
Improving the experience of
our patients which will be
reflected in internal and
national patient surveys.
Priority 2
Managing and reducing
violence.
Priority 3
Prevention and control of
infection to ensure compliance
with Infection Control
Standards.
Quality Summary Overview · 5
Priority 1
Improving Patient
Experience
Reports from Patient
Surveys
In addition to a number of
audits and surveys that take
place in the Trust we also took
part in the UK Mental Health
Survey 2008, carried out by the
Picker Institute. This allows us
to understand what service
users think of healthcare
services and where
improvements can be made. A
total of 850 service users from
our Trust were invited to take
part, of which 315 returned a
completed questionnaire, giving
a response rate of 38.4%.
Positive Areas:
• Our Care: Overall: people
rating our care as good, very
good or excellent has increased
from 68% in 2006, to 76% in
2007 to 84% this year. This is
good news: an 8% increase in
patient satisfaction.
• Health professionals:
Generally people feel health
professionals (psychiatrists,
community psychiatric nurses,
6·
others) listen, treat them with
respect and dignity and they
have confidence and trust in
them. (We get ratings of
between 82% and 91% for
dignity and respect for the
various professions). The
ratings in most categories have
improved over the last 5 years.
• Care Co-ordination: there has
been a significant increase in
people saying they can always
contact their care co-ordinator
if they have a problem
(increased from 70% to 77%).
Our results in this area have
improved significantly over the
last 5 years.
• Support in the Community:
results in this area are generally
positive. However, people
saying that day centre activities
were definitely helpful have
gone down from 70% to
55%. This reflects a move
away from dedicated day
services to a more integrated
model with main stream
opportunities in learning,
training and employment.
Quality Account 2008/09
Areas for improvement:
• Medications: Although the
number of people saying they
definitely have a say around
medication decisions has
improved from 40% to 44%
there has been little significant
change in the last few years.
Only 40% are saying they are
definitely being told about
side effects. We are
progressing improvements
through a Medications Group
developing checklists for staff
and service users about
medications. We are rolling
this out to evaluate its impact
and results so far are
promising.
• Care Plan: Our service users
have identified this as an area
for improvement. 48% are
saying they are not offered a
written or printed copy of their
care plan. Also only 41% are
saying they are definitely
involved in deciding what is in
their care plan (it was 45% last
year). Through the Involvement
Group and working with the
Care Programme Approach
(CPA) office we have put
together an action plan to
tackle issues around care
planning and review.
• Care Review: Again this has
been identified as a key area
for improvement in both
people saying they definitely
can express their views (down
from 79% to 66%) and the
care review was definitely
helpful (down from 52%
to 40%).
How do we compare with
other Trusts?
Based on 38 questions, we are
in the top 20% of Trusts for the
following 7 questions:
• Community Psychiatric Nurse
treating you with dignity and
respect
• Other health professional
listening to you carefully
• Other health professional
treating you with dignity and
respect
• Having a say in decisions
about the medication you
take
• Finding talking therapy helpful
• Care review: being given a
chance to talk to your careco-ordinator about what
would happen
• Overall: your diagnosis having
been discussed with you
We are in the bottom 20% on
the following 3 questions:
• Enough time to discuss your
condition and treatment
• Being told you could bring a
friend or relative to your care
review
• Finding your last care review
helpful
We are in the middle 60% for
the other 28 questions.
Admission to Forensic Services over 3 months on waiting lists
80%
70%
60%
50%
40%
30%
20%
10%
Apr
08
May
08
Jun
08
Jul
08
Aug
08
Sep
08
Oct
08
Nov
08
Dec
08
Jan
09
Feb
09
0%
Mar
09
Discharge from Forensic Services over 3 months on waiting lists
80%
70%
60%
50%
40%
30%
Access and waiting –
how long people wait
to access our services
20%
10%
Apr
08
May
08
Jun
08
Jul
08
Aug
08
Sep
08
Oct
08
Nov
08
Dec
08
Jan
09
Feb
09
0%
Mar
09
Local Services
The Trust has targets set both internally by our Trust Board
and by external bodies i.e. our Commissioners and the
Healthcare Commission (now Care Quality Commission) to
monitor how long people wait to access our services. These
targets have been subject to a number of changes over the
year 2008/09. We have set rigorous targets to ensure
people receive an appointment quickly following referral to
our services. From September 2008 the targets for both
medical and non medical appointments were reduced to 8
weeks i.e. people referred to our services should receive an
appointment within 8 weeks of their referral. We aim to
see 90% of service users within 8 weeks and at the end of
March 2009 92.1% of people referred for general
appointments were seen within this time.
Admission and
Discharge to and
from Forensic
Services
The Trust is measured on its
waiting times for admission to
and discharge from Forensic
Services with a target of 3
months for both. The
admission and discharge
process is rigorous to ensure
Forensic Service Users receive
appropriate treatment and
support. During 2008/09
considerable work has
improved the waiting times
and the Trust achieved 93% of
service users being admitted
within 3 months of referral
and all service users being
discharged within 3 months
from agreement to discharge
at the end of March 2009.
Access and Waiting 2008/09
105%
100%
95%
Target: 90%
90%
85%
80%
75%
70%
65%
60%
Apr
08
May
08
Jun
08
Jul
08
Aug
08
Sep
08
Oct
08
Nov
08
Dec
08
Jan
09
Feb
09
Mar
09
Non medical (90% target)
Medical (100% target)
All excluding gender (90% target)
Priority 1 · Improving Patient Experience · 7
Trust response to complaints
We monitor our response to any complaints against a Trust
target of 80% responded to within 25 days. The Trust has
consistently scored well through 2008/09 with only a slight
dip in January 09.
Complaints received 2008/9
We try to address any concerns raised by service users and
carers as they arise and make changes where necessary. We
also ensure that users and carers are aware and can choose
how to make a complaint under the NHS Complaints
Procedure. In 2008/09, a total of 418 complaints were
received across the Trust. This represents a 6.5% decrease in
complaints compared with the previous year.
Performance
We respond to at least 80% of complaints within the
timeframe specified by the NHS Complaints Regulations and
the new regulations which came into force from 1 April
2009. The table below gives data for Local and Forensic
Services for Stage 1 of the NHS Complaints Procedure.
et
rg
ta
ce
an
m
or
rf
pe
in
%
ith
w
to e
d ram
de ef
on im
sp t
re ory
s
% lat
nt
ai
gu
pl
re
om
fc
ro
be
um d
N ive
ce
re
Local Services
Division
120
87.5%
80%
Forensic Services
Division
298
90%
80%
Trust-wide Total
418
89%
80%
Stage 2 independent review requests
During 2008/09 the Trust continued to advise complainants of
their right to apply to the Healthcare Commission for
independent review under Stage 2 of the NHS Complaints
Procedure if they were dissatisfied with the response provided
at Stage 1. There were 38 applications by complainants to the
Healthcare Commission during 2008/9, which represents
approximately 9% of total complaints received in this period.
The comparable percentage figure for 2007/08 was 6%. More
information on learning the lessons from complaints can be
found in the Annual Report.
Risk And The Care
Programme Approach (CPA)
The Care Programme Approach (CPA) is the main way in which
the coordination of care is reviewed and documented as people
move through services. Service users are actively involved in
planning their care, and the Trust uses the Care Programme
Approach to monitor how clinicians respond to patient need
and national targets.
On discharge service users are issued with a care plan which is
created with them and those involved in providing care. This
process can also involve family and carers, with the service
user’s consent.
One of the key targets is that service users are followed up at
home within 7 days of discharge from an in-patient stay. The
target for this is 95% with the Trust achieving 93%. There are
many reasons for this; including people returning to their own
locality away from the county area or going on holiday,
however this is a priority area for improvement and we are
focusing on ensuring we are able to follow up service users
who may leave the region after discharge more effectively.
Monitoring of 7 Day Follow Up
of Service Users Discharged
from In-Patient Care
(acute and rehabilitation units)
Adult Mental Health – Care Programme Approach 7 Day
110%
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Apr
08
8·
Quality Account 2008/09
May
08
Jun
08
Jul
08
Aug
08
Sep
08
Oct
08
Nov
08
Dec
08
Jan
09
Feb
09
Mar
09
Patient Safety Incidents
Priority 2
Managing and
Reducing Violence
The safety of patients is a key objective for the Trust and
recognised as a challenge for all staff. The reporting of patient
safety incidents is an essential part of ensuring that effective
lessons and learning can take place.
The Trust recognises that
this is an issue of concern
for both staff and service
users. There are systems in
place to help the organisation
to learn from what happens,
to train staff in managing
situations and the
refurbishment and replacement
of buildings addresses this
issue in their design.
The Trust reports all incidents
of assault on staff in the
organisation to the National
system.
The National Patient Safety Agency (NPSA) operates an incident
reporting system known as the National Reporting and Learning
System (NRLS). This system is reliant upon organisations reporting
patient safety incidents to the NRLS who then look for national
trends and apply learning where applicable. This learning comes
in the form of National reports or Safety Alerts which are
distributed across the organisation by the Risk Department. The
NPSA also produce a 6-monthly report which is now made
public. This report enables the Trust to compare itself with other
Trusts. Our Trust is fully engaged with this process and we report
patient safety incidents on a regular basis. 41.0% of all our
incidents reported are patient safety related. It is generally
acknowledged that Trusts which have a high incidence of
reporting are safe Trusts, because the culture encourages staff to
be open and transparent.
The comparison of the number of incidents reported within our
broad categories for the last three years demonstrates that:
Violent Incidents by Type
3500
• Between 2006/7 and 2008/9 there has been an increase in self
harm of 13%. This is mainly attributable to the opening of the
Women’s Service at Arnold Lodge.
3000
2500
2000
• There is a welcome decrease in the number of patient on
patient violent incidents of 12.2%.
1000
500
0
Physical Assault
2006/07
2007/08
2008/09
Harassment
Verbal Abuse
Aggressive /
Hostile
Notes:
• Physical assault includes: assault, sexual assault, injuries
caused during restraint
• Harassment includes: threat of physical violence, attempted
and alleged assault, alleged sexual assault
• Verbal abuse includes all other incidents of verbal abuse
• Aggressive/hostile includes damaging organisational
property, inappropriate behaviour and other
• There is a marked increase in clinical incidents of 23.5% over
the last three years. This is as a result of an increase in the
reporting of medication incidents, patient slips or trips and the
fact that we now ask for staff to report incidents of rapid
tranquilisation where this was not the case in previous years.
Despite the high number of patient safety incidents reported to
the NRLS it is encouraging to note that not all result in injury and
only very few result in serious injury. The following graph
demonstrates this and is taken from the last report published for
our Trust by the NPSA.
% of Total Incidents Reports
60%
% of total incidents reports
1500
50%
40%
30%
20%
10%
0%
No Harm
Low
Moderate
Severe
Death
Percent across cluster
Percent from Nottinghamshire Trust
Priority 2 · Managing and Reducing Violence · 9
Improved
Patient Safety
The following graphs show a comparison of the patient
safety incidents over the last two years.
Patient Safety Incidents 2007/08
Security Incident 2%
Self Harm 35%
Personal Accident 11%
Incident Rates
Since the implementation of
the Trust’s Incident Reporting
process in October 2004 there
have been over 65,000
incidents reported which
equates to approximately
14,500 incidents per annum or
1,200 per month. To quote the
National Patient Safety Agency,
Other 1%
Clinical Incident 23%
Violence 27%
Patient Safety is paramount in
our services. The following
measures of safety show the
complex nature of our services
and as discussed earlier in
relation to risk management
the prime concern is to reduce
risks and learn from incidents.
Missing Person 1%
‘in general, the higher the rate
of reported incidents, the
stronger the reporting culture
in that organisation’.
Staff have the opportunity to
report adverse incidents
whether they be health and
safety related or violence
related. However, the Trust can
also demonstrate that patients
are confident that they can
report incidents through staff.
This is evidenced by the fact
that 41.9% of all incidents
reported are patient-related i.e.
reported by, or on behalf of
patients.
The chart below shows a
breakdown of all incidents
reported over the last three
years and splits them into
broad categories:
Incidents by Category, 2006/07, 2007/08, 2008/09
8000
Patient Safety Incidents 2008/09
7000
6000
Security Incident 2%
Self Harm 34%
5000
Personal Accident 9%
4000
Other 1%
3000
2000
1000
Violence 24%
10 ·
Missing Person 2%
Quality Account 2008/09
2006/07
2007/08
2008/09
Violence
Vehicle
Incident
Self
Harm
Security
Incident
Personal
Accident
Other
Missing
Person
Ill Health
Fire
Incident
Complaint
Clinical
Incident
0
Clinical Incident 28%
Safeguarding
Management of
Serious Untoward
Incidents (SUIS)
Where incidents are of a serious nature the Trust carries
out investigations to ensure learning from the incident.
Each of the Clinical Divisions has Serious Clinical Incidents
Review groups with senior representation from both
clinical and managerial staff.
The following graphs show the percentage of serious
incidents across the care groups in the Trust and the
incidents by month.
Serious Untoward Incidents by Care Group / Directorate
CAMHS 5%
CLD 3%
Rampton 27%
MHSOP 7%
Estates / Facilities 0%
Safeguarding Team 0%
Trust 1%
Community Forensic 7%
Wathwood 3%
Arnold Lodge 5%
Incidents by Month, March 2007 to March 2009
40
35
30
25
20
15
The above graph shows there is not a statistically
significant trend (less than 8 consecutive plots above or
below the median). The median number of incidents per
month is 24.
Mar 09
Jan 09
Nov 08
Sep 08
Jul 08
May 08
Mar 08
Jan 08
Nov 07
Sep 07
Jul 07
May 07
10
Mar 07
Activity for 2008-09
Ongoing reviews of policy,
procedure and guidance
continue to ensure the
development and embedding
of an evidence-based
approach to safeguarding
into practice; including
significant audits into the
arrangements made for
children and young people
visiting psychiatric settings.
Such audits contribute to
providing assurances to the
Local Safeguarding Children
Boards of which the Trust
contributes as a key member.
AMH 42%
5
Working closely with
Partners, the strategic role
for the Safeguarding Team
has been further developed,
engaging in a range of
activities with colleagues
from both the statutory and
non-statutory sectors.
The Team continues to
provide clinical advice,
supervision and guidance to
Trust staff in all domains of
safeguarding in order to
affect dynamic and positive
responses in this complex
area. For the year 2008/09,
this included:
• 128 referrals to Children
and Young People’s
services, representing 62%
of all safeguarding children
advice calls received
• 72 referrals to Adult
Services (51%)
• 54 recorded Adult
Safeguarding referrals
made to the local
authorities, 71 Child
protection referrals from
the City and 87 from the
County.
• The team has delivered
significant amounts of
Level 1 Safeguarding
Children Training. Adult
Safeguarding Training is
delivered in collaboration
with colleagues from the
Learning and Development
Department.
External Involvement
The Safeguarding Team was
pleased to receive
“Significant Assurance” from
the NHS internal audit
department, which has in
turn generated an action
plan that is reported and
quality assured through the
Trustwide Safeguarding
Forum.
Moving Forward
2009/10 will see an increase
in activity in the multi agency
approach to domestic abuse.
This will be an area for
continued focus in order to
deliver the difference for our
service users in this area.
Following the high profile of
the National Safeguarding
Agenda in 2007, the Trust
responded with the
development and
implementation of the
Safeguarding Team. A Nurse
Consultant and two Specialist
Practitioners with an
Executive Lead, address and
drive forward the
Safeguarding agenda across
the Trust.
In the coming year the
Safeguarding Team will focus
on consolidation of the
above work and the
development of the
following themes:
• Trustwide Domestic Abuse
Strategy
• Implementation of the
Safeguarding Education
Strategy
• Development of the
proposed Serious Case
Review Implementation
Group
• Supporting the integration
of the Common Assessment
Framework (CAF) into
clinical practice
• Provision of appropriate
visiting facilities for
children and families.
Priority 2 · Managing and Reducing Violence · 11
Priority 3
Prevention
and Control
of Infection
Infection prevention and
control remains one of the
NHS’s top priorities,
including Nottinghamshire
Healthcare.
There was a requirement for
the Trust to have
comprehensive plans in place
for the prevention and
management of Pandemic
influenza by December 2008.
All areas have robust plans in
place.
The Trust has participated
actively in the NHS East
Midlands “Hand in Hand
Fighting Infections Together”
campaign using leaflets,
posters and DVDs to raise
awareness.
The Trust monitors the number
and type of infections alert i.e.
Methicillin-Resistant
Staphylococcus Aureus (MRSA)
and Clostridium Difficile.
During 2008/09 there were no
cases of MRSA bacteraemia.
There have been 6 outbreaks
of diarrhoea and vomiting
across both Divisions in the
last year. All resulted in wards
being closed but were
managed appropriately with
plans being developed quickly
and acted upon. There was no
adverse outcome from any of
the incidents. There have been
a number of cases of
Clostridium Difficile within
Local Services and no cases
within the Forensic Division.
Each year the Patient
Environment Action Team
(PEAT) carries out a
programme of internal and
externally validated inspections
of our facilities. The
inspections review standards
related to the environment in
relation to:
• Food
• Privacy and Dignity
• Cleanliness
The following chart shows the
comparison of our PEAT scores
for 2007/08 and 2008/09.
Patient Environment Action Team Reports
Local Division
Score 2007/08
Score 2008/09
Environment
Bassetlaw Hospital Mental Health wards
Highbury Hospital
Queen’s Medical Centre Mental Health wards
Millbrook Unit
Thorneywood
Good
Good
Poor
Good
Good
Good
Good
Acceptable
Good
Acceptable
Food
Bassetlaw Hospital Mental Health wards
Highbury Hospital
Queen’s Medical Centre Mental Health wards
Millbrook Unit
Thorneywood
Excellent
Good
Excellent
Good
Good
Good
Excellent
Excellent
Excellent
Good
Privacy & Dignity
Bassetlaw Hospital Mental Health wards
Highbury Hospital
Queen’s Medical Centre Mental Health wards
Millbrook Unit
Thorneywood
Excellent
Excellent
Good
Good
Good
Excellent
Good
Good
Good
Unacceptable*
Score 2007/08
Score 2008/09
Environment
High Secure
Medium Secure
Low Secure
Good
Acceptable
Acceptable
Good
Acceptable
Acceptable
Food
High Secure
Medium Secure
Low Secure
Good
Acceptable
Excellent
Good
Good
Acceptable
Good
Good
Good
Good
Good
Good
Forensic Division
Privacy & Dignity
High Secure
Medium Secure
Low Secure
*Remedial work has already taken place at Thorneywood to address this outcome.
12 ·
Quality Account 2008/09
Ensuring Quality in the Future:
responses to regulators
Healthcare Commission and
Care Quality Commission
The Trust was able to declare full compliance with
the Healthcare Commission Core Standards in the
2008 Annual Health Check Declaration. This rating was
published in October 2008 and includes a performance
score for the quality of services we provided from April
2008 to the end of March 2009. The Trust was delighted
to be awarded a score of “Excellent” for “Quality of
Service” provision which we feel reflects our commitment
to continuous quality improvement.
The 2009 Annual Health Check Declaration will be
published in October 2009 and measures our performance
from April 2008 to the end of March 2009. We were able
to declare full compliance for the majority of the Core
Standards. The Trust was awarded an unconditional
registration for the Compliance with the Care Quality
Commission Registration for Healthcare Associated
Infections (HCAI). However within the Inspection a
number of breaches of the Hygiene Code were identified.
The Trust acted promptly to resolve these issues which
related to the cleanliness of facilities and some reusable
medical devices. The majority of these breaches have now
been resolved and high standards re-established. The
remaining building/facility improvements are in progress
and will be resolved in 2009.
National
Health
Service
Litigation
Authority
(NHSLA)
The Trust, like any other
organisation, has to have a
range of policies and
procedures which enable it to
act as a competent and safe
Trust. The evaluation of the
Trust’s competence in this area
is undertaken by the National
Health Service Litigation
Authority (NHSLA). The
standards they assess the
organisation by are new ones
and the Trust was chosen as
one of only a few national
pilots to validate the
standards. In November 2007
the Trust was successful in
achieving the Level 1 Standard
of the NHSLA Pilot Mental
Health and Learning Disability
Standards. The programme is
now being developed to
address the requirements to
meet Level 2 of the new
standards with an assessment
planned for November 2009.
Service Review of Drug and
Alcohol In-patient Services
The Healthcare Commission carried out spot check
inspections for Drug and Alcohol in-patient services
nationally and reviewed our services in 2008. The Trust was
rated as Good for these services, which reflects their status as
high standard specialist services serving the City and County.
Foundation Trust
Equivalence - Assessment
The Trust is working towards
achieving Foundation Trust
equivalent (FTe) status. This
involves a rigorous assessment
of the quality of our services
and the way we organise and
manage our business.
In the last year we have made
positive steps in the
achievement of these
standards and will continue to
move these forward in
2009/10. We have recently
been subject to an external
Historic Due Diligence Review,
which has helped us identify
those areas where our
business and financial plans
need to be more robust. The
report did state that the Trust
seems well prepared
compared to other Trusts, but
we will work hard to make
sure that the forms and
freedoms of FTe bring benefits
to our staff, service users and
their carers.
Ensuring Quality in the Future · 13
Health of
Nation
Outcome
Scores
(HoNOS) as
a clinical
reporting
tool has been
available in the
Trust for a
number of years.
The Trust has
measured the
number of adult
HoNOS assessments
carried out each
month. There is a
slight dip around the
time of the
implementation of the
new patient
information system
(RiO in November 08),
however numbers are
now again at the
expected level.
AMH
350
300
250
200
150
100
50
130%
120%
110%
100%
90%
80%
70%
60%
50%
40%
May
08
Jun
08
Crisis Resolution
14 ·
Jul
08
Aug
08
Sep
08
Oct
08
Nov
08
Dec
08
Early Intervention in Psychosis
Quality Account 2008/09
Jan
09
Feb
09
Jun 09
Apr 09
We have undertaken an analysis of the distribution of scores
for each question on the HoNOS assessment. For 2009/10 we
aim to undertake a comparison of HoNOS assessments over
time to show the change in scores as treatment has occurred.
Local Delivery Targets, April 2008 to March 2009
Apr
08
Feb 09
Dec 08
Oct 08
Aug 08
Jun 08
Apr 08
Feb 08
Dec 07
Oct 07
Aug 07
0
Jun 07
• There are no areas where
statistically significant
deterioration has occurred
from the 2007 National Staff
Our staff are vital to the delivery
Survey.
of high quality clinical care. The
Trust received a very positive
• The Trust’s results in the
outcome from the 2008
National Staff Survey compare
National NHS Staff Survey,
favourably against similar
together with extra information
Trusts.
from an extra set of local
questions. The Trust achieved a
• 8 of the 12 Local Questions
response rate of 67% – within
inserted by the Trust into the
the highest (best) 20% of
National Staff Survey indicate
Mental Health and Learning
a positive response rate which
Disability Trusts and higher than
is above 60%. The questions,
the national average for the
designed by Gallup, measure
whole NHS (55%).
the strength of a workplace
and are linked to productivity,
We were also ranked 13th in
profitability, retention and
the Health Service
customer satisfaction.
Journal/Nursing Times Top 100
Healthcare Employer Awards.
• Responses to the Healthcare
We were the highest ranking
100 Awards resulted in the
large organisation and the best
Trust being ranked 13th
in the East Midlands.
nationally, the best in the East
Midlands. Respondents
The headline information from
commented that they felt
the National NHS Staff Survey
supported, opportunities for
2008, Local Staff Survey
training were praised, along
Questions and HSJ/Nursing
with the friendly atmosphere
Times Top 100 Healthcare
and that the organisation has
Employers are:
been like a second family.
• The staff survey response rate
• The overall engagement level
was over 19% higher than
amongst survey participants
the Trust’s response rate for
was 78%, higher than other
2007 which was 48%.
NHS Mental Health
participants in the Awards
• In 16 areas within the
and higher than the overall
National Staff Survey the Trust
Healthcare 100 figures.
is ranked in either the highest
Health of Nation
Outcome Scores
Apr 07
(best) 20% of Mental Health
and Learning Disability Trusts
or better than average against
other Mental Health &
Learning Disability Trusts in
England.
National NHS
Staff Survey
2008, Local
Questions and
Healthcare 100
30%
Mar
09
Assertive Outreach
Activity
The National Service Framework (NSF) for Adult
Mental Health services provided best practice
guidelines for the development and provision of
mental health services. Activity for these teams
has been monitored through local agreements
and national targets. The Trust has achieved on
all its targets for these teams. The activity
reports to the left are provided for Assertive
Outreach services, Early Intervention in Psychosis
and Crisis Resolution:
Clinical Effectiveness
The Trust is developing measures of effectiveness with clinical teams in individualised quality accounts.
However the following measures are routinely monitored and progressed.
National Targets and Regulatory Requirements
Target
Trust Achievement
March 2009
Access to Crisis Resolution Home Treatment (Trustwide)
(1 Oct 08 - 31 Mar 09, via Service Mapping, collection Spring 2009)
Trust Target 100%
Achieved
Best Practice in Mental Health Services for People with a
Learning Disability (Trustwide)
Trust Target 100%
Achieved
Care Programme Approach (CPA) 7-Day Follow-Up
Trust Target 95%
93.0%
Achieved
18 out of 24
Data Quality on Ethnic Group (Qtrs 1-3 2008-09)
Trust Target 95%
96.0%
Delayed Transfers of Care (Trustwide) (Year 2008-09)
Trust Target 7.5%
6.4%
Drug Users – Number recorded as being in effective treatment (Trustwide)
(Year 2008-09) (Revised national target)
National and
Trust Target 85%
82.0%
Mental Health Minimum Data Set (MHMDS) – Completeness
(Qtrs 1-3 2008-09)
Trust Target 95%
Achieved
National Target not set
To be confirmed
To improve yearly
Achieved
Target
Trust Achievement
March 2009
Safety Domain (Spring 2009)
National average or above
Awaiting results
Health and Wellbeing Domain (Spring 2009)
National average or above
Awaiting results
Clinical Quality Domain (Spring 2009)
National average or above
Awaiting results
Patient Focus and Access Domain(s) (Spring 2009)
National average or above
Awaiting results
Child and Adolescent Mental Health Services (CAMHS)
Mental Health Minimum Data Set (MHMDS) – Patterns of Care
(Qtrs 1-2 2008-09 prior to changes to CPA)
NHS Staff Satisfaction (Autumn 2008-09)
Experience of Patient
Conclusion
The Trust has developed its approach to quality measures
and accounts well ahead of the national timescales and is
engaged with regional and national developments.
Challenges lie ahead in delivering periodical and relevant
quality measures back to teams to drive changes in practice
however the Trust is committed to a quality approach.
It is hoped that this first Quality Account has demonstrated
the importance of quality to the organisation. We know
there are areas of development to be addressed but can
assure all of our service users that future developments will
be to their benefit, part of our commitment to providing
the most effective, highest quality clinical services possible.
We leave the last word to someone who has used our
services and has a vested interest in the quality of those
services – Jim Radburn.
From my involvement, we have
gained a strategy for working age
dementia, which started in a very
small way but ended up in the
launch of the strategy itself. The
strategy has involved carers all
the way and the public, they’ve
had their opinion in the strategy
written down on how we would
like it best. The Trust came out to
see us in asking us our opinion,
they just didn’t say we’re going
to do it this way, they came and
asked, what we need? What is
the best way forward, for us?
Jim Radburn, Carer
Ensuring Quality in the Future · 15
This report is available free of charge. For further copies please contact
the Communications Team at Nottinghamshire Healthcare NHS Trust,
Freepost MID30082, Nottingham, NG3 6ZX or telephone 0115 952 9464.
This document is also available in other languages and formats upon
request.
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