Oxleas NHS
Foundation Trust
Quality Accounts
2009/10
Oxleas NHS Foundation Trust
Quality Accounts
2009/10
1
2
Oxleas NHS Foundation Trust
Quality Accounts
2009/10
1.0
Our commitment to quality
Our purpose at Oxleas is “to provide the best quality health and social care to local people”.
High quality care means offering the care that people need where they need it and helping them
to stay well and maximise their potential within their local communities.
We have always been rated by the Care Quality Commission (and previously the Healthcare
Commission) as providing excellent or good quality services. This has been achieved by clinicians
and managers working together to meet patients’ needs and by having a strong emphasis on
patient and carer involvement. This strong focus on quality was recognised this year by the Royal
College of Psychiatrists who named us ‘Provider of the Year’.
We are not complacent about quality and recognise that our standards need to improve
continually. Oxleas’ Council of Governors is involved in agreeing these priorities and ensuring that
the Board of Directors is held to account. In consultation with the Council of Governors, we have
continued to work on our four ‘must do’ objectives over the past year. These objectives are:
•
Increasing support for families and carers;
•
Providing better information for our patients and their carers;
•
Enhancing assessment and care planning;
•
Improving the way we relate to patients and their carers.
QUALITY ACCOUNTS
Quality Accounts
Following the quality review of our governance structures in 2008/09, we have established a
Quality Board which is chaired by our medical director and supported by the new quality and audit
team. The overall aim of the Quality Board is to provide assurance to the Board of Directors on the
quality of our services and to promote a culture of continuous improvement and innovation. There
is a particular focus on improving patient experience, patient safety and clinical effectiveness.
The quality report you will read over the following pages demonstrates the improvements we have
made over the past year and highlights our future priorities. It is based on information gathered
both within the trust and externally and is, to the best of my knowledge, accurate.
Stephen Firn
Chief Executive
3 June 2010
Oxleas NHS Foundation Trust
Quality Accounts
2009/10
3
QUALITY ACCOUNTS
2.0
Our quality priorities for improvement
2.1
Progress against our quality priorities in 2009/10
In 2009/10, we identified four priorities for improving the quality of the services we offer to our
patients and their carers. The following section demonstrates how we have performed against the
improvement targets we set ourselves in 2009/10.
The four priority areas were:
1 Increasing support for families and carers;
2 Providing better information for our service users and carers;
3 Enhancing care planning;
4. Improving the way we relate to both our service users and carers.
In last year’s quality report, we displayed charts from the 2008 national patient survey which
was aimed at patients who had used our community mental health services. We are unable to
show comparisons to the 2009 national patient survey as the questions and the type of patients
surveyed had changed; 2009/10 survey was aimed at inpatients. However we have been able to
use local measures to show improvement in the priority areas.
2.1.1 Priority 1: Increasing support for families and carers
During 2009/10, we made good progress against our priority to improve the support we provide
for the families and carers of our patients.
This evaluation is based on achieving our local improvement objectives shown in table 1 below:
Table 1
Improvement
Objective
4
Target
by end of 09/10
Baseline at
31 March 09
Achievement
31 March 10
To involve our service users’ families
and carers more, we need to be
aware of who they are and share
this information within our clinical
information system (RiO).
60% of service users on
New Care Programme
Approach have their carer
details on RiO.
18.6%
77.5%
To understand the requirements
of families and carers, we need
to engage with them and assess
their needs through offering carer’s
assessments. We need to record the
outcomes of these assessments within
our clinical information system (RiO).
50% increase in number
of carers who have
been offered or received
a completed carer’s
assessment (compared
with the 2008/09
baseline).
284 carers
469 carers
To deliver meaningful and best
practice engagement with families
and carers it is essential our staff
are trained in family inclusive
practice.
25 teams across the trust
to receive training in
family inclusive practice.
Piloted in
2008/09
Oxleas NHS Foundation Trust
Quality Accounts
2009/10
22 teams cross
trust have
been trained
– training
continues into
2010/11.
Our second priority in 2009/10 was to provide better information for our service users and carers.
Our progress on the chosen improvement objectives is detailed below and shows where we have
provided better information to all our service users and where further development will take place
in 2010/11. A clear example of where improvements have been made is that all newly admitted
clients to our acute inpatient units (working age and older adult wards) are given a welcome
pack which provides them with information about the unit and their care. In one directorate, our
modern matron also holds advice sessions to support patients.
The table below (table 2) shows progress against our 2009/10 improvement objectives:
Table 2
Improvement
Objective
Target
by end of 09/10
Baseline at
31 March 09
To ensure we provide all
sectioned service users
with an explanation of
their rights under the
Mental Health Act both
verbally and in written
format at the point of their
admission and record this
on our electronic records
system (RiO). This should
be part of our standard
clinical practice.
Compliance with
Section 132 of
the Mental Health
Act demonstrated
through RiO
recording in all
cases.
Current
practice is
manual
To ensure service users
and families have all the
information they require
to understand the care
they will receive and what
they can expect within our
inpatient services.
Modern matrons
ensure that all
newly admitted
patients and their
carers are offered
appropriate
information.
New target
(not previously
monitored)
Achievement
31 March 10
We have 54.1% of explanation
of rights recorded on RiO due to
restrictions with the RiO system
QUALITY ACCOUNTS
2.1.2 Priority 2: Providing better information for our service users and carers
Further focus to improve electronic
recording will continue in 2010/11
helped by the implementation of
the next version of RiO.
We have now put in place
the following:
An acute inpatient pledge
to our patients.
Patients are given welcome
packs for the unit which
provide them with all
relevant information.
All newly admitted patients
are seen by the modern
matron or nominated deputy
within 2 working days.
Oxleas NHS Foundation Trust
Quality Accounts
2009/10
5
QUALITY ACCOUNTS
Table 2 continued
Improvement
Objective
Target
by end of 09/10
Baseline at
31 March 09
To ensure all stakeholders,
service users and carers
are able to access
up-to-date and relevant
information concerning
our services via our
website.
New website
will be launched
providing up-todate information
about the trust,
our services and
mental illness and
learning disability.
Existing
website
2008/09.
Achievement
31 March 10
The new website was launched
in July 2009. There were over
35,000 visits to the site by the
end of March 2010.
It contains quality approved
information about our services
and other community services.
It also contains information
about mental health and
learning disability conditions,
including over 50 videos and
audio clips.
An Independent accessibility
audit has been carried out by
the Shaw Trust with positive
recommendations.
2.1.3 Priority 3:
Enhancing care planning
We have made progress in enhancing the care planning process for all our patients. We continue
to give clear information about care planning and ensure that all service users have a copy of their
care plan. We aim to maintain this high level in 2010/11.
The table below (table 3) shows progress against our 2009/10 improvement objectives:
6
Oxleas NHS Foundation Trust
Quality Accounts
2009/10
Improvement
Objective
Target
by end of 09/10
Baseline at
31 March 09
Achievement
31 March 10
To ensure that all professionals have
access to an up to date care plan of
patients they treat. This plan must
be recorded in our electronic clinical
records system (RiO).
All patients on New Care
Programme Approach
(CPA) have a care plan
on RiO.
98.6%
99.2%
To ensure crisis plans have been
developed for all patients. This is a
mandatory element of the care plan
and should be appropriately recorded
in RiO.
All patients on New CPA
have a crisis plan on RiO.
93.5%
93.7%
To ensure care plans remain
relevant and meet our patients’
needs they must be reviewed and
updated regularly.
90% of patients on New
CPA have a CPA review
at least once every six
months.
89%
91.2%
To ensure that discharged
patients are seen during their
most vulnerable period in the
community (within 7 days of
discharge).
All patients on New CPA
are followed up within
7 days of discharge from
inpatient care.
100%
100%
QUALITY ACCOUNTS
Table 3
2.1.4 Priority 4: Improving the way we relate to both service users and carers
The fourth priority is to improve the way we relate to service users and their carers. An example of
how we have tackled this is the use of the Patient Experience Tracker on our inpatient wards which
enables service users to inform us about their experience of the ward and the quality of the care
they receive.
Another example of improving the way we relate to service users and carers is seen within our
Greenwich Inpatient Unit where following admission of a patient, the ward manager contacts the
carer or close relative to find out if they have any issues or concerns that need to be addressed.
The table below (table 4) shows progress against our 2009/10 improvement objectives:
Oxleas NHS Foundation Trust
Quality Accounts
2009/10
7
QUALITY ACCOUNTS
Table 4
Improvement
Objective
Target
by end of 09/10
Baseline at
31 March 09
To use lessons learned
from complaints and
PALS (Patient Advice
and Liaison Service) to
improve our practice.
To do so effectively,
we must ensure good
communication and active
discussion of these issues
throughout the trust.
Lessons learned
from complaints
and PALS are
discussed at
local governance
or management
groups.
New target
To deliver improvements
in the way we relate to
service users, we need
to ensure communication
between staff and
service users is supportive,
clear and that we
adopt high standards
of customer care.
Reduce the
proportion of
complaints and
PALS issues
relating to staff
attitude (compared
with 08/09
average of all
complaints).
29%
Achievement
31 March 10
The review of complaints is
a standard item on all local
governance/management
agendas across the trust.
19.2%
64 complaints.
Target <23%.
8
To ensure service users
and carers feel they can
trust us, we need to
reply to their concerns
and resolve complaints
thoroughly and fairly.
Maintain over 95%
of all complaints
being resolved by
the trust.
To gain greater
understanding of our
service users’ and carers’
opinions regarding
quality, we need to
provide a mechanism to
request their feedback
more frequently.
All acute inpatient
services to use
the Patient
Experience
Tracker and
make unit-wide
improvements
from year-start
baseline.
Oxleas NHS Foundation Trust
Quality Accounts
2009/10
100%
Currently in
place in 6 of
13 working
age adult
and older
adult wards.
This has been maintained
over the year at a 100%
of complaints being resolved
by the trust.
All Working Age Adult acute
inpatient and functional
Older Adults acute wards use
the patient tracker.
2010/11 Quality Priorities
There has been a great drive within the trust to ensure involvement of our patients, carers,
members, staff and commissioners in reviewing our performance, 2009/10 improvement
objectives and agreeing our priorities for 2010/11. This was undertaken at several forums such as
the following:
• S ervice user forums which took place in boroughs covered by our services. These events also
involved local PCT commissioners;
• C
onsultation with our Council of Governors (including staff governors) and trust senior
clinicians at board away days;
• C
ommissioner contract negotiations on our Quality and Safety Improvement Plan and the
Commissioning for Quality and Innovation Framework goals (CQUIN) for 2010/11.
Following the above process, we have chosen three priority areas for 2010/11 under the three
domains of quality as described in High Quality Care for All (2008):
QUALITY ACCOUNTS
2.2
• Patient Experience;
• Patient Safety;
• Clinical Effectiveness.
The priorities listed below will be monitored through our Quality Board and at local level by the
directorate quality groups. The trust quality and audit team will support the measurement and
reporting of all improvement goals.
The priorities listed below are also part of our Quality and Safety Improvement plan agreed with
our PCT commissioners and progress reports will be sent to our commissioners on a quarterly
basis.
Oxleas NHS Foundation Trust
Quality Accounts
2009/10
9
QUALITY ACCOUNTS
10
2.2.1 Priority 1: Patient Experience
Under patient experience, we will continue to focus on our previous four priority areas which have
been our ‘must dos’ for the past two years.
Patient Experience
areas for improvement
Improvement
Goal
Baseline at
31 March 10
Target improvement
2010/11
Increasing support for
families and carers
To increase the number
of carers of clients on
new CPA who have
been offered a carers’
assessment as recorded
on our electronic clinical
records system (RiO)
469
carers
A 50% increase in the number
of carers of clients on CPA
who have been offered or
received a carers’ assessment
Providing better
information for our
patients and carers
To report on patient
experience feedback
with particular focus on
information provided to
patients admitted to our
acute inpatient units who
were given information
about the side effects of
their medication
New target agreed
under our local
commissioning
quality framework
(CQUIN)
To carry out audit to assess
patients’ experience on
provision of information about
their medication
To Improve
Care Planning
To continue our focus on
increasing the percentage
of patients on new CPA
with a crisis plan
93.7%
To ensure that we have more
than 95% of our patients on
new CPA with a crisis plan
recorded on RiO
Improving the way we
relate to both service
users and carers:
To reduce the number of
complaints we receive
relating to staff attitude
64 complaints
To see a further reduction of
at least 5% from the March
2010 baseline number
Oxleas NHS Foundation Trust
Quality Accounts
2009/10
19.2%
Patient Safety areas for
improvement
Improvement
Goal
Baseline at
31 March 10
Target
improvement
2010/11
Ensuring a provision of an
age appropriate environment
for emergency admissions of
16-17 year olds in our acute
wards
To provide an appropriate
ward within the trust for
emergency admissions of
16-17 year olds
100%
compliance
To maintain
100% compliance
Following up patients on CPA
who have been discharged
from our acute inpatient units
To follow up all patients on
new CPA discharged from
hospital within 7 days
100%
compliance
To maintain
100% compliance
Following up patients who
have been discharged from
our acute inpatient units with
a history of self harm
To follow up all patients with
a history of self harm within
48 hours of discharge from an
acute inpatient ward
100%
compliance
100%
Improving transition planning
between our children and
adult mental health services
Improving transition planning
between our children and
adult mental health services
To identify patients who are
17 years of age and confirm
support arrangements are in
place at the age of 18
New target agreed
under our local
commissioning
quality framework
(CQUIN)
100%
To ensure that all identified
17 year olds who need to be
transferred to adult mental
health services have had a
transfer CPA 3 months prior
to transfer
QUALITY ACCOUNTS
2.2.2 Priority 2: Patient Safety
95%
Oxleas NHS Foundation Trust
Quality Accounts
2009/10
11
QUALITY ACCOUNTS
12
2.2.3 Priority 3: Clinical Effectiveness
Target
improvement
2010/11
Clinical Effectiveness
areas for improvement
Improvement
Goal
Baseline at
31 March 10
Compliance with NICE
guidelines for schizophrenia
and bi-polar disorder: physical
health measurements and
screening for metabolic side
effects in assertive outreach
teams
To increase the proportion of
patients with schizophrenia
or bipolar illness under the
care of our assertive outreach
teams who have had an
annual physical health check
in line with NICE guidelines
77.5%
Increasing access to
psychological therapies within
secondary mental health
services
To increase the number
of patients receiving
psychological therapies
To ensure baseline information
on prevalence and purpose
of antipsychotic use in people
with dementia
To undertake a baseline
audit of number of patients
prescribed antipsychotics as
a proportion of total number
of patients with dementia
and other identified national
indicators
New target
(establishing
a baseline for
2010/11)
Completion of annual
audit with an action
plan to address the
issues raised by the
audit
To improve the physical health
care of patients on new CPA
To ensure that all patients
who suffer from long term
physical health conditions
like diabetes or coronary
heart disease receive annual
physical health checks
New target agreed
under our regional
commissioning
quality framework
(CQUIN)
80% of physical
records obtained from
GP practices
Oxleas NHS Foundation Trust
Quality Accounts
2009/10
3090 patients
19.2%
To improve on the
2009/10 baseline
and improve on our
benchmark status with
other mental health
trusts
10% increase on
March 2010 baseline
number
Board statements of quality assurance
2.3.1 Review of services
During 2009/10, Oxleas NHS Foundation Trust provided mental health (including forensic services)
and learning disability NHS services across Bexley, Bromley and Greenwich; in addition to forensic
services in Lewisham.
Oxleas NHS Foundation Trust has reviewed all the data available to them on the quality of care in
all these NHS services.
The income generated by the NHS services reviewed in 2009/10 represents 100% per cent of the
total income generated from the provision of NHS services by Oxleas NHS Foundation Trust for
2009/10.
2.3.2 Participation in clinical audits and national confidential enquiries
During 2009/10, 7 national clinical audits and 21 national confidential enquiries covered NHS
services that Oxleas NHS Foundation Trust provides.
QUALITY ACCOUNTS
2.3
During 2009/10, Oxleas NHS Foundation Trust participated in 100% of national clinical audits, and
81% of national confidential enquiries which it was eligible to participate in.
The national clinical audits and national confidential enquiries that Oxleas NHS Foundation Trust
was eligible to participate and participated in during 2009/10 are as follows:
National Clinical Audits
Participation
1
POMH –UK: High dose and combined antipsychotics on acute wards
✔
2
POMH-UK: Screening for metabolic side effects of antipsychotic drugs in
patients treated by assertive outreach teams
✔
3
OMH-UK: Assessment of side effects of depot antipsychotics
✔
4
POMH-UK: Use of antipsychotics in people with learning disability
✔
5
POMH-UK: Medicines Reconciliation
✔
6
POMH-UK – Quality of monitoring in patients prescribed lithium
✔
7
RCP Continence Care Audit
✔
✔
National Confidential Enquiries
National confidential enquiries into suicide and homicide by people with
mental illness (NCI/NCISH)
Oxleas NHS Foundation Trust
Quality Accounts
2009/10
13
QUALITY ACCOUNTS
The national clinical audits and national confidential enquiries that Oxleas 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 Clinical Audits
Percentage
against
registered cases
1
POMH –UK: High dose and combined antipsychotics
on acute wards
136
100%
2
POMH-UK: Screening for metabolic side effects of
antipsychotic drugs in patients treated by assertive
outreach teams
186
100%
3
POMH-UK: Assessment of side effects of depot
antipsychotics
391
>90%
4
POMH-UK: Use of antipsychotics in people with
learning disability
68
70%
5
POMH-UK: Medicines Reconciliation
83
100%
6
POMH-UK – Quality of monitoring in patients
prescribed lithium
260
>50%
7
RCP Continence Care Audit
75
94%
National Confidential Enquiries
17
81%
National confidential enquiries into suicide and homicide
by people with mental illness (NCI/NCISH)
14
Number of
cases
submitted
Oxleas NHS Foundation Trust
Quality Accounts
2009/10
All national audits have a trustwide and directorate lead who have joint responsibility to ensure
that the results of our audits are discussed at trustwide, directorate and at team levels. The action
plans for improvement are aggregated and implemented to improve performance in time for the
next audit round.
The reports of 56 local clinical audits were reviewed by the provider in 2009/10 and Oxleas NHS
Foundation Trust is following recommendations from the action plans to improve the quality of
healthcare provided. The results and agreed actions are presented to a multi-disciplinary clinical
audit directorate meeting where the action plan is monitored and implemented before a re-audit
is carried out.
2.3.3 Participation in clinical research
The number of patients receiving NHS services provided or sub-contracted by Oxleas NHS
Foundation Trust that were recruited during that period to participate in research approved by a
research ethics committee was 102.
QUALITY ACCOUNTS
The reports of 7 national clinical audits were reviewed by the provider in 2009/10 and Oxleas NHS
Foundation Trust is following recommendations from the action plans to improve the quality of
healthcare provided.
Oxleas NHS Foundation Trust was involved in conducting 19 National Institute for Health Research
(NIHR) clinical research studies, 10 more than in the previous year, and national systems such as
the Research Passport Scheme and CSP (co-ordinated system for gaining NHS permission) were
used where appropriate to manage 100% of these studies proportionally according to risk.
Two Clinical Studies Officers from the Mental Health Research Network have been recruited to
support our participation in NIHR studies. Additionally, we hosted 22 research ethics committeeapproved research studies and 29 service evaluation projects. As a result of participating in
research, Oxleas staff authored a total of 81 publications, of which 58 were journal articles, 20
were book chapters and 3 were books. We are committed to meeting the national target of
doubling recruitment totals to portfolio-adopted studies over the next five years, using a yearly
15% stepped increase.
2.3.4 Use of the Commissioning for Quality and Innovation (CQUIN) Framework
Our income in 2009/10 was not conditional on achieving quality improvement and innovation
goals through the Commissioning for Quality and Innovation (CQUIN) payment framework as this
was not part of our negotiations with the local Primary Care Trusts.
Goals for quality improvement and innovation through the Commissioning for Quality and
Innovation payment framework have been identified for following 12 month period of 2010/11
and this is available on request from:
Oxleas NHS Foundation Trust
Communications Department
Pinewood House
Pinewood Place
Dartford
Kent
DA2 7WG
Oxleas NHS Foundation Trust
Quality Accounts
2009/10
15
QUALITY ACCOUNTS
2.3.5 Registration with the care quality commission
(CQC and periodic/ special reviews)
Oxleas NHS Foundation Trust is required to register with the Care Quality Commission and our
current registration status as of 31st March 2010 is registered without Conditions.
The Care Quality Commission has not taken enforcement action against Oxleas NHS Foundation
Trust during 2009/10.
2.3.6 Quality of Data
Oxleas 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 (April 2009 – February 2010 as March data has
not been circulated):
- which included the patient’s valid NHS Number was: 98.4% for admitted patient care; 99.5% for
outpatient care.
- which included the patient’s valid General Practitioner Registration Code was: 100% for
admitted patient care; 100% for outpatient care.
Oxleas NHS Foundation Trust score for 2009/10 for Information Quality and Records Management,
assessed using the Information Governance Toolkit was 90%.
Oxleas NHS Foundation Trust was not subject to the Payment by Results clinical coding audit
during the reporting period by the Audit Commission.
3.0
Our Quality Overview
Within this section of our Quality Report, we give an overview of how we performed in 2009/10
against both locally agreed quality performance measures and nationally defined and regulated
quality performance measures.
3.1
Agreed local quality indicators
As outlined in our Annual Report for 2008/09 we have continued to monitor the following
indicators to judge the quality of the care we provide. These measures reflect the three main
aspects of quality and our progress during 2009/10 can be seen below:
• patient safety;
• clinical effectiveness;
• patient experience.
16
Oxleas NHS Foundation Trust
Quality Accounts
2009/10
Rationale for this
measure
2007/08
2008/09
2009/10
Data
source
Improve prescribing
practice: % adherence
to the standard for
prescribing high dose
anti-psychotics
Prescribing medication
safely and in line with
best practice and NICE
guidance is essential to
providing a safe service.
We are involved in
auditing our prescribing
practice through POMHUK. Our involvement in
these audits gives us a
clear indication of the
quality of our prescribing
practice and how we
benchmark with other
trusts
Prescribing
appropriate
dose:
73%
adherence
Prescribing
appropriate
dose:
80%
adherence
Prescribing
appropriate
dose:
83%
adherence
Prescribing
single antipsychotic:
71%
adherence
Prescribing
single antipsychotic:
74%
adherence
Prescribing
single antipsychotic:
79%
adherence
POMHUK &
pharmacy
monitoring
(governed
by national
definitions)
Prescribing
single
generation
antipsychotic:
80%
adherence
Prescribing
single
generation
antipsychotic:
84%
adherence
Prescribing
single
generation
antipsychotic:
91%
adherence
QUALITY ACCOUNTS
Patient safety
measures
This column
has been
updated as
09/10 data
was shown in
the 2008/09
column
last year
Reducing mixed sex
accommodation: % of
single sex bedrooms
or bays
A national priority for
2009/10 is to reduce
the amount of mixed sex
accommodation to ensure
patients are cared for with
privacy and dignity and in
a safe environment
100%
100%
100%
Estates
information
(governed
by national
definitions)
Oxleas NHS Foundation Trust
Quality Accounts
2009/10
17
QUALITY ACCOUNTS
18
Meeting national
standards for medium
secure services:
number of 2008
national medium
secure standards met
in baseline inspection.
New national medium
secure service standards
were introduced in
2008/09. A baseline
assessment of our
compliance with these
standards which address
both safety requirements
for patients and the public
has been undertaken. We
plan to improve on this in
2009/10.
N/A
159
standards
met out
of 192
standards
191
out of 192
standards
have been
met. The 1
outstanding
standard
will be
delivered
in 2010/11
Medium
Secure
Standards
Inspection
(governed
by national
definitions)
Reducing healthcare
acquired infections:
number of MRSA and
Clostridium difficile
cases reported.
Reducing healthcare
acquired infections is a
key national priority for all
trusts.
2 C Diff
0 MRSA
1 C Diff
0 MRSA
0 C Diff
0 MRSA
National
reporting
(governed
by national
definitions)
Patient experience
measures
Rationale for this
measure
2007/08
2008/09
2009/10
Data
source
Staff attitude and
communication:
number of complaints
received regarding
staff attitude or
communication.
Establishing good
relationships with our
service users and carers
was one of our priority
work streams in our
2008/09 Annual Plan
and will continue to be
in 2009/10.
Percentage
of incidents
with staff
attitude
raised
within a
complaint
= 27%
Percentage
of incidents
with staff
attitude
raised
within a
complaint
= 29%
Percentage
of incidents
with staff
attitude
raised
within a
complaint
= 19.2%
Trust
complaints
database
(Local
indicator
defined)
% of patients who felt
they were listened to
by the professional
whom they last saw.
Positive relationship
between clinicians and
service users is key to
providing high quality
services which meet
service user needs.
84%
85%
82%
National
Patients’
Survey
(governed
by national
definitions)
Oxleas NHS Foundation Trust
Quality Accounts
2009/10
Rationale for this
measure
2007/08
2008/09
2009/10
Data
source
% of patients who felt
they were involved in
their care planning.
Involvement in the care
planning process can
deliver better quality
outcomes for service
users as this encourages
engagement in the plan
and ensures the plan
picks up all care needs.
50%
57%
Not
applicable
to 2009
survey
National
Patients’
Survey
(governed
by national
definitions)
% of patients who
received sufficient
information about
medication.
Providing service users
with good quality
information about
their care, especially
medication, supports
compliance with
medical prescribing.
73%
(Community
population)
81%
(Community
population)
55%*
(Inpatient
population
survey
result)
National
Patients’
Survey
(governed
by national
definitions)
% of patients who felt
carers were supported.
Carers involvement in
service users’ care can be
vital. Therefore supporting
carers can have a
significant impact on the
overall quality of the care
we provide to service
users.
34%
39%
Not
applicable
to 2009
survey
National
Patients’
Survey
(governed
by national
definitions)
QUALITY ACCOUNTS
Patient experience
measures
* The 2009 survey involved patients receiving care on acute wards in hospital rather than from community services (2008
survey). One would expect different levels of satisfaction. However, we have taken steps to improve information available
including ward information packs.
Oxleas NHS Foundation Trust
Quality Accounts
2009/10
19
QUALITY ACCOUNTS
20
3.2
National targets and regulatory requirements
In 2009, the Healthcare Commission judged Oxleas to have made ‘excellent’ use of resources (this
score was derived from the trust’s Monitor rating) and to have delivered ‘good’ quality services:
The tables below detail our performance against the criteria used to assess the quality of the
services we deliver:
Annual Health Check 2009
Core Standards
There are 24 standards intended to ensure that
services are safe, equitable and of acceptable quality.
The standards are grouped into six areas.
• Safety
• Clinical and cost effectiveness
• Patient focus
• Accessible and responsive care
• Environment and amenities
• Public Health
Oxleas NHS Foundation Trust
Quality Accounts
2009/10
Level of performance
Full compliance on all
core standards
Required
performance
to achieve
Level of
performance
(2008/09)
Status
Data Quality on Ethnic Group
>90%
98%
Achieved
Patterns of care from the mental health minimum
data set (MHMDS)
>80%
N/A
N/A
Completeness of the mental health minimum data set
(MHMDS)
>99%
98.8%*a
Under
achieved
Access to crisis resolution home treatment (CRHT)
>90%
99%
Achieved
Child and adolescent mental health services (CAMHS)
>21/24
18/24*b
Under
achieved
Care Programme Approach (CPA) 7 day follow up
>95%
100%
Achieved
Delayed transfers of care
<7.5%
2.8%
Achieved
Best practice in mental health services for people with
a learning disability (implementing the “Green light
for mental health” framework)
>42/48
44/48
Achieved
Experience of patients
Results of National
Patient Survey *c
Below
average
NHS Staff satisfaction
>3.549
Achieved
3.769
Oxleas NHS Foundation Trust
Quality Accounts
2009/10
QUALITY ACCOUNTS
Existing Commitments and National Priorities
(Mental Health Services)
21
QUALITY ACCOUNTS
Existing Commitments and National Priorities
(Learning Disability Services)
Required
performance
to achieve
Level of
performance
(2008/09)
Status
Campus Closure
N/A
N/A
N/A
Care Plans
100%
100%
Achieved
Delayed Transfers of care
<7.5%
0%
Achieved
Ethnic coding data quality
>85%
100%
Achieved
* a
* b * c New processes have been put in place to improve data completeness.
An action plan has been delivered and we are now achieving 24/24.
The 2009 survey involved patients receiving care on acute wards in hospital rather than from community services (2008 survey). One would expect different levels of satisfaction. However, we have taken steps to improve
patient satisfaction.
As a foundation trust, we were also required to deliver against the following Monitor requirements
in 2009/10.
22
Monitor’s requirements
Level of performance
Ensure that at least 95% of all enhanced patient discharges are
followed up within seven days.
Achieved
Maintain the level of crisis resolution home treatment (CRHT) teams
agreed in the 2003/04 planning round.
Achieved
Ensure that the level of delayed transfers of care does not exceed 7.5%.
Achieved
Ensure that at least 90% of admissions have access to crisis resolution services.
Achieved (100%)
Oxleas NHS Foundation Trust
Quality Accounts
2009/10
Bexley Care Trust, NHS Bromley, NHS Greenwich
Comments on Oxleas NHS Foundation Trust’s Quality Report 2009/10
Bexley Care Trust, NHS Bromley and NHS Greenwich (the PCTs) share the commitment to quality
set out by Oxleas NHS Foundation Trust (Oxleas), “to provide the best quality health and social
care to local people” and support the broad vision for quality improvement set out in the annual
Quality Report.
The PCTs recognise that Oxleas has always been rated as either “good” or “excellent” for the
quality of services by the Care Quality Commission and previously by the Healthcare Commission
and congratulate clinicians, staff and management for this sustained success which led, this year,
to Oxleas being named “Provider of the Year” by the Royal College of Psychiatrists.
During 2009/10 Oxleas have demonstrated good progress against their four priority areas:
1 Increasing support for families and carers: including greatly improved recording of carer details,
a large increase in the number of carers who have completed carers’ assessments and much more
training for staff in family inclusive practice.
QUALITY ACCOUNTS
4.0
2 Providing better information for service users and carers: including providing patients with
information about their legal rights, providing patients with information about the care they
will receive and providing local people with information about Oxleas in a new website.
3 Enhancing care planning: including ensuring that all clinicians have access to care plans,
ensuring that crisis plans have been developed for all patients and keeping in contact with
vulnerable patients after they have been discharged.
4 Improving the patient experience and learning from complaints, improving communications
between staff and patients and implementing the use of the Patient Experience Tracker.
The PCTs applaud the progress that has been made in these areas and support the quality
priorities for 2010/11, which were developed following a period of staff and user engagement.
Oxleas’ priorities for next year are grouped as “improving the patient experience,” “patient
safety”, and “clinical effectiveness”. The PCTs support this approach and the continued focus on
2009/10 priorities under the “patient experience” banner. As part of the commissioning process
the PCTs will take an active interest in supporting improvements where the very highest standards
have yet to be achieved.
The new priorities focus on improving patient safety are particularly welcomed. The PCTs are
aware that Oxleas is amongst the lowest reporters of patient safety incidents to the National
Reporting and Learning Service managed by the National Patient Safety Agency. A high rate of
reporting patient safety incidents (underpinned by an approach that enables learning) is generally
regarded as indicating an ‘open culture’ in which staff feel free to raise issues and play an active
role in improving the quality of services. The PCTs recommend that Oxleas investigate the low
reporting rate and take any actions that might be required to support staff to report incidents in
an open and supportive manner. This will benefit patients and staff alike therefore making explicit
that the culture enables failings in ‘quality’ not to occur.
Oxleas NHS Foundation Trust
Quality Accounts
2009/10
23
QUALITY ACCOUNTS
The quality priorities centred on implementing clinical effectiveness are also welcomed, in
particular the priority for ensuring that patients’ physical health issues are addressed alongside
their mental health problems. The PCTs wish to see this priority extended to include supporting
patients to quit smoking. This is an important priority and the PCTs are keen to see that it is
implemented in all the health care settings where Oxleas delivers services.
The PCTs note the wide range of clinical audit work that Oxleas has engaged with during the year.
Clinical audit is a key tool for monitoring and improving the quality of patient care and the PCTs
recommend that Oxleas are more proactive in sharing the results of audits and all other quality
reporting information with partner organisations and commissioners so that a more holistic and
joined up approach to developing improvement plans can be implemented.
This is the first year that the PCTs have been invited to comment on the Oxleas Quality Account
and we are pleased to be able to do so. In future years we would like more time to review the
report, allowing us to engage with our local general practitioners and provide a more widely
considered response.
Graham Hewett
Head of Quality and Integrated Governance, NHS Greenwich
On behalf of Bexley Care Trust, NHS Bromley and NHS Greenwich.
4.1
Comments from Local Involvement Networks (LINks)
Comments from Greenwich Local Involvement Network
During the past six months, Greenwich LINk have formally agreed to attend Oxleas NHS
Foundation Trust’s Council of Governors. We are pleased that we are now in a position of having
our and our many and varied participants’ views accepted and discussed by this committee and
that co-operation is very much to the fore. Greenwich LINk Members have a working knowledge
of volunteering and peer mentoring which they are willing to contribute to Oxleas’ development
of these roles and committees.
Comments from Bromley Local Involvement Network
Bromley LINk congratulates Oxleas on what is generally an excellent quality report. The LINk would
also like to make the following comments:
1.0 We are pleased that the trust has had successes in each of the 4 quality priority areas and urge the trust to continue this progression in parallel with its priorities for 2010/11.
2.1.1 Bromley LINk is pleased that Oxleas is engaging with more carers, and would urge that this work continues.
2.1.2the LINk notes the problems regarding compliance with Section 132 of the Mental Health
Act. We understand that new software should rectify this, and hope to see a far higher
rate of recording in next year’s report. We acknowledge that there have been great
improvements in the trust’s website.
24
Oxleas NHS Foundation Trust
Quality Accounts
2009/10
2.1.4we are pleased to see a large reduction in the percentage of complaints relating to staff
attitude. We would suggest that figures on overall numbers of complaints received by the
trust may be useful in next year’s report in order to better understand this statistic.
We understand that some service users find it difficult to register complaints and hope that this
situation can continue to be pro-actively monitored by the User Carer Council. The LINk hopes
that complaints are resolved to the satisfaction of both the trust and the complainant wherever
possible.
2.2.2Bromley LINk welcomes the progress in the provision of single sex accommodation for
all service users and an age appropriate environment for 16-17 year olds.
We note the current 100% follow-up rate for discharged service users and will be monitoring
this on an ongoing basis.
QUALITY ACCOUNTS
2.1.3we endorse the need for effective care planning. We would therefore encourage the trust
to ensure not only that all patients have a crisis plan recorded on RiO, but also that all
patients understand their plans wherever possible as the LINk is aware of some patients
who are unsure of what to do in a crisis.
2.2.3the LINk welcomes the increasing use of psychological therapies both in primary and
secondary care as we understand that they are well received by current service users. We
would also encourage the trust to further consider alternative therapies as a means of
accommodating the cultural, faith and spiritual needs of patients.
3.1
T he LINk is unable to comment in depth on the prescription of high dose anti-psychotics.
However, whilst we understand that Oxleas is a high performer in this area compared
to other trusts and service users have been involved in this work, we would hope to see
improved adherence to NICE guidelines in next year’s report.
The LINk is pleased to see that the Patient Experience remains a priority for 2010/2011, as current
measures indicate that there is room for improvement in several areas.
3.2 B
romley LINk notes that London mental health trusts did not perform well in the 2009
national patient survey, and understands that initial results for the coming year are
much improved. We support the increased efforts to improve the satisfaction of Oxleas
in-patients.
Oxleas NHS Foundation Trust
Quality Accounts
2009/10
25
QUALITY ACCOUNTS
Comments from Bexley Local Involvement Network
Bexley LINk would firstly like to compliment Oxleas NHS Foundation Trust on this Quality Account.
It is felt that the report is concise and well prepared. Bexley LINk would like to comment on the
following areas: 2.1
T he Bexley LINk would like to recognise the success of the trust in 4 of the quality priority
areas and we hope to see continued progress made in the coming year.
2.1.1We are heartened to see that progress has been made to improve the support given to
families and carers.
2.1.2We acknowledge the technical problems the trust has encountered with regards to
compliance with Section 132 of the Mental Health Act and we understand that this situation
should be rectified in the coming year with the introduction of new software. The trust’s
website has undergone much change for the better during 2009/10.
2.1.3Enhanced Care Planning, we acknowledge the progress made but urge the trust to ensure
that all patients have crisis plans recorded on RIO in the coming year.
2.1.4The LINk would like to acknowledge the progress made with regards to the reduction of the
number of complaints made relating to staff attitude. Also the LINk would like to reconfirm
the importance of learning from past complaints to ensure that problems are addressed
thus ensuring further complaints regarding the same issue are not received.
2.2.2The LINk is pleased that the trust has achieved compliance with regards to ensuring
provision of an age appropriate environment for 16-17 year olds, furthermore we are
heartened to note that the trust achieved 100% rate of follow ups relating to patients
discharged with CPA and patients with a history of self harm.
2.2.3 T he LINk agrees with the need for and welcomes the addition of the target that will ensure
that patients suffering from a long term condition will receive yearly physical health checks.
3.2
T he Bexley LINk notes that the trust has achieved below average results in the national
patients survey 2009/10, however we believe that the results for 2010/11 are much
improved. We acknowledge and welcome the increased effort by the trust to improve
patient satisfaction.
Overview and Scrutiny Committees were unable to comment on the Quality Report due to
the General Election.
26
Oxleas NHS Foundation Trust
Quality Accounts
2009/10
Oxleas NHS Foundation Trust
Quality Accounts
2009/10
27
Contact us
Trust Secretary
Oxleas NHS Foundation Trust
Pinewood House
Pinewood Place
Dartford
Kent
DA2 7WG
email: anne.rozier@oxleas.nhs.uk
Tel: 01322 625700
Fax: 01322 555491
Patient Advice
and Liaison Service
If you require information, support or
advice, please contact us free on:
Tel: 0800 917 7159
Trust membership
To become a member of Oxleas NHS
Foundation Trust contact us on:
Tel: 0800 389 6642
Email: foundation.trust@oxleas.nhs.uk
or join online at
www.oxleas.nhs.uk
Careers
For the latest information on
vacancies at Oxleas, please visit our
website at www.oxleas.nhs.uk