Portsmouth Mental
Health Services
Quality Accounts
Quality of services delivered during 2009/10
Quality improvement priorities for 2010/11
Document published 30th June 2010
Contents
Statement on Quality from the Chief Executive
3
Statement by Associate Director to assure accuracy of document
4
1.
Background
5
2.
Portsmouth Mental Health Services
6
3.
Providing Quality Mental Health Services during 2009/2010
8
4.
Commissioning for Quality and Innovation (CQUIN)
10
5.
Prioritising Quality Improvement initiatives for 2010/2011
13
6.
Review of Services: Statements of Assurance from the Board
19
7.
National Clinical Audits
20
8.
Local Clinical Audits
21
9.
Local clinical research activity
23
10. Care Quality Commission Registration
24
11. Comments on these Quality Accounts
26
12. Publishing a Quality Account
29
13. Conclusion
30
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Statement on Quality from the Chief Executive
“I am delighted to present the first Quality Accounts report regarding Mental
Health Services within Portsmouth Community and Mental Health Services.
This provides an opportunity to demonstrate the work that has taken place to
improve patient safety and ensure a good patient experience.
The aim of Quality Accounts is to drive constant improvement in care.
‘High Quality Care for all’ (DH 2008) is a report that sets out a vision for an
NHS with quality at its heart. As part of this increased focus on quality, the
Government proposed that all health care providers should produce Quality
Accounts. Quality Accounts is a document that provides information for the
public on the quality of care their local health care services are delivering.
In publishing information on quality, NHS providers will constantly review and
commit to improvements in their services. The public are invited to hold the
NHS provider to account for the commitments they have made in the
publication.
Portsmouth Community and Mental Health Services Board of Directors, the
senior managers and the clinical leaders are committed to delivering an
ambitious programme of continuous quality improvement during the year of
2010/11.
We have welcomed the introduction of Quality Accounts in the NHS as an
opportunity to publicly confirm commitment to quality. We have therefore
agreed targets and priorities for continuous quality improvement that we know
will stretch us in the coming twelve months to deliver the ongoing real
improvements that service users, carers, partners and commissioners expect “
Tracy Sanders
Chief Executive Officer
Portsmouth City Teaching Primary Care Trust
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Statement by Associate Director to assure accuracy of document
“This Quality Account reports the quality of Portsmouth Mental Health Services
delivered in 2009/10 and the improvement priorities planned for the services
during 2010/11.
The public and patients are invited to use this Quality Account to gain a high
level understanding of the quality of Portsmouth Mental Health Services, to see
what the service does well, where it needs to improve, and to understand what
it is doing to achieve improvement in quality.
This Quality Account is both retrospective and prospective. It aims to improve
organisational accountability to the public by looking back on the previous
year’s information regarding the quality of services, explaining both what has
been done well, but also where improvement is needed. Crucially, this
document will look forward, explaining what has been identified as the priorities
for improvement over the coming financial year, and how the service will
achieve and measure these.
The information presented within this Quality Account and the improvements
identified as priorities as a result, have been decided by involving all interested
parties; for example, patients and their carers, staff and clinical teams;
commissioners and regulators.
To the best of my knowledge the information in this document is accurate”
Susan Marshall
Associate Director of Clinical Standards
Portsmouth City Teaching Primary Care Trust
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1. Background
During 2009/2010, until 31st March 2010, Portsmouth Mental Health Services
were delivered by Portsmouth City Teaching Primary Care Trust, and known as
Portsmouth Community and Mental Health Services.
On 1st April 2010, Portsmouth Community and Mental Health Services,
integrated with Southampton Community Healthcare to form a new provider
organisation known as Solent Healthcare. Solent Healthcare is now the
organisation that delivers Portsmouth Mental Health Services.
‘High Quality Care for All’, published by the Department of Health in June 2008,
set the vision for quality to be the guiding principle for the NHS and proposed
that all health care providers should produce Quality Accounts. However, the
requirement to publish a Quality Account in June 2010 applies only to those
providers who deliver acute, mental health, learning disability and ambulance
services. Providers of primary care and community services will be brought into
the requirement in 2011 subject to a testing and evaluation exercise. Therefore
these Quality Accounts relates only to the mental health provision within
Portsmouth Community and Mental Health Services and the 2011 report will
include all the community services provided by Solent Healthcare.
For the period of April 1st 2009 to March 31st 2010, Portsmouth Mental Health
Services had a budget of £23.2million to provide services to over 600,000
people across Portsmouth and South East Hampshire.
Portsmouth Mental Health Services are an established provider and have
developed an excellent reputation for high quality service provision, innovation
and robust financial management. The services have a business orientated
culture and a strong focus as high quality, effective services which are flexible
and responsive to clients’ needs.
In order to provide a quality service, it is important to review where the services
are now and plan for the future, therefore this information is published in this
Quality Account. This in turn has informed the priorities set out for
improvements of the service and benefit of patients, clinicians and managers,
and will be used to inform local accountability for services, and to assist
clinicians, commissioners and patients in driving improvements.
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2. Portsmouth Mental Health Services
There are three services within Portsmouth Mental Health Services:
•
•
•
Child and Adolescent Mental Health Services (CAMHS)
Adult Mental Health Services (AMH)
Older Peoples Mental Health Services (OPMH)
The three services work closely together to ensure that the pathway for the
patient, especially if they are in transition between services, is as seamless as
possible and of the very highest quality.
All Mental Health Services are staffed with different professionals working
together as a Multi Disciplinary Team. The professionals include amongst other
professionals; nurses, psychiatrists, social workers, psychologists, occupational
therapists and psychotherapists.
More information regarding the services can be access from the website
www.solent.nhs.uk but the following is a brief overview to the three services.
2.1 The Child and Adolescent Mental Health Service
The Child and Adolescent Mental Health Service provide community treatment
for children and adolescents up to the age of 18 years. This service works
closely with General Practitioners and includes primary care and community
mental health teams. The primary care teams main area of focus is early
diagnosis. The community mental health teams deliver long term specialist
treatment. This service also works with child development centres which focus
on the early development of children between 0 and 5 years.
2.2 The Adult Mental Health Service
The Adult Mental Health Service is the largest of the three services and delivers
a range of services spanning the whole pathway of care to people in the age
range of 18 to 65 years. Examples of these are;
•
•
•
•
•
Psychology Services that offer short term counselling within primary care
as part of the National programme on Improving Access to Psychological
Services (IAPT).
Mental Health Liaison Services based within the Emergency Department
at Queen Alexandra Hospital supporting the public that present at the
Emergency Department and either have or are suspected to have
mental health problems.
Crisis Resolution and Home treatment Services providing an appropriate
alternative to inpatient acute admission.
Community Mental Health Teams (working closely with the Crisis
Resolution and Home treatment Services) providing the majority of the
mental health care in the community.
In patient and day treatment services.
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2.3 Older Peoples Mental Health Service
Older Peoples Mental Health Service provides assesses and treats two main
groups; people over 65 with functional mental illness and people of any age
who have dementia. This service offers a flexible mix of community, day care,
out patient and in patient services including therapy services. It aims to keep
people as independent as possible whilst maintaining their dignity. The services
include;
•
•
•
•
•
•
Community based services
Early onset dementia service
Memory clinic service
Intermediate care team
Psychology and counselling services
In patient and day treatment service
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3. Providing Quality Mental Health Services during 2009/2010
During 2009/10 the mental health services within Portsmouth Community and
Mental Health Services managed to achieve significant improvements in key
quality measures.
Adult Mental Health Service residential services have been working on the
rapid improvement programme for intensive care units, the productive ward
series, increasing service user and carers’ involvement and developing more
deliberate approaches to quality improvement in the use of work plans for all
inpatient services.
The Crisis Resolution and Home Treatment Service (CRHT) is one the best
performing in the country.
The Forensic Unit has been updating the
environment to ensure that it is line with the National Minimum Standards for
Forensic Inpatient Settings.
Within the Community, the Mental Health Liaison Team (MHLT) has been
taking part in a National Accreditation Programme to become a beacon site for
best practice. This will shortly be peer reviewed by the Royal College of
Psychiatrists.
The Care Programme Approach (CPA) audits have consistently evidenced that
the community teams have embedded the Care Programme Approach within
the culture of their practice.
Towards the end of 2009 The Talking Change Service was launched which is
aimed at improving access to psychological therapies for people with mild to
moderate depression within the community. Service users report that their
overall view is “extremely positive” about the service they are accessing.
Child and Adolescent Mental Health Services (CAMHS) has received
substantial new investment in the last few years that has enabled them to
enhance provision up to 18 years including:
•
•
•
•
•
the opening of a brand new refurbished unit in the community which now
offers families a safe, accessible and quality environment
dedicated teams for children and young people with learning disability
and children in care
increased range of interventions offered in line with the evidence base
including Dyadic Developmental Psychotherapy, Multi-Family Therapy,
Art Therapy and Dialectical Behaviour therapy.
being part of a national network for quality multi agency provision and
successfully improving on the standards of care
being cited as an example of good practice in several national
publications
The new Older Peoples Mental Health (OPMH) Unit, The Limes, opened in
November 2009. The Limes is a purpose-built 36-bedded facility for acutely ill
older people with mental health problems and dementia. The three main drivers
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influencing the design of the build were dignity in care, infection prevention and
positive risk management.
The Lowry Treatment Centre has been recently refurbished. The Centre offers
support and treatment for older people with mental health problems and
dementia on a daily and sessional basis. Courses for older people with
Dementia and their carers, for example the memory service, are now more
reflective of the National Dementia Strategy guidelines.
OPMH have developed, in line with the Code of Practice: Mental Health Act
(DH 2008), a robust infrastructure for Infection Prevention and Control (IPC),
including link nurses on every ward, publicly displayed and available cleaning
schedules, Modern Matron Inspections and a cleaning assurance sign-off
linked directly to the agreed cleaning schedules.
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4. Commissioning for Quality and Innovation (CQUIN)
The Commissioning for Quality and Innovation (CQUIN) framework makes a
proportion of providers’ income conditional on quality and innovation.
Commissioners set Portsmouth Community and Mental Health Services
Commissioning for Quality and Innovation targets that were linked to achieving
certain quality related targets. Once those targets are achieved, the provider
then has the proportion of income that is linked to that CQUIN target. This
ensures that providers have financial incentives for improving the quality of the
service they provide.
Table one provides a breakdown of the CQUINS targets set for 2009/10 which
Portsmouth Mental Health Services have been successful in achieving.
Table One: Overview of Current Indicators
For Organisational Effectiveness and Quality
Commissioning Annual
Year To
for Quality and Target
Target
Innovation
Achievement
targets
Date Year
To
Date
Actual
(March
2009)
Mental
Health
Minimum Data Set
Delayed
Discharge
Reduction
Adult Mental Health
Crisis Resolution and
Home Treatment
Adult Mental Health
Early
Intervention
Psychosis. To exceed
Early
Intervention
Psychosis
caseload
target by 10% to
prevent disability by
intervening early
Infection Control Hand
washing. Audit of
Hand washing to be
undertaken in line with
guidance
7 day follow up
85%
85%
85%
7.5%
7.5%
5.5%
436 Episodes
363
549
122
118
120
95%
100%
100%
Access for people with
learning disability.
Rating 4
Rating 4
Rating 4
A
full
range
of
Services for children
and young people
with learning disability.
Rating 4
Rating 4
Rating 4
16-17 year olds who
require
a
mental
health service have
access to services
and accommodation
appropriate to their
age.
Rating 4
Rating 4
Rating 4
Y
Y
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24 Hour cover is
available to meet
urgent mental health
needs of children and
young people and for
specialist
mental
health assessment to
be undertaken.
A full range of early
intervention support
services delivered in
universal settings and
through
targeted
services for children
with mental health
problems
commissioned
through partnership.
Rating 4
Rating 4
Rating 4
Rating 4
Rating 4
Rating 3. Some services
in place but more still to
be developed via joint
commissioning with local
authority.
4.1 Explanation of Current Indicators referred to in Table One
The ratings are devised as such:
Rating 1 – Protocols / mechanisms not in place
Rating 2 - Protocols / mechanism in place but not implemented
Rating 3 – Protocols / mechanism partially in place and implemented
Rating 4 – Protocols / mechanisms fully implemented
The mental health minimum dataset requires mental health trusts to ensure that
a minimum level of data is held about all service users as part of information
governance and safe delivery of care. Portsmouth Mental Health Services
have consistently demonstrated compliance in this area.
The Department of Health (DH) has also set some targets around delayed
discharges from inpatient mental health settings. This is a national challenge
due to a lack of available accommodation to house these clients in a timely
fashion. Clinical leads and staff have been working together across care
pathways to ensure that those clients that are identified as no longer needing
inpatient acute care are transferred in as timely manner as possible. This has
meant working closely with social care, the voluntary and private sector, to
ensure that the pathway for clients is as smooth as possible.
The Early Intervention and Psychosis Service (EIP) aims to intervene in the
early stages of a psychotic illness to ensure that long term outcomes for clients
are enhanced. The EIP has exceeded the national targets for caseloads within
EIPs.
Infection control has been a priority during the last year. Inpatient settings
within Adult Mental Health and Older Peoples Mental Health have evidenced
compliance with hand washing standards through monthly audits that is now
showing a steady improvement.
Mental Health Trusts are also required to demonstrate how they ensure that
people with learning disabilities who come through their services have their
pathways adequately altered to meet their needs. There are four ratings of
compliance depending on how well implemented the systems are within the
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trust. In 2008/2009 the service was unable to declare full compliance in this
area, however, this year after the necessary improvements have been made,
full compliance can be declared.
The Care Programme Approach (CPA) requires that all patients that have been
discharged from inpatient settings are followed up within 7 days of discharge.
The national target is 95% and in 2008/2009 the service was unable to declare
compliance. Since then the community mental health team managers have
worked hard to improve this and the service is now at 100% and would like to
maintain this. The service is on course to declare compliance for 2009/2010.
Within CAMHS it is required nationally that a full range of comprehensive child
and adolescent mental health services is offered. This is defined through four
main indicators listed in Table One with a description of what has to be in place.
As Table One shows, all are currently met apart from one where work is
currently in progress, with partners within the local strategic partnerships, to
improve on the access to early intervention services.
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5. Prioritising Quality Improvement initiatives for 2010/2011
During 2009/2010 the Adult Mental Health and Older Peoples Mental Health
Services commissioned an external company to obtain feedback from service
users regarding the Mental Health Services provided. The external company
had experience in health and social care and used a large range of methods to
obtain the data. The outcome of this report has informed all the service
priorities for improving patient experience when accessing services.
Key areas have been identified to improve the safety and effectiveness of
services. The recent annual health check by the Health Care Commission
evidenced an underperformance on seven day follow up for clients and this has
become an area for improvement.
Following a National Institute of Clinical Excellence (NICE) audit for the care
delivered to people with Schizophrenia, there were also some areas highlighted
that require improvement. These will be carried out to be assured compliance
with the NICE guidance.
The following priorities have been agreed by a combination of feedback from
service users, the public, performance data from national indicators for quality,
and views of key stakeholders within the organisations management.
5.1 Selected Priorities and Proposed Initiatives
The selected priorities and proposed initiatives for 2010/2011 are given under
the headings of:
•
•
•
Patient Experience
Effectiveness
Safety
5.1.1Patient Experience
Patient Experience Priority 1: Improve in all areas of customer service
High quality customer service is a key part of the whole patient experience.
Quality customer service means everyone regardless of where they are
accessing a service can expect to be spoken to in a courteous manner, given
information regarding aspects of their care in a timely manner, and feel satisfied
about the quality of customer service as well as the quality of care that is
delivered along with it.
In 2009/2010 the customer satisfaction survey that was undertaken highlighted
poor experience in areas of customer satisfaction. This was reported to be
particularly in the manner in which the service communicated with service
users. It is important to improve the quality of customer service in 2010/2011.
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Objective
To Improve levels of satisfaction in
customer
service
by
agreeing
standards for customer service and
complimenting the staff training that is
already in place.
Measure
Repeat customer satisfaction survey.
90% of Service users surveyed to
report that they strongly agree all
aspects of customer service were of a
high standard.
Patient Experience Priority 2: Improving access to service for all service
users
It is vital that all aspects that affect people’s ability to access the service are
examined to improve access to the services. One of the themes that came
from the service users’ survey was regarding the ability to attend appointments
without directions. Service users reported that they found it difficult to find
some of the community clinics and thus were unable to attend appointments in
a timely fashion. This is something that can affect access to services and as
area for improvement.
Objective
Measure
To ensure that maps are included in Repeat customer satisfaction survey
all appointment letters to clients
95% of service users report having
received
a
map
with
their
appointment letters
To improve overall levels of 90 % of service users to report overall
satisfaction within the early onset satisfaction with all aspects of service
dementia services
within the early onset dementia
services
Patient Experience Priority 3: To make the transition from children to
adult services as smooth as possible for young people
Objective
To ensure
experience
positive
Measure
that young people’s 90% of those young people asked
during transition is strongly agree that they found their
transition very positive
Patient Experience Priority 4: Choice of clinic times and venues within
CAMHS
Objective
Measure
To offer choice of clinic times and 100% of patients offered choice of
venues for all patients
times and venues
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5.1.2 Effectiveness
Effectiveness Priority 1: Improve the care of people with Schizophrenia
Clinical effectiveness is the extent to which specific clinical interventions do
what they are intended to do and ensuring that the outcomes for the patients
are as high as possible.
With most mental health problems, there are studies and guidelines that inform
clinicians what should be done to ensure the best outcome for patients
whatever their diagnosis.
In 2008 the Department of Health circulated a national audit to measure the
extent to which clinical practice for people with Schizophrenia as their primary
diagnosis was in line with the National Institute of Clinical Excellence (NICE)
guidance on Schizophrenia. Adult Mental Health Services scored below
average when compared with the national average. This needs to be improved
in 2010/2011 to ensure the next national audit evidences the service is enabling
the best possible outcomes for patients with schizophrenia.
Objective
Improve
access
interventions.
to
family
Measure
78% of records audited show
evidence of family interventions being
considered/offered when appropriate.
The national average of 24% will be
met with 24% of clients having
Advance Decisions in place.
Evidence will show all clients with
Schizophrenia have been given the
opportunity
to
make
Advance
Decisions.
Improve
Information
about The national average of 71% will be
Schizophrenia
to patients
and met.
relatives.
Effectiveness Priority 2: Develop a pathway for people with Borderline
Personality Disorder
It is nationally recognised that people with borderline personality disorder have
very complex needs which services across the health economy find difficult to
meet. This is largely down to a combination of factors such as training being
required, lack of understanding, lack of specialist facilities and treatments such
as dialectical behavioural therapy (DBT) being difficult to access. DBT is
psychotherapy for illnesses such as borderline personality disorder.
Local services face the same issues as mental health services nationally.
However, getting all services within the local health economy to agree on key
treatment approaches, principles and pathways for people with BPD will
increase the level of consistency in clinical approach. Evidence shows this will
help people with BPD by reducing the incidences of self harming behaviour and
improving the quality of their overall experience through the entire pathway of
care.
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Objective
Develop and agreed BPD pathway
Measure
Pathway in place by April 2011.
Effectiveness Priority 3: 28 day readmission rate
This relates to the percentage of people that are readmitted to inpatient acute
settings following discharge within 28 days. The National Target for this is
currently at around 11%. This is a national priority to be met.
Objective
Reduce the 28 day readmission rate
Measure
Reduction of between 2-4 %
Effectiveness Priority 4: Levels of dehydration and nutrition
For older people with mental health illness, the risk of dehydration and
malnutrition can be higher than the average for older people. Ensuring that
patients in the ward environment and in the community maintain good levels of
nutritional balance and do not become dehydrated is important.
Objective
All Patients have food and fluid charts
that are completed consistently and
care plans that are tailored to meet
any specific needs.
Measure
Audit of 50 records to evidence
assessment and care planning.
Target of 100% of sample taken.
5.1.3 Safety
Safety Priority 1: Improve on patients feeling safe within the clinical
settings
It is vitally important that in all the clinical areas within the service provide an
environment in which patients can feel safe. In 2009/2010, some service users
reported that in some of the service environments they did not feel safe due to
a number of contributory factors ranging from the physical environment to
interactions with other service users. This is an area for improvement in
2010/2011.
Objective
Improve on perception of safety in
clinical areas by responding to
service user feedback i.e. improved
lighting.
Measure
Repeat survey to show that 90% of
service users surveyed report feeling
safe in their environment.
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Safety Priority 2: Seven Day Follow up
This is a national priority and relates to the percentage of people who are
discharged from hospital and followed up within seven days of discharge with a
contact in the community. National data suggests that this seven day period
after discharge is of vital importance with regards to keeping patients safe.
Studies have shown that most suicides that take place after discharge from
hospital take place within the first seven days of discharge. Unfortunately in
2008/2009 the service was unable to meet the target of 95% in this area. In
2010/11 this will be 100%.
Objective
Improve on seven day follow up
Measure
100% target.
Safety Priority 3: Methicillin-resistant Staphylococcus Aureus (MRSA)
screening for all elective admissions within Adult Mental Health and Older
Peoples Mental Health
All staff within the service currently work hard to ensure that the risk of hospital
acquired infections for all patients coming into inpatient areas is eliminated.
The more screening for Methicillin-resistant Staphylococcus aureus (MRSA)
that is undertaken, the more chance there is of identifying those that are
infected and taking the necessary measures to ensure that such infections do
not spread.
Objective
Measure
To screen all elective admissions for 100% of clients admitted screened
MRSA.
for MRSA.
5.2 National Priorities and Indicators for Mental Health Trusts
The Care Quality Commission has published a list of indicators that apply to all
trusts and PCT’s that provide mental health services. The service will report on
these in the end of year Quality Account Report for 2010/2011.
•
•
•
•
•
•
•
•
•
•
•
•
Access to crisis resolution home treatment (CRHT)
Access to health care for people with a learning disability
Best practice in mental health services for people with a learning
disability
Care programme approach seven day follow up
Child and adolescent mental health services
Completeness of the mental health minimum dataset
Data quality on ethnic group
Delayed transfers of care
Drug users in effective treatment
Experience of patients
NHS staff satisfaction
Patterns of care for mental health minimum dataset (MHMDS)
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6. Review of Services: Statements of Assurance from the Board
During 2009/10 Portsmouth Community and Mental Health Services provided
and/or sub-contracted twenty two NHS Services of which four related to the
mental health services.
Portsmouth Mental Health Services have reviewed the data available on the
quality of care in all four of the NHS services relating to mental health. These
were;
• AMH: Hampshire Partnerships NHS Foundation Trust: Provision of ECT
and Psychiatric Liaison
• Learning Disabilities: Portsdown Practice: Provision of Medical cover to
Thomas Parr House
• Substance Misuse: Portsmouth Counselling Service: Provision of
counselling services
• Substance Misuse: No Limits: Provision of Tier 2 substance misuse
services
The income generated by the four mental health NHS services reviewed in
2009/10 represents 37 per cent of the total income generated from NHS
services by the whole of Portsmouth Community and Mental Health Services
for 2009/10.
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7. National Clinical Audits
During 2009/10 three national clinical audits were undertaken by Portsmouth
Mental Health Services.
Portsmouth Mental Health Services were not subject to any national
confidential enquiries during 2009/10.
Portsmouth Mental Health Services were eligible to participate in three
national clinical audits during 2009/10.
Portsmouth Mental Health Services participated in three national clinical
audits during 2009/10, they were:
•
•
•
Falls national audit
Care Programme Approach national audit
Quality Improvement Network for Multi-Agency CAMHS audit
The reports of the three national clinical audits were reviewed in 2009/10.
The below is an example of the actions that Portsmouth Mental Health
Services intends to take to improve the quality of healthcare provided from
one of the audits:
Quality Improvement Network for Multi-Agency (QINMAC) Audit
1. continue development of outcome measures work
2. continue to monitor the collection and inputting of data as it can be time
sensitive
3. time spent entering Strengths and Difficulties Questionnaire scores
could be reduced using the direct scoring tool
4. input into IT discussions and needs and liaise with other QINMAC
members regarding their use of RiO
5. potentially invite social services to attend a team meeting to update
6. the team should review agreements already in place and consider
modifications
7. consider other agreements which would help clarify protocols with
partner agencies
8. inter-service agreements could be developed
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8. Local Clinical Audits
A total of twenty one local clinical audits for AMH, OPMH and CAMHS were
reviewed in 2009/10.
8.1 Adult Mental Health Clinical Audits undertaken in 2009/2010 were:
• Chronic Fatigue Syndrome service audit
• Informed Gender Practice audit
• Prescribing Benzodiazepines (NICE guidance)
• Preventing Harm to Children Care Programme Approach
• Documentation Improvement audit
• Management of Aggression & Violence Measure
• Clinical Risk Measure
• Management of Aggression & Violence Measure- Hamble House
• Observation Procedures –Hamble House
• Clinical Supervision
• Records & Record keeping
• Observation Procedure- Fairoak
• Physical Health care Measures – Fairoak
• Measuring met & unmet needs for appropriate matching skills for staff &
patients in AMH
Examples of changes and improvements to patients care:
Measuring met and unmet needs:
• Health promotion with weight management and smoking cessation
promoted with patients.
• Improved support for patients seeking employment, social inclusion for
patients with Schizophrenia
Observation Procedures:
• All patients given information on observation requirements and
documented in the records
• All patients have observation status reviewed daily
Clinical Supervision:
• Supervision undertaken monthly, and recorded as per policy. A copy is
kept by both supervisee and supervisor.
• All supervisors have been trained to deliver supervision.
• Contract / agreement set between both supervisee and supervisor
8.2 Children Adolescent and Mental Health Clinical Audits undertaken in
2009/2010:
• Eating Disorders (NICE Guidance)
• Anger Management programmes in Portsmouth schools
• Implementation of care Planning
• Quality network for Multi agency CAMHS
Examples of changes and improvements:
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•
•
Documentation in records regarding prescribing for patients with
anorexia nervosa
Improved liaison and communication form to improve the quality of
information in referrals in order that urgency can be assessed
8.3 Older Person Mental Health Clinical Audits undertaken in 2009/2010:
• Repeat audit of prescribing standards
• Repeat audit Dignity Challenge
• Clinical supervision
Examples of improvements and changes:
• Dignity improvements
• Increase in availability of occupational therapist at week ends for
patients.
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9. Local clinical research activity
The number of patients receiving NHS services provided or sub-contracted by
Portsmouth Mental Health Services that were recruited during that period to
participate in research approved by a research ethics committee was eight.
The research activity is being undertaken by staff within their professional
development and undertaking academic studies. Some of the research activity
includes:
• Victims of homicide with mental illness
• Eating disorders and CBT
• A Qualitative Study in Accessible Information
• Oxford Community Treatment Order Evaluation Trial (OCTET)
• Feasibility study of culturally adapted Cognitive Behaviour Therapy
• An Ordinary Life: Mental Health Service Users Experiences of Living at
Yew House
• Study of Suicide in the Criminal Justice System: Nested Case-Control
• Decisions Regarding ADHD Management
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10. Care Quality Commission Registration
During 2009/ 10 Portsmouth Community and Mental Health Services declared
“Insufficient Assurance” in two Standards for Better Health areas:
•
C4b Healthcare Organisations keep patients, staff and visitors safe
by having systems to ensure that all risks associated with the
acquisition and use of medical devices are minimized.
•
C11b. Healthcare organisations ensure that staff concerned with all
aspects of the provision of healthcare participate in mandatory
training programmes
C4b was declared as Insufficient Assurance as there were a lack of up to date
inventories of medical equipment in some service areas and a robust
procurement process was not in place.
C11b staff training was taking place for all mandatory and statutory training but
some service areas were not up to date with their training and the data base
was not capturing all of the training that was taking place.
In both of these areas, action plans were developed and implemented.
Portsmouth Mental Health Services are required to register with the Care
Quality Commission and its current registration status is full compliance
against the Essential Standards from 1st April 2010.
The Care Quality Commission has not taken enforcement action against
Portsmouth Community and Mental Health Services during 2009/10.
10.1 Information on the quality of data
Portsmouth Mental Health Services submitted records during 2009/10 to the
Secondary Uses Service (SUS) for inclusion in the Hospital Episode Statistics
which are included in the latest published data.
Portsmouth Mental Health Services were provided by Portsmouth City
Teaching Primary Care Trust for the period of 2009/10. The data available on
the Information Governance Toolkit relates to the whole organisation at that
time and data for the mental health services alone is not available. Detail of the
toolkit is available for further viewing at;
www.igt.connectingforhealth.nhs.uk/Requirements.aspx?tk=40
3416972356402&lnv=4&cb=16%3a55%3a56&sViewOrgType=6
Portsmouth City Teaching Primary Care Trust overall (which provided mental
health services) score for 2009/10 for Information Quality and Records
Management assessed using the Information Governance Toolkit was as
follows:
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Initiative
Clinical Information Assurance
Results
(based
on
version 7 )
requirements
75% (GREEN)
Confidentiality and Data Protection
76% (GREEN)
Assurance
Corporate Information Assurance
50% (AMBER)
Information Governance Management
77% (GREEN)
Information Security Assurance
71% (GREEN)
Secondary Use Assurance
71% (GREEN)
As seen in the toolkit, the initiative Corporate Information Assurance (marked
Amber above) comprised of the following four requirements:
1. Does the PCT have documented and implemented procedures for the
creation and filing of electronic corporate records to enable efficient
retrieval and effective records management?
2. Does the PCT have documented and implemented procedures for the
creation, filing and tracking/tracing of paper corporate records to enable
efficient retrieval and effective records management?
3. Does the PCT have publicly available, documented and implemented
procedures to ensure compliance with the Freedom of Information Act
2000?
4. Has the PCT carried out an inventory of its corporate records and
information as part of the information lifecycle management strategy?
Regarding requirement 3, the Portsmouth City Teaching Primary Care Trust
Annual Governance Report identifies that from January 2009 to December
2009 the PCT received 280 Freedom of Information requests. Of the total
requests received during 2009, 96.5% received a response within the 20 day
deadline. None of the 3.5% of delayed responses were from the Mental Health
Services.
The Mental Health Services (now provided by Solent Healthcare) will review
how it meets the requirements 1, 2 and 4 in the year 2010/11.
Portsmouth Mental Health Services was not subject to the Payment by Results
clinical coding audit during the reporting period by the Audit Commission.
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11. Comments on these Quality Accounts
Both the lead commissiong PCT and the Local Involvement Network have
viewed and provided comments on this account, which are displayed below.
11.1 Quality account statement 2010 PHMS – NHS Portsmouth
Commissioners fully support increasing transparency within the NHS by
providing patients and residents with information on the quality of the services
provided for them. Quality accounts also provide an opportunity for the services
to demonstrate their commitment to their patients and the quality culture
developed within their organisations.
Quality improvement is a continuous process. The information presented within
these quality accounts should simply reflect the ongoing work that has occurred
throughout the year and that which is planned over future years. The production
of quality accounts therefore should not become a burden on providers.
The production of quality accounts for all providers has been a challenge this
year. Guidance on their structure and content was not published until late last
year. This has meant it was difficult for them to develop their quality accounts
and take them through their governance systems within the specified timelines.
However, commissioners fully expect that all providers will meet these
deadlines next year.
Last year Portsmouth Mental Health Services (PHMS) and NHS Portsmouth
were the provider arm and commissioning arm respectively of Portsmouth City
Teaching PCT (PCtPCT).
Although there was clear separation of the
governance structures to enable a clear divide between commissioners and
providers both arms of the PCtPCT were overseen by Tracy Sanders, Chief
Executive Officer (CEO).
Since April 2010, PCMHS has completely separated from NHS Portsmouth to
form Solent Healthcare. Although Tracy Sanders is CEO of NHS Portsmouth
she has provided a statement within this quality account in her role as former
CEO of PCMHS. Therefore the Deputy CEO of NHS Portsmouth, Rob Dalton,
has provided this commissioner statement in order to retain governance
integrity.
The information provided by PCMHS in this quality account is accurate from the
checks the commissioners have undertaken. The commissioners support the
priority areas selected for improvement next year and the rationale for their
choice. Solent Healthcare must continue to demonstrate its engagement and
involve all stakeholders in their quality improvement work.
The Department of Health will be undertaking an evaluation of all quality
accounts published in 2010. Commissioners will work with Solent Healthcare to
ensure that any learning and recommendations are incorporated in to future
accounts. Solent Healthcare, from 2011, must also produce a quality account
for its community services.
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The economic outlook over the coming years is bleak. Difficult decisions will
need to be made on how resources within the NHS will be used to achieve the
best outcomes for patients. Also, Solent Healthcare, as a new organisation, is
going through a complex change process. It is imperative that patients and the
care they receive always remains the primary concern.
11.2 Quality account statement 2010 PHMS – Portsmouth LINk
Shaping Health and Social Care
Portsmouth
Local
Involvement
Network (LINk) Commentary on:
Port smouth Mental Health Services Quality Account s 2009/ 10
The Portsmouth Mental Health Services Quality Accounts appear to be a
comprehensive statement of the position with regards to national targets and
priorities, identifying areas of satisfactory performance as well as areas needing
improvement.
Detailed Local Involvement Network (LINk) comments are as follows:
o Members of the Portsmouth LINk have seen considerable improvement –
through substantial investment – in the amenities available through
Portsmouth Mental Health Services, particularly on the St James Hospital
site. The LINk has observed some impressive facilities, clearly staffed by
knowledgeable and caring people.
o The LINk also acknowledges that the year covered by these Quality
Accounts has been one of almost continuous change for Portsmouth
teaching Primary Care Trust, which has worked hard to ensure that
patients were not disadvantaged by change implementation.
o The LINk has an ongoing project to investigate ways to improve interagency working by health and social care organisations generally, and
has been involved in initiatives particular to discharging patients from our
Acute Trust hospital. Better internal communications within PHT,
Portsmouth tPCT (and now including Solent Healthcare) and Adult Social
Care – as well as between these organisations – is seen as vital to
improving patient outcomes and experience in the discharge process.
Proposals to improve the experience for patients, including those with
mental health needs, leaving hospital but needing support in the
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community in order to do so are a step in the right direction. However,
this is not a problem for the Acute Trust to resolve in isolation; only better
and faster inter-departmental and inter-agency communications and
cooperation will eventually improve the discharge process, thereby
releasing beds to more needy patients and ensuring that patient do not
remain in hospital inappropriately.
o The LINk has become concerned to find that adult patients exhibiting
symptoms of an acute mental health episode out of hours for access to
services at an appropriate Portsmouth Mental Health Services site are
directed to the Emergency Department (ED) at the Queen Alexandra
Hospital where, although ED staff do their best for patients, neither the
facilities nor the experience and knowledge are continuously available to
deal appropriately with such episodes. The LINk believes that, as
described in previous comment, the experience and outcomes for these
patients would be improved by better inter-agency working than is
currently happening in practice.
o The LINk is also working on a project to highlight areas where improved
communications between Service Providers would improve the care
available for people having a dual diagnosis involving substance misuse
and mental health problems. This work is progressing in cooperation with
a local organisation, Portsmouth Users Self Help (PUSH), and findings
will be presented to appropriate Health and Social Care agencies when
complete.
o The comments by the CQC are noted by the LINk, especially those
relating to staff training. The LINk believes that training is essential to
ensure that patients remain safe, feel safe and gain maximum benefit
from treatment while in the care of Portsmouth Mental Health Services.
The LINk is confident that the relationship so far established with the
tPCT, Solent Healthcare and Portsmouth Mental Health Services will
develop further and more deeply and be of benefit to patients.
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12. Publishing a Quality Account
The requirement of publishing this Quality Account will be met by uploading it to
the NHS Choices website.
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13. Conclusion
The service is committed to improving the quality of the patient’s experience,
effectiveness of the services and the safety of the patient.
This publication focuses on patients’ experiences when receiving services,
looking at the factors that shape them and what can be done to improve them.
To improve the experience of patients, care, compassion, respect, privacy and
dignity are enshrined in the values of the health professionals that work within
the service, and the staff are highly motivated to care for patients with humanity
and decency.
Engaging both the public and patients in monitoring the care and service
provided is key to planning new developments for the future. It is hoped this
publication will go some way towards achieving this.
Contacts for Further Information
Gordon Muvuti – Head of Clinical Governance and Quality Improvement for
the Adult Mental Health Business Unit
Tel: 02392683343
Susan Marshall - Associate Director Clinical Standards and Patient Safety
Tel: 02392684777
More information regarding services can be access from the website
www.solent.nhs.uk
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