Sussex Partnership NHS Foundation Trust
Quality Account 2009-2010
Annual Report 2009 - 2010 1
Quality Account 2009-10
Quality Account 2009-2010
This Quality Account forms part of Sussex Partnership NHS
Foundation Trust’s Annual Report for 2009-10.
Its purpose is to review the quality of services provided by Sussex
Partnership for the year April 2009 - March 2010 and to set out the
quality priorities for the year April 2010 - March 2011.
Publication of the Quality Account in this format is a requirement of
Monitor, the independent regulator of NHS Foundation Trusts.
Foreword
Sussex Partnership aims to provide high quality care for all people
using the services of the Trust.
This quality account sets out how we provided high quality, accessible
and cost effective care during the year 2009-10.
It also sets out our priorities for the current year 2010-11. During this
year we will place a particular emphasis on delivering safe services,
increasing effectiveness and improving the experience of the people
who use our services. We will work closely with service users, staff
and stakeholders to make sure that quality continues to improve.
The Board of Directors have put in place a system of internal control
to provide assurance that these Quality Accounts are fairly stated.
The details of this are given in full in Part One of the Annual Report
in my Statement of Internal Control.
Lisa Rodrigues, Chief Executive
Sussex Partnership NHS Foundation Trust
2 Sussex Partnership NHS Foundation Trust
Quality Account 2009 - 2010 3
Quality Account 2009-10
1. Introduction
We included our first separate report on
quality as a chapter in the Annual Report
for 2008-09.
For the year 2009-10 onwards all NHS
trusts are required by law to publish this
information. We have taken this
opportunity to develop the Quality
Account. This year it is presented as a
separate section within the Annual Report
which can be read either as part of the
larger report or as a separate document in
its own right.
The Quality Account aims:
• to make Sussex Partnership more
transparent and accountable for our
performance
• to engage service users, stakeholders and
staff in quality issues, and
• to demonstrate real improvements in
service quality.
Last year we made a commitment to
develop reliable ways of measuring the
quality of our services and through this
process to establish sound working
relationships with service users,
commissioners and partner agencies.
It is our intention that the Quality Account
will continue to evolve in future years.
We will do this by making sure that we
listen to the suggestions of our partners
and those who use our services, and by
comparing our performance with those of
similar organisations.
We will expand the content to cover
validation and auditing of quality
measures, effective ways of securing public
engagement and matching our goals with
the quality priorities of our commissioners.
There are three broad areas of quality:
• patient safety - ensuring that we
‘do no harm’
• clinical effectiveness - evaluating clinical
quality of care and clinical and
functional outcome
• patient experience - ensuring good
quality of non-clinical care
2. Priorities for 2009-10
The priorities for the year covered by this
Quality Account were:
• customer experience,
• measuring outcomes,
• Mental Health Act compliance,
• reduced staff sickness and agency usage
and
• reduced ‘Did Not Attend’ rates.
Our performance is set out in section 5
“Quality performance in 2009/10”. This
section gives the background to the
priorities.
Customer experience included
- dignity and respect
- medication information
- developing new ways of measuring
satisfaction
Feedback from people who use the Trust’s
services is extremely important. We looked
at two areas which mirrored questions in
the national annual patient survey medication information and dignity and
respect - and started work to develop our
feedback systems to make us more
responsive.
Outcome measures
Our services are designed to help people.
By introducing outcome measures for the
people who use our services we can assess
the usefulness of the treatments we
provide.
Sussex Partnership has over
90 spirituality advisors representing the major faiths
4 Sussex Partnership NHS Foundation Trust
Quality Account 2009 - 2010 5
Quality Account 2009-10
Mental Health Act compliance
The Mental Health Act provides a legal
framework for some of the care we
provide. Complying with the Act helps us
to be fair, consistent and supportive
towards our most vulnerable service users.
Reduced staff sickness and use of agency
These two measures help to show the
consistency of care provided by staff.
Did Not Attend’ rates
‘Did Not Attend’ is a term used when
someone misses an appointment with
their health professional. This is a missed
opportunity for the service user to receive
treatment and wastes resources.
3. Priorities for 2010-11
Sussex Partnership has nine quality
priorities for 2010-11. These have been set
by the Trust after discussion with our Governors and partners and include
suggestions put forward by them.
Patient safety
Serious Untoward Incidents
Each Serious Untoward Incident affects
service users and staff. Making these a
priority for reporting will help us learn
the most from such incidents to improve
safety.
Minimise the risks associated with
unexpected deaths
In any large mental health trust there will
sadly be unexpected deaths from time to
time. Each one is a personal tragedy. We
will review and analyse each one fully to
make sure that we learn any lessons and
minimise future risk.
Quality Account 2009-10
Effectiveness
4. Statements of assurance from the Board of Directors
Outcome measures
We will continue the focus on a robust
way of measuring outcomes so that we
and the people who use our services can
see what effect treatment has on their
well-being.
Background
During 2009-10 Sussex Partnership NHS Foundation Trust provided
248 NHS services. We have reviewed all the data available on the
quality of care in all of these NHS services.
Did Not Attend (DNA) rates
This indicator is a useful pointer to all
three elements of quality – safety,
effectiveness and patient experience.
Drug users in effective treatment
This national indicator relates to people
who misuse substances, a care group that
is often not included in other indicators.
Patient experience
Pilot tracking systems
We will explore new ways to gather
information about the patient experience.
Waiting times
These are an important aspect of the
patient experience (but need to be looked
at alongside effectiveness indicators to be
really useful). We will explore a number of
waiting measures to include in next year’s
Quality Account.
Users with a current care plan
This indicator is featured in the Trust’s
audit plan.
The income generated by the NHS services reviewed in 2009-10
represents 100 % of the total income generated from the provision
of NHS services by Sussex Partnership for 2009/10.
Audits and enquiries
During 2009-10 these services were covered by two national clinical
audits and one national confidential enquiry. Sussex Partnership
participated in 50% of the national clinical audits and 100% of
national confidential enquiries in which we were eligible to
participate. The details are set out in the table below.
The National
Clinical Audit and Patient
Outcomes Programme:
Current status of
national programme
Sussex Partnership NHS
Foundation Trust
situation
Psychological
Therapies
In development / piloting
Trust participating
from May 2010
Treatment Resistant
Schizophrenia
In development / piloting
Recruitment
starts late 2010.
Dementia
In development / piloting
Audit focus is on
General Hospital settings.
Running
Trust is participating.
Mental Health
The National
Confidential Enquiries
Suicide & Homicide by
people with
mental illness
The Trust participated in one national clinical audit for which data
was collected in 2009/10. This was the national confidential enquiry
into suicide and homicide by people with mental illness. Forty-eight
(60%) cases were submitted against 80 that were required by the
terms of the enquiry. There are no reports available for this audit as
yet because it was in the initial stages of the process.
Achieve NHS Litigation Authority (NHSLA)
level 2
The NHSLA is a risk management agency
that rates the effectiveness of control
measures within NHS trusts.
6 Sussex Partnership NHS Foundation Trust
Quality Account 2009 - 2010 7
Quality Account 2009-10
Commissioning for Quality and Innovation
£0.940m of Sussex Partnership’s income in
2009/10 was conditional upon achieving
quality improvement and innovation goals
agreed between Sussex Partnership and its
commissioners.
This was agreed through the
Commissioning for Quality and Innovation
payment framework which sets out
measurable quality goals as part of our
formal contract.
For more information contact Tony Sharp,
Head of Business Planning, email:
tony.sharp@sussexpartnership.nhs.uk,
Sussex Partnership NHS Foundation Trust,
Arundel Road, Worthing, West Sussex
BN13 3EP.
Care Quality Commission reviews
We are pleased to report a very positive
view of our services from the Care Quality
Commission, the independent watchdog
of the NHS:
Data quality
Sussex Partnership 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:
5. Quality performance in 2009-10
We measured our performance in 2009-10
against 14 indicators. The first eleven were
agreed by the Trust with our partners. The
last three are mandatory measures which
all trusts are required to include in their
quality reports.
- which included the patient’s valid NHS
Number (including a status of ‘trace in
progress’) was: 95.80% for admitted
patient care and 99.07% for outpatient
care.
1. Minimising the risks associated with
unexpected deaths
In Sussex Partnership the rate of unexpected
deaths has reduced significantly over the
past two years (see table below).
- which included the patient’s valid
General Practitioner Registration Code
was: 97.30% for admitted patient care and
97.57% for outpatient care.
We are committed to providing safe,
supportive care, and minimising risk
amongst people using our mental health
services. For a small number of people
who use our services and a very small
number of people admitted to mental
health hospitals, highly risky behaviour
and determination to self harm provides a
challenge to the careful safety measures in
place to protect patients from harm.
Sussex Partnership was not subject to the
Payment by Results clinical coding audit by
the Audit Commission during the
reporting period.
Payment by Results
Sussex Partnership score for 2009-10 for
Information Quality and Records
Management, assessed using the
Information Governance Toolkit, was level
2 on a scale that runs from 1 - 3. The score
was 7.34 out of a maximum of 9.
• Our registration with the Commission
has been accepted without conditions
- the formal recognition that the
Commission has no concerns about
Sussex Partnership
As mental health trusts have increased
significantly in size and reduced in
number, it can appear that each one is
experiencing an increase in the numbers
of deaths.
In fact the rate of such deaths nationally
has remained fairly constant over the past
ten years, and because of improvements in
practice that rate is very slowly reducing.
The figure below shows the number of
unexpected deaths reported by Sussex
Partnership over the last two years. A total
of 111 deaths were reported in 2008/09.
This fell to 60 in 2009/10.
Unexpected deaths (Sussex Partnership) April 2008 - March 2009
compared with April 2009 to March 2010
2008/09
2009/10
25
20
15
10
5
0
April
May
June
July
August
September October
November December
2008/09
12
16
8
5
9
6
6
5
2009/10
10
8
5
6
5
3
4
2
January
February
March
21
10
7
6
1
6
6
4
Month
• No enforcement action has been
required at any time against Sussex
Partnership
We minimise the risk of unexpected deaths by ensuring that we share learning
from Serious Untoward Incidents Trust-wide, that we tackle performance
issues immediately and we deliver our service development priorities.
• Sussex Partnership has not been the
subject of any special reviews or
investigations by the Commission during
the year.
8 The death of anyone using our services is
a tragedy and we do everything we can to
avoid such events from occurring. This is a
national issue that is frequently discussed
by those running mental health services
across the country.
Unexpected deaths reported 2008/09 and 2009/10
N u m b er o f u n ex p ected d ea th s
Research and development
Sussex Partnership recruited 783 patients
receiving our NHS services during 2009-10
to participate in research approved by a
research ethics committee. Of these, 497
were for National Institute for Health
Research studies and the rest were for
student or non funded studies.
Quality Account 2009-10
We are part of the national Leading Improvement in Patient Safety
programme in conjunction with the Institute of Innovation and Improvement
Sussex Partnership NHS Foundation Trust
We make
use of National
Safety Agency tools including the Suicide
Quality
Account
2009 - Patient
2010 Prevention Toolkit and the Manchester Patient Safety Framework.
9
Quality Account 2009-10
Quality Account 2009-10
We are part of the national Leading Improvement in Patient Safety
programme in conjunction with the Institute of Innovation and
Improvement
We make use of National Patient Safety Agency tools including the
Suicide Prevention Toolkit and the Manchester Patient Safety
Framework.
We have invested in a programme to identify and remove ligature
points which has resulted in improvements to our working age
services.
The total number of unexpected deaths includes a much smaller
number of inpatient deaths. The numbers over the last three
reportable years are:
• 2006: 5 (four suicide verdicts and one open verdict)
• 2007: 3 (three suicide verdicts)
• 2008: 3 (two suicide verdicts and one inquest pending)
We do everything we can to keep people safe whilst in our care.
Detailed and continuing risk assessment is one of the most important
tools available to help keep patients safe. Doctors, nurses and other
care staff work hard to understand how each person is feeling. They
carry out risk assessments and develop individual care plans to
provide safe supportive care. We follow national guidance on the
removal of known ligature anchor points and in carrying out good
patient observation. We have implemented national guidance and
best practice on all aspects of suicide prevention.
We will continue to concentrate on minimising the risks associated
with unexpected deaths and will continue to report on this important
area in future quality Accounts.
resulting actions.
All SUI final reports are considered by the Deputy Director of Nursing –
Governance
and Assistant
Chief Operating
Officer
to identify
action and
All SUI
final reports
are considered
by the
Deputy
Director
of Nursing learning
- Governance
and the
Chief into
Operating
Officer
identhemes. These
are Assistant
then incorporated
an integrated
actiontoplan.
tify action and learning themes. These are then incorporated into an
integrated
action
plan.is gathered against the individual actions under each
Each month,
evidence
identified theme. The Health and Social Care Governance Group approves
Eachthemonth,
evidence
is gathered
against
the individual
actions
closure of
actions, once
satisfied they
are complete
and no further
work is
under
each
identified
theme.
The
Health
and
Social
Care
Governance
required.
Group approves the closure of actions, once satisfied they are
complete and no further work is required.
numberofofreported
reported Serious
Untoward
Incidents
fell over fell
the last
twothe last
TheThe
number
Serious
Untoward
Incidents
over
(see
table
below).
This isThis
due is
to due
a stronger
screening
process screening
twoyears
years
(see
table
below).
in part
to a stronger
introduced
on
1
July
2009,
which
made
sure
that
incident
reporting
across the
process introduced on 1 July 2009, which made sure that incident
Trust was
consistent
from that
date
onwards. from that date onwards.
reporting
across
the Trust
was
consistent
Serious Untoward Incidents April 2009 - March 2010
compared to April 2008 - March 2009
2008/09
2009/10
35
N u m b er o f S U Is
We minimise the risk of unexpected deaths by ensuring that we share
learning from Serious Untoward Incidents Trust-wide, that we tackle
performance issues immediately and we deliver our service
development priorities.
Serious Untoward Incidents reported 2008/09 and 2009/10
Sussex Partnership
a strict process for making sure that we act on
2. Serious
Untowardhas
Incidents
Serious
Untoward Incidents
(SUIs)
promptlyfor
andmaking
that we follow
up resulting
Sussex
Partnership
has a strict
process
sure that
we act on
actions.
Serious Untoward Incidents (SUIs) promptly and that we follow up
30
25
20
15
10
5
0
April
May
June
July
August
September
October
November December
2008/09
21
23
14
12
20
12
19
8
2009/10
13
19
11
10
5
7
5
6
January
February
March
30
21
17
19
5
7
10
6
Month
3 Infection control
Since Sussex Partnership was formed in 2006 there have been no cases of
MRSA bacteraemia infections. We have reported five cases of clostridium
difficile over the same period, none of them fatal. The last case of clostridium
difficile was in July 2009.
4 Did Not Attend rates
A campaign to reduce the number of missed appointments (DNAs) had good
results during the year.
10 Sussex Partnership NHS Foundation Trust
An extra 14,969 additional appointments were kept, equivalent to the work of
14 full time staff, after a new policy was introduced. The overall percentage of
Quality Account 2009 - 2010 11
Quality Account 2009-10
Quality Account 2009-10
4. Did Not Attend rates
A campaign to reduce the number of
missed appointments (DNAs) had good
results during the year.
An extra 14,969 additional appointments
were kept, equivalent to the work of 14
full time staff, after a new policy was
introduced. The overall percentage of
DNAs reduced from 10.57% to 8.08% - a
2.49 percentage point improvement.
• We are developing a recording system to
include the outcome scores as part of
5 Outcome measure development
our overall care records.
Priority One in the Trust’s Business Plan for 2009-10 was “Quality
• All our clinical staff are trained to use
improvements and outcome measurements.” Within this we set an objective
outcome
in use
for by
their
for the
90% of
service usersmeasures
to have measured
outcomes
the end of March
2010.
care group.
During the year we achieved several key milestones towards this objective:
• A An
outcome measure was identified
for every
group based on
communications
strategy
hascare
helped
existing national systems. Most care groups using a version of the
toHealth
make
allNation
staff
aware
of(HoNOS).
the project
of the
Outcome
Scale
Our Child and
Adolescent Services
use athe
different
measure
called the
requirements
and
Trust’s
desire
toStrengths and
Difficulties Questionnaire (SDQ).
both athe
quality
and
thethe outcome scores as
 improve
We are developing
recording
system
to include
part of our overall care
accountability
ofrecords.
services.

All our clinical staff are trained to use the outcome measures in use for
their care group.
• We
A communications
strategy has
helpedand
to make
all staff aware of the
surveyed service
users
staff
project requirements and the Trust’s desire to improve both the quality
survey
and shared
the results with the
and the accountability
of services.
 project
We surveyed
service users
and staff survey and shared the results with
steering
group.
the project steering group.
Percentage of patients with a valid HoNOS score
100%
80%
72.7%
Total attended
Total DNA
Overall DNA
532,496
56,278
10.57%
601,166
48,565
8.08%
5. Outcome measure development
Priority One in the Trust’s Business Plan for
2009-10 was “Quality improvements and
outcome measurements.” Within this we
set an objective for 90% of service users
to have measured outcomes by the end of
March 2010.
60%
56.4%
45.8%
40%
26.9%
20%
4.8%
8.1%
15.2%
Staff sickness
The average staff sickness rate for the year was 4.9%. This is above
our target of 4.5% and is, therefore, an area for improvement.
Actions being taken to reduce sickness include:
• Introducing a new Staff Wellbeing and Occupational Health service
from April 2010
• The continuation of an Employee Assistance Programme to provide
support for staff experiencing difficulties
• Ensuring return to work interviews are held when staff return from
a period of sick leave
• A rolling schedule of training for managers
• Use of the new ‘fit note’ instead of traditional ‘sick notes’.
The use of agency staff
In 2009-10 we spent £5.091m on agency staff, a big reduction on the
previous year’s total of £8.642m. We will continue to make every
effort to recruit to vacant posts to bring this down to the targeted
1% of pay spend.
0%
Sep-09
Oct-09
Nov-09
Dec-09
Jan-10
Feb-10
Mar-10
600
500
6 Reduced staff sickness and reduced use of agency staff
These two measures relate to staff. They are included here because the
quality of care and outcomes for patients are better when care is provided in a
Graph 1: Agency Target
700
% with valid HoNOS score
Target % of services to have measured outcomes
During the year we achieved several key
milestones towards this objective:
400
300
200
100
64
• An outcome measure was identified for
every care group based on existing
national systems. Most care groups
using a version of the Health of the
Nation Outcome Scale (HoNOS). Our
Child and Adolescent Services use a
different measure called the Strengths
and Difficulties Questionnaire (SDQ).
12 6. Reduced staff sickness and reduced use of agency staff
These two measures relate to staff. They are included here because
the quality of care and outcomes for patients are better when care is
provided in a consistent manner. Staff sickness and the use of agency
staff can detract from this consistency.
£000s
3. Infection control
Since Sussex Partnership was formed in
2006 there have been no cases of MRSA
bacteraemia infections. We have reported
five cases of clostridium difficile over the
same period, none of them fatal. The last
case of clostridium difficile was in July
2009.
0
Apr
May
Jun
Jul
Aug
Sep
2009/10 Monthly Target
Oct
Nov
Dec
Jan
Feb
Mar
2009/10 Monthly Actual
The use of agency staff reduced significantly and consistently
throughout the year except for a steep rise in the final month. The
rise was mostly as a result of the increase in the number of locum
doctors in older people’s mental health services and working age
adults services.
Sussex Partnership NHS Foundation Trust
Quality Account 2009 - 2010 13
Quality Account 2009-10
Quality Account 2009-10
7. Drug users in effective treatment
Massive harm is caused by the misuse of
alcohol and drugs. Sussex Partnership and
our commissioners recognise this. One of
our objectives is to increase the number of
people in effective treatment with a focus
on crack and/or opiate users of any age.
We measure this against a standard
national indicator which compares the
numbers in effective treatment compared
with the previous year.
By ‘effective treatment’ we mean
retention in treatment for 12 weeks or
more and care planned discharge in
advance of 12 weeks.
By ‘planned discharge’ we mean:
• treatment completed;
• treatment completed - drug free, or
• treatment completed - occasional user
(not heroin or crack cocaine).
1,200
EastbourneSMS
Eastbourne
Substance Misuse Services
1,000
HastingsSMS
Hastings
Substance Misuse Services
800
Hastingsand
andRother
RotherCSMT
Community
Hastings
600
Never
EastSussex
SussexPartnership
Partnership
East
1,400
Seldom
Substance Misuse Services
Sometimes
Brighton
B&H
SMS and Hove
Mostly
Numbers recorded as being in effective treatment (PDUs - all ages)
Always
Performance can only be reported 105
days in arrears because of the way the
indicator works.
Performance against target: Number of drug users in effective treatment
Numbers
in Effective Treatment
1,600
8. Dignity and respect
Sussex Partnership introduced ten
hand-held patient tracker devices and
used them in our Early Intervention Teams
between 1 November and 31 December
2009. The total number of responses was
165 and gave extremely positive feedback
about the service. The cumulative report
below shows the responses received
during this period.
Are you able to contact the
team when you need to?
108 42 11 3
1
Do you feel involved in
decisions about your care?
99
0
49 11 6
Are you treated with dignity
132 24 7
and respect?
Is the team helping
you to understand your
experiences?
94
1
1
47 20 3
1
Substance Misuse Team
400
UpliftedYear
yearend
end target
target for
Uplifted
for90/10
09/10
Brighton
B&H
SMS and Hove Substance
Feb-09
Mar-09
Apr-09
May-09
Jun-09
Jul-09
Aug-09
Sep-09
Oct-09
Nov-09
Dec-09
Jan-10
Overall are you satisfied with
the care you are receiving?
Notes:
• Hastings SMS (Substance Misuse Services) and Hastings CSMT (Community
Substance Misuse Team): new cases were transferred from the SMS to the CSMT in
April 2009. The graphs for these services reflect the gradual take-up of new cases
by the CSMT during the year and corresponding fall in SMS cases
• The numbers for the East Sussex teams were above target at the end of 2008-09
outturn (1071)
106 47 8
Very poor
Jan-09
Poor
0
Satisfactory
Excellent
Misuse Services
UpliftedYear
yearend
end target
target for
Uplifted
for90/10
09/10
EastSussex
SussexPartnership
Partnership
forforEast
Good
200
2
2
For more details about the project see section 10 ‘Developing new ways of measuring satisfaction’.
9. Medication information
The 2009 national patient survey reported
that 55% of respondents in this Trust felt
the purpose of their medication had been
explained. This puts Sussex Partnership
within the same band as 60% of trusts.
However, only 33% of respondents felt
they received enough explanation about
the potential side-effects of their
medication. This result puts us in the
bottom fifth of trusts and comes despite
a sustained programme from the Trust’s
pharmacy team to make information
widely available, including specific
information about side-effects and their
likelihood.
Action to make medication information
available included:
• A poster campaign on all units and
teams called “Your Medication - Things
You Should Know – Things You Should
Ask”. This encourages patients to ask
questions about their illness, their
treatment plan and their medication including questions about side-effects,
such as what are they and how likely are
they to occur.
• A direct link from the Trust website to a
huge range of information leaflets, some
produced in-house, some by other trusts
and some by national groups such as the
United Kingdom Psychiatric Pharmacy
Group (UKPPG). From this group there
is a range of information leaflets
covering over 60 of the medicines most
commonly used in mental healthcare.
They are all in user-friendly question and
answer format and deliberately avoid
the use of medical jargon.
• A link from the website to information
supported by the UKPPG and the
National Institute for Mental Health in
England.
14 Sussex Partnership NHS Foundation Trust
Quality Account 2009 - 2010 15
Quality Account 2009-10
This provides comprehensive information
on over 100 mental health medicines or
medication groups and on 17 mental
health conditions. It also compares the
main treatments used and their side
effects.
• Stocks of medication information leaflets
are held by many units and teams in
hard copy so that they are readily
available to patients.
• A new set of standards, agreed by the
Trust’s Drugs and Therapeutics Group, on
how information should be provided
and the establishment of a “medication
information champion” within each
team or unit, responsible for ensuring
that an appropriate range of printed
information leaflets is kept available,
that leaflets are easily accessible to
patients and that patients are
encouraged to use them.
10. Developing new ways of measuring
satisfaction
Sussex Partnership has agreed a six point
programme to develop new ways of
measuring customer satisfaction. This has
been formally included in our
Commissioning for Quality and Innovation
(CQUIN) agreement with commissioners.
The purpose of the CQUIN is to set a
clearly measurable set of quality
improvements.
Postcards
The postcard monitoring project was
launched in October 2009. The project is
based around feedback postcards which
ask five simple questions about customer
satisfaction. The postcards are given out at
reviews and on discharge from a service.
The postcards are colour coded by care
group and local community.
The questions were developed in
consultation with staff in all care groups
16 Quality Account 2009-10
and with feedback from service users. An
Easy Read version of the card for learning
disability was launched in January 2010.
The cards have been translated into key
community languages of Arabic, Bengali,
Cantonese, Farsi, French, Italian,
Mandarin, Polish, Portuguese and Turkish.
Use of the postcards is being promoted to
staff through our website including access
to translated versions. Posters have also
been produced for our reception and
waiting areas.
The postcards have been launched in all
care groups except Access (because of the
different nature of the service and the
potential high numbers of people who use
it). A pilot using electronic patient tracker
devices in Access, asking the same
questions, was launched in Brighton and
Hove in March 2010.
The results are made available to the care
groups each month and are reported
monthly to the Board of Directors in the
Quality report. They are published every
quarter on the Trust website and reported
to commissioners.
978 postcards had been returned by March
2010 with an overall positive response
rate of 90%. The majority of respondents
agreed that:
• Staff were approachable and friendly
• The service helped them feel better
• They were given the information they
needed
• They felt involved in decisions about
their care
• They were able to get help when they
needed it
Data can be analysed by care group and by
locality (East Sussex, West Sussex, Brighton
and Hove).
Sussex Partnership NHS Foundation Trust
Patient experience trackers (PETS)
The PETS are an electronic device which
can be used to ask customer experience
questions. Responses are returned
automatically to a central server and data
analysis is provided weekly.
Feedback suggests that this particular
device may not be well suited to being
used on a mobile handheld basis. We are
now concentrating on using them in
reception areas mounted on a stand. This
will capture more people’s feedback and
reflects the successful use of PETS in other
health settings.
To date the PETS have been used:
• 2 months in Acute inpatient services in
West Sussex
• 2 months with the Early Intervention
service
• Pilot use in East Sussex Acute services
since January 2010. Here we focussed on
key issues identified as part of the
National Patient Survey. This has helped
us to identify progress against key
performance areas on a local basis
• In reception areas in Access, Child and
Adolescent and Older People’s services.
It is too early to report back on the data
from this.
ways, although take up to date has been
low.
The Department of Health has
commissioned the Patient Opinion website
to provide patients and the public with
the option of commenting on-line on their
experience of using services and getting a
prompt response. The site is linked directly
to NHS Choices.
Using the Trust’s membership
We developed an on-line survey for our
Foundation Trust members during 2009-10
linked to Better by Design, our service
improvement strategy. This survey is
reported on in more detail in the main
Trust Annual Report for 2009-10.
Developing involvement forums
Sussex Partnership works with a wide
range of involvement forums across
Sussex including different care groups. We
are mapping all these forums so that we
can better capture the feedback they give
the Trust and then act on it.
The information will be collated by the
Trust’s patient and public involvement
team. The team will keep central records
and ensure that action is taken to follow
up the feedback.
On-line surveys
We have subscribed to software that
enables us to undertake on-line surveys
with staff, service users or the public. We
are developing guidelines on the best use
of this system before launching it widely
within the Trust during 2010-11.
We are continuing to develop a range
of mechanisms to measure the satisfaction of the people who use our services.
The 2010/11 quality Account will include
detailed information on satisfaction from
these new mechanisms in addition to the
information to the progress reported here.
On-line feedback - patient opinion.
People who use our services can comment
on line though the national Patient
Opinion web site. We were one of the
first mental health trusts to work with
Patient Opinion and have advertised the
site through our postcards and in other
11. Mental Health Act
compliance – consent to treatment
Sussex Partnership received a positive and
helpful report on our compliance with the
Mental Health Act.
Quality Account 2009 - 2010 17
Quality Account 2009-10
Quality Account 2009-10
This noted that we have improved the way
we assess people’s capacity to consent to
admission in that initial capacity
assessments are now routinely completed
by nursing staff on all patients being
admitted.
The commission were pleased with our
new processes and procedures to improve
the quality of practice and commented
favourably on examples of good practice.
Two areas were highlighted from the 2009
acute inpatient survey. These were:
13. Delayed transfers of care
A delayed discharge is when a patient is assessed as medically ready
to be discharged from an inpatient bed but cannot leave because of
non medical delays. These may include funding, housing or care planning issues.
Mental health legislation requires the
‘treating clinician’ to assess the patient’s
capacity to consent to treatment, where
possible to seek the patient’s consent and
to record the patient’s consent or refusal
in the clinical notes.
• The extent to which the side effects of
medication were explained. The action
we have taken on this point is included
at point 9 in this chapter.
The indicator is expressed as a percentage of bed days occupied
within the reporting period due to a patient being deemed ready for
discharge but still occupying an original bed. The Monitor target is
for this to be no higher than 7.5%: the Sussex Partnership figure was
4.7%.
• Involvement in decisions about care. We
have introduced much more regular
service user feedback a set out in section
8 of this Account.
12. Seven-day follow up
Patients are more at risk of suicide within seven days of being
discharged from an inpatient unit. The seven-day follow up process
aims to reduce the number of suicides at this vulnerable time.
Monitor expects us to achieve face to face or phone contact within 7
days for at least 95% of our cases. During the year the Trust achieved
between 98% and 99%.
Percentage of Bed Days Lost
Percentage of bed days lost
8.0%
7.0%
Trust
6.0%
Target
5.0%
4.0%
3.0%
Q1
Q2
Q3
Q4
2009/10
East Sussex
98.6%
99.5%
99.4%
100.0%
99.3%
West Sussex
99.1%
99.2%
99.0%
97.9%
98.8%
Brighton & Hove
99.2%
98.5%
98.7%
98.2%
98.7%
Trust
99.0%
99.2%
99.1%
98.6%
99.0%
Monitor Target
95.0%
18 95.0%
95.0%
95.0%
95.0%
Sussex Partnership NHS Foundation Trust
2.0%
Apr May Jun Jul - Aug Sep Oct Nov Dec Jan Feb Mar Apr May
-09 -09 -09 09 -09 -09 -09 -09 -09 -10 -10 -10 -10 -10
Care Group
Q1
Q2
Q3
Q4
2009/10
Working age adults
94.9%
95.9%
96.7%
96.9%
96.1%
Older people
95.1%
94.5%
95.0%
93.9%
94.7%
Child and adolescent
96.7%
98.0%
95.7%
96.4%
96.7%
Learning disability
94.2%
99.5%
100.0%
100.0%
98.2%
Secure and forensic
100.0%
100.0%
100.0%
100.0%
100.0%
TOTAL (inc Home Leave)
95.6%
96.1%
96.6%
96.4%
96.2%
Target
92.5%
92.5%
92.5%
92.5%
92.5%
Quality Account 2009 - 2010 19
Quality Account 2009-10
Quality Account 2009-10
14. Crisis team gatekeeping
Gate keeping admissions is about keeping people out of hospital
where alternative services exist to help them. Sussex Partnership
performed well on this indicator, consistently above 99% against a
threshold of 95%.
6. Conclusion
This Quality Account has three key aspects:
This target covers all admissions of working age adults but not
transfers or admissions to psychiatric intensive care units.
• To publish the quality priorities for 2010-11 and
Our crisis home treatment teams are responsible for reducing
inappropriate inpatient admissions and provide crisis care in the
home or in the community. They are required to provide a mobile 24
hour, seven days a week response to requests for assessment and be
actively involved in all requests for admission.
This should involve face to face contact unless it can be deemed that
this was not appropriate or possible. For each case where face to face
contact is deemed to be inappropriate, a self-declaration is required.
For Mental Health Act assessments the team should be notified of
assessment; assess all these cases before admission happens; and be
central to the decision making process in conjunction with the rest of
the multi disciplinary team.
• To re-publish the quality priorities agreed in 2008-09 for
implementation in 2009-10
• To report on quality performance for the year 2009-10.
The publication of this Quality Account demonstrates the commitment of Sussex Partnership to improve the quality of services through
close working with service users, staff and other stakeholders. It
shows a real commitment to improve quality and recognises that
openness and involvement will enable the Trust to scrutinise our behaviour and put the associated learning into practice.
Developing a Quality Account has strengthened our resolve to deliver
excellent care to the people we serve. Sussex Partnership will
reinforce the process of reporting on the quality of services by
working with our stakeholders to develop the priorities and measures
that will feature in next year’s Quality Account.
Gate-keeping of Inpatient Admissions
Q1
Q2
Q3
Q4
2009/10
East Sussex
100.0%
100.0%
100.0%
100.0%
100.0%
West Sussex
100.0%
99.2%
99.3%
99.6%
99.5%
Brighton & Hove
100.0%
100.0%
100.0%
100.0%
100.0%
Trust
100.0%
99.7%
99.7%
99.8%
99.8%
Monitor Target
95.0%
95.0%
95.0%
95.0%
95.0%
20 Sussex Partnership NHS Foundation Trust
Quality Account 2009 - 2010 21
Appendix - Statements from Sussex Partnership NHS Foundation Trust’s partner organisations
Quality Account 2009-10
1. West Sussex Health Overview and Scrutiny Committee
Thank you for offering West Sussex Health Overview and Scrutiny Committee (HOSC) the
opportunity to comment on Sussex Partnership NHS Foundation Trust’s Quality Account for
2009/10.
As Quality Accounts were only introduced this year, the process for HOSC involvement has not been
fully established, and it is clear that this first year will be very much a developmental stage. Given
the short timescales which NHS Trusts have had to meet in preparing this year’s Accounts, there has
not been the opportunity to involve HOSCs in the way the guidance seems to intend (e.g. involving
HOSCs at an early stage as part of year-round ongoing discussions). The HOSC Business Planning
Group will be giving detailed consideration to how the Committee will input into Quality Accounts
in the future at its meeting in July. A key focus for HOSC input is likely to be its NHS Trust Liaison
Members, but I will write to you following this meeting to set out our plans in detail.
However, in general terms, HOSC welcomes the additional focus on providing information about
quality of care and priorities for improvement to the public and patients. I am pleased that the
priorities for improvement in 2010/11 you have identified reflect some of HOSC’s key concerns
relating to mental health services - particularly safety and patient experience. I welcome the fact
that Sussex Partnership NHS Trust achieved Care Quality Commission (CQC) registration “without
conditions”, and ask that you take into account the results of the 2009 CQC Inpatient Survey
(published recently) in future performance monitoring and service planning. HOSC also welcomes
the decision Sussex Partnership Trust has taken to hold its Board of Directors meetings in public
from April 2010, and hopes that it will continue to work transparently and collaboratively with key
local stakeholders, including the HOSC.
Yours sincerely
Christine Field
Chairman, West Sussex Health Overview and Scrutiny Committee
Image: Launch of our new out of hours telephone support line
22 Sussex Partnership NHS Foundation Trust
Quality Account 2009 - 2010 23
Quality Account 2009-10
3. NHS West Sussex
2. East Sussex Health Overview and Scrutiny Committee
Thank you for offering East Sussex Health Overview and Scrutiny Committee (HOSC) the
opportunity to comment on Sussex Partnership Trust’s draft Quality Account for 2009/10.
As this is the first year of the national Quality Account process, HOSC recognises that there has
been a limited lead in time for Trusts in preparing their Accounts. As you have acknowledged in
your letter of 13th May, this tight timescale has also limited HOSC’s ability to participate in the
process and to allocate time and resources to reviewing draft Accounts. Consequently, the
Committee does not intend to submit a statement for inclusion in your Account this year.
However, in general terms, HOSC welcomes the additional focus on providing information about
quality of care and priorities for improvement to the public, service users and carers. The
Committee is pleased to see areas HOSC has highlighted, such as learning from serious untoward
incidents and unexpected deaths, reflected in the Trust’s priorities for 2010/11.
HOSC particularly views Quality Accounts as an opportunity to ensure that whole health
community priorities are reflected across organisations, ensuring that the combined focus of local
NHS organisations is brought to bear on these areas where there is significant potential to improve
outcomes or patient experience.
As you suggest, HOSC would welcome earlier involvement in the development of future years’
Quality Accounts now that the process is established and the timetable less constrained. In
particular, the views HOSC gathers from service users and the public could help to inform
discussions on priorities.
We look forward to receiving a copy of the final Quality Account and to hearing from you
regarding the process for 2010/11.
I welcome the publication of the Quality Account from Sussex Partnership NHS Foundation Trust
for 2009-10. It demonstrates a commitment to improving quality for all the users of its services,
and confirms that the Trust has been prepared to work closely with commissioners to help achieve
improvements in the quality of services.
One of these achievements was to introduce continuous assessment of how patients felt about the
services they used. Through a simple-to-use postcard questionnaire, patients have been able to
comment on services and the results of the survey are published on the Trust website. In 2010/11
commissioners will also expect to hear how lessons learned from the complaints which they have
received are being used to improve services to the satisfaction of people with mental health needs
and their carers.
Ensuring that services are effective in improving the quality of people’s lives is a priority for
commissioners. The Trust made great strides last year in using standardised outcome measures to
indicate how treatment and care was supporting the recovery of those with mental health needs.
Commissioners will continue to work with the Trust to make sure that such measures are used to
improve clinical practice and to improve the experience of patients.
We continue to work with the Trust to ensure that people with mental health needs receive the
support they want to live independent and fulfilling lives. Trust performance against the standards
set for access to social care needs to be improved. We expect close partnerships between clinicians,
social work practitioners, service users, carers and voluntary sector organisations will be required to
support excellence in personalised care. This year we will expect to see more people in receipt of
direct payment and less people accommodated in residential care.
We also want the Trust to continue to strengthen its relationship with GPs so that patients receive
prompt and effective treatment. Whist waiting times have been improved, close work with primary
care staff has suggested that this remains an area for improvement. It will be important for the
Trust to deliver a greater proportion of its services in GP practices; to respond quickly to those who
need urgent care; and to provide timely access to those needing readmission to specialist
community services.
One area where the Trust has been very open and willing to share its learning has been in the area
of patient safety, including the investigation of unexpected patient deaths and other serious
incidents. The Trust produces reports that analyse the causes of such incidents and lists the actions
required to reduce or remove the possibility of similar incidents occurring in the future. The Trust
has responded to commissioners’ comments on these reports in an open and collaborative way. We
will continue to work closely with the Trust to ensure that actions are embedded across the whole
organisation, wherever they are relevant. We will also need to work closely with the Trust to
ensure that care planning meets contractual standards and that care plans are informed by
properly implemented risk assessments.
Yours sincerely
Councillor Sylvia Tidy
Chairman, Health Overview and Scrutiny Committee
John Wilderspin
Chief Executive
NHS West Sussex
24 Sussex Partnership NHS Foundation Trust
Quality Account 2009 - 2010 25
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