Quality
Account
2009/2010
Contents
Part 1
3
Part 2
7
Part 3
15
Statement from the Chief Executive
The Way Forward 2010/2011
Key Achievements from 2009/2010
The Horder Centre
Quality Account
Part 1
Statement from the Chief Executive
The Horder Centre was founded in 1954 and so has developed over 50 years’ of
healthcare expertise and is now a recognised leading Centre of Excellence for orthopaedic
care in the South East. We are a registered charity (Number 1046624) dedicated to
providing high standards in healthcare on a not-for-profit basis. All surpluses generated
from our work are reinvested back into the charity – to provide healthcare benefit;
developing staff to deliver the Centre’s aims; investing in quality; and improving services
and facilities. We are currently embarking on a major redevelopment programme to
improve patient experience, safety and comfort through the redesign and refurbishment
of the Centre.
Our services are available to all, either through private referral or through the
Government’s Patient Choice scheme. Indeed, more than 90% of our patients are now
referred to us under the NHS, a figure we are proud of.
Purpose
The Horder Centre’s charitable purpose is to advance health, and the relief of patients
suffering from ill health, aiming to provide ‘benefit’ to as many people as practicable in
our catchment area. The Centre achieves this aim by caring for and treating patients
with painful and often debilitating arthritic, orthopaedic and related conditions.
Values
We believe it is The Horder Centre’s values which differentiate us from other healthcare
centres in the area. Our promise to our patients is that we are reliable, open and honest,
effective and safe and work to a high standard, treating them with respect in a warm,
friendly environment.
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The Horder Centre
Quality Account
Aims
I The Horder Centre will be the first hospital of ‘choice’ for patients and
GPs in its core catchment area who require access to orthopaedic and
related services.
I To promote innovation and enhance the safety and quality of the Centre’s
therapeutic treatments, care and rehabilitation programmes in a unique,
caring environment.
I To enhance our range of services. To advance health in a way that will
promote health and wellness to all areas of the community.
I To provide an effective, high value-for-money service, ensuring what we
provide is cost effective and easily accessible.
I To demonstrate the outcomes and impact of The Horder Centre’s work
on individuals and the sections of the community it serves.
“I have been very pleased with
my care and would certainly
say the staff here are warm,
friendly and caring. My GP
referred me here and I would
definitely recommend it.”
Mr E, East Sussex
4
The Horder Centre
Quality Account
The key strengths of The Horder Centre lie in our charitable status and the
demonstrably high quality of the service we provide. We have a strong reputation
amongst those who have used our services or know someone who has benefited from
treatment and care at The Horder Centre. The Centre has a unique atmosphere, a
warmth and friendliness which are perceived by all who come through its doors.
The Horder Centre is not about doing extraordinary things but doing ordinary things,
extraordinarily well.
A summary of our achievements, of which we are particularly proud, include:
I Low infection rates, including zero MRSA.
I Excellent outcomes – low unplanned re-admissions and returns to theatre.
I Very high patient satisfaction.
I Our warm, friendly and caring environment, as stated by our patients.
I The Government’s 18 week “referral to treatment” target consistently
achieved.
I Our high level of cleanliness.
I All Care Quality Commission (CQC) minimum standards met.
I Development plans will raise our standards and patient comfort
still higher.
Our charitable status means that The Horder Centre will endeavour to take an ethical
stance in all its activities, including its dealings with all parties with an interest in our
work, particularly patients and staff, whilst ensuring effective governance of all its
activities. This has resulted in very low staff turnover, providing excellent continuity of
care. The Centre’s specialist nature is also a key strength which allows it to run
efficiently and develop its reputation as a Centre of Excellence. We are particularly proud
that its finances have been managed in such a way as to allow major expenditure into
significant service improvement through redesign, such as single rooms and development
of a gym facility.
The Horder Centre’s focus on quality and continuous improvement in all aspects of care
is reflected in our commitment to clinical governance, audit and developing strong
stakeholder relationships. Our relationship with our Consultants for example is one of
partnership, working together with the entire hospital team to ensure the optimum
outcome for our patients.
5
The Horder Centre
Quality Account
The Horder Centre’s Board and Executive have truly embraced the Quality Account as
an opportunity to state its commitment to quality and promote those areas that are
particularly successful. The formulation of this account has also focused attention on
those areas of the service we can improve, identifying – with our stakeholders and service
users – our priorities for this coming year. A great deal of effort has gone into the creation
of this Quality Account, having been written with the involvement of key individuals
and the Management team, utilising feedback from the Board, patients, visitors,
Consultants and staff. Therefore with all best intentions I am able to state that to the
best of my knowledge, the information in this document is accurate.
“My family and friends are amazed
Di Thomas
Chief Executive
at the recovery I am making
which is helped by the very good
booklet you supply giving the
stages of progress, the exercises,
and providing answers to queries
and the confidence to move.”
Mrs A, West Sussex
6
The Horder Centre
Quality Account
Part 2
The Way Forward 2010/2011
The ethos of delivering continuous quality improvement is at the heart of everything we
do. The key areas chosen for development during 2010/2011 are:
Clinical Effectiveness
I Review the current patient pathway for hip and knee replacements to
ensure best practice and with an aim to reduce the length of stay to less
than 4 days.
I Provide professional management training (Certificate in Management)
and coaching skills for all key managers. Improve our induction
programme, setting the tone and expectation for all new employees.
Patient Safety
I New build and refurbishment project will enable all patient rooms / areas
to have piped oxygen and suction available.
I Improve anaesthetic services to support upper limb surgical techniques,
ensuring improved day care process and reduced average length of stay.
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The Horder Centre
Quality Account
Patient Experience
I Introduce a new coffee shop service for patients and relatives.
I Improve the outpatient waiting facilities to provide a warmer,
lighter environment.
I Promote ‘wellness’ classes with priority for assisting patients with
improvements to their health i.e. smoking cessation, weight loss, healthy
eating. Provide gym facilities and fitness classes.
These areas were chosen through continuous communications with our service users.
We have utilised patient satisfaction comments, staff survey feedback and comments
from our Consultants to ensure priorities were identified.
Progress is reviewed on a monthly basis at Executive meetings and Management Team
meetings to ensure timescales are met. Feedback is given at management meetings and
a summary discussed with the Board.
There are continuous processes in place to monitor satisfaction from our users, together
with patient forums twice a year to ensure that quality is assessed on an on-going basis.
These forums will continue through 2010/11.
“During the five days spent with you,
all of the staff (at every level) were
extremely kind and considerate,
making my stay with you as pleasant
as possible in the circumstances.”
Mr D, Kent
8
The Horder Centre
Quality Account
Statements from the Board
This section provides the mandatory information for inclusion in a Quality Account, as
determined by Department of Health regulations.
1. Review of Services
During 2009/10 The Horder Centre provided four NHS services.
The Horder Centre has reviewed all the data available to it on the quality of care in
these services.
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 The Horder Centre
for 2009/10.
2. Participation in clinical audits
During 2009/10, five national clinical audits and one national confidential enquiry
covered NHS services that The Horder Centre provides.
During that period The Horder Centre participated in 80% national clinical audits and
100% national confidential enquiries of the national clinical audits and national
confidential enquiries which it was eligible to participate in.
The national clinical audits and national confidential enquiries that The Horder Centre
was eligible to participate in during 2009/10 are as follows:
I National Elective Surgery – Patient Reported Outcome Measures
(PROMs): hip and knee replacements.
I National Joint Registry (NJR): hip and knee replacements.
I National Comparative Audit of Blood Transfusion: changing topics.
I National Confidential Enquiry into Patient Outcome and Death
(NCEPOD).
The national clinical audits and national confidential enquiries that The Horder Centre
participated in during 2009/10 are as follows:
I National Elective Surgery – Patient Reported Outcome Measures
(PROMs): hip and knee replacements.
I National Joint Registry (NJR): hip and knee replacements.
I National Confidential Enquiry into Patient Outcome and Death
(NCEPOD).
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The Horder Centre
Quality Account
The national clinical audits and national confidential enquiries that The Horder Centre
participated in and for which data collection was completed during 2009/10, are listed
below alongside the number of cases submitted to each audit or enquiry as a percentage
of the number of registered cases required by the terms of that audit or enquiry.
PROMS
Knee replacement
Hip replacement
Total eligible episodes
Count of questionnaires*
% compliance
659
703
100%
664
679
100%
*On occasion, the pre-operative questionnaire may be completed by a patient significantly in advance of
the operation, so the questionnaire may be counted but the eligible episode may not have occurred.
NJR
Hip & Knee replacements
Total forms completed
1920
% compliance
96%
“The care I received was brilliant.
My doctor recommended I attend
The Horder Centre and I am glad I
did. I have found the forum
meeting very useful.”
Miss K, West Sussex
The reports of four national clinical audits were reviewed by the provider in 2009/10 and
The Horder Centre intends to take the following actions to improve the quality of
healthcare provided:
I Ensure patient expectations post surgery are explored prior to surgery
to ensure expectations are realistic and surgery is appropriate.
I Review length of stay for joint replacement surgery.
I Ensure as many patients complete both PROMS and NJR forms correctly
to ensure/maintain high compliance levels.
I Post surgery PROMS data has not yet been issued and therefore will be
reviewed when available.
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The Horder Centre
Quality Account
The reports of three local clinical audits were reviewed by the provider in 2009/10 which
were reviewed by our Clinical Governance Committee. The Horder Centre intends to
take the following actions to improve the quality of healthcare provided:
I Improve patient information to provide a consistent message to patients.
I Review anaesthetics used in hip surgery.
I Mobilise hip patients on day of surgery where possible.
I Teach the use of physiotherapy aids at pre-admission clinic.
I Review pain control protocols for post-operative patients.
I Improve patient record documentation.
Other studies, conducted at The Horder Centre, have included the evaluation of specific
prosthesis over time, including a 15 year multicentre study of the Exeter hip stem.
Results to date show excellent outcomes as reported by our patients.
Exeter Patient Outcome Study (EPOS) commenced in 1999. Initially it was a seven
centre national study to look at the Exeter stem to run for a period of 5 years.
The Horder Centre was one of the centres chosen to carry out the study involving
approximately 300 patients. The study has now been extended for a further 10 years
and only four centres are now involved, one of which is The Horder Centre. Results show
a general high rate of satisfaction with the operation.
3. Research
Participation in clinical research
The number of patients receiving NHS services provided or sub-contracted by The
Horder Centre in 2009/10 that were recruited during that period to participate in
research approved by a research ethics committee was zero.
“This was my third operation at The Horder Centre, right hip
replacement in 2007, left knee in 2008, and each time I have
been treated with such skill warmth and kindness by all
members of staff. The comfort of a nurse when you are feeling
below par is worth far more than any amount of medication.”
Mrs F, Kent
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The Horder Centre
Quality Account
4. Goals agreed with commissioners
Use of the CQUIN payment framework
The Horder Centre income in 2009/10 was not conditional on achieving quality
improvement and innovation goals through the Commissioning for Quality and Innovation
payment framework because the organisation does not use any of the NHS National
Standard Contracts and is therefore not eligible to negotiate a CQUIN Scheme.
5. Statements from the Care Quality Commission (CQC)
The Horder Centre is required to register with the Care Quality Commission and it is
registered under the Service Category of ‘Independent Hospital’ (IH) and under the
Service User Category of ‘Acute hospitals (with overnight beds) (AH).’ The Horder Centre
has the following conditions on registration:
I This establishment is registered to provide treatment and care under the
following service user categories only: – Acute hospitals (with overnight
beds) AH.
I Notification in writing must be provided to the Care Quality Commission
at least one month prior to providing any treatment or service not
detailed in your statement of purpose.
I A maximum of 59 patients may be accommodated overnight at any
one time.
I Services may only be provided to persons aged 18 or over.
The Horder Centre was inspected by the CQC on 28th April 2009 and demonstrated that
it meets all the National Minimum Standards inspected and had no areas of
non-compliance.
The Horder Centre has not participated in any special reviews or investigations by the
CQC during the reporting period.
The Care Quality Commission has not taken enforcement action against The Horder
Centre during 2009/10.
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The Horder Centre
Quality Account
6. Data Quality
6.1 NHS Number and General Medical Practice Code Validity
The Horder Centre submitted records during 2009/10 to the Secondary Uses Service for
inclusion in the Hospital Episodes Statistics which are included in the latest published
data. The percentage of records in the published data which included the patient’s valid
NHS number was:
I 40% for admitted patient care; and
I 40% for outpatient care.
Although all records submitted by The Horder Centre do contain an NHS number it is
not currently possible to confirm the validity of the remaining 60%; we are awaiting
access to the NHS’s tracing service to allow this to take place.
The percentage of records in the published data which included the patient’s valid
General Medical Practice Code was:
I 100% for admitted patient care; and
I 100% for outpatient care.
“…your nurses were “The Best”. The catering was excellent and
I suppose it was a bit like a holiday!”
13
Mr R, East Sussex
The Horder Centre
Quality Account
6.2 Information Governance Toolkit attainment levels.
The Horder Centre score for 2009/10 for Information Quality and Records Management
assessed using the Information Governance Toolkit was 66%.
As an NHS Business Partner, The Horder Centre is obliged to meet just one of the
Information Quality and Records Management requirements from the Information
Governance Toolkit. This is in respect of NHS number validation (see Section 6.1 of this
report). An attainment level of 0 to 3 can be achieved although level 2 is all that is
contractually required. The Horder Centre has achieved this level (hence 66%) although
is actively working towards achievement of level 3.
6.3 Clinical coding error rate
The Horder Centre was not subject to the Payment by Results clinical coding audit
during 2009/10 by the Audit Commission.
However, our clinical coding is carried out by suitably qualified coders provided by an
external company. Training and development of our own staff is underway so we may
carry out this function ourselves, following which the external company will provide
ongoing mentoring and audit services.
The Audit Commission has announced its intention to carry out a clinical coding audit
of Independent Hospitals during 2010/11. Having been one of the pilot organisations
involved in testing the audit process, The Horder Centre will be happy to participate in
the formal audit.
“My sincere thanks to you
and The Horder Centre for
an efficient and effective
service. Everybody I came in
contact with was very
professional, pleasant and
seemed to enjoy their work”.
Mr R, Kent
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The Horder Centre
Quality Account
Part 3
Key Achievements from 2009/2010
Specific goals and the broader aim of advancing health and providing benefit to ever
increasing numbers of patients in the South East Coastal area, by providing orthopaedic
and musculoskeletal (e.g. rheumatology, physiotherapy) services, have been achieved.
825 more patients benefited from treatment, care and services provided by The Horder
Centre last year, with a total of 4434 receiving surgery.
Process efficiencies
We have worked hard to reduce the number of day cases converted to inpatient overnight
stays (known as “daycase conversions”) and this figure is now less than 3%, which puts
us in a good position in preparation for the new day care unit.
8%
Intended management conversion rates 2009/2010
6%
4%
2%
Daycase-to-Inpatient
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The Horder Centre
Quality Account
Keeping this figure as low as possible demonstrates effective management of our
caseload, ensuring patients admitted for minor day case procedures are able to return
home the same day. However, this must always be balanced against the need to ensure
our patients are only discharged when it is clinically appropriate to do so.
Capital investment programme
The commencement of the new build project was delayed significantly due to planning
issues however further refurbishment and enabling works have taken place:
I 4 new physiotherapy rooms.
I Refurbishment of all old toilets and bathrooms.
I Fire doors replaced in key areas.
I New MRI pad built and access improved.
I Redundant areas in Outpatient’s Department reconfigured to improve
the waiting area and increase capacity.
Leadership
The Board saw the appointment of a new Chair.
A new competency assessment framework was established for the Executive Team and
the existing framework refined and embedded for all staff. Leadership and management
training took place for all managers and team leaders.
Stakeholder engagement
The Horder Centre is continually reviewing the service level given to its users with the
aim of continuous improvement. All inpatients and day care patients are sent a patient
satisfaction survey after discharge from
hospital to ascertain any areas for
improvement. Currently 99% of our patients
rate the care received from The Horder Centre
as excellent, very good or good.
At the beginning of 2009, a patient
questionnaire was formulated for outpatients.
This was introduced for a period of 6 weeks in
order to give a snap shot of patients’ perception
of care. A total of 365 questionnaires were
returned.
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The Horder Centre
Quality Account
The highlights from this exercise include 100% of those replying giving excellent scores
for receptionists being courteous and helpful; being treated with respect and dignity and
for knowing and understanding what the next step of their treatment plan was on
leaving The Horder Centre. 99.5% were happy with the level of personal privacy afforded
to them.
The key areas identified for improvement were to have more chairs and seating
available; improved car parking space; a shuttle bus to Crowborough; and a warmer
waiting area. Whilst they did not want to make use of our Complaints Policy, 12% of
patients were unaware of how to make a complaint should they need to do so. Plans are
in place with regards to all the issues which were raised as areas for improvement, with
many of them being addressed within the new building development.
An impressive 99% of patients would recommend the Horder Centre. When asked ‘What
did you like best about The Horder Centre’, answers included ‘friendly/relaxed
atmosphere’, ‘friendly and efficient staff’, ‘the cleanliness’.
3,913
73
Feedback is also sought from our Consultants. As well as the Practice Privileges process
(method by which Consultants are approved to work at The Horder Centre), Medical
Advisory Committee and Consultant Appraisal system, a business development meeting
was held with each Consultant orthopaedic surgeon. The purpose of the meeting was to
establish where the Centre could do more to support them or identify ways to attract
more patients or provide more benefit.
Each and every Consultant was pleased with the efficiency of the Centre, particularly in
the way the operating theatres were run. The key area identified for improvement was
to increase the number of “advanced practitioners”, providing further training for staff
to progress into this enhanced role which will support the Consultants in Outpatients
and Theatres, which in turn will reduce the call on their time, improve patient
satisfaction and provide a career path for more senior staff. A number of surgeon
assistants have now been trained and appointed at this level.
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The Horder Centre
Quality Account
Student nurses continue on placement from Brighton University and we have also
recruited three volunteers to date with a further three more in the pipeline.
We also contacted all GP surgeries within the core catchment area and held eight
well-attended GP-focused educational events (CPA accredited).
Two Patient Forums have been held during the last year. These forums have been well
attended by both patients and their companions, with 50 attending the last session,
giving them a chance to share their perception of the Centre. Feedback received from the
groups was highly positive, with guests speaking of the excellent level of care they
had received. Many said they were made to feel welcome by staff while others added
nothing was ever too much trouble. All agreed that the patient forum meeting had been
a valuable opportunity to pass on their experiences and to help develop the Centre.
“From the moment I arrived to the moment
I left just over 48 hours later, I was treated
with the highest possible professional skill
and personal kindness and consideration…”
Mr A, East Sussex
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The Horder Centre
Quality Account
Quality and range of therapeutic treatments, care
and rehabilitation programmes
We reviewed the services provided in our outpatient setting, which has led to a more
comprehensive outpatient service being introduced. A Back Service has commenced with
one of our outpatient physiotherapists identified to support our Consultant lead in spinal
conditions. A training plan has been formulated and a comprehensive physiotherapy
triage service is being designed and will commence in September. Acupuncture services
have also been introduced under physiotherapy.
Patient information literature has been comprehensively overhauled, in conjunction with
an external company (EIDO Healthcare) who are experts in “informed consent”. Patients
need to be properly informed so that they can share in the decision-making process
regarding their treatment and this step will ensure our patients have the information
they need.
Five submissions have been made for quality awards, relating to website; brochure
design; operating theatre efficiency; day care processes; and best employer.
There have been a significant number of continuous improvement workshops coaching
staff in how to conduct improvement projects. User booklets have been issued and a
number of projects conducted. The key work streams which have resulted in service
improvements are:
I Pre-admission and Outpatient services.
I Improved process and building design, facilitated by the architects on the
new development.
I Clinical coding, which has improved and enhanced the quality of the data
we submit to the Department of Health.
Information technology
An Internet Café was opened and made available to staff and visitors. This will be used
to facilitate e-learning for staff during 2010. The Centre’s website has been
comprehensively redesigned, with specific areas newly designed for patients and GPs
and other health professionals. There has also been an upgrade of software across all
departments, including the introduction of MS Office 2007. Over 100 hrs of training
episodes took place on the new software, improving knowledge and skill and greatly
appreciated by staff.
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The Horder Centre
Quality Account
Care Quality Commission (CQC) Indicators
Each quarter, the Horder Centre is required to submit data to the CQC on a defined
set of clinical indicators. Our results reflect the high level of care given to our patients
and provide evidence for our claim of low infection rates and excellent outcomes.
Indicator
Inpatient mortality
Total Number for the 12 Months
March 2009 to April 2010
%
0
0
23
0.97
8
0.34
Unplanned transfers to
another hospital
20
0.84
Mortality within 7 days
of discharge
1
0.04
Pulmonary Embolus at
The Horder Centre
7
0.30
Deep Vein Thrombosis (DVT)
at The Horder Centre
1
0.04
Inpatient dislocation
at The Horder Centre
2
0.23
70
3.76
Hip replacements (arthroplasty)
infection rate
2
0.24
MRSA positive blood cultures
0
Peri-operative mortality
(i.e. within 48hrs of surgery)
Unplanned readmissions within
29 days of discharge
Unplanned returns to the
operating theatre
Unplanned overnight admission
following day case surgery
0
0
Knee replacements (arthroplasty) 5
infection rate
0.6
MSSA positive blood cultures
0
0
0
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The Horder Centre
Quality Account
Statement from Co-ordinating Commissioner
NHS West Kent confirm the information published in the Quality Account, although not
fully audited, to be a true and accurate representation of the services and quality
standards attained by the Horder. We continue to be very satisfied with the treatment
and levels of care our patients receive.
Rachel Jones
Assistant Director Acute Contracting Team
Kent & Medway Acute Contracting Team
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