Quality Account
2009/10
Contents
Introduction from the Chief Executive
Page 1
Part 1
Statement on Quality from the Chief Executive
Page 3
Part 2
Priorities for Improvement
Assertive Outreach: Broken Engagement
Facilitated Early Discharge
Early Intervention in Dementia
Page 6
Statements of Assurance from the Board
Review of Services
Participation in Clinical Audits
Participation in Clinical Research
Goals Agreed with Commissioners
What Others Say About Us
Data Quality
Page 9
Part 3
Review of Quality Performance
Patient Safety
Safeguarding
Infection Control
7 Day Follow-up (Post Discharge)
Patient Experience
Patient Environment Action Team
Community Forum
Effective Communications
Clinical Effectiveness
Offering Treatment Choice
Rapid Access to Medication Programme (RAMP)
Psychiatric Liaison
Staff Experience
Staff Wellbeing
NHS Staff Survey
Page 14
Page 18
Page 21
Page 24
Statements from Local Involvement Network, The Health
Overview & Scrutiny Committee and Primary Care Trust
Worcestershire Mental Health Partnership NHS Trust
Quality Account 2009/10
1
Introduction from the Chief Executive
Dr Ros Keeton
The
vision
of
Worcestershire
Mental
Health
Partnership is to be
the
preferred
provider of services
to the population
we serve.
We are
committed to
maintaining and improving the
quality of services we provide Neil Lockwood: Chairman (Back Left) and Ros
whether that be direct care Keeton: Chief Executive (Front Right) with the
from clinical services, or food
winners of the Outstanding Achievement
Award 2009
and support services - it is all of
vital importance to our service
users, our carers, our staff and
our partners.
Provide positive support
through a well trained and
We aim to:
sensitive workforce, delivering
Provide person centred care
outcomes for service users,
and treatment that maintains
carers and their families
people's health and promotes
independence, rehabilitation
Deliver high quality integrated
and recovery
services
Provide timely access and early
help for those in need of
specialist services
Ensure excellent performance
and efficiency
Our vision is underpinned by 4 core principles that uphold and embed
the commitment to provision of quality services in everything we do:
Choice: including choice of
professional, environment,
treatments and support.
—
Responsiveness: sensitive in the
design of services and guided by
the needs of those who use our
services.
Worcestershire Mental Health Partnership NHS Trust
Integration: services being person
centred and holistic, delivered in
partnership with both the statutory
and voluntary sectors.
—
Shared Care: promoting joint
working and smooth transfers of
care.
Quality Account 2009/10
To extend our relationship
with organisations that buy
our services to ensure the
Trust is the provider of
choice
2
To maintain a culture of
service improvement across
all our services
Link Nurseries
Create an inclusive and
supportive culture which
upholds the principles of the
NHS
Underpinning our vision and
values are a number of corporate
objectives, developed each year
within our services.
Our current objectives are:
To become an NHS Foundation
Trust and maximise benefits for
members and our community
To develop and extend the
range of specialist services to
meet specific needs
To sustain and develop
partnerships with key
partners
We believe that delivery of high
quality services is a team effort.
Our dedicated staff, working with
our service users and carers, shape
and drive quality improvements.
We have a lot of hard work
ahead, but we are committed to
the quality agenda. We have
what it takes to continue to
provide and develop high quality
healthcare to the population we
serve.
I hope you will find this Quality
Account both informative and
useful.
To maintain and develop
integrated
governance
arrangements and ensure our
services are safe, effective and
fully accountable
T o e x t e n d c h oi c e a n d
personalisation in order to
deliver a patient led service
To strengthen our strategy of
involving people in our
organisation and the work we
do
www.worcsmhp.nhs.uk
Hydrotherapy Pool, Osborne Court
Quality Account 2009/10
3
Statement on Quality from the Chief Executive
Dr Ros Keeton
This is the first year we have been
legally required to publish a
Quality Account. We welcome
this move towards greater public
accountability for the quality of
our services.
This process
enhances our own commitment
to improving the quality of care
we deliver to our service users
and carers.
Prior to Quality Accounts, our
organisation had a long
established practice of setting
ourselves standards and
reviewing the quality of the
services we provide. We agreed to
adopt three Governance priorities
in 2009/10 and these were:
Infection Prevention
Control
Safeguarding
Documentation
and
Each part of the organisation is
signed up to achieving these
standards and is required to
demonstrate
how
they
contribute consistently to these
three priorities.
This Quality Account has been
developed as a direct result of
feedback we received from our
key partners. Our Quality
Account is driven by our service
users, their carers, our staff,
and the communities we serve.
From the outset we have aimed
Worcestershire Mental Health Partnership NHS Trust
to engage as many people as
possible in the production of this
Quality Account including:
An article in the local
newspaper inviting members of
the public to tell us what
improvements we could make
Leaflets and posters in all our
services promoting our Quality
Account and asking people to
give us their thoughts
Talking to our existing service
user, carer and community
groups
Gi vi n g Q ua l i ty Ac cou nt
presentations and making sure
people knew how to get
involved
An article in our newsletter to
our 4500 Foundation Trust
members
Hadley Unit
Quality Account 2009/10
An article in staff Team Brief,
promoting this Quality Account
and giving our staff the
opportunity to tell us about
improvements we could make
Meeting our commissioners
and listening to their feedback
on how we deliver services
both now and in the future
We worked hard to respond to
the needs and concerns of our
service users, their carers, our
staff, our communities and our
commissioners.
We were disappointed not to
have achieved two Care Quality
Commission (CQC) national
targets in 2008/09. As a result our
clinical services rating was
reduced from “Excellent” to
“Weak”. Since then we have
taken positive action to address
the problems in these areas. We
have monitored our performance
against the national targets and
we are confident that we will
achieve a higher rating in
2009/10.
4
From 1st April 2010, all Trusts
must register with the CQC and
meet a number of new
standards. We have declared
“full compliance” with these
and have successfully registered
with the CQC without any
compliance conditions.
We have established our own
Partnership Forum where we
engage with organisations with
an interest in the services we
provide. We have developed
Directors and facilities staff during a visit to proposals for engaging those
one of our catering departments people who have expressed an
interest in being members of
This report captures our efforts to
our prospective NHS Foundation
improve the service user
Trust. These include new forums
experience. We are proud of the
for service users, for carers and
improvements we have made to
for other members.
the quality of services across the
trust in 2009/10 by:
We recently held an event for
members where two guest
Developing new services
speakers spoke about dementia.
Helping people stay in their
We will be holding further events
own homes
later this year.
Refurbishing inpatient areas
Providing our staff with a
Our Trust Board has been
rewarding place to work
engaged with the Quality
Account process from the outset.
They have visited sites
throughout the year to determine
www.worcsmhp.nhs.uk
Quality Account 2009/10
5
for themselves the quality of
services delivered by our Trust.
The Trust holds in-depth
Performance Reviews for each of
its Business Units twice a year.
These reviews are an essential
way of assuring the Trust Board
that high quality care is being
delivered by the services and to
ensure that any risks to that
quality are brought to the
attention of the Trust Board.
our services and we will continue
to work with them to deliver high
quality, safe, effective and service
user focused services.
I confirm to the best of my
knowledge and belief the
information in this document is
accurate.
The quality of our services is also
reviewed by our commissioners
on a monthly basis using Clinical
Quality Review forums. Patient
Experience, Patient Safety and
Clinical Effectiveness are all
considered within this forum.
Our service users, carers, staff and
commissioners have told us what
they think about the quality of
Worcestershire Mental Health Partnership NHS Trust
Quality Account 2009/10
Priorities for Improvement
Assertive
Outreach: Broken
Engagement
6
Facilitated
Early
Discharge
Early
Intervention in
Dementia
Based on feedback received from
service users, carers, staff and
commissioners, the Trust has
selected three priorities for
improvement in 2010/11.
the service user and ensure they
are safe.
These priorities promote the
three domains of quality set out
in Lord Darzi’s report “High
Quality Care for All”, which are:
We selected this as a priority as it
promotes patient safety and
aligns with the Commissioning for
Quality and Innovation (CQUIN)
scheme agreed with our
commissioners.
Patient safety
Clinical effectiveness
Patient experience
Why is Broken Engagement a
priority for us?
Assertive Outreach: Broken
Engagement
What is it?
Assertive Outreach Teams work
with people who have severe and
enduring mental illness and who
are at risk of disengaging with
mental health services.
This service helps to keep “hard
to engage” service users safe.
When a service user misses two or
more appointments in a row it is
known as Broken Engagement.
When this happens, staff in the
team will act quickly to contact
www.worcsmhp.nhs.uk
Steven Jew at AIM’s Community Art Group
(Shrub Hill Workshop move on project)
Quality Account 2009/10
7
What are we doing to improve
services?
What are we doing to improve
services?
We do everything we can to keep
service users engaged with us.
We monitor when they miss two
appointments in a row.
This
helps us improve how we work
with service users to improve
their care and wellbeing.
We believe that between 5% to
15% of people can be offered
treatment at home as an
alternative to staying in hospital.
How will we measure progress?
The first step will be to find out
how we are doing now. We will
find out how often Broken
Engagement occurs now.
We will then implement an action
plan and monitor our progress in
achieving
these
actions
throughout the year. The plan
will include regular checks of how
often Broken Engagement occurs.
Progress will be routinely
reported to the Trust Board.
Facilitated Early Discharge
What is it?
This service helps people to be
safely discharged from hospital
quicker because of the extra care
we provide to them at home.
Why is Facilitated Early Discharge
a priority for us?
We selected this as a priority as it
promotes patient safety and
patient experience. It also aligns
with the CQUIN scheme agreed
with our commissioners.
Worcestershire Mental Health Partnership NHS Trust
The time from a patient’s
discharge from hospital to the
time of their next “face to face”
contact with the Crisis Resolution
Home Treatment teams should be
within 48 hours.
How will we measure progress?
We wi l l re vi e w pa ti e nt s
discharged from adult acute care
who were suitable for early
discharge and ask if we saw them
within 48 hours.
We will monitor our progress
throughout the year and report
to the Trust Board on a regular
basis.
Early Intervention in
Dementia
What is it?
Our team will help people and
their carers who are worried that
they may have a dementia by
offering a comprehensive range
of services and support.
Why is Early Intervention
Dementia a priority for us?
in
Dementia currently affects
820,000 people in the UK. We
know that people are living
longer and that dementia may
occur in people aged under
65-years.
Quality Account 2009/10
Key studies have found that we
need to do more to help people
who are worried that they may
have dementia.
8
Services need to be easier to
access. This has always been
important to us, but we want
to do more. We know that GPs
and other health and social
care services often have
difficulty recognising dementia.
People are often reluctant to
ask for help. As a result many
assessments do not take place
until there is a crisis.
We want to provide a range of
high quality services for people
with dementia.
What are we doing to improve
services?
We are working with existing
service users, their carers and our
staff to develop a specialist Early
Intervention in Dementia Service.
We are building a team that will
work across the County and we
aim to have this service in place
by July 2010. The service will
offer early assessment and
diagnosis, followed by support,
information and advice to those
who need it.
The service will also support
families and carers affected by
dementia by giving them the
chance to discuss care and future
living arrangements.
Dr. Bernie Coope: Lead Consultant,
Older Adult Mental Health
How will we measure progress?
We will check whether we are
achieving our goals by collecting
information from those people
and families who use the service.
We will ask them if they:
feel they have been offered
choices and appropriate
treatments
have been supported to make
decisions about their future
care
feel supported to live well with
dementia
We believe this will help us all to
work together more effectively,
supporting people and their
families.
www.worcsmhp.nhs.uk
Quality Account 2009/10
9
Statements of Assurance from the Board
Review of Services
We are legally bound to make the
statements shown in blue, and we
have provided further detail,
which is shown in black.
During
2009/10
the
Worcestershire Mental Health
Partnership NHS Trust provided
and/or sub-contracted six NHS
services.
Adult Acute Mental Health
Adult Community Mental
Health
Learning Disability
Older Adult Mental Health
Primary Care Mental Health
Substance Misuse and Prison
Health
The Worcestershire Mental
Health Partnership NHS Trust has
reviewed all the data available to
them on the quality of care in six
of these NHS services.
The income generated by the
NHS services reviewed in 2009/10
represents 100 per cent of the
total income generated from the
provision of NHS services by the
Worcestershire Mental Health
Partnership NHS Trust for
2009/10.
Worcestershire Mental Health Partnership NHS Trust
Participation
Audits
in
Clinical
During 2009/10 four national
clinical audits and one national
confidential enquiry covered NHS
services that Worcestershire
Mental Health Partnership NHS
Trust provides.
During
that
period
Worcestershire Mental Health
Partnership
NHS
Trust
participated in 0% 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 Worcestershire Mental
Health Partnership NHS Trust was
eligible to participate in during
2009/10 are as follows:
National Falls and Bone Health
in Older People
National Audit of Continence
Care
POMH (National Prescribing
Observatory for Mental Health)
Topic 1e supplementary follow
up of hi gh dose and
combination antipsychotic
prescribing
National Health Promotion in
Hospitals Audit
Quality Account 2009/10
National Confidential Inquiry
into Suicide and Homicide of
People with Mental Illness.
We usually participate in national
clinical audits. The reasons for
non-participation in the four
national clinical audits we were
eligible to take part in are as
follows:
National Falls and Bone Health in
Older People
The trust deferred participation
until 2010/11
National Audit of Continence
Care
Participation was not seen as an
audit priority for us as a mental
health trust.
National Prescribing Observatory
for Mental Health (POMH) Topic
1e supplementary follow up of
high dose and combination
antipsychotic prescribing
The Trust was not a member of
POMH in 2009/10 and therefore
could not take part in this audit,
however we plan to take part in
2010/11.
National Health Promotion in
Hospitals Audit
The Trust did not participate in
this audit due to the availability
of staff. We have an ongoing
local
audit
cycle
that
d e m on s t r a te s ye a r - o n - ye a r
improvement.
We recognise the importance of
participation in National Clinical
Audits and we plan to participate
in all National Clinical Audits in
2010/11 that we are both eligible
for and that we believe will add
value to services.
www.worcsmhp.nhs.uk
The national clinical audits and
national confidential enquiries
that Worcestershire Mental
Health Partnership NHS Trust
participated in, and for which
data collection was completed
during 2009/10, are listed below
alongside the number of cases
submitted to each audit or
enquiry as available as a
percentage of the number of
registered cases required by the
terms of that audit or enquiry
10
National Confidential Inquiry
into Suicide and Homicide of
People with Mental Illness,
(19 cases).
The report of one national clinical
audit was reviewed by the
provider in 2009/10 and
Worcestershire Mental Health
Partnership NHS Trust intends to
take the following actions to
improve the quality of healthcare
provided:
Appointment of Vocational
Services and Exemplar
Employer Lead
Develop a Family Intervention
in Psychosis training DVD
Focus on physical healthcare
The reports of 28 local clinical
audits were reviewed by the
provider in 2009/10 and
Worcestershire Mental Health
Partnership NHS Trust intends to
take the following actions to
improve the quality of healthcare
provided:
Reduce unnecessary prescribing
Improve the management of
patients’ medication when
admitted to hospital
Quality Account 2009/10
11
Further improve ‘immediate
life support’ skills of staff
Develop ways of monitoring
physical
health
of
out-patients
Amend clinical policies
The Trust has an Annual Clinical
Audit Programme that all
services participate in. The
programme covers audits of
guidance from the National
Institute for Health and Clinical
Excellence (NICE), prescribing
standards, Trust policies and
specific areas of clinical care, and
this provides a level of assurance
that quality is taken seriously by
the Trust.
Participation
Research
in
Clinical
The number of patients
receiving NHS services provided
or
sub-contracted
by
Worcestershire Mental Health
Partnership NHS Trust in 2009/10
that were recruited during that
period to participate in research
approved by a research ethics
committee was 100†.
Goals
Agreed
Commissioners
with
A proportion of Worcestershire
Mental Health Partnership NHS
Trust’s income in 2009/10 was
conditional on achieving quality
improvement and innovation
goals
agreed
between
Worcestershire Mental Health
Partnership NHS Trust and any
person or body they entered into
a contract, agreement or
arrangement with for the
provision of NHS services,
through the Commissioning for
Quality and Innovation payment
framework.
What Others Say About Us
Worcestershire Mental Health
Partnership NHS Trust is required
to register with the Care Quality
Commission and its current
registration
status
is
‚Registered‛. Worcestershire
Mental Health Partnership NHS
Trust has no conditions on
registration.
The Care Quality Commission has
not taken enforcement action
against Worcestershire Mental
Health Partnership NHS Trust
during 2009/10.
Worcestershire Mental Health
Partnership NHS Trust is subject
to periodic reviews by the Care
Quality Commission and the last
review was on 15th October
Further details of the agreed goals for 2009/10 and for the following
12-month period are available on request from:
Charlotte Windsor, Head of Information & Contracting
Worcestershire Mental Health Partnership NHS Trust
Isaac Maddox House, Shrub Hill Road, Worcester. WR4 9RW
† Please note that this figure includes both patients and staff
Worcestershire Mental Health Partnership NHS Trust
Quality Account 2009/10
2009. The CQC’s assessment of
the Worcestershire Mental Health
Partnership following that review
was ‘Weak’.
Worcestershire Mental Health
Partnership NHS Trust intends to
take the following action to
address the points made in the
CQC’s assessment:
Extend the programme of
exception reporting to close the
gaps on data entry for ‘Ethnic
Group’
Revise processes for data
collection and reporting to
ensure robust data availability
across all areas of performance
Establish the process of weekly
validation of discharges and
follow-up within 7-days, with
clear lines of responsibility
Ensure weekly clinical discharge
co-ordination meetings take
place to reduce delayed
discharge
Continue implementing the
“Green Light for Mental
Health” framework for people
with both Learning Disability
and mental illness. The Green
Light for Mental Health toolkit
paints a picture of what good
mental health support services
for people with learning
disabilities looks like and gives
a way of assessing how well
local services measure up to it
Worcestershire Mental Health
Partnership has made the
following progress by 31st March
2010 in taking such action:
Since April 2009, achieved
levels of 90% to 100% for
“Gate Keeping”
www.worcsmhp.nhs.uk
Processes for data validation
and exception reporting are in
place
Our action plan is on target to
deliver outcomes as planned
As a result, we are confident of
an improved result for 2009/10,
especially in relation to our work
on 7 day follow-up and Gate
Keeping.
12
Further information is available
on our website:
www.worcsmhp.nhs.uk.
Worcestershire Mental Health
Partnership NHS Trust has not
participated in any special
reviews or investigations by the
CQC during the reporting period.
Data Quality
Worcestershire Mental Health
Partnership NHS Trust submitted
records during 2009/10 to the
Secondary Uses Service for
inclusion in the Hospital Episode
Statistics which are included in
the latest published data. The
percentage of records in the
published data:
-which included the
valid NHS number was:
patient’s
99.0% for admitted patient care;
and 98.5% for outpatient care.
-which included the patient’s
valid General Medical Practice
Code was:
99.8% for admitted patient care;
and 99.9% for outpatient care.
Quality Account 2009/10
13
Worcestershire Mental Health
Partnership NHS Trust score for
2009/10 for Information Quality
and Records Management,
assessed using the Information
Governance Toolkit was 58.3%
This is a sub score from the
Information Governance Toolkit
where our overall score is 72%
answering 62 out of 64 questions.
Worcestershire Mental Health
Partnership NHS Trust was not
subject to the Payment by Results
clinical coding audit during
2009/10
by
the
Audit
Commission.
Worcestershire Mental Health Partnership NHS Trust
Quality Account 2009/10
Patient Safety
14
A key indication of an
organisation that takes Patient
Safety seriously is their ability
to learn lessons when things go
wrong. All incidents are taken
seriously and reviewed by the
Trust, and findings from these
reviews are always shared.
As part of our commitment to
improve patient safety, we held
a Rapid Improvement Event in
Staff sharing learning and ideas at a Rapid
November 2009. This event was
Improvement Event (November 2009)
supported by the NHS Institute
for Innovation and was attended by approximately 80 staff who were
encouraged to share ideas, concerns and good practice. The purpose of
the event was to improve and make safer the services we deliver by
bringing together the learning from recent incidents and then
communicating this throughout the organisation.
A range of activities are continuously taking place to make our services
safer for those we serve. During 2009 the Trust launched the Productive
Mental Health Ward initiative. This gives staff the tools to improve the
ward environment and release additional time for direct patient care.
Vanya Woods, Ward Manager of Harvington Ward said:
“We have been able to change our handovers which has reduced them
to 30 minutes instead of the hour we were spending on them before.
This means that over the course of a week we are saving approximately
20 hours, which we are now using on direct patient care.”
It is expected that once this way of working and thinking is embedded
into the daily activity of the ward, the process will support and enhance
a culture of ongoing improvement owned by the ward team.
Based on the feedback we received from our service users and carers,
staff and commissioners, the following section reflects the areas of
Patient Safety that they felt had the highest impact on quality in
2009/10. These were Safeguarding, Infection Control and 7 day
follow-up post discharge.
www.worcsmhp.nhs.uk
Quality Account 2009/10
Safeguarding
15
Worcestershire Mental Health
Partnership Trust is committed to
safeguarding the vulnerable
adults and children who come
into contact with our services.
This is not only for service users
but also for their families,
especially children.
In November 2008 the Trust
appointed a Safeguarding Named
P ro fe s si on a l (sa f e g ua rd i n g
manager) to manage and lead
safeguarding and ensure our
services and staff were supported
in their commitment to
safeguarding.
148
(56%)
The number of new
staff receiving
safeguarding
awareness training in
2009/10.
A safeguarding children
declaration was published on the
Trust’s website.
This provided
assurance that children who
directly come into contact with
the Trust (or as a family member
of one of our service users) are
safeguarded from harm.
The Trust has recently carried out
an internal audit of safeguarding
children to monitor progress.
This showed steady progress in all
areas of safeguarding children.
There were no areas of high risk
identified and an action plan has
335
The number of staff
who completed online
training for Child
Protection in 2009
Worcestershire Mental Health Partnership NHS Trust
been developed to monitor
further improvements.
Criminal Records Bureau (CRB)
Checks to ensure safer
recruitment of staff has been our
policy since 2002.
405
The number of
Criminal Records
Bureau checks
completed in 2009/10
During 2009 we ensured that
those employed prior to 2002 also
had CRB checks.
Safeguarding
training
requirements for all our staff
have been analysed and are being
addressed. In addition to Trust
training events, staff also receive
training
through
the
Safeguarding Children Board and
the Adult Protection Team.
Figures from both of these
agencies for 2009 show that:
119 staff received Safeguarding
Children training in 2009
114
staff
received
Safeguarding Adults training
Infection Control
Infection Prevention and Control
is a key target for the NHS and
we are committed to ensuring
that the risks of healthcare
associated infections to our
service users are minimised.
ZERO
The number of new
cases of MRSA or
Clostridium difficile in
2009/10
Quality Account 2009/10
prevention and control and
their role in reducing infections
Promoting hand hygiene
through use of floor stickers
and hygienic hand rub
Participating in government
initiatives including the
“Clean Your Hands”
campaign and Infection
Control Week
An infection control charter
for service users, carers,
visitors and staff has been
developed.
Copies are
available in each ward area
and provide information on
standards and what can be
done to minimise the risk of
infection
Carole Clive: Nurse Consultant,
Ensuring that when
Infection Control
refurbishing a building or
We acknowledge that infection
designing a new one,
prevention and control is
infection prevention and
everyone’s responsibility. In
control is considered
addition, the infection prevention
and control team:
7 Day Follow-up (Post
Provide specific advice and
guidance
Ensure that appropriate
policies and procedures are in
place
Ensure clinical environments
are audited on an ongoing
basis
Make sure staff receive training
Ensure levels of infection in
both the community and
inpatient settings are
monitored and acted upon
Across the Trust there have been
a number of ongoing initiatives
to reduce infection:
Ensuring that staff attend
appropriate training so that
they understand infection
www.worcsmhp.nhs.uk
16
Discharge)
We are committed to providing
appropriate care for all those
with severe and enduring mental
ill health. It is important that we
follow-up quickly all service users
on the Ca re P rogra mme
Approach (CPA) when they are
discharged from hospital.
97%
87%
57%
2007/08
2008/09
2009/10
7 Day Follow-up 2007-2009
Quality Account 2009/10
17
Since 2007, when we followed-up
57% of patients post discharge;
we have shown continued
improvement, achieving 97% in
2009.
We are pleased with the progress
made to date in this area. Staff
are committed to ensuring the
safety of our service users and are
now reviewing and strengthening
their existing processes to
maintain this high level of 7 day
follow-up, and build on it
wherever possible.
Worcestershire Mental Health Partnership NHS Trust
Quality Account 2009/10
Patient Experience
18
We value the time taken by our service users and carers to work with us
to help us improve the Patient Experience. Feedback from our Service
User and Carer Advisory group, our Community Forum and service user
surveys provides essential insight into the way our services, staff and
buildings are viewed. We always aim to offer a positive experience for
everyone, and welcome feedback on everything from mealtimes to the
way we discuss treatments.
We learn from all the feedback we receive. In particular a complaint is
considered in great detail, with learning plans developed and shared
across the organisation.
The following section is a reflection of the feedback we received from
staff, service users, their carers and our commissioners. It captures a few
more details of what we have done in 2009/10 to improve the patient
experience.
Patient Environment Action
Team
Patient Environment Action
Teams (PEAT) assess every ward in
England. Teams are made up of
NHS staff, including nurses,
doctors, directors, service users
and community representatives.
In February 2010 four of
wards scored “Excellent”
environment.
The other
were “Good”, but most were
close to scoring Excellent.
our
for
five
very
Improvements and redecoration
planned for the next few months
should show an improvement in
our PEAT scores for the next
review.
www.worcsmhp.nhs.uk
Hillcrest is a lovely
building with some lovely
staff. It’s a shame that
you have to be very ill to
access the services.
We have started to do our own
housekeeping at the Newtown
site.
This has given us more
control over the quality of
services we provide resulting in
us:
Offering a wider choice of food
Reducing food waste
Improving overall cleanliness
Quality Account 2009/10
Community Forum
Our Community Forum has
undertaken studies in 2009/10
of:
19
In-patient catering
Display boards and leaflet
racks
External areas
As a direct result of the studies
by the Community Forum we
have:
Improved the menu options for
inpatients, offering a wider
choice and healthier menu
Increased the overall quality of
the mealtime experience to
improve the health benefits to
service users
Developed a policy for display
boards and leaflet racks
Redesigned the garden at Hill
Crest
Improved the upkeep of
grounds at Bromsgrove,
Malvern, Redditch and
Worcester
New Gardens at Hill Crest
Bought garden furniture for
our Kidderminster site
Effective Communications
Service Users Survey
Since 2006 we have undertaken
annual surveys of service users
who have had contact with us in
the previous 12-months. These
surveys are our main way of
seeing if we are meeting the
wishes of our service users and
finding ways to improve.
Environment
Food
Privacy & Dignity
Abberley and Clifton
GOOD
ACCEPTABLE
EXCELLENT
Athelon and Berkeley
GOOD
EXCELLENT
EXCELLENT
Church View
EXCELLENT
SELF CATERING†
EXCELLENT
Clent Ward
EXCELLENT
EXCELLENT
EXCELLENT
Cromwell House
EXCELLENT
SELF CATERING†
EXCELLENT
Harvington and Witley
GOOD
EXCELLENT
EXCELLENT
Hill Crest
GOOD
EXCELLENT
EXCELLENT
Keith Winter Close
GOOD
SELF CATERING†
EXCELLENT
EXCELLENT
SELF CATERING†
EXCELLENT
Osborne Court
Trust PEAT Results - Worcestershire Mental Health Partnership NHS Trust (February 2010)
† Self catering promotes user choice and independence
Worcestershire Mental Health Partnership NHS Trust
Quality Account 2009/10
The way we communicate with
our service users and their carers
has a direct impact on the patient
experience. The 2009 service user
survey told us how well our staff
talk with service users, their carers
and their families. The results of
the survey told us:
73%
felt they were told
about possible side
effects of their
medications
77%
felt their family or
someone close were
involved as much as
they would have liked
95%
felt they were given
enough time to discuss
their condition
This is a good start and we are
doing more work to improve
further.
20
“My Hospital Book”
What medication is being
taken, and when
How to tell how someone is
feeling
What help is needed with
everyday living
It also tells staff what not to do
and about things that might
cause upset or discomfort.
“My Hospital Book”
People with a learning disability
in Worcestershire can now visit
hospitals with more confidence
that their health needs will be
met.
The book contains personal
information about the extra help
people with a learning disability
might need when using health
services.
Whilst most people are able to
tell staff these things, for people
with a learning disability giving
such information has been a
problem. “My Hospital Book”
addresses this by putting all the
information in one place and we
would like to thank all those
people with a Learning Disability
who were fully involved in
making ”My Hospital Book”.
The booklet tells staff:
Who to contact
Of any allergies or dietary
needs
www.worcsmhp.nhs.uk
Quality Account 2009/10
Clinical Effectiveness
21
In addition to providing a safe environment and a good experience,
another area of quality we are interested in is Clinical Effectiveness.
Clinical effectiveness can be summarised as a range of quality
improvement activities and initiatives, including improving treatments
based on the views of service users, carers and staff.
Based on feedback from our consultation with service users and carers,
staff and our commissioners, the following section highlights 3 areas
where the Trust has improved clinical effectiveness during 2009/10.
Offering Treatment Choice
known as gate keeping.
Our Crisis Resolution and Home
Treatment (CRHT) service is crucial
in supporting service users.
During 2009/10 we have built on
this success, consistently assessing
between 90% and 100% of
admissions every month.
Wherever possible we offer
people the choice to be
supported in their own home as a
safe alternative to hospital
admission. This is recognised as
best practice.
In 2008/09, 70% of service users
admitted to acute wards were
first seen by CRHT to ensure
hospital treatment was the only
possible option.
This is also
2009/10
100%
80%
60%
2008/09
40%
20%
Rapid Access to
Programme (RAMP)
Medication
RAMP is targeted at difficult to
engage substance misuse service
users such as people who are
“rough sleepers” or who are
homeless, and those who have
had treatment before that has
not been successful. The
programme brings people into
the substance misuse service
faster than normal.
It is known that these people are
at high risk of physical and
mental health complications and
that their general health is often
worse than that of the general
population.
0%
A M
J
J
A
S
O
N D
J
F M
RAMP started in 2008, and aimed
to work with 60 homeless drug
“Gate-kept“ Admissions 2009/10
Worcestershire Mental Health Partnership NHS Trust
Quality Account 2009/10
users in its first year. RAMP’s aims
were to see:
A significant reduction in street
drug use
A significant reduction in
harmful behaviours particularly
injecting
A significant reduction in crime
More people helped with
housing, employment and
training
RAMP staff help the service users
to improve various aspects of
their lives such as:
The level of service I
have received has been
exceptional - nothing was
too much trouble for the
whole team.
22
They really liked the joint
support that they received
from the team
They compared it very
favourably with treatment they
had received in other services
Psychiatric Liaison
Their ability to live without
drugs
Their coping skills
Their confidence
Their access to housing,
education and voluntary work
During the first year RAMP
worked with 62 people and 40
either moved on to other
treatment or remained in the
RAMP programme. This is a good
success rate for this group of
people.
The service has received good
feedback from its users;
commenting that they would like
more services like RAMP across
the county and:
It was good to be able to get
into treatment quickly with
few barriers
They liked the “down-toearth” approach of the
programme
www.worcsmhp.nhs.uk
Deliberate Self Harm is a major
public health issue, resulting in
around 170,000 hospital
attendances per year. The risk for
suicide is 15 times higher for
people who self harm.
For
women this risk increases by 23
times.
Our Mental Health Liaison Service
started in May 2009. Its main aims
are:
To provide a service to all
people with deliberate self
harm who attend the Accident
and
Emergency
(A&E)
department s
at
Worcestershire Royal and
Alexandra Hospitals
To provide advice, support and
assessment to people with
mental health needs within
A&E
To provide a plan of care to
everyone admitted to A&E with
deliberate self harm
Quality Account 2009/10
To signpost service users and
their carers to the most
appropriate agencies following
discharge
23
To help A&E staff by offering
regular training about working
with people who have self
harmed or who have symptoms
of mental illness.
In 2009/10, the service received
1121 referrals. from both
Worce ste rshire Roya l a nd
Alexandra Hospitals.
What do service users and
Accident and Emergency staff
think about the new service?
95%
of service users asked
thought that staff
listened
When asked to describe the care
they received the most used
descriptions were:
Understanding
Helpful/Helpfulness
Good or Excellent
Listened/Listening
Kind/Caring
Respectful
The liaison staff were
extremely understanding
I am very appreciative of
their help.
What have we achieved?
All assessments resulted in high
quality care plans with
approximately half of those seen
being referred onto other mental
health agencies. This service is
helpi ng to mi nimise t he
occurrence of serious incidents for
people who are at high risk.
The Mental Health Liaison service
is linked with the Crisis Resolution
and Home Treatment service and
can therefore facilitate fast track
access to admission or Home
Treatment as appropriate.
The team has integrated itself
with the A&E departments and
established itself as a valued part
of the acute hospitals. The team
has also promoted its availability
and accessibility and made the
referral process simple and easy.
Staff working in A & E reported a
positive impact, especially in
relation to people being safely
discharged. They also said our
service had helped to identify and
address their training needs.
The majority of staff in
A & E said, in their opinion, the
service had a positive impact on
patient care. 75% said it had a
positive impact on discharge
planning.
Worcestershire Mental Health Partnership NHS Trust
Quality Account 2009/10
Staff Experience
Staff Wellbeing
Delivering high quality services is
a team effort.
We take the
health and wellbeing of our staff
very seriously and
monitor
wellbeing across the Trust.
During 2009/10 we worked with
staff
by
listening
and
understanding their concerns and
working with them to turn things
around.
We established a SWIFT group
which brings together staff of
different grades and from
different services to discuss issues
of concern and to work with
managers to address these. By
improving the support available
to staff, and helping them to
make positive changes, we are
working together to increase
staff wellbeing.
Staff who are supported, listened
to and have a rewarding place to
work are better placed to deliver
high quality care for our service
users.
www.worcsmhp.nhs.uk
24
The Staff Wellbeing Improvement
Focus Team was set up in June
2009 to promote health and
wellbeing at work.
Since it was established two
events have been held for staff to
discuss with senior managers how
we can ensure that:
STAFF feel valued and receive
recognition for all they do
WELLBEING and healthy
lifestyles are promoted and
encouraged
IMPROVEMENTS
in
communication are developed
and implemented
FOCUS is placed on individual
members of staff and their
development needs
TEAMWORK is fostered within,
and across services, in order to
achieve the best outcomes for
our service users and their
families
SWIFT has recently undertaken a
staff survey and the results will be
considered at the next staff
forum event.
NHS Staff Survey
In the autumn of 2009, the Trust
participated in the annual
national NHS staff survey.
Quality Account 2009/10
25
The key questions in the survey
were structured around the four
staff pledges set out in the NHS
Constitution, plus two additional
themes covering staff satisfaction
and equality and diversity. 30%
of the responses to the key
questions placed the Trust in the
top 20% of mental health/
learning disability trusts.
An action plan to address the
areas for improvement has been
developed. The focus for this
action plan is on improving:
Attendance/access to training
Internal communications
The appraisal process
The feedback to the reporting
of errors, near misses etc.
Worcestershire Mental Health Partnership NHS Trust
This action plan builds on the
work we have already done in the
following areas:
We have reviewed and
improved staff Team Brief
We have provided a staff
notice-board on our Intranet
We have introduced new
appraisal documentation
Staff have been offered
appraisal training
Throughout 2010/11 both the
Trust Board and staff will be
receiving regular progress reports
on the delivery of the action plan.
Quality Account 2009/10
Statements from Local Involvement Network, The
Health Overview & Scrutiny Committee and Primary
Care Trust
Worcestershire LINk congratulates the Worcestershire Mental
Health Partnership Trust (WMHPT) on its achievements. We
know that WMHPT communicates well with its stakeholders
and we look forward to the relationship with LINk being
strengthened here too. The establishment of a Partnership
Forum is proving successful with input from organisations not previously involved with
WMHPT. Three new forums are proposals for engaging people who have expressed an
interest in joining the prospective Foundation Trust (FT). There will be a significant delay
in establishing these after the current Forums are dissolved in June. It is feared by members
of the abolished forums that work they undertook will have no follow up in order to
maintain improvements. The new forums will be limited to members of the FT and not
open to the wider community.
We note that Assertive Outreach: Broken Engagement is seen as a priority for the coming
year and will follow progress with interest. Similarly, WMHPT’s work to develop a specialist
team for early intervention in Dementia service must be applauded. The information and
seminars made available to the community and members will help to highlight early
problems and services available. We note the work planned on Facilitated Early Discharge
and wish WMHPT well with this endeavour.
The review of services was improved by the appointment of Business Leads. Taking part in
national clinical audits is very important. We hope that unnecessary prescribing can
continue to be reduced and monitored. The quality of service users’ data is so important
and trust that staff were fully trained on how to implement data entries. It would be
helpful if the same data systems could be used across WMHPT and Social Care.
Safeguarding of children and vulnerable adults was given due attention.
We are pleased that WMHPT takes infection control so seriously. The Care Programme
Approach is a good initiative. We are aware that some service users are not made aware of
this and request that WMPT makes informing service users a priority.
PEAT scores are high and we congratulate WMHPT on this. The quality of the Patient
Experience is considered a high priority by the Trust. The work by the Community Forum is
recognized and acted on. ‘My Hospital Book’ is very useful asset and all carers and service
users who require this should have it available.
www.worcsmhp.nhs.uk
Quality Account 2009/10
Clinical work, especially with hard-to-reach potential service users, is essential and we are
pleased to note that WMHPT made such good progress with its RAMP team and those who
self harm. We are pleased to see that the management of work across acute and mental
health settings has improved.
Good quality staff training is essential to build a strong, committed and well-trained work
force. In order to maintain this it is essential that management committees are attended so
that issues are discussed fully and good decisions made. We are aware that a strong capital
building programme is planned and hope that this will be implemented soon, with service
users and staff kept informed of developments.
Statement from The Health Overview and Scrutiny Committee (HOSC)
This Quality Account gives a picture of the NHS provider services and the provided services
undertaken by Worcestershire Mental Health Partnership NHS Trust.
The Trust is exploring its approach to quality and quality improvements through its plans.
A key issue that had concerned Worcestershire County Council's Health Overview and
Scrutiny Committee had been the high rate of staff sickness and how this impacts on the
patient experience.
It is interesting to note the findings of the staff survey, that the rate of sickness absence
has increased and also the increase in the negative responses to the survey. The HOSC
acknowledges that mental health services are a difficult and challenging service area and
that sickness rates tend to be high nationally. The HOSC has noted that Worcestershire
Mental Health Partnership NHS Trust compares favourably with the national picture.
The HOSC welcomed the inclusion of Early Intervention in Dementia as one of the Trust's
priorities for improvement. The HOSC also welcomed that the Trust has detailed how it
will measure progress for its priorities for improvement.
The HOSC further welcomed the Trust's work to seek feedback from its service users and
carers.
Worcestershire County Council's HOSC looks forward to a continued improvement of
services.
Worcestershire Mental Health Partnership NHS Trust
Quality Account 2009/10
NHS Worcestershire is pleased to have the opportunity to comment on the Quality Account
for Worcestershire Mental Health Partnership NHS Trust. We can confirm that the
information within the Quality Account is accurate and fairly interpreted. As commissioner
of services from Worcestershire Mental Health Partnership NHS Trust we feel that the
report reflects the quality and safety priorities that have been jointly agreed. The report
provides a representative and balanced perspective of the quality of healthcare provided.
We are pleased to see the continued improvement in services particularly the improvement
in Dementia Services and the development of the Psychiatric Liaison Service. NHS
Worcestershire will continue to work with colleagues in the Worcestershire Mental Health
Partnership NHS Trust to monitor the quality and safety of services.
www.worcsmhp.nhs.uk
Quality Account 2009/10
tel: 01905 681 517
Produced by:
Worcestershire Mental Health Partnership NHS Trust
Isaac Maddox House
Shrub Hill Road
Worcester
WR4 9RW
email: pals@worcsmhp.nhs.uk
web: www.worcsmhp.nhs.uk