Quality Account
2010-2011
Ashton, Leigh and Wigan
Community Healthcare NHS Trust
Quality Account
2010-2011
Contents
Title
Page
1. Statement of Chief Executive Officer
4
2. Local Services
6
3. Regulatory Bodies and Management of Risk
9
4. Leadership and Development
13
5. Transforming Community Services and Productive Community Services
16
6. Quality, Innovation, Productivity and Prevention (QIPP) Framework
18
7. Statements for Partnership Working 20
8. Patient Safety (including Infection, Prevention and Control)
23
9. Lessons Learnt
26
10. Clinical Effectiveness
28
11. Patient Experience
31
12. Clinical Audit and Research Programmes
34
13. Performance Framework 36
14. Quality Improvement 2011/2012
40
15. Comments on Our Quality Account
43
3
1. Statement of Chief Executive Officer
We are pleased to present the first annual Quality Account for Ashton, Leigh and Wigan Community
Healthcare NHS Trust (ALWCH).
Three years ago, Lord Darzi produced a report on the NHS entitled, “High Quality Care for All”.
The report stressed the importance of delivering care which is as safe and effective as possible for
patients and ensures they are treated with compassion, dignity and respect.
Hospitals were urged to produce annual reports, highlighting their achievements and reflecting
feedback from local people.
This practice is now being rolled out to other NHS organisations to encourage their leaders and
Boards to examine the quality of the services they provide.
Boards are required to provide assurance to patients, the public and commissioners that every
aspect of their work is regularly scrutinised.
After working at “arms length” from NHS Ashton, Leigh and Wigan since 2008, the Primary Care
Trust’s provider organisation was established as an NHS Trust in its own right in November 2010.
From 31 May 2011 Ashton, Leigh and Wigan Community Healthcare NHS Trust became known as
Bridgewater Community Healthcare NHS Trust. This follows the expansion of the trust to cover
the provision of NHS community health services in Ashton, Leigh & Wigan, Halton & St Helens,
Trafford, Warrington and also delivers community dental services in the above areas plus Bolton,
Stockport, Tameside & Glossop and Western Cheshire.
Our new Trust has committed to achieving Foundation Trust status by April 2013.
Our purpose is the safe delivery of high quality care to the local population closer to home. We
believe that the Foundation Trust model will help us achieve this ambition, reinvesting surpluses to
improve our services which we will deliver efficiently and effectively. We will improve the service
experience offered to patients and engage the community, our patients, public and partners through
membership and governorship, to have a say in the direction and choices of our organisation
This first report focuses on the Borough of Wigan. Wigan is an area with high levels of poverty;
about a third of the population live in the most deprived 20% of places in England. Our service
delivery is located throughout the Borough to provide care in some of our most deprived areas. At
any point in the Borough patients are never more than two miles from one of our facilities.
The organisation puts the patient and family at the heart of all of its activities, placing the highest
priority on their experience of the care we deliver.
The means of measuring quality for community services, which cover the whole age range from
birth to end of life and a wide portfolio of specialities, are still being developed both locally and
nationally. Indeed, this Trust has played a significant part in the national Transforming Community
Services programme from its earliest days, redesigning services and creating a platform for change
that addresses the need to reduce unnecessary hospital admissions and tackle health inequalities
in the areas we serve.
We are working in times of significant financial challenge and have made every effort to ensure
that quality has not been compromised by economy and efficiency drives, embracing the Productive
Community Services programme which has been produced by the NHS Institute for Innovation and
Improvement and the “Inspire” services experience programme promoted by NHS North West.
This report demonstrates that we have accepted our local and national responsibilities to improve
quality, nurture innovation, increase productivity and enhance prevention of ill health.
The document reviews what has been achieved in 2010/11 and describes our priorities for quality
improvement for 2011/12.
4
Key achievements in 2010/2011:
• Patient safety – electronic incident reporting
• Patient experience – all services participate in the patient survey programme
• Clinical effectiveness – extent of clinical audit activity within services
• Service developments - establishment of Macmillan-funded Cancer and Palliative Care Allied
Health Professionals (AHP) Team in December 2010.
Plans for 2011/2012:
• To continue to work towards Community Foundation Trust Status
• To work with the Foundation Trust Network to develop Monitor’s existing Quality Compliance
Framework so that it is appropriate for use with community services. Bridgewater Community
Healthcare NHS Trust will work closely with commissioners to complete this work. This will ensure
that clinical quality and service performance continues to improve
• To work across the expanded footprint to continue to improve our patients’ experience.
We would like to thank all of the staff who have contributed to our first Quality Account. The
Account has been reviewed and the content agreed by the ALWCH Board.
To the best of our knowledge the information shared in this Quality Account is reliable, accurate
and represents a true picture of our organisation’s performance during 2010/2011.
Kate Fallon
Harry Holden
Chief Executive Officer
Chairman
5
2. Local Services
ALWCH formed care groups in 2007 following a review of services. Each care
group is made up of several multi-disciplinary teams, each with their own
delegated budget and a care group manager. This pioneering work helped to
inform the Transforming Community Services programme which was launched
nationally in 2009.
6
Children, Young People and Families Care Group
This care group focuses on the health and wellbeing of every child and young person in the Wigan
Borough. It ensures that children are healthy and safe. It also works with parents, carers and
families to maximise the potential of all children.
Its services are involved in safeguarding, prevention, acute interventions and palliative care, as
well as therapy to enable rehabilitation.
Services are delivered as close to home as possible within clinics, educational premises and where
appropriate in patients’ homes. Services are also delivered within a juvenile prison and in specialist
paediatric hospital out patient and in patient facilities. These represent the inclusive and integrated
nature of paediatric services with partner agencies within the local authority and the acute trust.
Health and Wellbeing Care Group
ALWCH recognises that all community practitioners have the opportunity to affect the health
and wellbeing of individuals, families and communities. It is the core function of this care group
to promote and support self-care (patients looking after themselves in a healthy way e.g. taking
medicine, doing exercise) and maximise opportunities to work with staff within other care groups
to promote health. It includes services delivering support to enable people to make key lifestyle
changes and better manage their health and wellbeing.
It also provides specialist nursing and therapy interventions for adults with a learning disability.
Services are delivered through specialist teams across community and local authority premises
as well as through community services such as podiatry, health visiting and district nursing. The
shape and location of service delivery is determined by integrating health and wellbeing messages
through education, leisure and social care provision.
Acute Care Closer to Home Care Group
This care group focuses on delivering quality acute care in the community. It provides assessments
and treatments previously only available in hospital settings and works with partner agencies to
prevent admission or re-admission and to reduce length of hospital stay.
The care group provides medical, nursing and therapy services. It delivers acute care within
community settings, including vulnerable people and hard to reach groups.
A borough wide service is delivered as close to home as possible, including home based provision
by a flexible and highly mobile workforce.
Long Term Conditions Care Group
This care group provides services to people with chronic illnesses that can limit lifestyle. It provides
clinical treatment and delivers personalised, responsive, holistic care in the full context of how
people live their lives. It provides information about the choices available locally to enable patients
to self-care in partnership with health and social care professionals.
Services work together to deliver integrated care pathways ensuring a smooth transfer of patients
across teams when patients’ needs change.
Services are provided within community premises and within patients’ homes. There is a strong
link with primary and acute care with staff offering flexible and patient centred support.
7
Independent Living Care Group
This care group adopts a philosophy of rehabilitation and re-ablement for all. It utilises its
multidisciplinary and inter-agency teams to deliver local person-centred rehabilitation.
The care group will ensure that all individuals have a safe, efficient and effective service, which
achieves and maintains maximum health and independence.
Services are delivered from community premises and in patients’ homes, in conjunction with social
care, primary care and acute partners.
Complex Community Care Group
This care group provides people approaching the end of their lives with high quality, accessible
care to enable them and their families to make important choices about how they want to be
cared for and their place of death. Competent and compassionate care allows patients a dignified
death and gives families support in bereavement. Nursing and therapy teams work together to
support patients and their carers to access key help and resources as required from teams across a
number of care groups.
Services are delivered in patients’ homes and in community facilities. They deliver integrated
treatment and advice with social care, the hospice and acute services in order to ensure seamless
and patient centred provision.
8
3. Regulatory Bodies and
Management of Risk
The Care Quality Commission
ALWCH is required to register with the Care Quality Commission and our
current registration status is compliant with no conditions of registration.
The Care Quality Commission has not taken enforcement action against our
organisation during 2010/2011.
ALWCH has participated in two special reviews by the Care Quality Commission
relating to the following areas during 2010/2011:
• Services for people who have had a stroke and their carers and
• Support for families with disabled children.
Following a review of stroke services, ALWCH will continue to work with NHS
ALW and Wrightington, Wigan and Leigh NHS Foundation Trust to improve
stroke care for patients and carers.
ALWCH is waiting for the results of the review regarding ‘Support for families
with disabled children’.
9
Data Quality
All NHS trusts have a responsibility to ensure their data is accurate and fit for purpose. High
quality information means better patient care and patient safety. Having high quality information
available will mean that clinicians have greater levels of confidence that they are advising patients
about the best care for them on the basis of accurate, up to date, complete information.
ALWCH will be taking the following actions to improve data quality.
Training Strategy
We are continuing to work to a training strategy that was agreed in 2008. This was implemented
in order to improve the quality of data collected via our information system; iPM (Lorenzo).
It also aims to address training issues with both newly trained staff and staff that have been
using the system for some time, but need refresher training.
Every new member of staff is trained and monitored for a number of weeks to ensure that
their data is correct and that any training issues are quickly rectified.
Data Quality Reporting
Data Quality Reports are available to clinical staff and their managers to allow data quality
errors to be identified and corrected. This enables teams to take responsibility for improving
the quality of data within their services.
Data Quality Drop-in Days
The Information Team holds drop in days which provide an opportunity for staff identified
on the data quality reports. The staff work through the records with the data quality and
training staff. Following the session, data quality staff will monitor the individual’s inputting
and any further issues identified will be addressed.
MIST (Management Information System Tools)
The Management Information System Tools (MIST) is used to produce management information
from the data inputted in to the Lorenzo system. Staff members record how they use their time.
This report takes the staff member to a website containing three sections:
• Group Data Quality
• Staff Data Quality
• Activity Chart. The information contained within these three sections provides managers with a vital resource to
help them evaluate staff performance and manage improvement.
10
NHS Numbers and General Medical Practice Code Validity
Ashton, Leigh and Wigan Community NHS Trust did not submit records during 2010/2011 to the
Secondary Uses Service for inclusion in the Hospital Episode Statistics which are included in the
latest published data.
However, a Community Information Data Set is now available for local implementation from the 1st
April 2011. The purpose of the proposed Community Information Data Set standard is to provide
national definitions for secondary uses data available from community healthcare providers in
England. It is intended to reflect the key information captured from any patient who is referred to
or is receiving a community healthcare service.
Clinical Coding Error Rate
ALWCH was not subject to the Payment by Results clinical coding audit during 2010/2011 by the
Audit Commission.
Information Governance (IG) Toolkit Attainment Levels
The IG Toolkit is used to assess whether an organisation has the necessary safeguards in place for
the appropriate use of patient and personal information.
The Information Quality and Records Management attainment levels assessed within the
Information Governance Toolkit provide an overall measure of the quality of data systems,
standards and processes within an organisation.
ALWCH NHS Trust Information Governance Assessment Report score overall score for 1st November
2010 to 31st March 2011 was 44% and was graded red.
ALWCH NHS Trust will be reassessed against the latest version of the toolkit for the period 1st April
2011 to 31st March 2012. This reassessment will take place before 31st July 2011. Robust action
plans will be put in place to show how we will improve the areas that may not meet the required
level of compliance.
11
Management of Risk
The Board understands its responsibility in ensuring that risk is effectively managed and is
committed to ensuring that risk management is fully embedded within the organisation’s culture
and processes. To achieve this we have a Risk Management Strategy and associated procedures
that are fully implemented throughout the organisation.
National Patient Safety Agency (NPSA)
NHS organisations make monthly submissions to the NPSA on patient safety incidents. NPSA develop
national initiatives and training programmes to reduce incidents and promote safer practice. We
get alerts from NPSA and assess them within the stated timescales. Action plans are put in place
where applicable to our organisation. At the end of the reporting period we were working on
three alerts to fully meet the recommendations. The alerts are:
• Essential care after an inpatient fall
• Safer ambulatory syringe drivers
• Preventing fatalities from medication loading doses.
NHS Litigation Authority (NHSLA)
The NHSLA handles negligence claims and works to improve risk management practices in the
NHS. All NHS organisations contribute to this insurance scheme and are audited to make sure that
robust and effective systems are in place to manage risks and incidents.
Our last assessment took place when we were still part of our local primary care trust (NHS ALW).
At this time the organisation was successfully assessed at level 1 by the NHSLA. The organisation is
waiting to be notified by NHSLA when the next assessment will take place. It is expected that this
will be within 12 to 18 months.
12
4. Leadership and
Development
Leadership
We believe that excellent leadership will enable ALWCH to achieve our vision
of delivering the highest quality, safe healthcare.
Leadership has been reviewed and developed at all levels within the
organisation to enhance existing skills. This work will ensure that ALWCH
has the skills to progress in our journey to become a Community Foundation
Trust.
Executive and Non Executive Directors have completed self and peer
assessments. The results have influenced a programme of board development.
We have also developed a leadership programme for all our team leaders based
upon the NHS Institute of Innovation’s Productive Leader Programme. This will
allow all team members to increase their skills, capability and confidence in
delivering high quality patient care.
13
In today’s NHS, we need to ensure that staff are able to work in new ways and in different
environments. To achieve this they need to extend and improve their skills. We are developing
career frameworks that provide the flexibility for staff to change roles and settings to meet the
response to changing patterns of care. All of our care groups develop workforce plans that reflect
medium to long term workforce requirements and succession planning.
All our staff are required to participate in an annual Performance Development Review (PDR). At
this meeting each individual’s competencies, skills and objectives are reviewed and agreed for the
following year. We believe that it is fundamental that all our staff recognise the importance of
their contribution to ALWCH NHS Trust achieving its objectives.
At the end of the 2010/2011 reporting period 49% of our staff had participated in a PDR. We
recognise that this figure needs to improve and our aim is to achieve 100 % compliance within
the following year. We are pleased to report that at the end of April 2011 this figure has already
improved to 71%.
We have chosen four examples of development during 2010/2011 to demonstrate the variety of
activities undertaken.
Leadership forum
A leadership forum has been established by the Divisional Director for clinical staff working at
Bands 7 and 8. The aim of the forum is to enhance the leadership skills of staff working at this level
in the organisation.
Safeguarding children training
Following a year of working hard to improve the number of staff completing safeguarding
children training, a report from E-Academy (the training provider) indicates that ALWCH has the
highest level of safeguarding training activity across all agencies within the Wigan Borough. The
e-learning company has used ALWCH as an example of good practice.
14
Supervision
All of our healthcare staff are required to participate in clinical supervision. Within an increasingly
complex health care system, the process of supervision offers support to professionals and acts as
a safeguard to the public.
The Supervision Policy has been reviewed to ensure that our staff gain the most from the process
and that the quality of patient care is enhanced.
Rewarding Excellence
We held our first staff recognition awards in September 2010. The awards celebrate the achievements
of those individuals and teams who have made a difference to patients, the organisation and have
demonstrated excellence in their work. Shortlisted individuals and teams had an opportunity to
share their experience and knowledge with colleagues during a series of presentations throughout
the day. There were five award categories – each of which reflects the ALWCH organisation values
– Open, Caring, Innovative, Expert and Efficient. An overall winner was also chosen from the
category winners.
We will hold our second ceremony in September 2011.
Some of our service developments in 2010/ 2011
• Assistant Practitioners qualified within the Learning Disabilities Team
• Specialist Dietitian post on Eating Disorders Team
• Integrated Health Services Team for vulnerable expectant mothers, babies and siblings
established, including Baby & Tots Speech and Language Therapist
• Community Cardiology/Respiratory Technician appointed as part of Care Closer to Home agenda
• Pilot of breathlessness pathway undertaken in partnership with a GP consortium.
15
5. Transforming
Community Services and
Productive Community
Services
The Transforming Community Services (TCS) programme aims to improve
community services so that they can provide modern personalised and
responsive care of a consistently high standard.
In order to organise the care we provide around the needs of our patients, we
established care groups in 2007. A considerable amount of work has taken
place since then and our work around Transforming Community Services (TCS)
has continued to build upon these developments.
Significant redesign of clinical teams took place during 2010/2011 and a
service transformation programme called Productive Community Services was
commenced. This programme aims to release more time for clinical staff to
spend providing direct care to patients. Clinical teams look at the way they
work and have permission to find new ways of working. This results in extra
time to care for patients.
16
Productive Community Services will be the way we achieve the Transforming Community Services
ambitions of:
• Getting the basics right
• Making everywhere as good as the best
• Delivering evidence based practice
• Developing and supporting people to design, deliver and lead high quality community services.
We began the Productive Community Services Programme in August 2010 and all clinical teams
within the organisation will go through the nine modules of the programme during the next two
years.
Already a physiotherapy team based at Leigh Infirmary has been able to increase the time available
for patient contact by 24%.
Other significant Transforming Community Services programmes have included our participation
in a National Mobile Health Worker Pilot study of mobile working technology solutions. This took
place with some staff across the following clinical teams during 2010/2011:
• Advanced Practitioners for Nursing Homes
• Community Matrons
• Intermediate Care Co-ordinators
• Community Development Workers
• Echocardiology Technician
• Community Matron (Neurology)
• Counselling Service
• Neurological Occupational Therapy
• Speech & Language Therapy
• Cardio-respiratory Team
• District Nursing Out-of-Hours Team
• Health Visiting.
Key findings of the review of the pilot included:
• Mobile working increased efficiency
• The devices helped to reduce admissions in those teams with that remit
• The devices helped clinicians reduce their “no access” visits by an average of 17% over the initial
three month period.
17
6.Quality, Innovation,
Productivity and
Prevention (QIPP)
Framework
The Quality, Innovation, Productivity and Prevention (QIPP) framework aims to
ensure that the NHS progresses from good to great. There is a drive towards a
more preventative and people-centred service that is better for patients. There
is also an expectation that NHS services will be more productive, capable and
resilient.
Our approach to Transforming Community Services and the QIPP agenda
is to promote a culture within the organisation that believes that quality
and productivity can co-exist. We also believe that safe services and patient
experience can be improved whilst costs are reduced.
Keeping people healthy, treating patients earlier to prevent complications and
reducing waste and errors are our key values. Implementing programmes of
work during 2010/2011 has ensured that we meet the challenges of improving
quality and increasing productivity whilst driving the development of a
healthcare culture that is true to the values of our organisation.
18
Our objectives and work streams for 2010/2011 are outlined below:
QIPP element
Some of the things we have done
Quality
• Team Leader Development Programme
Providing consistently good
care for every patient first time,
every time.
• Care pathway development.
• Implementation and compliance with NICE guidelines.
• Registration with the Care Quality Commission
• Professional advice and professional development
• Development of clinical competencies
• Communicate with public and Friends of ALWCH
Innovation
• Use of NHS Evidence search engine
Being able to think differently
about what we do, how we do
it today, and what we need to
do beyond tomorrow.
• Establishment of a Quality and Innovation Forum
• A staff suggestion scheme called ‘What’s the Big (or
Small) Idea?’
• Implementation of Rewarding Excellence Scheme
• Encourage staff to submit successful service
developments for regional and national awards
Productivity
• The Productive Community Services
Delivering the right care to
as many patients as is safely
possible with the same or less
resource.
• Care group service redesigns
• Improve accessibility and reduce waiting times
• Patient Access Policy
• Community Nursing Project
• Establishment of a Single Point of Access
• Increase availability of mobile technology
Prevention
• Promote a health lifestyle with all of our patients
Preventing harm to patients
and staff, at all times, whilst
avoiding unnecessary acute
admissions for patients.
• Work with Public Health to target deprived areas
• Implement the Make Every Contact Count framework
• Improved the way that we check staff hand washing
19
7. Statements from
Partners
We are required to send copies of our draft Quality Account for comment
to commissioners, LINkS and the Overview and Scrutiny Committee prior to
publication. Any comments offered must be included within the final published
version of the Quality Account.
NHS Ashton, Leigh and Wigan
‘Overall NHS ALW considers that the Bridgewater Community Healthcare NHS
Trust (formerly Ashton, Leigh and Wigan Community Healthcare) provides high
quality care for the patients of Wigan, and has shown continued progress in
setting its own quality agenda, and developing its own quality standards. We
are assured that the services provided are safe for patients, there have been no
incidents which have given cause for concern.
In terms of effectiveness we would encourage the organisation to continue
its process of auditing NICE guidance for compliance, as it is only through
observation of actual practice that compliance can be assured.
20
ALWCH scores well on existing patient experience surveys; our only concern as discussed in the Clinical
Quality Reviews, is that it would seem that in some services relatively few patients have completed
the forms, which begs questions about how representative the samples are. We suggest that the
total number of patients within a service be used to determine an appropriate sample size.
Provision of service data has proved quite difficult for ALWCH in the past, as it has for most
community services. However, current developments make this imperative as we move away from
block contracts and GP Commissioners will want to know what they are paying for. Such service
activity data will also prove useful for assessing quality, as by knowing total patient numbers we
can calculate percentage coverage and rates of events such as pressure ulcer incidence, which in
turn allows benchmarking.’
Overview and Scrutiny Committee
Wigan Council’s Adult Health and Wellbeing Scrutiny Committee welcomes the opportunity to
comment on the Quality Account of Ashton, Leigh and Wigan Community Healthcare NHS Trust and
also thanks the Chief Executive Officer for attending our June 2011 meeting to discuss the topic.
Although the Committee is not, at this moment in time, able to comment on particular facets of the
Quality Account with authority or expertise, it does acknowledge and support the Trust’s desire to
provide the safe delivery of high quality care to the local population closer to home. This can only be
achieved by agencies working together. The Quality Account certainly demonstrate engagement in
terms of practitioner, service users and the community at large to take services forward.
The Committee would also like to say that the format of the Quality Account is pleasing to the
eye which aids understanding. The Trust’s areas for improvement are clearly identifiable. The
Committee will monitor progress against these issues periodically.
The Committee endorsed the Trust’s application for Foundation Trust status and wishes it well in
taking this project forward.
The Committee will continue to develop working relationships with the Trust during 2011/2012.
21
Comments from Health and Care Together – the Wigan
Borough Local Involvement Network (LINk)
A Local Involvement Network (LINk) is made up of individuals and community groups who work
together to improve local health and social care services.
The LINk listens to local people to find out what they like and dislike about local health and social
services. They also work with the people who plan and run services with the aim of making them
better.
The Wigan Borough LINk is called Health and Care Together. They have supported ALWCH to
become one of the first Community Healthcare Trusts in the country.
Some of the comments that Health and Care Together has made about ALWCH during 2010/2011
are listed below:
• ALWCH has worked with the Health and Care Together Steering Group
• ALWCH has responded to issues received from the wider community over the past year
• Health and Care Together welcomes the commitment to bring services closer to home, promoting
health and wellbeing and to the prevention agenda
• The Steering Group was unanimous in their approval of the change of name to Bridgewater Community
Healthcare NHS Trust.
In the future Health and Care Together would like to see the following developments:
• Health and Care Together would like to establish a more formalised approach to involvement
with the Trust
• Now that ALWCH NHS Trust is working across a number of Boroughs there is a need for them
to continue networking with us and other neighbouring LINks to encourage better patient
participation at all levels.
22
8. Patient Safety
Patient safety is of utmost importance to everyone within ALWCH NHS Trust.
We want to protect the health and wellbeing of every patient we see.
Infection, Prevention and Control
Infection prevention and control continues to a priority for ALWCH NHS Trust.
ALWCH is working to ensure that standards about the prevention and control
of infection are rigorously followed by all staff members.
ALWCH continues to work with the ‘cleanyourhands’ campaign and ‘Essential
Steps to Safe Clean Care’ programme. Simple measures such as clean working
environments and good hand hygiene techniques are known to significantly
reduce risks from infection.
23
To ensure that these measures take place we are working on the following projects:
• We have developed a link practitioner network across the organisation
• The roll out of the Aseptic Non Touch Technique programme (ANTT) for all District Nursing and
Podiatry staff during 2010
• We have established a Community Premises Inspection Team audit based on the Patient
Environment Action Team ‘PEAT’ audit. These audits look at the cleanliness of patient areas
within buildings and some of the systems and processes followed by staff in relation to infection
prevention and control. Members of the public who have registered as Friends of ALWCH will be
involved in these inspections during 2011/2012
• One to one hand hygiene training with staff using UV light training tools.
All NHS acute trusts in England have had to monitor and report Meticillin-resistant Staphylococcus
aureus (MRSA) bacteraemia and Clostridium difficile infection rates. NHS Ashton, Leigh and Wigan
is responsible for monitoring and reporting all MRSA bacteraemia and Clostridium difficile within
the Wigan Borough. ALWCH is continuing to work closely with NHS ALW to further reduce the
number of these avoidable infections.
Following any reported incidents of Clostridium Difficile infection or MRSA in the blood stream,
the Infection Control Lead carries out a thorough look at the patient’s clinical care to try to identify
the reasons why the person has the infection. Where necessary, action is taken to reduce the risk
of further infection.
We are fully compliant with the Hygiene Code and the requirements of the Care Quality Commission.
ALWCH will continue to improve standards around infection prevention and control in 2011/ 2012.
Incident reporting
ALWCH continues to improve patient safety by learning from patient safety incidents that have
been reported. All staff are actively encouraged to report incidents and ensure that incidents are
reported in a timely manner. Each incident is reviewed by relevant managers and members of the
Risk and Safety Team to ensure that all appropriate changes are made.
2010/2011 has seen the introduction of online incident reporting across the organisation. This has
resulted in an increase in incident reporting and submission of reports to the National Patient
Safety Agency (NPSA).
Staff have found the online reporting system to be more accessible and easier to complete. There
has been a 146% increase in patient safety incident reports submitted by ALWCH to the NPSA.
Quarterly reports have routinely been submitted to our Integrated Governance Committee, the
organisation’s highest level subcommittee to the Board with responsibility for risk.
The risk management systems that we have in place are independently audited and reported
to the Board and the Audit Committee in order that the organisation has assurance that these
systems are robust and the Board is suitably aware of patient safety issues.
Service leads routinely meet together on a monthly basis to discuss all outstanding incidents,
risks, service improvements and other patient safety issues. We have a Patient Safety Group with
representation from across the care groups. This group monitors programmes of work to improve
safety such as the Patient Safety Express initiative and other ongoing work.
A patient safety incident (PSI) is defined as an incident reportable to the National Patient Safety
Agency (NPSA) National Reporting and Learning System (NRLS). In 2010 – 2011 877 patient safety
incidents were reported. The total number of face to face patient contacts for this period was
984,582. Therefore, the number of incidents that occurred equates to only 0.09% of the total
number of patient contacts.
24
The table below shows that three of our top four patient safety incidents during 2010 – 2011 relate
to pressure ulcers.
Patient safety incident
Number
Ulcer found on first contact
126
Ulcer acquired in community setting
81
Ulcer developed in other agency
69
Communication failure outside of team
64
Guidance issued by the National Institute of Health and Clinical Excellence (NICE) states that all
pressure ulcers that are grade 2 or above should be reported as a clinical incident. Compliance with
this guidance has led to a significant increase in the numbers of pressure ulcers being reported.
A Tissue Viability Group has been established to improve the care that these receive. The group
conducted a prevalence survey in December 2010 and it was found that less than 2% of patients
who were being treated by the District Nursing Service at this time had pressure ulcers.
The Tissue Viability Group is linking with a national programme called Safety Express to continue
to address care relating to pressure ulcers.
Safety Express
We are participating in a national improvement programme called Safety Express with Wrightington,
Wigan and Leigh NHS Foundation Trust as the host organisation. The programme aims to achieve
significant reductions in four avoidable harms and support improvements in productivity. The four
harms are:
• pressure ulcers
• serious harm from falls
• catheter acquired urinary tract infections
• venous thromboembolism (VTE).
This exciting programme is part of the North West strategic approach to improving patient safety.
We are also participating in the Safety Thermometer Survey of the prevalence of these four
avoidable harms. This is a complementary piece of work that will allow ALWCH to benchmark with
other NHS Trusts.
25
9. Lessons Learnt
Learning from information relating to patient experience is key to the continual
improvement and development of our services. ALWCH recognises that there
is a need to continue to learn and improve patient care from the information
received from a variety of sources. These include:
• incidents
• complaints and PALS (Patient Advice and Liaison Service) enquiries
• patient survey results
• staff survey results.
26
Listed below are some examples where issues were identified and actions were taken to make
patient care better:
• Following a complaint the assessment form for Paediatric Physiotherapy has been amended to
include additional information. The Gait Pathway has also been reviewed and amended so that
children who have difficulty walking are referred for more specialised care at an earlier stage
• A number of changes have been put in place at the GP Out of Hours Service. These include:
• Improved recruitment and training processes for doctors
• Audits are conducted on the performance of all the doctors
• A standard protocol has been issued to all doctors regarding the legibility of prescription notes
• Changes have been made to the Podiatry appointment system, referral processes and criteria for
access to help improve waiting times
• The telephone number for the Out of Hours District Nursing Service has been placed in a
prominent place on the front of the new care record that is given to patients
• The referral form that District Nurses receive has been re-designed to ensure that all appropriate
information is included.
In 2011/2012 we will look at ways to improve the learning that already takes place.
27
10. Clinical Effectiveness
Clinical Effectiveness is about making sure that everything we do is designed
to provide the best outcomes for patients. We want to ensure that the care we
deliver is clinically effective and evidence based.
Implementation of NICE Guidance
The National Institute for Health and Clinical Excellence (NICE) is an independent
organisation that provides national guidance on promoting good health and
preventing and treating ill health. NICE was set up in April 1999 to ensure that
everyone in England and Wales has equal access to medical treatments and high
quality care from the NHS.
Guidance from NICE exists to provide advice to NHS clinical staff, commissioners
and patients about those treatments that are clinically and cost effective.
ALWCH NHS Trust ensures that all relevant NICE guidance is reviewed by
teams within each care group and that action plans are in place if there are
recommendations that are not currently being met. All decisions are recorded
on a database and quarterly compliance reports are written for the Integrated
Governance Committee.
28
In the year from April 2010 to March 2011, NICE issued 124 guidance documents of which 24
of these documents were relevant to services within ALWCH. The organisation has declared full
compliance with nine of these 24 guidelines. There are currently 15 action plans in place where
services are working towards compliance.
Essence of Care
The Department of Health has produced a benchmarking toolkit as a national response to patient
concerns about care. The toolkit is designed to help staff members share and compare practice
and develop action plans to improve patient care. The ‘Essence of Care’ toolkit consists of patient
focused benchmarks for 12 fundamental aspects of care. These are: bladder, bowel and continence
care; the care environment; communication; food and drink; personal hygiene; prevention and
management of pain; prevention and management of pressure ulcers; health and wellbeing;
record-keeping; respect and dignity; safety and self care.
ALWCH NHS Trust is a member of the Greater Manchester Essence of Care Network (GMEC). This
is a supportive network of representatives involved in implementing Essence of Care from trusts
across Greater Manchester. Representatives meet regularly to agree the evidence for best practice
and devise benchmarking tools. Results are compared across the region allowing the identification
and sharing of good practice and areas for improvement.
GMEC produce their annual report in October 2010 and so the results reflected here are from
information that was collected between April 2009 and March 2010. During this time ALWCH NHS
Trust has participated in all six of the benchmarks that were examined by GMEC. The results of
these are listed in the table below.
Audit Title
ALWCH NHS Trust Results
Communication Organisation Report
Below regional average (by 1%)
Pressure Ulcer Management Below regional average (by 12%)
Hygiene Organisation Report
Above regional average (by 8%)
Safety Organisation Report
Above regional average (by 9%)
Record Keeping /Documentation
• Patient focus dataset Above regional average (by 3%)
• Risk dataset
Above regional average (by 13%)
Nutrition Organisation Report
Above regional average (by 5%)
In all areas except Pressure Ulcer Management, ALWCH NHS Trust is performing close to or above
the regional average. A working group has been established to examine and enhance pressure
ulcer management and it is expected that ALWCH NHS Trust will have an improved score when this
area is audited in the future.
29
Clinical Governance Development Plan
ALWCH is accountable and responsible for ensuring that the services provided are both safe
and of acceptable quality and that the organisation continuously strives to improve the overall
quality of care people receive. The Clinical Governance Development Plan identifies priorities
for improvement that cover a wide range of initiatives. The plan is written in line with the Care
Quality Commission’s Essential Standards of Quality and Safety.
At the end of March 2011, 44 out of 58 objectives have been completed. The actions that were not
completed have been moved to the Clinical Governance Development Plan for 2011/2012.
Medicines Management
Medicines play an important part in the care of patients. ALWCH has a part-time Medicines
Management Lead (pharmacist) and a full-time Non Medical Prescribing Lead (nurse) who support
and provide training to staff in the safe and effective use of medicines. The organisation has policies
and procedures in place to ensure patient safety from prescribed and administered medicines. In
addition to doctors, appropriately trained nurses within ALWCH prescribe medicines to enable
patients to receive treatment more quickly. The Medicines Management Lead is notified of all
reported incidents involving medicines and together with the Risk Team ensures that actions are
put in place to prevent any reoccurrence of similar types of incident.
30
11. Patient Experience
ALWCH wants to know how our patients feel about the experiences that they
are having when they are cared for within any of our services.
In order to monitor the patient experience, a cycle of surveys has been rolled
out across all the care groups. Nationally assured quality indicators are used.
Each care group carries out at least one survey per month and the results are
monitored and fed back to the services as well as reported to our Board.
31
The table below shows some the results of the surveys for each Care Group for 2010/2011.
It identifies:
• Overall satisfaction with the service
• How satisfied patients were that they were treated with Dignity and Respect.
• Whether patients were seen on time or satisfied with their wait
Care Group
Overall
satisfaction with
the services
How satisfied
were you that
you were treated
with dignity and
respect?
Were you seen on
time or satisfied
with your wait
Acute Care Closer to
Home
92%
96%
82%
Children, Young
People and Families
94%
100%
92%
Complex Community
Care
96%
99%
82%
Health and
Wellbeing
97%
96%
76%
Independent Living
91%
97%
88%
Long Term Conditions
91%
95%
89%
As the survey results to date have been very positive and have shown a very high level of satisfaction,
we have set the bar very high to measure the results. In 2011/2012 any results that are below 90%
will be examined and any that are below 80% will be treated as a priority for further action.
The red score of 76% in the Health and Wellbeing Care Group is in relation to the length of time
patients are waiting for their counselling sessions to begin. The counselling service has recently
undergone a service re-design and has action plans in place to reduce the length of time that people
are waiting. This will be monitored by further satisfaction surveys in 2011/2012.
These are some comments that have been received from patients
• “Everyone concerned is very obliging. Thank you very much”. - Long Term Conditions - Chronic
Obstructive Pulmonary Disease (COPD)
• “Found the people kind, helpful and they didn’t rush you. Also because I need a return visit
it was explained what problems I had and if I agreed. Very dignified” - Independent Living –
Mobility Service
• “A very supportive service who liaises well with other professionals and keeps all informed and
included in process” - Health and Wellbeing – Adult Learning Disability Service
• “Thank you so much for your help and support“ - Children, Young People and Families – Children’s
Learning Disability Service
• “Very well looked after by the team and now more confident about going home” Acute Care
Closer to Home – Access to Community Services Team
• “The support meant such a lot to all the family” - Complex Community Care, MacMillan Team
32
Programme Endeavour
ALWCH has commissioned a research project to monitor patient experience. This is being carried
out by Salford University. The aim of the project is to explore the quality of service delivery as it is
experienced by service users. It focuses on the ways that people make sense of what has happened
to them through the stories they tell.
This is being done by carrying out in depth interviews with patients from each of the care groups,
drawing out their actual experiences of using the services and using their narratives to inform
quality improvements.
Complaints
We aim to learn from both compliments and complaints as a part of improving the patients’
experience.
During 2010/2011 we received 38 complaints. These were divided across a range of issues. Themes
are summarised in the table below.
Theme of complaint
Number
Clinical treatment/diagnosis problems
18
Appointment waiting times
7
Attitude of staff
3
Nursing care
3
Aids and appliances
2
Customer care
2
Patient’s privacy and dignity
1
Referral problem
1
Equipment
1
Every complaint received is investigated to fully understand what has happened and to actively
seek the lessons that can be learned from it. Complaints are reported to the Board within the
Patient Experience Report.
A patient story is now presented to the Board each month. This is a compelling way to illustrate
the patient’s experience. This ensures that every patient’s experience is at the core of all work that
is carried out by staff at all levels in the organisation.
33
12. Clinical Audit and
Research Programmes
ALWCH aims to deliver high quality care which is measured through Clinical
Audit. This takes place within the organisation and through external audits.
Auditing our clinical practice is an essential part in ensuring effectiveness.
Clinical guidelines define best clinical practice; it is clinical audit that investigates
whether best practice is being carried out.
During April 2010 to March 2011 one national clinical audit covered NHS
Services that ALWCH provides. There were no confidential enquiries that
related to ALWCH’s services.
During this period ALWCH participated in 100% 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 ALWCH
was eligible to participate in during April 2010 to March 2011 inclusive are as
follows:
34
The National Falls & Bone Health Audit
The National Falls & Bone Health Audit for 2010 was in two parts. The first part required that
ALWCH complete an organisational questionnaire. This was fully completed and submitted. The
second part did not involve ALWCH because cases to be reviewed were to be identified and
reviewed by the local acute trust. The report for the National Falls & Bone Health Audit is due for
publication in May 2011.
National Clinical Audit of Continence
ALWCH reviewed one national clinical audit report during 2010/2011. The National Clinical Audit
of Continence was included in the list of National Clinical Audits for the Quality Accounts (NHS
Foundation Trusts) for 2009/2010 and they published their combined organisational and clinical
report in September 2010. ALWCH met nine of the 11 applicable report recommendations and
action plans are in place to meet the two recommendations that were not fully met.
Local Clinical Audits
ALWCH published 22 clinical audit reports for a wide variety of clinical teams during 2010/2011.
These included:
• Audit of Management of Obese and Overweight Children at Development Review NICE CG43 (priority audit)
• Re-audit the Effectiveness of Staff Knowledge re Standard Operating Procedures Controlled
Drugs (3rd Cycle)
• Re-audit of Antibiotic Prescribing for Respiratory Tract Infections (NICE CG69) - Priority Audit
• Re-audit of Hand Hygiene (Cycle 2 and Cycle 3).
All of these audits have action plans with identified completion dates in place to ensure that the
recommendations are met. The audit regarding the Referral, Assessment and Intervention within
Adult Learning Disabilities (Cycle 2) identified that all standards were being met and an action
plan was not required.
Commitment to research as a driver for improving the quality
of care and patient experience
ALWCH has a Research Sub-group that is attended by clinical staff representing each of the care
groups. In April 2010 a research seminar for staff took place with the aim of encouraging staff to
explore suitable topics for research. A further seminar took place in May 2011.
During 2010/2011 37 patients receiving NHS services provided or sub-contracted by ALWCH NHS
Trust were recruited to participate in research approved by a research ethics committee. This figure
is for UKCRN (United Kingdom Clinical Research Network) Portfolio studies only.
ALWCH was involved in conducting 35 clinical research studies in primary care, 17 of which were
approved during 2010/11, with sub-specialities of cancer, diabetes, musculoskeletal, and medicines
for children.
35
13. Performance
Framework
ALWCH measures performance against a range of targets set by NHS Ashton,
Leigh and Wigan - our commissioning PCT. These targets are designed to
improve access to services, improve the quality of care delivered to patients
and improve the health of the local population.
Several initiatives to improve efficiency, patient experience, access to services
and improve service monitoring were implemented throughout 2010/2011.
36
These initiatives are:
• Patient Pathway Reviews which set out to ensure that resources are focused on the important
interventions and care packages that are shown to improve outcomes for patients
• Improvements in quality of information recorded about patient care so that patients and GPs
have better information about what patients need and how their care is delivered
• Improved recording of patient contact across all care groups so that the organisation can identify
areas upon which to build and develop
• The re-introduction of a Management Information System Tool (MIST) to enable managers
to spend more time on the front line working alongside healthcare professionals to improve
patient care.
The initiatives described above have succeeded in further improving efficiency throughout the
year. Despite the challenging financial climate, the number of patient contacts and the number of
care packages delivered has seen an increase.
Patient Access Policy
A Patient Access Policy was introduced within 2010/2011 with the aim of improving access to
services for patients. This has impacted positively on both waiting times and numbers of patients
waiting to receive their first appointment. Adoption of an ‘opt-in’ policy for appointments has also
had further positive impact for certain services where it was deemed appropriate.
Review of Services
During 2010/2011 ALWCH provided and sub-contracted a total of 74 NHS services.
ALWCH has reviewed all the data available to them on the quality of care in 74 of these NHS
services. (74 is based on the number of service level agreements during the reporting period).
The income generated by the NHS services reviewed in 2010/2011 represents 98.8% of the total
income generated from the provision of NHS services by ALWCH for 2010 /2011.
37
Commissioning for Quality and Innovation (CQUIN)
A proportion of ALWCH’s income in 2010/2011 was conditional on achieving quality improvement
and innovation goals agreed between the organisation and NHS Ashton, Leigh and Wigan through
the Commissioning for Quality and Innovation payment framework.
The CQUIN payment framework aims to support the cultural shift towards making quality the
organising principle of NHS services, by embedding quality at the heart of commissioner-provider
discussions. It is an important lever to ensure local quality improvement priorities are discussed and
agreed at board level within and between organisations. It makes a provider’s income dependent
on locally agreed quality and innovation goals (1.5% on top of actual outturn on 2010/2011).
The use of the CQUIN framework demonstrates our active engagement in quality improvements
with our commissioners.
ALWCH has achieved the required targets set for five out of the six reportable indicators at the end
of Quarter 4 2010/2011 and the return has been be submitted to NHS ALW for ratification.
Indicator
Minimum data set
Breastfeeding
Target Achievements
Achieved
Not achieved
Chronic Obstructive Pulmonary Disease
Achieved
Falls
Achieved
End of Life
Achieved
Readmission avoidance (home visits)
Achieved
Weight Management in Insulin Independent
Diabetes Mellitus and Cardio-vascular Disease
Achieved
The financial implications of not achieving the Breastfeeding Measure within Quarter 4 are a loss
of £51,712 to the organisation.
The CQUIN indicators for 2011/2012 are listed in section 14.
38
Clinical Quality Dashboard
During the early part of 2010/2011 ALWCH developed a corporate dashboard to present to
the Board. This consists of high-level Key Performance Indicators (KPIs) that the organisation
would measure itself against. KPIs are now commonly used in the NHS to examine and compare
performance across organisations.
KPIs are organised into categories supporting the organisation’s objectives. The dashboard shows
the performance for the current month and for any previous quarters.
The idea behind the dashboard is to present our Board with the high-level picture of performance
including the ability to view more detailed information if needed.
Prison Healthcare Indicators
ALWCH is responsible for health care services at Her Majesty’s Young Offenders Institute (HMYOI)
in Hindley. The quality of health care at the prison was assessed in May 2010 against a series
of indicators. The assessment looked at 37 indicators and Hindley HMYOI was found to be fully
compliant (green) with all of the indicators except one. This related to Hepatitis B vaccination that
had been refused by some of the service users. An action plan has not been developed as there is
further discussion taking place regarding the issue of refusal.
Clinical Quality Review Meetings
It is necessary that senior staff from ALWCH meet with NHS ALW to fulfill the requirements of the
NHS standard contract. The purpose of this meeting is for NHS ALW to review ALWCH’s performance
with regard to clinical quality. A broad range of clinical quality topics are reviewed at each bimonthly meeting. This assures NHS ALW of the clinical quality that is being delivered by ALWCH.
Staff Survey
The NHS Staff Survey helps trusts to review and improve the work experiences of their staff so that
they can provide the best care to patients. The survey took place between October and December
2010 and reports 38 key findings about working in the NHS.
A summary of the results is given below:
• The survey indicates that ALWCH is in the top 20% of trusts regarding 10 of the 38 key findings
• ALWCH is average or above in 20 of the 38 key findings
• ALWCH is below average with 18 of the 38 key findings. This includes being in the lowest 20%
of trusts for nine key findings.
ALWCH recognises the importance of having valued and motivated staff and we will be developing
action plans to address the issues raised in the staff survey.
39
14. Quality
Improvements 2011/2012
ALWCH is committed to delivering the highest quality of care to our patients.
We believe that we have established a firm foundation upon which to build
further quality improvements within all of our services. The priorities for
quality improvement will continue to be:
• patient experience
• patient safety
• clinical effectiveness
40
CQUIN for 2011/ 2012
The following CQUIN indicators have been negotiated with NHS Ashton, Leigh and Wigan for
2011/2012:
• Increase the number of breastfeeding mothers at six weeks
• To safeguard children through increased assessment and referral to integrated targeted services
for children and families
• Support smokers who access ALWCH services to quit smoking by ensuring that staff have appropriate
skills, competence and knowledge to raise health issues with patients and signpost to appropriate
support services/advice (Implementing the ‘Making Every Contact Count’ programme)
• Audit of the care experienced by people on the Integrated Care Pathway for the Last Days of Life.
The main challenges facing the care groups in 2011/2012 will be the changes anticipated within
the public health sector. In particular it will be of critical importance to deliver against ‘Essential
Public Health’ and ‘Making Every Contact Count’ which are some of the new CQUIN targets set
for 2011/2012.
Key Performance Indicators and Clinical Quality Dashboards
Key Performance Indicators (KPIs) enable organisations to look at the quality of services delivered
and ensure that that the quality of services continues to improve.
Our agreed indicators focus on patient safety, clinical effectiveness and patient experience. These
are regularly reported to the ALWCH Board.
During 2011/2012 ALWCH NHS Trust faces the challenge of redefining the corporate dashboard to
incorporate the performance of all its new divisions. This will be an organisational priority for the
forthcoming year.
41
Clinical Governance Development Plan and Clinical Audit Plan
A Clinical Governance Development Plan and a Clinical Audit Plan for 2011/2012 have been collated
and this will drive forward a range of clinical improvements that will benefit patients.
Productive Community Services
ALWCH plans to continue with the roll out of this programme to ensure that the majority of teams
have started the programme by the end of March 2012.
Quality Developments for 2011/ 2012
We have listed below some of the developments that our services will be working on in the
forthcoming year:
• Implementing revised podiatry waiting list system
• Implementing single patient use instruments instead of single use instruments that are disposed
of after each use
• Working practices are being reviewed to reduce waiting times for treatment within Falls and
Community Physiotherapy
• To complete a clinical audit in relation to patient falls (based on NICE guidelines)
• Reviewing and updating equipment leaflets (occupational therapy)
• Reviewing and updating patient information booklets within the Community Neurosciences Team
• Reviewing clinical documentation systems within the Community Neurosciences Team
• Review the method of obtaining and recording informed consent within the Community
Neurosciences Team
• Participate in the National Audit of Parkinson’s Disease
• Roll out of the Essential Public Health Training across the Ashton, Leigh & Wigan Division of the
Bridgewater Community Healthcare NHS Trust
• Implementation of Making Every Contact initiative across services in the Ashton, Leigh & Wigan
Division of the Bridgewater Community Healthcare NHS Trust
• Developing a programme with an identified GP practice to support doctors with cervical
screening for ladies with a learning disability
• Adult Learning Disability service is working towards implementing the Transforming Community
Services outcome measures
• Introduced psychometric measures into the Counselling Service based on recommendations
from NICE.
In 2011/2012 we will continue to develop additional quality initiatives to ensure that all people
who use our services have the safest care and the best possible experience.
42
15. Comments on Our
Quality Account
We would like to hear your views on the content of our first Quality Account
so that we can improve next year’s document.
• Did you find the Quality Account useful?
• Was it written in a way that you could understand?
• Is there anything else that you would like to see included in our next
Quality Account?
You can provide your comments by contacting:
Clinical Governance Manager
Telephone number 01942 482652
43
Notes:
44
Notes:
45
Notes:
46
Ashton, Leigh and Wigan Community Healthcare NHS Trust is now
known as Bridgewater Community Healthcare NHS Trust
Headquarters
Bevan House, 17 Beecham Court,
Smithy Brook Road,
Wigan, WN3 6PR.
Tel: 01942 482630
Email: enquiries@alwch.nhs.uk
www.alwch.nhs.uk