Barnet Community Services (BCS)
Quality Account 2010/11
30 June 2011
Publication date: 30 June 2011
1
ContentsPart1
Statement from Director of Nursing & Quality (Barnet Primary Care Trust 2007-2011) ............ 3
About this Quality Account ................................................................................................... 4
Purpose of this document ..................................................................................................... 4
Introduction to Barnet Community Services (BCS) .................................................................. 5
Formal statements required by the Department of Health ..................................................... 7
Review of quality performance 2010-11 ...............................................................................12
Priorities for improvement ...................................................................................................30
Statement from Associate Director of Barnet operations ......................................................32
2
STATEMENT FROM DIRECTOR OF NURSING & QUALITY (BARNET PRIMARY CARE
TRUST 2007-2011)
This is the first time that Barnet Community Services have published a
quality account and this provides them with an opportunity to review
the quality of their services and prioritise areas of improvement for
2011-12.
On the 1st April 2011 Barnet Community Services joined Central London
Community Healthcare NHS Trust to form one new community health
organisation, and I believe that this will provide them with an exciting
opportunity to deliver high quality services that are integrated and
closer to home. Healthcare is constantly changing and becoming more
responsive to the needs of a modern society, Barnet Community
Services have demonstrated in this account the steps they have taken to
respond to this.
The priority areas that have been identified for 2011-12 incorporate the views of patients and
their families, clinicians and other stakeholders. Additionally there is significant research to
suggest that improvement in these important areas do make a difference to the quality
outcomes for patients.
1. Improve our risk assessment of patients in our care by implementing falls, nutrition and
skin risk assessment into our in patient and district nursing services
2. Continue to gather detailed understanding of patient experience in order to improve
quality
3. Development of our clinical staff to deliver a therapeutic relationship with our patients
and clients that is built upon compassion, dignity and care
4. To fully implement the High Impact Actions for Nursing and Midwifery and the revised
Essence of Care Benchmarks
5. Review clinical demand across district nursing services analysis specific clinical practice
Central London Community Healthcare NHS Trust will be monitoring the performance of quality
through their governance arrangements and ultimately through their Trust Board. Through
these times of transitional change there is an even greater need to ensure quality is integral to
all service provision. As the departing Director of Nursing & Quality I would strongly remind the
trust to keep safeguarding children and vulnerable adults on your radar at all times, as the
measure of a good service is not how we treat the general population but how we respond to
the needs of the most vulnerable in society.
I declare that to the best of my knowledge the information contained in this Quality account is
accurate.
Alison Pointu
3
ABOUT THIS QUALITY ACCOUNT
This is the Barnet Community Services Quality Account relating to the period 2010/2011 until
the merger with Central London Community Healthcare NHS Trust (CLCH) on 1st April 2011. As
of this year, there is a new requirement from the Department for Health that all community
healthcare providers should produce a Quality Account.
PURPOSE OF THIS DOCUMENT
Summary of this section
• Quality Accounts are annual reports to the public about the quality of NHS services
• Their main purpose is to encourage NHS providers to take a robust approach to quality
• They do this by making providers more accountable to patients and public
• This is our first Quality Account – as of this year, there is a new requirement from the
Department for Health that all community healthcare providers should produce a
Quality Account
• The Quality Account includes two main sections:
o A review of how we performed last year, covering the three main areas of quality:
safety, patient experience and effectiveness
o A set of key priorities for improvement next year, and plans for how we will
measure that improvement
The Health Act 2009 sets out the duty for all providers of NHS community healthcare services in
England to produce Quality Accounts: annual reports to the public on the Quality of services
they deliver. This is our first Quality Account.
According to the Department for Health, “Quality Accounts aim to enhance accountability to the
public and engage the leaders of an organisation in their quality improvement agenda.’’ They
provide information about the quality of the services which that organisation delivers. By
publishing their Quality Account each provider led by their Board, is committing to improve the
quality of care it delivers locally and inviting the public to hold them to account.
The public, patients and others with an interest will use a Quality Account to understand:
• What an organisation is doing well;
• Where improvements in service quality are required;
• What the organisation’s priorities for improvement are for the coming year; and,
4
•
How the organisation has involved people who use their services, staff, and others with
an interest in their organisation in determining these priorities for improvement. “1
For further details around Quality Accounts, please see the NHS Choices website:
http://www.nhs.uk/aboutNHSChoices/professionals/healthandcareprofessionals/qualityaccounts/Pages/about-quality-accounts.aspx
INTRODUCTION TO BARNET COMMUNITY SERVICES (BCS)
Barnet Community Services provides healthcare outside of hospital in Barnet and provides care
for approximately a population of 325,000.
BCS provides a range of services by the highly
committed teams that comprise Barnet Community
Services. In the past year we have made great
progress to improve access to treatment by growing
the services that are already in place, reducing waiting
times, delivering immunisation programmes and
offering people more of the services they really need,
where they need them.
Our Vision is to provide outstanding
health services, responsive to the local
communities we serve, and to deliver
high-quality care when and where it is
needed.
2010/11 has been a very successful year, with some of
the key achievements including triaging and treating
over 100,000 people in our Walk in Centres (WiCs),
having contact with over 550,000 patients and service
users in community settings and successfully managing
over 800 inpatient admissions.
1
Department for Health, 2010, “Quality Accounts toolkit 2010/11”
5
Barnet Community Services (BCS) and
Central London Community Healthcare
NHS Trust (CLCH) merged on 1st April
2011. How have we have covered this
in our Quality Account?
The merger on 1st April 2011 was after
the end of the 2010/11 year, which is
the period covered for this report.
Therefore CLCH produced a separate
Quality Account for 2010/11.
Although the two documents are
separate, we have worked together to
ensure that our priorities for
improvement are aligned. From next
year we will produce a single Quality
Account covering the whole of CLCH
across four boroughs
You can find the CLCH report here
www.clch.nhs.uk
Key facts about BCS
• Medium sized Community Provider (London)
• Good reputation
• Strong performance history
• Track record for innovation
• High level of service user satisfaction expressed
• Due to become part of an aspirant Community Foundation Trust from 1st
April 2011
• £50 million turnover
• Approximately 1,000 staff (800 W.T.E)
• 750,000 patient contacts for 2009/10 (not including day surgery or OPD)
• 100,000 attendances in WIC’s (7% growth year on year currently)
• 65 beds (14 stroke) – occupancy currently approximately 95%.
6
FORMAL STATEMENTS REQUIRED BY THE DEPARTMENT OF HEALTH
Statement from the Care Quality Commission (CQC)
BCS is required to register with the Care Quality Commission and its current registration
status is fully registered. The Care Quality Commission has not taken enforcement action
against BCS during 2010-11.
The CQC visited Barnet Community Services on the 2nd of June 2010 to inspect the Edgware
Community Hospital and Finchley Memorial in patient wards for cleanliness and infection
control. The inspection consisted of 14 measures. The overall judgement that the inspection
gave was that they had minor concerns about the provider’s compliance with the regulation
on cleanliness and infection control.
The inspection report indicated that on the 14 measures inspected 11 had no areas of
concern and 3 areas for improvement. To address the outcome of this report, an action
group was convened consisting of the Director for Quality and Performance, Barnet
Community Services (BCS) (who is also the Director of Infection Prevention and Control
(DIPC)), the DIPC for NHS Barnet, the Head of Infection Control NHS Barnet, Infection control
nurse, BCS and Head of Estates, NHS Barnet. This group compiled a joint action plan to
ensure engagement and consistency with completing actions across provider services and
the commissioning organisation. This action plan has been presented to both BCS and NHS
Barnet’s Integrated Governance Committees and remained a standing item on their agendas
for oversight and scrutiny until all actions were completed.
Our actions to improve data quality
The type and detail of information we collect has been improved over the past year, and staff
training has addressed many of the issues we had. To do this we have had support from
Information Technology project managers who have worked with us to tailor the data we collect
and the systems we have in place. We have more work to do to be able to have up to date
accurate information which is produced in balance score card styles which helps us to react
more quickly to issues in services and the needs for change, however we have made
considerable improvements in 2010/11.
The Trust’s Information Governance (IG) framework, including Data Quality (or ‘Information
Quality Assurance’) policy, responsibilities/management arrangements are embedded in the
Trust’s Information Governance and Information Management & Technology Security Policy.
7
Information on quality assurance
BCS has established and maintains policies and procedures for information quality on:
• Assurance and the effective management of records.
• Undertakes and commissions annual assessments and audits of its information quality
and records management arrangements.
• Data standards are set through clear and consistent definition of data items, in
accordance with national standards.
• BCS promotes information quality and effective records management through policies,
procedures/user manuals and training.
BCS will be taking the following actions to improve data quality through:
• Further training of staff.
• Improved data quality monitoring mechanisms.
NHS number and general medical practice code validity
BCS did not submit records during 2020-11 to the Secondary Uses service for inclusion in the
Hospital Episode Statistics which are included in the latest published data.
Information governance toolkit attainment levels
The BCS Information Governance Assessment Report score overall score for 2010-11 was 60%.
Below is a summary of the scores from the IGT V8 for this year and last year.
IG toolkit initiative
2009-10
2010-11
Scores
1 - Information Governance Management
80%
80%
2 - Confidentiality & Data Protection Assurance
73%
66%
3 - Information Security Assurance
71%
62%
4 – Clinical Information Assurance
75%
53%
5 - Secondary Use
71%
33%
6 - Corporate Information Assurance
83%
44%
Total
75%
60%
Clinical coding error rate
BCS was not subject to the Payment by Results clinical coding audit during 2010-11 by the Audit
Commission.
8
Participation in clinical audit
During 2010-11, two national clinical audits and zero national confidential enquiries covered
NHS services that BCS provides. During that period BCS participated in two and zero National
Confidential Enquiries of the national clinical audits and national confidential enquiries which it
was eligible to participate in. The following table shows the national clinical audits and national
confidential enquiries that BCS was eligible to participate in during 2010-11, and which of those
in which we actually participated:
National clinical audits & national confidential enquiries for which BCS was eligible in 2010-11
– and those in which we actually participated
Service
Title
Type of project
Borough
BCS participated
Falls
National
Falls National clinical Barnet
Yes
and Bone Health audit
Audit
Continence
National Audit of National clinical Barnet
No
continence care
audit
Stroke
Stroke Sentinel National clinical Barnet
Yes
Audit
audit
The reports of 30 local clinical audits were reviewed by the provider in 2010-11 and BCS intends
to take the following actions to improve the quality of healthcare provided:
Major planned improvement actions resulting from local clinical audits conducted during
2010-11
Service(s)
In patient
rehabilitation
In patient
rehabilitation
All services
Safeguarding
Audit
Major planned improvement actions
Deteriorating
patient Implementation of Bristol MEWS observation
initiative
chart
Medicines Management
Implementation of a Medicines Management
competency framework and workbook for
nurses
Resuscitation Equipment Additional staff awareness sessions on good
resuscitation practice
Updating and standardizing equipment across
services
Single displayed equipment checklist list
Record keeping
Additional staff awareness sessions on good
record keeping practice
Abbreviations list
9
Participation in research
1. BCS is the lead organisation in a regional innovations research project with Brunel University
examining the use of console technology in clinical practice. BCS is also applying for Regional
Innovation Funding for the continuation of the research project 2011/12.
2. Cross sectional study looking at the prevalence of non motor symptoms and their impact on
the quality of life in patients with idiopathic Parkinson’s disease.
10
Use of the CQUIN payment framework
2010-11 framework:
CQUINs
The CQUIN payment framework enables commissioners to reward excellence, by linking a
proportion of healthcare providers' income to the achievement of local quality improvement
goals. Since the first year of the CQUIN framework (2009/10), many CQUIN schemes have
been developed and agreed.
Its aim is to support the vision set out in High Quality Care for All of an NHS where quality is
the organising principle. The framework was launched in April 2009 and helps ensure quality
is part of the commissioner-provider discussion everywhere. For the financial year
2010/2011 BCS agreed seven CQUINs with NHSB. These included:
• Smoking cessation,
• Recording of ethnicity
• COPD
• Adult Type 1 diabetes
• End of Life care
• Learning disabilities
• Patient experience
Within each area specific metrics were decided for each CQUIN and these concentrated on
qualitative rather quantitative data collection with an emphasis on improving services. The
payment to BCS would be made when the agreed metrics had been reached / achieved. It
took a long time to agree and therefore the time to implement was rather restricted. Some
of the 10/11 CQUINs were rolled forward from last year and were not specifically quality
improvements but about numbers and data capture and accuracy.
Our achievements in 2010/11 were that we collated 9,029 patient experience survey
responses across all clinical areas within BCS. For our palliative patients we implemented a
field on RIO to record patients on the Liverpool Care Pathway and developed an
organisational wide policy on caring for palliative care patients. Within the CQUIN for LD BCS
explored the relationship with GPs to improve the services to patients and for the CQUINS in
11/12 this area will be expanded. Staff within BCS were also trained to refer patients
attending other services to the smoking cessation service and we had great success in
identifying the improvements that we have made to the COPD service and the care that we
deliver.
2011-12 frameworks
•
The prevention, development and deterioration of all grades of pressure ulcers in the
district nursing services.
•
To introduce falls risk assessments within district nursing and inpatient areas across
Barnet to appropriately refer patients at risk leading to a prevention in falls.
•
Improve care for patients entering the last year of life and the last days of life.
•
Improving care to patients with COPD.
•
Improving health care for people with learning disabilities.
•
To improve communication between children services, sexual health and PHC.
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REVIEW OF QUALITY PERFORMANCE 2010-11
This section of the report presents an overview of our quality performance last year, covering
each of the three domains of quality: safety, experience and effectiveness. Further detail can be
found in our “Delivering a high quality service within BCS progress report”:
Summary of this section
Safety: Providing safe and effective care is a fundamental principle of healthcare
provision and it is included in the BCS strategic goals and it is a fundamental aspect of the
BCS Quality, Risk and Performance Strategy that was developed in July 2010. Within the
strategy there is an emphasis on an open learning culture and BCS has promoted a
culture of openness and also emphasised that risk management is an integral part of all
staff responsibilities. The focus for 11/12 would be to continue working with staff to
increase incident reporting and managing risks.
Experience: A fundamental aspect to improving quality is to understand what the patient
/ client experience is when people are accessing services that BCS deliver. Understanding
what patients want in their health care experience when receiving care from BCS will
allow BCS to develop services that are fully patient and user focused. Within the quality
strategy there are specific patient experience objectives that have been developed to
improve the quality of care to the patient /client. Since the introduction of the quality
strategy we have been implementing different ways to measure and understand the
patient experience and we have been working widely across the organisation with a
range of activities including implementing patient stories to implementing electronic
ways of collating survey information.
Effectiveness: To be a truly clinically effective organisation BCS needs a workforce that is
competent, well educated and capable of delivering evidenced based care to all users.
Several initiatives have been introduced into BCS to improve the clinical effectiveness
ranging from uploading a NICE web portal so all staff can easily access NICE standards
from the BCS intranet to reviewing, authorising and implementing the BCS medicine
management policy. Within the BCS Board Assurance Framework, objective four explores
the development and implementation of a systematic approach to clinical leadership that
supports decision making to drive the ongoing delivery of safe and effective services and
business developments. One of the controls BAF 4001 identified was the need to develop
a Clinical Executive Committee (CEC).
Safety
Patient safety is a national and a local priority. Providing safe and effective care is a fundamental
principle of healthcare provision, it is included in BCS strategic goals and it is a fundamental
aspect of the Quality, Risk and Performance Strategy.
12
Within the strategy there is an emphasis on an open learning culture where incidents and
complaints are investigated thoroughly to determine the root causes and action is taken, where
appropriate, to improve services as a result. BCS recognises the importance of continuing to
promote a culture of openness within a learning environment where risk management is
everyone’s business. Within BCS risk management is an integral part of all staff responsibilities
and not just that of any one individual or department. It is the responsibility of all staff to
practice safely and to participate in the assessment, reporting and management of risk.
The Health and Safety at Work Regulations 1999 advises that organisations should assess how
effectively they are controlling risks, how well they are developing a positive health and safety
culture, and that lessons are learned from incidents.
Within BCS there are systematic processes in place at clinical team, department and corporate
levels, for reviewing complaints, PALS issues, claims, incidents and near misses. The review
process allows BCS to:
• Identify trends
• Inform risk registers
• Inform business planning objectives
• Identify lessons
• Share lessons
• Improve services
BCS also actively seeks to learn from other organisations, and has strong links with the National
Patient Safety Agency and national reporting and learning processes.
Clinical and non clinical incident reporting
All accidents and incidents (including a near miss situation) are formally reported through the
BCS incident reporting system. Incidents are reviewed and graded by the Ward or Service
Manager. Depending on the seriousness and grading of the incident, a review may be held in
order to determine the facts and details surrounding the incident. Incident investigations are
monitored by the Quality and Performance team to ensure that root causes have been
identified and that learning has been documented. These are reflected in quarterly incident
trend reports which are received by the Integrated Governance Committee for scrutiny.
BCS incidents are currently reported on line through the Safeguard system. These incidents are
then analysed by the Health & Safety Manager who leads on analysing non-clinical incidents and
the Quality and Patient Safety Officer who leads on analysing clinical incidents. Reports are then
prepared which identified trends in reported incidents, detailing cause groups and the nature of
incidents by services/departments. The reports are then submitted to the Integrated
Governance Committee.
The reports showed that the total number of incidents, both non-clinical and clinical incidents
reported for the period of 1 January 2010 to 31 December 2010 was 580. Non-clinical incidents
reported accounted for 181 incidents and clinical incidents reported accounted for 399.
13
The most frequently reported types of incidents are:
Non –clinical Incidents
• Infection Control Incidents 39 reported incidents
• Security Incidents 32 Incidents
• Abusive, Violent Or Disruptive Incidents 31 reported incidents
• Slips, Trips, Falls and Collisions 28 reported incidents
Clinical Incidents
• Slips, Trips, Falls and Collisions 239 incidents
• Treatment Incidents 48 incidents
• Access, Appointment, Admission, Transfer and Discharge 13 incidents
• Clinical Assessment 10 incidents
Quarterly incident reports are also prepared and provided for the Corporate Health and Safety
Committee and are categorised as Health, Safety and Security Incidents, Fire Incidents, and
Infection Control Incidents, in-depth reports are also submitted to the Corporate Health &
Safety Committee who are responsible for actioning any recommendations and taking forward
any significant concerns. Any concerns would be fed through to the Integrated Governance
Committee as part of the committee accountability structure.
A joint non-clinical and clinical quarterly report was prepared and provided for the Integrated
Governance Committee to ensure lessons were learned and that any risks identified were dealt
with appropriately.
Serious Incidents
All incidents are investigated following the Trust's Serious Incident Management Policy; this was
updated in 2010 and implemented to provide support and guidance to staff on investigation
techniques and provides useful templates to aid the investigation process. Additionally a variety
of expertise in BCS has been utilised to widen the availability of lead investigators to conduct
investigations. A Serious Incident sub group has been established and meets monthly to review
and performance manage the implementation of the serious investigation action plans. The
leads from the clinical services that have been part of investigations are also present to ensure
that lessons are learned and appropriate actions are taken. This group scrutinises the evidence
provided to support implementation and closes the serious incident when all evidence is
available. The outcome of these serious incident investigations are discussed at the Integrated
Governance Committee and Trust Board Meetings so assurance can be given that appropriate
action has been taken.
In terms of meeting report submission deadlines to NHS London, these have all been completed
within the 60-deadline. BCS is working hard to further streamline processes to meet the new 45day deadline for submission of final reports. The quality of final investigation reports has greatly
improved.
Wound Management Serious Incidents
In June 2010 NHS London issued guidance that all Grade 3 and 4 pressure ulcers must be
reported as Serious Incidents following guidance from DoH. According to the European Pressure
14
Ulcer Advisory Panel newly acquired pressure ulcers in a clinical setting should include all
patients who have developed a pressure ulcer after 72 hours of admission/transfer in a
healthcare setting.
A separate work stream has been developed to facilitate the investigation of grade 3 and grade
4 pressure ulcers in view of the new guidance issued. BCS have adapted the Barts and the
London Root Cause Analysis Tool for investigating pressure ulcer incidents. This has been rolled
out with a local reporting framework to ensure staff are aware of local procedures and
responsibilities particularly in relation to raising the awareness of reporting incidents to
safeguarding.
Risk registers
A total review of the Trust Risk Register was undertaken during 2010 with all entries revalidated
and repopulated and the risk register was redesigned to reflect the Trust’s Board Assurance
Framework. All entries within the register must have identified controls in place, an action plan
and review date. All these controls need to be in place prior to validation by the Integrated
Governance Committee.
The risk register remains a dynamic document, continually evolving, and is updated monthly. Its
format has been revised to include organisation-wide risks that link to individual directorates.
An operational risk group meets monthly to scrutinise and challenge risk register entries and
monitor action plans. The corporate risk register is also reviewed by the Trust Board and, as part
of monitoring the effectiveness of the internal system of control, by the Executive Management
Team and Integrated Governance Committee monthly.
The Significant Risk Register includes all risks that are rated at 12 and above and is now a
dynamic and continuous living document, with entries being added, validated and removed on a
regular basis. A complete audit trail is available providing evidence of actions taken to address
identified risks. This is reviewed monthly by the Integrated Governance Committee.
The total number of open risks reported as of 1st March 2011 is as follows:
Service
Lower Rated Risks
Green
Amber
(1-6)
(8-10)
Significant Risks
Upper
Red
Amber(12(16-25)
15)
Total
Risks
Director of Operations
Community Adult Services
Adult Learning Disabilities & Children’s
Services
Human Resources & Education
Finance & Business Development
Health and Safety
Infection Control
Information Governance
Total
2
7
3
0
0
0
0
3
2
0
0
3
2
10
8
3
1
1
3
0
20
0
7
2
6
2
17
1
0
3
1
0
10
0
0
0
0
0
3
4
8
6
10
2
50
There were 13 risks detailed on the significant risk register as of March 1st 2011.
15
Central Alerting System
The Central Alerting System (CAS) is an electronic web-based system developed by the
Department of Health (DoH), the National Patient Safety Agency (NPSA), NHS Estates and the
Medicines and Healthcare Products Regulatory Agency (MHRA), as a means of communicating
safety information to medical device users in healthcare and social care. The Integrated
Governance Committee is responsible for the monitoring of the CAS Alert System. Progress
reports are provided on a quarterly basis. From February 2011 these reports are also a standing
agenda item on the Medical Devices Committee.
The responses sent in relation to issued alerts from the Trust are monitored by the MHRA and
Strategic Health Authority (SHA). The compliance and performance of BCS in relation to set
deadlines are reported upon by the SHA. It is clear that implementation of these alerts, where
relevant will help prevent potential adverse outcomes for patients in the future.
The process for disseminating alerts has been revised during 10/11 to ensure that feedback
from recipients through nominated points of contact is timely and coordinated in order to
effectively process the alert through the various response stages and also to track the progress
of compliance with the alert actions.
Comparative data in the table and chart below show significant progress in the administration
and processing of alerts over the last two years. As can be seen from the data there have been
substantial improvements in performance.
Not acknowledged within
deadline
Not completed
Deadline
2008
Number
24
within 31
Percentage
21%
2009
Number
5
34%
1
Percentage
5%
2010
Number
0
Percentage
0%
1%
3
2%
Figure 1: Central Alerting System comparative data 2008-2010
40%
34%
30%
21%
20%
10%
5%
1%
0%
2%
0%
2008
2009
Not acknowledged within deadline
2010
Not completed within Deadline
16
It is anticipated that improvements will be made in the way the alerts are managed within the
organisation with the implementation of the new process for disseminating alerts. The BCS
operational management areas are already making great strides with adapting to the new
process and the responses from the operational areas are coordinated and timely. This
facilitates timely communication related to the determination of relevance of the alert with the
DoH, the plan of action if relevant and the evidence to support compliance. Work is also
underway in terms of auditing compliance with alerts.
CQC registration
From April 2010, the regulation of health and adult social care changed. Legislation has brought
in a new registration system that applies to all regulated health and adult social care services.
From April 2010, all health and adult social care providers who provide regulated activities are
required by law to be registered with the Care Quality Commission. To do so, providers must
show they are meeting new essential standards of quality and safety across all of the regulated
activities they provide.
In April 2010 Barnet PCT was successfully registered with the CQC and deemed compliant to
provide regulated activities without any conditions of registration. As part of the ongoing
programme of monitoring compliance with the regulations, a scheduled programme of receiving
assurance reports at the Integrated Governance Committee throughout the year was identified
to monitor progress using the CQC provider compliance tools.
A CQC registration internal audit was undertaken November in 2010 as part of the 2010/11
annual internal audit plan. Formal feedback has been received from RSM Tenon and was very
positive with two medium level recommendations that include training for staff involved in the
CQC process and ongoing monitoring compliance of the regulations. An action plan was
developed after the audit report findings and was submitted to RSM Tenon. It is being
implemented into BCS.
Outcome leads have been identified within the action plan. Each lead is required to complete
an assurance progress report which helps them to focus their attention on the work streams
necessary to ensure ongoing compliance with each standard area and in addition to provide
assurance that there has not been a lapse since the initial registration. Detailed evidence is kept
within a shared folder against each regulation; this is updated and scrutinised each time
evidence is submitted by the Head of Integrated Governance with a discussion around any gaps
in assurance.
CQC Visit
The CQC visited Barnet Community Services on the 2nd of June 2010 to inspect the Edgware
Community Hospital and Finchley Memorial in patient wards for cleanliness and infection
control. The inspection consisted of 14 measures. The overall judgement that the inspection
gave was that they had minor concerns about the provider’s compliance with the regulation on
cleanliness and infection control.
The inspection report indicated that on the 14 measures inspected 11 had no areas of concern
and 3 areas for improvement. To address the outcome of this report, an action group was
convened consisting of the Director for Quality and Performance, Barnet Community Services
(BCS) (who is also the Director of Infection Prevention and Control (DIPC)), the DIPC for NHS
17
Barnet, the Head of Infection Control NHS Barnet, Infection control nurse, BCS and Head of
Estates, NHS Barnet. This group compiled a joint action plan to ensure engagement and
consistency with completing actions across provider services and the commissioning
organisation. This action plan has been presented to both BCS and NHS Barnet’s Integrated
Governance Committees and remained a standing item on their agendas for oversight and
scrutiny until all actions were completed.
NPSA ORGANISATIONAL FEEDBACK REPORT 1ST OCTOBER 2009 TO 31ST MARCH 2010
All healthcare organisations are required to regularly upload their patient safety incidents to the
NPSA’s National Reporting and Learning System (NRLS). The NRLS is a system designed to draw
together reports of patient safety errors and systems failures from health providers across
England and Wales and to develop practical solutions to recurring patterns. Each report shows
the total number of incidents during a six month period. The information is broken down by
incident type, degree of harm and it also includes comparative information on rates and
consistency of reporting.
When BCS received the report we had been placed in the incorrect cluster. The organisation was
placed in the PCO-no inpatient provision cluster because there was no Hospital Episode
Statistics (HES) data available from BCS. It was therefore compared to non-peer organisations
which resulted in inappropriate comparisons being made. This was subsequently rectified.
It is important to note that the breakdown of incidents for the organisation has been adjusted
slightly to use the actual bed days activity data (which is not NPSA published data). This has
been provided by the Information Management Department in order to reflect the true position
of the rate of reporting for the organisation as opposed to the estimated bed day activity data
used in the analysis by the NPSA.
The total number of patient safety incidents reported to the NPSA for the period 1 October to
31 March 2010 amounted to 249. In the previous Organisation Patient Safety Feedback report
237 incidents were reported. The total number of Occupied Bed Days amounted to 16,096
which differ from the estimated bed days of 16,460.
The total number of incidents reported per 1,000 bed days = 15.47. In terms of a comparative
reporting rate this puts the organisation into the lower reaches of the middle 50% of reporters.
The National median is 23.6 incidents reported per 1,000 bed days. Comparing this with our rate
per 1,000 of 15.47 suggests that we are still significantly under reporting incidents. BCS reported
incidents in six out of the six months between October 2009 and March 2010, incidents are
normally uploaded monthly. In BCS 50% of incidents were submitted more than 44 days after
the incident occurred, this represents a significant improvement since the last report where 50%
of incidents were submitted more than 95 days after the incident occurred. As part of the
implementation of the Quality, Risk and Performance strategy awareness is being raised
amongst staff to report serious safety risks promptly so that lessons can be learned and action
taken to prevent harm to others. In addition local managers are being urged to complete their
own actions within a specified time frame to enable an incident to be uploaded.
18
Top 10 Incident Types
99.9%
100.0%
total
Clinical Assessment
2.0%
3.2%
10.0%
All other catagories
Medical device/ equipment
2.0%
2.1%
Disruptive, aggressive behaviour
2.4%
Infrastructure (including staffing, facilities, environment)
2.4%
2.9%
Consent, communication, confidentiality
3.6%
3.5%
Documentation (including records, identification)
3.6%
3.7%
Treatment, procedure
2.4%
4.5%
Implementation of care and ongoing monitoring/ review
0.0%
Access, admission, transfer, discharge
Medication
Barnet Community
Services
All primary care
organisations w ith
inpatient provision
7.4%
5.2%
8.6%
4.0%
11.0%
Patient Accident
0.0%
71.5%
43.9%
20.0%
40.0%
60.0%
80.0%
100.0%
120.0%
Per Cent of Incidents
Graph 1 Top 10 Incident Types
Graph 1 shows the top ten incident types reported to the National Reporting and Learning
System (NRLS). The BCS reporting profile looks different from similar organisations in terms of
the numbers and types of incidents reported. This may reflect differences in reporting culture
but does identify high risk areas such as medications where clearly there is under reporting of
incidents.
The data for falls indicates a high level of reporting compared to cluster organisations. The
National Patient Safety Agency (NPSA) is urging NHS organisations across England and Wales to
follow guidelines aimed at reducing patient falls. Falls can adversely affect the recovery of
patients which is why it is essential that risks are reduced as much as possible. There is further
work being undertaken by BCS in reducing harm and injury from falls by introducing a fall risk
assessment for all patients under our district nursing and in patient care. This will help identify
patients that are at a risk of falling and allow further appropriate interventions to be
implemented to try and prevent falls.
Table 1 shows the number of incidents reported by degree of harm for BCS. Graph 2 represents
the comparative data. Comparison of harm profiles are difficult as not all organisations apply the
national coding of degree of harm in a consistent way. Nationally, 68% of incidents are reported
as no harm, and just less than 1% as severe harm or death.
19
Table 1 Degree of harm Barnet Community Services
Barnet Community
Services Figures
None
124
Low
93
Moderate
30
Severe
1
Death
1
Total
249
Graph 2 Degree of Harm for primary care organisations
Incidents reported by degree of harm for primary care organisations with inpatient provision
Per Cent of Incidents Occuring
120.0%
99.9%
99.9%
100.0%
80.0%
All primary care organisations
with inpatient provision
65.3%
60.0%
Barnet Community Services
49.8%
40.0%
37.3%
25.5%
20.0%
12.0%
8.4%
0.0%
None
Low
Moderate
0.5% 0.4%
0.2%0.4%
Severe
Death
total
Trusts that report high levels of patient safety incidents suggest a stronger organisational culture
of safety because they take all incidents seriously and link reporting with learning from them.
This was highlighted by findings from the NHS Confederation and the National Patient Safety
Agency (NPSA). Building a safer patient culture is a key priority highlighted in Barnet Community
Services Quality, Risk and Performance Strategy. This has been transposed into a high level
action plan identifying key areas for improvement as outlined above.
Infection Control Audits
An audit of infection control practice is carried out annually within BCS to measure compliance
against national infection control standards. This summary of the report relates to the audits
completed within the clinical areas of Barnet Community Services between Sept 2010 and
March 2011. The tools used for the audits were part of the software called Infection Control
Audit Technology (ICAT). This software was devised by Infection Control Nurses and was based
on ‘Audit Tools for Monitoring Infection Control Standards, 2004’, produced by The Infection
Control Nurses Association, in partnership with the Department of Health.
The results of the audit are in the main lower than the results from the last audit report of
2009/10. The main reason is that all previous years the audits where self audited by the
20
department themselves which may question the validity and reliability. This year the audit
process was completed using computer software. A team of three trained external auditors
carried out all the audits across BCS. By using the software package and being externally audited
this increases the validity and reliability of the audits carried out. However when comparing the
audit results it is pertinent that comparisons are only made on a like for like basis so not all
sections can be compared. For an accurate comparison of the whole audit process it would be
pertinent for the audits to be carried out in future years using the same software package.
Infection Control Annual Report
This report gives an overview of the progress in infection prevention and control within BCS in
2010/11. It identifies the key achievements, outstanding areas for development and next steps.
BCS remains committed to monitoring and raising standards in infection prevention and control
in all areas and to ensuring that all directives are met and monitored. Getting the basics right,
including improving cleanliness and reducing infection remains one of the key objectives.
Progress has been measured throughout the year against the annual programme developed in
line with the Health and Social Care Act (2008), Code of Practice for the NHS on the prevention
and control of healthcare associated infections and related guidance, which has been monitored
by the BCS infection control committee (ICC). Compliance with infection prevention and control
and healthcare associated infections targets are also reported to the BCS Board through the
Integrated Governance committee.
There have been several significant achievements within 10/11. There were no attributable
cases within BCS of MRSA bacteraemia or C diff during this report period of April 2010 – March
2011 that required a root cause analysis.
A new hand hygiene audit tool based on the National Patient Safety Agency, adapted from the
World Health Organisation’s five moments for hand hygiene has been used for the Clean Your
Hands campaign monthly hand hygiene audits since December 2010.The current audit is based
on observation of opportunities where as the previous audit observed patients.
The overall Trust compliance rate is 93% - 100% for this period. The Trust compliance rate for
this period last year was 95 – 100%. The reduction in compliance rate would reflect the change
in audit tool as well as the reduction in areas that are now participating in Hand hygiene.
Nineteen policies for managing IC have been reviewed and verified through appropriate
committees and an ongoing policy audit programme is in place to ensure all policies are
regularly audited as outlined in the Health and Social Care Act 2008.
The uptake of statutory infection control training for all staff has continued to present
challenges in 2010 / 2011. The training attendance figures below relate to both NHS Barnet and
BCS as the education department is currently unable to separate the data:
Clinical staff - The BCS target is 95%. Up until 31.01.2011, 89% has been achieved.
Non clinical staff – The BCS Trust target is 95% Up until 31.01.2011 only 34% has been achieved.
21
A number of steps have been taken to improve the uptake of infection control training. This
remains an area of concern and sustained work needs to be undertaken to ensure this
percentage increases in 2011/12. The risk of non attendance at mandatory training has been
highlighted on the infection control risk register.
There have been two significant changes in clinical practice for IC. The removal of Hibiscrub from
Clinical hand hygiene sinks and the change of the skin preparation wipe. Traditionally Hibiscrub
(4% Chlorhexidine) has been used routinely by healthcare workers for hand hygiene. There is
evidence that this solution has caused hand problems with many staff suffering from dry sore
hands.
Hibiscrub is still available where required when invasive procedures are being carried out such
as in Theatres and in the Minor Surgery Units in Outpatients Department. The removal of the
Hibiscrub will not only save healthcare workers hands but also represents a saving for BCS. Hand
hygiene awareness sessions have been completed in conjunction with the Hibiscrub removal.
The current evidence base of EPIC 2 & NICE guidelines state that Healthcare workers should be
using 2% Chlorhexidine & 70% alcohol for skin cleansing prior to venepuncture The item of
choice at the beginning of this report year (April 2010) was only 70% alcohol in the form of a
wipe. This product has now been discontinued in line with the evidence base and replaced with
2% Chlorhexidine and 70% alcohol combined into a single wipe.
There have been two outbreaks of diarrhoea & Vomiting within BCS during the period April 2010
– March 2011. During July 2010, George Brunskill ward (GB) at Finchley Memorial hospital had a
period of closure due to an outbreak of diarrhoea and vomiting. A total of 11 patients developed
diarrhoea and/or vomiting commencing on as well as five staff members. The ward was closed
to admissions, discharges and transfers (except in a medical emergency situation) for a total of
eight days.
During March 2011 Marjory Warren Ward (MWW) at Finchley Memorial hospital had a period of
closure due to an outbreak of diarrhoea and vomiting. A total of 12 patients and two members
of staff developed diarrhoea and/or vomiting. The ward was closed to admissions, discharges
and transfers for seven days. In both episodes there were several areas of good practice that
were initiated that helped contain the problem and prevent further outbreaks. An action plan
was drawn up for staff learning after the first incident that was initiated after it was identified as
a problem on the ward.
Patient experience
A fundamental aspect to improving quality is to understand what the patient / client experience
is when people are accessing services that BCS deliver. Understanding what patients want in
their health care experience when receiving care from BCS will allow BCS to develop services
that are fully patient and user focused.
Within the quality strategy there are specific patient experience objectives that have been
developed to improve the quality of care to the patient /client ranging. Since the introduction of
22
the quality strategy we have been implementing different ways to measure and understand the
patient experience and we have been working widely across the organisation with a range of
activities including implementing patient stories to implementing electronic ways of collating
survey information. Outlined below are various reports that indicate the progress of each
activity.
Patient stories
Patient stories involve a clinical practitioner listening to a patient’s story of their experiences
whilst being cared for by BCS services. We have implemented a patient story programme within
BCS and have delivered two half training days for a range of clinical staff. At the present time
approximately 30 stories have been collected across BCS. Different clinical areas and have been
involved and the collation of the stories has ranged from the inpatient facilities to the speech
and language and district nursing. Within district nursing a clinician specifically undertook stories
with patients who had used our services where English is not their first language.
In the first workshop the training consisted of training staff how to undertake a patient story
explaining the different approach to questioning that was to be used to elicit open answers and
how they were going to collect the stories which involved gaining consent and IG information.
Thematic analysis of the qualitative data from the stories was undertaken at the second
workshop. Staff who had taken the stories listened twice to their own collected stories and
those of a partner to identify any aspect or issue that was occurring within the story. These
aspects and issues were then documented on a mind map and analysed to see if any of the
different aspects had commonality. In any particular story one issue for the patient can reoccur
throughout the story but when listening to several stories the clinicians in the workshop were
able to identify common areas that could be improved across the organisation to improve the
quality of care.
One of the key areas that were identified across all the stories was that at times staff could lack
compassion and did not always treat the patient with dignity and respect. Discussion in the
patient stories workshop explored the need for more training to be based around this aspect
with access to reflective analysis, role play and communication with compassion. This has been
addressed within the action plan and the quality directorate will be asking for specific training
packages within the training needs analysis that concentrate on compassionate care and
communication skills for caring.
Specific areas that arose for the inpatient wards were the need to develop communication
materials for patients and relatives to review prior to admission to the rehabilitation wards.
Patients reported that they were not always fully aware of what was provided and information
pre admission would allow for BCS to fully involve the patient in their forth coming care.
Another key theme across all the stories collected was the high level of care that we gave to
patients and their gratitude at being given access to good clinical expertise. Patients felt that this
was a good support to them. One patient in her story told of how our services prevented the
feeling of isolation and another reported that they were receiving care at home on their terms.
On practical level patients reported that the environment that they had been cared for in was
very clean and instructions and directions to some services had been very explicit and clear.
Within the action plan there is an element in which we need to share with our staff the good job
23
that they do and stories are being shared across the clinical teams and specific compliments will
be included within the quality accounts.
Implementing patient stories into BCS to gather qualitative data on how patient feel about our
services has been widely accepted. The particular staff involved in the training immersed
themselves in collecting the stories and found the experience worthwhile and therefore it is
recommended that further training is delivered to undertake more stories and for BCS to
continue collected data in this way.
Patient Surveys
BCS patient surveys for 2010/11 were carried out throughout the year and the result
communicated to enable services to make changes where necessary. The surveys were
conducted within all services provided by BCS and a total sample of 9000 patients was surveyed
which reflects an increase of 10% on last year’s 2009/10 survey responses. Completion was
voluntary; however, to ensure a high response rate, all teams, receptionists were given regular
reminders to encourage their patients to complete.
The surveys were undertaken in both electronic and paper based formats. This is the first year
that electronic devices were been employed to administer the patient survey. There is
increasing usage of this method by Trusts and there are 3 main companies which provide this
service. So far BCS have procured 8 devices which were placed in services where there is a high
volume of activity, e.g. Walk in Centres. These are basically hand held computers which have a
touch screen and data can be downloaded using a USB stick. There is no patient identifiable
information involved; patients are not asked for their name or demographic details. The
advantage is that the hand held devices are portable and can be easily moved around and used
at a variety of locations .The identical paper based surveys continue to be used by all services
and data from both electronic sources and paper based sources merged.
Questionnaire content
The survey questionnaire was generic to all services and covered a wide range of issues that are
important to patients when they access services. The survey takes a few minutes to complete. It
includes questions about being treated with dignity and respect, time waiting to be seen, being
involved in treatment decisions and overall satisfaction with care received.
The survey questions were intended to provide a broad overview of patients’ experiences when
they receive care from one of BCS and were based on the themes identified by research and
issues flagged by the national patient survey in this area. The analysis of patients’ responses for
each question were collated and categorised into –excellent, fair, poor, very poor. (See table 1)
The responses from the electronic devices were analysed separately and then merged.
24
Table 2: Analysis of patient survey responses 2010/11
Patient Satisfaction Score
Treated with dignity and respect
Satisfied with length of time waiting
Listened carefully to what I was saying
Confidence and trust
Involved in decisions about my care
Received information/advice on preventing illness & staying healthy
Clear guidance on follow up care
Satisfied with overall care
96%
85%
95%
96%
94%
88%
93%
95%
The results indicate that BCS scores highly in terms of treating patients with dignity and respect,
and there appears to be confidence and trust. Further work is needed on reducing the time that
patients are waiting in the department and priority given to providing advice and information on
how to stay healthy.
At the moment the paper based responses appear to be the most popular with patients and
staff. This maybe explained by the fact that the electronic devices are relatively new method
and therefore it is proposed that both methods are used as a means of data collection. There
are other methods which could be included for example on line methods and telephone
interviewing. Feedback on the survey results and action plans will be provided through posters
and website.
Patient Focus Groups
Four patient focus groups for inpatient areas at Edgware Community Hospital (ECH) and Finchley
Memorial Hospital (FMH) were held since November, attended by a small number of inpatients
and their relatives. The focus groups were held in the ward day room and all patients were
invited to participate. The focus group explored the nine key themes emerging from the
thematic analysis of the patient stories:
• Communication
• Cleanliness of environment
• Privacy and Dignity
• Hygiene
• Nutrition
• Therapy
• Nursing
• Activities
• Leadership
Other issues:
The key recommendations from the focus groups were that the Trust would benefit from
making improvements in the following areas: communication, nursing care, nutrition,
responding promptly to call bells and demonstrating compassion; and empathy for individual
patient needs.
25
A report was compiled following each patient focus group with key recommendations and an
action plan developed. (See Appendix 3 for the focus group report).
An implementation plan is led by named individuals and will be overseen by the Patient
Experience Strategy Group (PES). The teams will have project plans and actions to complete
within specific timescales and report into the PES.
Complaint Management
Complaints and PALS are a fundamental aspect to improving the quality across BCS. The
management of complaints allows the organisation to see areas of practice that need to be
improved. All staff across BCS are actively involved in responding to formal complaints and
investigating what has happened following the receipt of the complaint. This allows the staff to
understand what happens to a patient and reflect on the care or service that BCS delivered and
the changes in practices that are needed to improve our services.
Complaints
Over the last year we have been working with the complaints team and developing how we
work with clinical staff to be involved in the complaint responses. There is a target set by NHSL
on how quickly complaints must be responded to but we are able to negotiate the response
times with clients to allow improvements to be made to the quality and detail when providing
responses in more complex cases.
However, this quarter showed a very low response rate within our preferred timescale of 25
days and this maybe due to the changes in practice that have occurred across BCS in
encouraging staff who receive complaints to attempt local resolution and invite the patient /
client to a meeting to try and understand their concerns before writing a response.
From November 2010 - February 2011 we have received 25 complaints. The complaints are not
focused in one area but spread across all our services and identifying different aspects of our
service and the care that we have delivered.
The Patient Advice and Liaison Service (PALS)
The Patient Advice and Liaison Service (PALS) is a drop-in help, advice and information service
for patients, relatives or their carers. The PALS service offers a friendly, confidential service to
help sort out any concerns the patient may have about the care we provide, guiding them
through the different services available from the NHS.
PALS act independently when handling patient and family concerns, liaising with staff, managers
and, where appropriate, relevant organisations, to negotiate immediate or prompt solutions. If
necessary, PALS can also refer patients and families to specific local or national-based support
agencies. The PALS service also focuses on improving the service to NHS patients by listening
and responding to patients concerns and improvements are made to the services we provide.
This is the half yearly report for the period 1 July – 31 December 2010 from the Patient Advice &
Liaison Service (PALS).
The department handled 128 PALS comments, concerns and requests for information. There are
no specific time scales for acknowledging concerns and comments and by definition they are
usually acknowledged and responded to very quickly. The same also applies that there is no
26
timescale for resolving these concerns. The clients who contact PALS are informed they can take
their case to a formal complaint at anytime, although most cases are resolved locally.
Effectiveness
To be a truly clinically effective organisation BCS need a workforce that is competent, well
educated and delivering evidenced based care to all users. Several initiatives have been
introduced into BCS to improve the clinical effectiveness ranging from uploading a NICE web
portal so all staff can easily access NICE standards from the BCS intranet to reviewing,
authorising and implementing the BCS medicine management policy . The following will report
on the all the measures across BCS that have been developed and implemented to support
clinical effectiveness with BCS.
Clinical Executive Committee
Within the BCS Board Assurance Framework, objective four explores the development and
implementation of a systematic approach to clinical leadership that supports decision making to
drive the ongoing delivery of safe and effective services and business developments. One of the
controls BAF 4001 identified was the need to develop a Clinical Executive Committee (CEC).
The CEC was established in July 2010; it meets monthly and is very well attended. This
committee is accountable to the BCS Board and assurance is delivered through regular reporting
through to the BCS board with minutes also submitted to the Integrated Governance Committee
(IGC) for noting. The chair of the CEC is the Director of Quality and Performance and BCS Clinical
Director. The membership of the CEC is taken from a range of clinical leads from across all
clinical areas. The CEC is seen as a fundamental committee in improving clinical effectiveness.
The key roles for CEC are:
• To have a key role focused on clinical leadership for services provided by BCS and in
overseeing the development and authorisation of clinical strategy, policies and clinical
guidelines.
• To inform the organisation of NICE guidance and audit the NICE guidance compatibility.
• To support the organisation in clinical transformation by using an evidence base to
inform service developments.
• To consider the clinical risks identified within BCS and support in the identification of a
whole systems approach to safe and effective health care delivery for an identified
community.
• To ensure that all clinical developments are assessed with risks and benefits carefully
considered.
• To support the development of competency frameworks for specific clinical areas
• To act as the approval body for the annual self assessment declaration on those Essence
of Care Standards.
• To review the training needs analysis for BCS and put forward the clinical training
requirements to support transforming community services.
Every month there are standing agenda items for information, the purpose of which are to share
with all CEC members’ monthly NICE updates that include the publication of all new guidance,
the NPSA alerts that have been received by BCS and the CAS alerts that have been produced for
the month. The Chief Executive /Chief Nursing Office/ Allied Health Professional / Nursing and
27
Midwifery Council bulletins are also shared. Within this agenda item a verbal operational brief is
also given and an update on the statutory and mandatory training numbers to encourage the
clinical leads to ensure that all staff is adequately trained and competent.
Several internal presentations have been delivered since July 2010 to help inform clinicians of
initiatives and tools that can affect and improve various aspects of clinical care. These include a
presentation by NICE and the learning disabilities team along with the outcomes of the CQC
stroke audit. Changes in clinical practice are also presented so all clinicians across BCS are able
to engage with different aspects of clinical change. The last two presentations have related to
clinical transformation introducing BCS to the Malnutrition Universal Screening Tool and going
through the referral and treatment pathway for patients who are admitted to our rehabilitation
beds.
The Quality, Risk and Performance Strategy were presented to the CEC in May 2010 and
comments were taken and amendments added prior to submission to the IGC and BCS Board.
The agenda and work plan of the CEC is fully aligned with two of the key strategic objectives
contained within the BCS quality strategy namely clinical effectiveness and patient experience.
Several quality initiatives are led and performance managed within the CEC. The quality
initiatives that BCS is currently implementing are the High Impact Actions (HIA), Commissioning
for Quality and Innovation (CQUIN), Patient experience programme and the Clinical Quality
Standards within the Essence of Care standards. Each of these areas in explored further within
this document.
An essential responsibility of the CEC, with the support of the policy development sub group, is
of authorising new and updating current clinical policies. The policies are submitted to the CEC
membership for comment, the policy development sub group then review the comments with
the author and agree changes. Since July 2010 twelve policies have been authorised and four
policies are currently within the authorisation process. In December one of the policies
presented was the extensive wound management policy which is due to be presented for
authorisation after comments at March 2011 CEC. The development of this policy resulted from
a serious investigation which identified within in its action plan the need to review and develop
the wound management policy. This policy is fundamental to the care and management of
wounds, and in particular particularly pressure ulcers within BCS. It is a major undertaking and
links with the wound care formulary published in October 2010. The policies are all
implemented using the policy for policy application.
A monthly update is presented to the CEC on all aspects of infection control and the minutes of
the infection control subcommittee are submitted to the CEC for noting.
The CEC has full engagement from all types of clinicians across BCS. It is a very well attended
committee which has produced many quality initiatives that are being implemented across BCS
to improve patient care and experience. The CEC is also serving a function as a forum for
clinicians to review and share ideas about clinical practice which is supported by clinically
relevant presentations.
28
High Impact Actions
The High Impact Actions for Nursing and Midwifery: The Essential Collection was launched at the
Chief Nursing Officer’s (CNO) Business Meeting on 28 June 2010 in London. The High Impact
Actions which make up the Essential Collection that are being implemented into BCS include:
• Preventing avoidable pressure ulcers
• Ready to go no delays
• Preventing falls
• Keeping nourished
• Where to die when the time comes
• Protection from infection – catheter care
Each action has been allocated to a clinical area and action plans to implement the action have
been developed. The HIA’s are also included within our CQUINs, pressure ulcer action plans and
the organisational wide adoption of undertaking risk assessments for nutrition falls and skin
integrity.
A progress report is presented to the CEC on a monthly basis by the clinical leads implementing
each specific HIA initiative.
Essence of care
'Essence of Care' was first introduced in 2001 to support and address the fundamentals of care.
'Essence of Care 2010' is a tool designed to help healthcare professionals take a patient-focused
and structured approach to the sharing and comparing of practice. The aim to support localised
quality improvement is at the heart of the 12 revised benchmarks contained in this publication.
The updated 'Essence of Care 2010' supports and reflects a number of the themes in 'Quality
and Excellence: Liberating the NHS' and provides a suite of benchmarks to drive forward best
practice in delivering the fundamentals of care and improving the experiences of people who
use the services.
An initial meeting was held in January with the divisional managers to achieve consensus as to
what Essence of Care Benchmarks will be considered and then agree a way forward and
cascade this to clinicians with a project plan – at which point they will lead implementation on
this process going forward. Following debate it was felt that BCS should focus on benchmarks
that could be relevant to most working areas. These are:
• Respect including privacy and dignity.
• Communication.
• Record keeping.
It was also agreed that each divisional manager will lead on a benchmark with support from the
Head of Integrated Governance. They will organise their own sub groups seeking representation
from the different clinical areas therefore working across different disciplines to ensure cross
fertilisation of learning and sharing of good practice.
It was also agreed that if staff wished to implement other benchmarks they should also be
encouraged as best practice.
29
PRIORITIES FOR IMPROVEMENT
Summary of this section
Our five improvement areas for 2011-12 are as follows:
1. Improve our risk assessment of patients in our care by implementing falls,
nutrition and skin risk assessment into our in patient and district nursing services
2. Continue to gather detailed understanding of patient experience in order to
improve quality
3. Development of our clinical staff to deliver a therapeutic relationship with our
patients and clients that is built upon compassion, dignity and care
4. To fully implement the High Impact Actions for Nursing and Midwifery and the
revised Essence of Care Benchmarks
5. Review clinical demand across district nursing services analysis specific clinical
practice
We have identified a set of five major quality improvement areas for the coming year. These
areas are based on evidence of how we performed in 2010-11 and what our patients have told
us.
Table 3 shows the five improvement priority areas and the main next steps that we will take for
each one. Further detail in relation to each area is then explained below.
30
Table 3: Summary of main quality improvement areas and next steps for 2011-12
#
1
Quality
domain
Safety
Quality improvement
area
Improve our risk
assessment of patients in
our care.
Main next steps in this area
Implement falls, nutrition and skin risk assessment into our inpatient and district nursing services
Aim to have undertaken 60 patient stories
2
Experience
Continue to use electronic methods of gathering survey data
Continue to gather
detailed understanding of
patient experience in
order to improve quality
Embed a culture of valuing patient experience and seeking patient
feedback at all times
Conduct further detailed research and analysis to improve our
understanding of what is important to patients - and feed this into
ongoing improvement planning
Implement action patient experience action plan and performance
manage within the Patient strategy committee
5
Effectiveness
4
Effectiveness
3
Effectiveness
Train 20 staff on how to undertake patient stories
Development of our
clinical staff to deliver a
therapeutic relationship
with our patients and
clients that is built upon
compassion, dignity and
care benchmarks
Commission clinically specific customer care training. Have
requested within the training needs analysis for BCS
To fully implement the
High Impact Actions for
Nursing and Midwifery
and the revised Essence of
Care
High Impact actions implemented across BCS and performance
managed within the CEC
Review clinical demand
across district nursing
services analysis specific
clinical practice
Undertake a full capacity and demand project of our district nursing
services to review the working practice
Measure the patient experience on changes in practice
Full implementation of the Essence of care benchmarks and
performance managed within the essence of care steering group
To develop a scheduling framework for district nursing care to
allow for electronic scheduling of care
31
STATEMENT FROM ASSOCIATE DIRECTOR OF BARNET OPERATIONS
Quality is a fundamental strand to operational delivery and during 2010/11 a
comprehensive quality and risk strategy was developed for Barnet Community
Services which was underpinned by the three pillars of quality, patient
experience, clinical effectiveness and patient safety. The strategy was fully
implemented across Barnet Community Services. The quality directorate within
Barnet Community Services worked highly effectively as a team to drive quality
into operational service delivery, resulting in it being firmly embedded into practice and this can
be seen throughout the Barnet Community Services quality account.
Special thanks need to go to individuals working within the quality directorate for their hard
work, commitment and determination for placing quality at the top of the agenda for Barnet
Community Service’s delivery of clinical care.
Fiona Jackson
32