Barchester Healthcare’s
Independent Hospital Services
Quality Account
2011
Barchester Healthcare’s Independent Hospital Services, Quality Account 2011
Introduction
Barchester Healthcare is pleased to launch this Quality Account and
action plan for our registered hospital services.
Our hospital services work with adults of all ages who have long-term
conditions. We also support people with severe and enduring mental
health needs.
Together with the people we support and people acting on their
behalf we have developed ways to improve our services. This Quality
Account looks at areas for improvement such as: safety, patient
experience and clinical effectiveness. It reflects our commitment to
being open about what we do and how we work – and our
commitment to being accountable for the services we provide.
This Quality Account outlines our work on developing personalised
hospital-based services that achieve real outcomes.
The development of this Quality Account has been led by the Mental
Health Governance and Good Practice Group. They will continue to
lead on the agreed actions. As well as the targets we have set we
acknowledge the need to keep listening to the people we work with;
including commissioners and local communities, and update them
how we are progressing.
The content of this report has been reviewed by the Barchester
operations board in June 2011 and to the best of our knowledge
the information provided in it is accurate.
Mike Parsons
Founder and CEO, Barchester Healthcare
on behalf of the operations board.
2
Barchester Healthcare’s Independent Hospital Services, Quality Account 2011
Section one:
Barchester and Quality Accounts
Barchester Healthcare supports more than 10,000 people across England,
Scotland and Wales. Our services are growing every year. As part of this
process we have started to develop small registered hospitals, where this is
an identified need, with the local health and social care community.
We currently have six hospital sites, with 150 beds in total.
Our hospital environments support some people with long-term complex
needs, but our approach is to work with everyone to promote independence.
We work with individuals to keep the time that they need to spend away
from their families and communities to a minimum.
As an organisation, we have developed different ways of auditing –
whether our services are effective, safe and personalised – and the same
approach is taken in our hospital services. So, over the last year, we have
been working hard to understand more about what our hospitals are
doing well and where we need to develop the quality of the services
we provide. We have also been responding to the changes in how our
regulator, the Care Quality Commission, inspects all our services.
Quality Accounts are a new tool, designed to involve everyone we support
in helping us to shape services. We agree action plans for improving our
services with all our stakeholders and regularly report back on our progress.
A National Clinical Governance and Best Practice Committee oversees
the quality of how we work in our hospitals. The members of that
committee have taken responsibility for developing this Quality Account.
Members of the committee include all the hospital managers, the
Director of Quality, Development Director, Regional Operations
Director and Care Specialists.
3
Barchester Healthcare’s Independent Hospital Services, Quality Account 2011
The priorities that we have developed for improvement in 2011/12
are based on discussions we have had with commissioners and with
the NHS provider organisations that we have worked with in the
development of our hospital services. We have developed specific
measures which will help us show how we have changed what we
do as a direct result of listening to people.
We have also recognised that we need to develop a better way of
measuring how we do things that is just for our hospital services
and which provides easy-to-understand information for everyone.
This is one of the areas we have targeted for improvement this year.
We also have a national group supporting the development of the
Account, which includes people specialising in information, quality
and care management together with senior operational staff.
They will continue to review progress against our targets for 2011/12.
Barchester Healthcare was one of a very small number of service
providers asked to develop a Quality Account in 2010/11 for one of
our nursing homes. This was part of a pilot scheme. While nursing
homes are currently not formally required to have an Account, we have
learnt a great deal from the process of developing Quality Accounts,
which has had a positive impact on service quality and relationships
with stakeholders. For 2011/12, we are working with more of our
nursing homes to develop Quality Accounts. The measures used by
nursing homes do not appear in this Account for our hospital services
as priorities differ – but over 2011/12 we will work to see if there is a
way of bringing our approaches in these two areas together.
4
Barchester Healthcare’s Independent Hospital Services, Quality Account 2011
Section two:
Commitments
We have developed an action plan for how we are going to do the
things we have said we will do. This will be led by our National
Clinical Governance Group, and will be monitored by the
people we support.
The areas our Quality Account for independent hospitals will focus
and develop action plans for are:
Effectiveness
1. Personalised Care Pathways
All hospital services will create a personalised care pathway for each
patient, written in clear and easily-understood language. The care
pathway will explain what support the individual can expect to
receive; when they will receive it and how we will work with them
to see if things are working well. This is called an evaluation tool.
This pathway will explain the initial assessment process and how we
gain information to make sure we help people as effectively as possible.
It will be written over the first 72-hour period following admission and
will then be reviewed every six weeks.
The pathway will detail 1:1 sessions with key workers and named
nurses, together with support from psychological and psychiatric teams.
It will also be clear about what support the individual can expect from
multi-disciplinary team meetings, Care Programme Approach meetings
and Hospital Manager’s meetings. Our hospitals will use a variety of
methods to measure whether treatment is working well. The measures
will include Health of the Nation Outcome Scales (HONOS),
Recovery Star, which is a way of looking at individual recovery, and
National Institute for Clinical Excellence (NICE) clinical guidance.
5
Barchester Healthcare’s Independent Hospital Services, Quality Account 2011
People will be able to monitor their progress and become active partners
in choosing the most appropriate treatment options for them.
Target: 100% of people will have a care pathway in place by
April 2012, meeting the above standard.
Effectiveness
2. Ensure that everyone is able to return to the community as
quickly as possible, with all agreed outcomes achieved.
Each hospital will develop personalised care planning processes to
focus on returning people to the community as quickly as possible.
Monthly clinical governance meetings will examine the discharge
database to ensure patients are supported in the least restrictive
environments, maximising freedom and independence.
Each hospital will also report on its database to the National Clinical
Governance Body, which meets twice a month.
Targets: All hospitals to have a formalised review of discharge data
noted in the clinical governance minutes every month. This data
will be formally reported to the National Clinical Governance
Forum every two months. An annual report will be produced by
April 2012 to give a statistical analysis of discharge rates. This will
be shared with patients, commissioners and other stakeholders.
Effectiveness
3. Demonstrate a minimum of 25 hours a week structured
therapeutic activity for each patient.
Each hospital will be able to demonstrate that every individual we
support receives at least 25 hours of therapeutic activity each week,
evaluated in care planning (there may need to be exceptions to this
6
Barchester Healthcare’s Independent Hospital Services, Quality Account 2011
for people over 65 with very specific needs). It is important to note that
therapeutic activity is different to relaxing or leisure time – although for
some individuals learning to relax may be a therapeutic activity.
Therapeutic activity will be personalised for each individual and will be
agreed with the person concerned, family members where appropriate, and
funding agencies. Therapeutic activity will be planned on the basis
of the outcomes we have agreed for each person.
Targets: Develop new system to demonstrate outcomes and make
clear how resources are allocated by October 2011.
100% of people will have plans in place by April 2012, with any
exceptions agreed with the individual and the commissioner,
with reasons for exception clearly stated.
Effectiveness
4. We will review our current clinical information systems to
ensure that the data we need to routinely monitor this Quality
Account is provided through our centralised information systems.
By December 2011 we will have developed a new clinical information system.
It will be specific to the needs of the hospital services, conducted with
the people we support and commissioners and taken together with
other external systems such as Commissioning for Quality Initiatives
(CQUIN) and our care plan reviews.
Over the course of the year we will also work to establish a stronger
relationship between the information we collect to support current
commissioner requirements and national benchmarking data. For this
year, our action plans for improvement will be set against what we
know we currently have as a baseline for each target. We will work to
meet the targets we have set ourselves and report back on progress to
our Quality Report Panels. This will be monitored by each hospital
and nationally through the Clinical Governance and Best Practice
7
Barchester Healthcare’s Independent Hospital Services, Quality Account 2011
Committee. We will work together with our commissioners to find
ways to compare the data we collect with nationally collected data.
Target: System in place for all hospitals by December 2011.
Safety
5. Each hospital will be audited on a quarterly basis to ensure
its ethical practice continues to develop across the 12-month period.
Hospitals will be audited against best practice guidelines regarding:
•
•
•
•
•
•
•
the rights of individuals detained under the Mental Health Act.
the utilisation of the Mental Capacity Act.
Deprivation of Liberty Safeguards.
SOVA referrals.
Access to advocacy services.
The Human Rights Act.
The Equality Act 2010.
Included in this work will be developments in each hospital linked
to anti-stigma work, inclusion and service user empowerment.
Each hospital must show service development through the audit
scoring system and through clinical governance systems.
Target: To adapt and develop an audit tool to provide key
information by December 2011 and then develop key metrics
to report against by end of 2011/12.
8
Barchester Healthcare’s Independent Hospital Services, Quality Account 2011
Patient Reported Outcomes
6. Each hospital will evidence two service improvements that
have been made as a direct result of direct consultation with
people who use the service.
Using Barchester’s Making it personal audit and the Star Wards
scheme, the individuals who use services will make a meaningful
contribution to the management of the hospital.
Target: Each hospital will be able to evidence at least two service
improvements by April 2012 that have been implemented as a
direct result of involvement.
Medication management
7. There will be a review of medication on admission and at
monthly intervals for all the people we support.
Reviews will reduce all unnecessary medication use. In particular,
we will use psychological and behavioural assessments to find nonpharmacological approaches to working with the people we support.
Target: Use of drugs will be reduced by at least 10% over a
one-year period.
Action plan
An equalities impact assessment can be found on the Barchester
Healthcare website under Quality Accounts and a final action
plan will be available from the end of July setting out our route
to delivering on these commitments.
9
Barchester Healthcare’s Independent Hospital Services, Quality Account 2011
Section three:
About Barchester Healthcare: Funding, Registration,
Research, Staffing and Commissioner’s Comments
Funding: Barchester Healthcare provides services to more than
10,000 people in over 200 service sites. Our commissioners are the
individuals we support, who fund their choices through personal
budgets or private income; and resources from local authorities and
Primary Commissioning Trusts (PCTs). That means our health
income fluctuates on a daily basis because most of it comes through
individual nursing or continuing healthcare funding. In developing
this Account we have specifically reviewed the quality of six small
independent hospitals. Their income represents 4% of the total
income for Barchester generated from the provision of NHS
services over 2010.
Over the course of 2010 to date, we have met requirements for
being an approved provider for 'locked and unlocked' rehabilitation
services for Yorkshire and Humber Strategic Health Authority,
which will include some element of Commissioning for Quality
and Innovation (CQUIN) payment. Patients in our hospitals are
funded through individual contracts, and while we have developed
discussions with some commissioners in relation to CQUIN this has
not been formalised. The majority of Barchester Healthcare’s income
for 2010/11 was not conditional on achieving quality improvement
and innovation goals through CQUIN payment, because
commissioners of our services have not yet sought this approach.
However, we welcome the opportunity for further discussion over
the coming year.
Barchester Healthcare was not subject to the Payment by Results
clinical coding audit by the Audit Commission during 2010/11.
10
Barchester Healthcare’s Independent Hospital Services, Quality Account 2011
Registration: Barchester Healthcare is required to register with the
Care Quality Commission (CQC) and its current registration for its
independent hospitals is in respect of: 'Assessment of medical
treatment for persons detained under the Mental Health Act 1983’.
Barchester Healthcare has not participated in any special reviews or
investigations by CQC during the reporting period.
CQC has not taken enforcement action against Barchester Healthcare
during 2010.
Research: During 2010/11 Barchester Healthcare participated in
a national continence audit funded through the Department of Health.
Our intention is that as our hospital services develop in 2011/12 we will
become involved in more national audit programmes linked to research and
development, both independently and through innovative collaborations
with NHS providers.
As stated in Section 2 of this Quality Account we have identified, as a
priority, the need to improve our data quality and collection for 2011/12.
Barchester Healthcare did not submit records during 2010/11 to the
Secondary Uses service for inclusion in the Hospital Episode Statistics
which are included in the latest published data.
Staffing: Barchester Healthcare's innovative work in the area of
recruitment and training was recognised through the National Employer
Service, winning the Macro Apprentice Employer of the Year award in
2010. This award celebrates large employers who genuinely commit to
developing people within the apprentice framework and who successfully
integrate this approach into their culture. Barchester won three awards
out of five categories at the National Workforce Development Awards.
Barchester won in the category for Integrating Employment and Skills,
which was awarded for excellent retention
11
Barchester Healthcare’s Independent Hospital Services, Quality Account 2011
rates and a high success rate in developing and encouraging staff
who begin work with no qualifications. Barchester also won the
award for Supporting Young Talent for our record of attracting
young people to the sector, supporting them through
apprenticeships and work placement schemes.
For the third year running, Barchester featured in The Sunday Times
25 Best Big Companies To Work For, the only care organisation ever
to feature in this list. The list is based on confidentially and
independently researched employee recommendations.
Commissioner’s feedback: In developing this Account, we asked the
views of eleven primary care commissioners and two mental health
foundation trusts with whom we work collaboratively. We also
approached PCTs where we have hospital sites and commissioners
who support large numbers of the individuals we support. We reminded
all primary care trusts about the deadline for comment and made clear
the option for people not to comment if they were comfortable with
the content. Five PCT commissioners and one of our collaborative
partners responded. We are grateful for their comments about style,
content and approach.
Some of the comments included:
“I feel positive about the direction of travel and look forward
to a positive relationship with Barchester.”
PCT commissioner
“I confirm that I am supportive of the approach.”
PCT commissioner
12
Barchester Healthcare’s Independent Hospital Services, Quality Account 2011
“Thank you for sight of your Quality Account.The governance
arrangements you have in place to oversee the development of quality
approaches appear robust. You also report on excellent plans to drive
up quality although it is surprising that not everyone already has a
personalised care-plan. The Primary Care Trust has seen other Quality
Accounts in which an important component of the account has been
past performance on key quality indicators. In further accounts more
detail about actual performance would be welcome.”
PCT commissioner
“This looks really impressive.”
Partner, NHS mental health trust
“In general the areas that you intend to focus on are very positive and
would give us as a commissioners significant assurance as to the quality
of your services.
“The document feels more like a statement of strategic intention rather
than the sort of QA that I would expect from an NHS provider.
“There is no sense of ‘benchmarking’ against either internal or external
measures, where or indeed if they exist.”
PCT commissioner
“The layout and content are easy to the eye and easy to read - well done! ”
PCT commissioner
13
Barchester Healthcare’s Independent Hospital Services, Quality Account 2011
Actions in response to commissioning comments: We have
adjusted Section 2 to reflect comment on the need to develop
benchmarking and comparative data; something we are already
aware of. This year we approached the relevant PCT for our
hospitals and the lead commissioners for our services. Over 2011/12
we intend to develop stakeholder networks around each individual
hospital service which will enable stronger relationships with the
wider community, including Local Involvement Networks (LINks).
Barchester Healthcare would like to thank all commissioners
and others for their contribution to this Quality Account.
We look forward to working with all stakeholders over the coming
year to deliver the improvements to which we are committed.
14