Birmingham Community Healthcare
NHS Trust
Birmingham Community Healthcare NHS Trust
Quality Account
2010-11
It gives me great pleasure to introduce the first Quality Account for Birmingham Community
Healthcare NHS Trust.
The Quality Account aims to provide assurance to all our stakeholders that we are not only
committed to providing the highest quality clinical care, but also continuously seeking ways
to improve what we do.
Accounting for the quality of our care represents a unique opportunity to define quality in all its elements,
set priorities for improvement and then, through measurement, demonstrate progress.
We place great importance on the experience of our service users when they receive care and therefore our
focus on quality moves beyond measurement to encompass work that strives to ensure all experiences are
good, demonstrates best outcomes and make patient care safe.
Over the past year, we have seen an increasing commitment to put quality of care at the top of the Trust Board
agenda. To ensure that remains joined up from ward and team to Board level, all service areas have developed
clinical dashboards - a set of performance indicators - allowing regular review of performance in delivering
quality care. The Board meets monthly with a service user or clinician to discuss particular aspects of safety,
quality and patient experience.
Throughout this account you will see many examples of the highest quality clinical care.
In particular, we have continued to see a marked reduction in serious hospital infections, achieving all targets
for MRSA and Clostridium difficile cases. And we have developed a set of measures to improve patient safety,
such as falls prevention. The delivery of the programme to achieve same sex ward accommodation and visible
alerts such as embroidered privacy signs on bed curtains have also helped improve privacy and dignity.
We are proud of our record in delivering care of the highest quality. However, we remain focussed on those
areas where our regular reporting arrangements and patient feedback indicate we are not performing as well
as we would like. Plans are in place to start making improvements in these areas and we continue to work
with patients, staff and commissioners to perform even better during 2011-12.
In producing this report, we have consulted and engaged widely with patients, service users, commissioners,
LINks and the local authority health overview and scrutiny committee. We have also provided information for
our regulators, including our participation in national audits and research.
Sharing this report with you is of key importance to the Trust Board, and to me personally, so that you are aware
that BCHC is committed to improving the quality of care whenever an individual may need to use our services.
Thank you for taking time to look at our first annual Quality Account. Please let us know if you feel we could
improve it in anyway.
Finally, I confirm, in accordance with my statutory duty, that to the best of my knowledge the
information provided in this Quality Account is accurate.
Tracy Taylor, Chief Executive Birmingham Community Healthcare NHS Trust
[1] Quality Account 2010 -11
Contents
Section 1: Our values
page 3
Section 2: Our communities
page 4
Section 3: Putting quality first
page 6
Section 4: Our targets - CQUINs 2010-11
page 7
Section 5: Going forward CQUINs 2011-12
page 15
Section 6: Measuring quality
page 17
Section 7: Research
page 21
Section 8: Review of our services
page 23
Section 9: Engaging, listening, learning, improving
page 34
Section 10: National targets
page 49
Section 11: Statutory data
page 53
Section 12: Feedback from our stakeholders
page 58
Section 13: Contributors and acknowledgements
page 59
Section 14: Glossary of terms
page 61
The information contained in this Quality Account refers to all BCHC services except
Dental Hospital Services provided at Birmingham Dental Hospital. The Dental Hospital
Services Quality Account is published separately and is available on the BCHC website.
Quality Account 2010-11 [2]
Section 1: Our values
Accessible
We will provide a range of services that reach out into the community and
meet individual need where everyone counts; celebrating diversity and valuing
difference.
Responsive
We will listen and work with our service users and partners to meet needs and
improve health and wellbeing. We will encourage innovation and excellence,
celebrating success and learn from experiences.
Quality
We will provide safe, effective personalised care to the highest standard,
providing information to support service users and their carers to make
informed choices.
Caring
We will deliver our services with respect, compassion and understanding
where people are valued and we will act in their best interest.
Ethical
Promoting a culture of dignity and respect, we will make morally sound, fair
and honest decisions and be openly accountable. We will commit to investing
wisely whilst being socially and environmentally responsible.
Commitment
Through our actions and commitment, we will strive to make a positive
difference to people’s lives. We will value our staff, their commitment and the
contributions they make.
[3] Quality Account 2010 -11
Section 2: Our communities
Birmingham Community Healthcare was constituted as an NHS Trust on 1st November, becoming
independent of the Primary Care Trust structure.
A month later, more than 2,000 new colleagues transferred to BCHC from neighbouring localities as
Heart of Birmingham Teaching Primary Care Trust and NHS Birmingham East and North began the
process of divesting of their provider services.
Community dental services from Sandwell PCT and NHS Dudley were transferred to BCHC in February,
2011 with those from Walsall PCT transferring on 1st April, 2011.
Secretary of State for Health Andrew Lansley believes modernising the NHS depends on delivering the
sort of patient-focussed, flexible models of care that BCHC is already implementing.
During a visit to Birmingham in March, 2011, the Secretary of State saw first-hand how our integrated
community services are enabling growing numbers of people to receive the personalised healthcare
they need at home.
Mr Lansley visited the urgent care bureau at West Heath Hospital to see how our rapid response
service and integrated multidisciplinary teams have delivered an 11% reduction in GP medical referrals
to acute hospitals in South Birmingham.
Mr Lansley also visited the home of a patient to hear how personalised care provided at home allows
him to manage chronic breathing problems.
Mr Lansley said:
A modern healthcare system needs to be as responsive to individual need as possible. The
approach taken in Birmingham is very impressive because it is driven by the overarching aim of
putting the patient first - identifying the best place for them to receive their care and with the
flexibility to adapt that care over time.
Emma Edgington, Community Manager - Urgent
Care Bureau and Rapid Response, tells Mr Lansley
how the service is helping reduce acute admissions.
Quality Account 2010-11 [4]
[5] Quality Account 2010 -11
Section 3: Putting quality first
Birmingham Community Healthcare provides a combination of specialist and local healthcare services,
delivered on a locality basis, citywide and regionally in a wide variety of settings including community
hospitals, intermediate care centres, outpatient facilities and in people’s homes. We strive to deliver
high quality local services while recognising that patients travel from across the wider West Midlands
region to receive highly specialised services.
Our clinical strategy places the individual at the centre of service delivery, supporting our visions of
accessible and responsive, patient-focussed healthcare for people in all the communities we serve,
throughout their lifetimes. Birmingham Community Healthcare recognises its responsibility to ensure
that all the services it provides are safe, of high quality and that the patient has a positive experience
when receiving care in any setting.
The NHS identifies three fundamental elements of quality care:
safety
Patient safety patients are safe and free from harm.
effectiveness
Clinical effectiveness the treatment and care we deliver
is the best available.
experience
Patient experience service users have a positive experience
that meets or exceeds their expectations.
Quality Account 2010-11 [6]
Section 4: Our Targets - CQUINs 2010-11
What is CQUIN?
CQUINs (Commissioning for Quality and Innovation) are projects agreed between the commissioners
(who buy our services) and the Trust. The projects are set up to improve quality standards in key areas.
The 2010-11 CQUINs relate to South Birmingham Community Health, the interim identity adopted by
the provider arm of South Birmingham Primary Care Trust as it worked towards independent NHS Trust
status.
A proportion of Birmingham Community Healthcare’s income in 2010-11 was conditional on
achieving quality improvement and innovation goals agreed between BCHC and any person or
body they entered into a contract, agreement or arrangement with for the provision of NHS services,
through the Commissioning for Quality and Innovation payment framework.
Further details of the agreed goals for 2010-11, their rationale for inclusion and for the following
12 month period (2011-12) are available electronically at
www.bhamcommunity.nhs.uk/about-us/publications/cquin
CQUIN schemes for 2010-11
Falls
Description: Patients will have a falls assessment on admission or first
contact with a community service, using a nationally recognised process.
At-risk patients will have a personalised care plan.
safety
Achievement: We have exceeded our requirements both for inpatient
and community services. We have improved our documentation.
I had a fall at home and the receptionist at my doctor’s surgery told us about the falls
prevention service so we gave them a call.
One of the team came to see me and identified a number of practical things, like putting
additional steps in where it was steep to go from one room to another. He also worked with me
at home to rebuild my confidence and referred me to a clinic to help improve my balance.
I’ve never known such kind and patient people. I feel a lot more confident about going outside
now. Although I’m well into my 80s, I was still able to lead quite an active life until
recently. The falls service has given me back that independence and I can’t praise them
highly enough.
Falls prevention service user
[7] Quality Account 2010 -11
Nutrition
Description: Inpatients will have a nutrition assessment on admission
or first contact with a community service, using a nationally recognised
process. A personalised nutrition care plan will be written when required.
Achievement: We have exceeded the requirements in both inpatient and
community services.
safety
effectiveness
Nutritionist Kathy Roberts measures patient Doreen Jones’
arm to assess her body mass index (BMI).
It is estimated that malnutrition costs the UK over
£13 billion a year, twice the financial burden of
obesity. Early identification and appropriate management
of patients with poor nutritional status, or who are at risk
of malnutrition, allow the concentration of resources to
be applied where they are most needed and can increase
health benefits and recovery.
The organisation of nutrition support is a continuous cycle and, within the community setting,
a co-ordinated approach by a range of healthcare professionals is essential to identify, treat and
monitor patients who are malnourished or at risk of becoming so.
The Malnutrition Universal Screening Tool (MUST) is a nationally recognised and validated
nutrition screening tool developed by the British Association for Parenteral and Enteral Nutrition
(BAPEN) now in use in Birmingham Community Healthcare hospitals.
Its introduction has been accompanied by a comprehensive training, implementation and
monitoring programme which has now been rolled out to the integrated multidisciplinary
community team as well so that screening can be provided in a much wider range of locations,
particularly in patients’ own homes.
Kathy Roberts
Quality Account 2010-11 [8]
Glucose
Description: Ensuring equipment is in place for staff to deliver the service,
that staff have the knowledge and skills to deliver safe care and referrers
know the range of patients we are able to help.
safety
Achievement: We provided new glucometers, kits for staff to treat patients in urgent need of insulin.
A new training programme was developed and implemented. We ensured a stock of drugs was readily
available for those who needed them.
A small study has been undertaken to investigate how patients may self-medicate.
Caddy Vollands, diabetes nurse specialist,
explains the Think Glucose approach to
nurses during a workshop at West Heath
Hospital.
It is expected that the number of
people with diabetes will grow by up
to 50,000 cases per year. Already, one person
is diagnosed with diabetes, mainly Type 2,
every three minutes in the UK.
This situation is causing a rise in the number
of patients admitted to hospital whose
diabetes is a secondary condition. When
admitted, the healthcare professional often
‘takes over’ patients’ diabetes care when, in
many cases, the patient was managing quite
successfully at home.
This CQUIN scheme, using the elements of the Think Glucose initiative, is designed to develop
staff knowledge and improve the quality of patients’ care and overall experience.
The scheme looks closely at early identification and comprehensive assessment of patients’
diabetes needs from admission and also the overall patient experience and opportunities for
staff learning and development.
Staff have been ready and willing to change in order to improve quality. They see the benefits
and, over time, changes become part of everyday practice. We hope to roll out the scheme across
all wards within the Trust and also look more closely at the great work that is being undertaken
out in the community.
Caddy Vollands
[9] Quality Account 2010 -11
End of life care
Description: Improving the standard of care for people at the end of
their lives.
safety
Achievement: We have worked with health partners to improve the
care for these patients ensuring that an increasing number of GP practices use the approved
documentation to make sure people have the support and care they need when they need it.
Edward Stockwin has been cared for by Birmingham Community
Healthcare’s district nursing team since a diagnosis of cancer of
the bladder.
During radiotherapy, the 68-year-old suffered a cardiac arrest
and developed ongoing heart problems, further complicated
by diabetes. Ensuring Edward’s care is accessible when required
and responsive to his continuing needs presents considerable
challenges.
A Gold Standards Framework was agreed between Edward’s GP,
case manager and district nurses which ensures his care follows a
home-based palliative care pathway, incorporating family liaison
support for Edward’s wife and son, his day-to-day carers.
BCHC district nurses and a caseload manager, together with partners, regularly meet to discuss
his care and visit for routine health checks or to help deal with particular issues as they arise.
Edward said:
Like most people, I don’t want to go into hospital unless it’s really necessary so it’s
marvellous to have the support to help me manage at home. I can’t praise my care team
highly enough - the district nurses, the GP practice nurses and the family liaison workers
have all worked together, discussed my case together. I feel very well looked after.
District nursing team manager Julie Breen added:
Everyone involved in Edward’s care pathway - district nurses, his case manager, his
GP - have visited him and his family regularly for treatment and support of other kinds.
At each visit, the palliative care pathway is completed so that we are all alerted to
any changes in his condition and Edward doesn’t have to repeat himself to each healthcare
professional. Edward’s wishes are documented in his care plan and reviewed at each visit
and both he and his family know which part of the collaborative team to contact for
particular needs or issues.
Quality Account 2010-11 [10]
Dementia
Description: Develop a care pathway which shows which agency will
meet a patient’s care need at a given point in time. Staff will be trained in
dementia awareness.
effectiveness
Achievement: We have made progress towards achievement through an
ongoing programme staff awareness training and engaging in work with other agencies involved in
dementia care.
We recognise that further work is needed to develop an agreed dementia care pathway with our partners.
BCHC works with colleagues from Birmingham
City Council, commissioners, Birmingham and
Solihull Mental Health Foundation Trust, other
acute trusts and the Alzheimer’s Society to develop
a common action plan for developing a pathway for
people with dementia in Birmingham.
Frances Clarke, Associate Director of Nursing
Patient experience
Description: Undertake two patient surveys for inpatient and community
services and show an improvement between the first and the second
survey.
Achievement: Our patient surveys showed that we maintained and
improved levels of patient satisfaction. If you want to see how well
we did see page 31.
experience
The patient experience survey completed as part of
the CQUIN has shown where we needed to make
improvements in information for patients at the time of discharge.
We have made sure patients have information about who to
contact out of hours if they have a problem immediately after
discharge.
Alison Last, Associate Director of Patient Experience
[11] Quality Account 2010 -11
Smoking
Description: Identifying number of smokers in our outpatient areas and
offering them support to quit smoking.
safety
Achievement: We identify smokers and offer them support and
information to help them quit. A significant number of smokers have
taken up the offer of referral to the smoking cessation service.
I had back problems, so my GP referred me to
a medical centre for physio. On my first visit,
I was given a form asking whether I was a
smoker and, if so, whether I would like help to give up.
I’ve smoked on and off since I was 15. I’ve tried to give
up before, but this time there were a number of reasons
to help me summon the willpower, so I was more than
happy to accept the offer of support.
I’m approaching my 50th birthday and I want to do
everything I can to stay fit and healthy, rather than just
accept getting older and gradually more incapacitated. My dad smoked 60 a day and he died of
lung cancer. Since then, my three sisters and my mum have all managed to give up.
So I had become a secret smoker, whenever I was on my own, either at home or out walking
the dog or on my way to the shops. It had got to the stage where I wouldn’t even want to
socialise because I knew it would be time when I wouldn’t be able to have a cigarette.
I was given a 12-week course of nicotine patches and an inhalator as a cigarette substitute in
moments of crisis and one-to-one support is available at drop-in sessions at my GP practice.
The support has been excellent.
My ‘giving up’ day was my husband’s birthday - so it was a present for him and me. It’s given
me a whole new sense of freedom about my life and that’s thanks to the right support being
available at the moment when I was really motivated to quit.
Mum-of-two Alison Murphy
Quality Account 2010-11 [12]
Control of infection
Description: Reduce the incidence of Methicillin sensitive
staphylococcus aureus bacteraemia (MSSA).
effectiveness
Achievement: We have trained staff and improved our infection control
practices and reduced the incidence of MSSA.
Infection prevention and control is one of the highest ongoing
priorities for BCHC, with monthly monitoring by the Trust board
and executive management forum.
Having recorded no cases of MRSA bacteraemia in 2009-10
against an organisational target of fewer than six, we declared
one MRSA bacteraemia in 2010-11.
While the MRSA bacteraemia data remains healthy, with just
one case in 23 months, constant surveillance and prompt action
is required to maintain this excellent record.
The other monthly measure is the number of Clostridium
difficile cases - the trajectory for the organisation in 2009-10
was not to exceed 143 cases; the year end outturn was 23
confirmed cases. This year the trajectory is set at 88, (30%
reduction on last year’s figures) with just 18 cases to date.
Norovirus-related diarrhoea and vomiting was a problem in
inpatient wards during winter, in common with NHS facilities
nationwide. The infection control team has been instrumental in preventing wider spread and
as a result no clinical areas were closed during 2010-11, despite the annual seasonal challenges
that diarrhoea and vomiting illnesses bring (five clinical areas were closed in 2009-10 and
16 in 2008-9).
[13] Quality Account 2010 -11
Tissue viability
Description: All patients assessed on admission for risk of pressure ulcers
(sores) and care plans written to meet individual need. Reduce the
numbers of pressure ulcers that develop in our care and investigate why
they happen and minimise reoccurrence.
Achievement: Our staff were trained in assessment and record keeping
and we monitored that patients had care plans.
We changed our documentation to improve investigation and reporting.
safety
effectiveness
Executive safety visit.
The tissue viability CQUIN
increased our focus on
the prevention and management
of pressure ulcers. We identified
opportunities to improve the core
care plans and risk assessments used
by nurses and have now created a
multi disciplinary version which makes
it easier for clinical teams to identify
patients at highest risk.
Lisa Eden,
Associate Director of Therapies
pictured (second from left).
Quality Account 2010-11 [14]
Section 5: Going forward - CQUINs 2011-12
Our CQUINs for 2011-12 are projects agreed between the commissioners who buy our services and
the Trust. The projects are set up to improve quality standards in key areas.
Following national guidelines and in partnership with our commissioners, the Birmingham Community
Healthcare Board of directors have identified a number of key priorities for improvement across the
three dimensions of quality.
We are working with our service users, commissioners and other partners to further improve the
quality of care in the following areas:
•
•
•
•
•
•
•
patient experience in community hospitals
patient experience in community services
patient information about venous thromboembolism (VTE)
smoking and alcohol healthy lifestyle advice
falls risk assessment
nutrition and hydration assessment
improved access to health visiting teams
The results of these prioritised initiatives will be reported in the BCHC Quality Account for 2011-12.
Community hospitals and community services
Undertake two satisfaction surveys of inpatients and two of community
patients. Show an improvement between the first and the second survey.
experience
Patient information about Venous Thromboembolism (VTE)
Help patients and their carers to understand and reduce the risks of
Venous Thromboembolism by ensuring that at least 90% of patients
who are assessed as being at risk are given written information on their
condition.
safety
effectiveness
[15] Quality Account 2010 -11
Falls risk assessment
safety
Upon initial contact with the community team, all eligible patients will
have an assessment made of the risk to their health posed by falls. Where
this assessment identifies a risk to the patient, they and their carers will be given information orally
and in writing about what measures they can take to prevent further falls.
Nutrition and hydration assessment
Description: The Trust will record the percentage of patients who
are assessed for signs of malnutrition using a recognised tool. Based
on these results we will agree quarterly improvements with our
commissioners.
safety
effectiveness
Improved access to health visiting teams
effectiveness
Description: The Trust will measure the percentage of babies who receive
a visit within 15 days of the birth and will also measure the number
of parent / carers of babies new to the area who are contacted within
five days of referral from a GP. Based on these results we will agree quarterly improvements with
our commissioners.
Smoking and alcohol healthy lifestyle advice
effectiveness
Improve the general health of the population by ensuring that 90% of
frontline staff are trained to deliver healthy lifestyle support and advice,
especially to smokers and patients who drink more than the recommended number of units of alcohol.
Quality Account 2010-11 [16]
Section 6: Measuring quality
Participation in clinical audit
During 2010-11, there were 53 national clinical audits, of which five were agreed as appropriate to the
services that Birmingham Community Healthcare provides. There was one national confidential enquiry
that was relevant to the NHS services that BCHC provides. During that period BCHC participated in
(100%) national clinical audits and (100%) national confidential enquiries of the national clinical
audits and confidential enquiries which it was eligible to participate in.
The national clinical audits that BCHC was eligible to participate in during 2010-11 is as follows:
•
•
•
•
•
National Sentinel Stroke Audit (Organisational) Audit 2010
National Continence (Organisational and Clinical) Audit
National Occupational and Depression Screening Audit for occupational health services in the NHS: round 2
National Falls and Bone Health for Older people (Organisational audit)
National Audit of Services for People with Multiple Sclerosis 2011 (Organisational)
The National Confidential Enquiries that BCHC participated in during 2010-2011 are as follows:
Cardiac arrest (National Cardiac Arrest Audit).
The number of cases submitted to this enquiry was three, which was 100% of the number of
registered cases required by the terms of the enquiry.
In 2011-12 BCHC will be actively engaging and involving patients, carers and members of the
public in our audit programme. We want people to help us decide what to audit and how, assist
us in conducting the audits across our clinical areas, and to give us their views on the analysis of
our audits and what actions should be put into place as a result of an audit.
If this is something you are interested in please contact
Patient experience on tel: 0121 465 7810 or email: adam.dandy@bhamcommunity.nhs.uk
[17] Quality Account 2010 -11
The reports of the national clinical audits has been reviewed by the provider in 2010-2011 and BCHC
intends to take the following actions to improve the quality of healthcare provided.
National audit
Actions taken and % of registered cases
submitted by BCHC expressed as % of total
number of cases submitted for these audits
nationally
National Sentinel Stroke Audit
Discussion continues with our commissioners to develop
a pilot for improved early supported discharge for stroke.
On Ward 8 we have reduced the length of stay for stroke
rehabilitation patients by 5 days. BCHC and University
Hospital Birmingham provided a joint submission of 60
registered cases which met the criterion for this audit.
BCHCs/UHBs contribution to the total number of registered
cases submitted nationally for this audit is 0.5%.
National Continence
The clinical lead for the audit attended the audit
dissemination workshops. Initial report has been reviewed
by the continence team and work is being taken forward.
BCHC submitted 33 registered cases which met the criterion
for this audit. BCHCs contribution to the total number of
registered cases submitted nationally for this audit is 0.2%.
Implementing NICE public health
guidance for the workplace: a
national organisational audit of
NHS Trusts in England
Awaiting publication of national report.
Organisational audit only, BCHC was not required to submit
individual registered cases under the terms of this audit.
The results have been reviewed by the
National Occupational and
occupational health service provided for the Trust. BCHC
Depression Screening Audit for
submitted 40 registered cases which met the criterion
occupational health services in the
for this audit. BCHCs contribution to the total number of
NHS: round 2
registered cases submitted nationally for this audit is 0.5%.
The due date for the audit report is April 2011.
Development of action plans are deferred until the reports
National Falls and Bone Health for
are published. Organisational audit only, BCHC was not
Older people
required to submit individual registered cases under the
terms of this audit.
The reports of local clinical audits were reviewed by the provider in 2010-11 and the BCHC intends
to monitor progress through the divisional governance arrangements or through the corporate work
streams. For a full report on action plans for local audits across the three former organisations, please
refer to BCHCs Clinical Audit Annual Report available July 2011.
Quality Account 2010-11 [18]
Clinical Champion Carron Sintler
Carron Sintler has been BCHC’s ‘clinical champion’
since November 2009, seconded one day a week from
her core role as a consultant physiotherapist for stroke
services to take a careful look at how changing some key
care pathways could deliver real benefits.
Our clinical leadership committee identified
some priority areas and, as stroke and brain
injury was one of the services selected, I took
on the role of ‘clinical champion’.
The role is about looking strategically at stroke and brain
injury pathways, initially in South Birmingham, then
across the city. All aspects of the pathway are evaluated, in order to identify best practice and
areas for improvement.
A typical pathway for brain injury or stroke starts on arrival at A&E followed by a period of
stabilisation, treatment and early rehabilitation at an acute hospital. Patients may then transfer
for further inpatient rehabilitation at Moseley Hall Hospital, before being discharged to an
appropriate community service.
It is that last stage, which can in fact be the most lengthy and complex, where the pathway does
not work as well as we would like. For example, access to rehabilitation, therapy and support
is not always timely. Some simple measures to integrate services and join up the pathway could
really improve quality.
The work has found highly specialised rehabilitation for those very complex patients who need
it and high quality generic support - community physio, occupational therapy and nursing,
provided by our integrated multidisciplinary teams. But a large number of patients fall between
those two camps. Future work needs to explore development of services that meet the needs of
this core group.
That said, we need to build flexibility into the pathways, because no two patients are
exactly alike. The consequences of stroke and brain injury are far-reaching so we must think
broadly when planning services. For example, young adults with brain injury - have they got
dependents? What help do they need to return to their roles in family and society, including
work? Without the right support, it is easy for some to drift away from services and maybe even
to the fringes of society.
I am very pleased to be able to continue this important piece of work and am looking forward
to exploring the role of BCHC in providing innovative services for stroke and brain injury.
Carron Sintler
[19] Quality Account 2010 -11
Waiting times audit at Castle Vale wound care clinic
The wound care clinic pictured outside Castle Vale
Primary Care Centre.
When a patient queried the length of time he had been
kept waiting past his appointment time for a wound care
clinic at Castle Vale Primary Care Centre, staff responded by
promptly surveying wider opinion about the quality of care
they were delivering.
The Castleton district nursing team, which runs the clinic, was pleased with overwhelmingly
positive feedback on a range of indicators. Patients said they were given the respect, care
and information they expected and all respondents rated the overall experience as at least
satisfactory and, in most cases, good or excellent.
Nevertheless, the 17-strong team’s continuous pursuit of improvement led them to reflect on
their working practices. Team leader Anne Lee said that one of the most significant changes
was to encourage greater flexibility and discretion in assessing the necessary duration of
appointments according to individual clinical needs.
We were formed from the merger of two existing district teams and we felt, as a result, there
were small inconsistencies in our practice around managing information, in particular booking
appointments and recording notes.
We’re all completely dedicated to providing the best possible service. But, sometimes,
it’s worth reflecting on what you’re doing because a small change multiplied by several
members of staff and many hundreds of separate patient engagements can actually
add up to a very big change for the benefit of our service users.
The team remain engaged in an ongoing process of evaluation and improvement as part of
the NHS Institute of Innovation and Improvement’s ‘productive community services’, which the
Castleton team is piloting in the former NHS Birmingham East and North area.
Quality Account 2010-11 [20]
Section 7: Research
Research
The new BCHC has a unique opportunity
to establish itself as a major player and
influence in community health research.
Paradoxically, being the largest community
provider in the UK provides both opportunities
and challenges to the development of research.
The size of the new organisation gives enormous
potential for significant partnerships with
universities and other external bodies, offering
attractive possibilities of large community-based
projects through an array of patient pathways.
On the other hand, the services delivered by BCHC are diverse and, with increasing high quality
competition for research funding, a prioritisation strategy and a Trust–wide, cohesive research
plan are essential.
The organisation’s vision is to provide accessible, responsive healthcare and work with, for
and in the community. Our vision for research in BCHC is to contribute significantly towards
realising that vision by improving the care and wellbeing of people in our communities through
high quality, inclusive, locally relevant and scientifically significant research at both national and
international level.
To realise our aspirations, we have begun to develop a five-year research strategy. A central
plank of the plan will be the establishment of significant partnerships between BCHC and all the
universities of West Midlands (as well as other external organisations). A stakeholder meeting
was scheduled for May 2011.
BCHC needs to lead in implementing evidence-based practice and innovative service delivery.
Essential to this is a culture where research, development and innovation is at the core of
the organisation’s identity. Achieving this does not only depend on our staff but also the
involvement of patients and other service users in the identification, prioritisation and design of
research. Our research strategy will be the backbone to establishing the culture we need and
to shaping the organisation’s identity so that our research can properly inform the provision of
more flexible, patient-focussed services, increased patient self-management, improved quality
and productivity, and the delivery of innovative treatments and practices.
Dr Clive Thursfield, Research Lead
[21] Quality Account 2010 -11
Participation in clinical research *
Commitment to research as a driver for improving the quality of care and patient experience.
BCHC uses national systems to manage the studies in proportion to risk and implements the NIHR
Research Support Services standard operating procedures.
Participation in clinical research demonstrates BCHC’s commitment to improving the quality of care we
offer and to making our contribution to wider health improvement. Our clinical staff stays abreast of
the latest possible treatment possibilities and active participation in research leads to successful patient
outcomes.
Recruitment
The number of patients receiving NHS services provided or sub-contracted by BCHC in 2010 -11 that
were recruited during that period to participate in research approved by a research ethics committee
was 147. Confirmed recruitment figures are only available for UKCRN Portfolio Research. This is an
increase on last year’s (2009-10) participant recruitment when 84 participants were recruited to clinical
studies.
Trust engagement in clinical research
Our engagement with clinical research also demonstrates BCHC’s commitment to testing and offering
the latest medical treatments and techniques.
During 2010 -11, 29 members of clinical staff at BCHC participated in research approved by a research
ethics committee. This includes three chief investigators and 25 principle investigators. Clinical staff
participated in research covering all Trust directorates.
*The data here refers to BCHC services excluding dental services which are recorded in the
Dental Services Quality Account .
Quality Account 2010-11 [22]
safety
Section 8: Review of our services
Promoting a patient safety culture (former NHS BEN)
The National Patient Safety Agency (NPSA) states that a high level of incident reporting is a positive
reflection of a high level of safety consciousness within an organisation.
NPSA data for the former Birmingham East and North PCT for April 2009 - September 2010 indicated
a relatively low number of patient safety incidents were being reported compared to what would have
been expected. Patient safety leads worked with staff to provide training and support in the use of the
incident reporting system and rates of reporting improved significantly the following year.
Number of patient safety
incidents reported
1000
900
800
700
600
500
400
300
200
100
0
861
318
April 2009 September 2009
April 2010 September 2010
Time period
* Please note while it is difficult to directly compare these figures due to changes in the way the
NPSA categorised the Trust, overall the numbers reported from the range of services within the
Trust in 2010 significantly improved.
[23] Quality Account 2010 -11
safety
Executive safety visits (former SBCH)
The Trust’s Board has continued to maintain a strong focus upon the quality of services provided
during 2010-11 and has continued its programme of executive safety visits.
Executive and non-executive directors (including the chief executive) and senior members of the
nursing and therapies directorate participated in a programme of safety visits to clinical teams.
Team leaders were provided with patient safety information for their area and asked to discuss a
number of prompts with their staff in order to identify topics they would like to discuss during the
visit. Following the visit an action plan is developed with agreed timescales for implementation.
Listed below are just a few examples of action taken following visits in 2010-11:
•
•
•
•
•
•
Patient status boards introduced in a ward area to allow better planning and co-ordination of staff rest breaks.
Easy chew menu choices introduced for people using the service who require a soft food diet.
Training for new housekeepers reviewed in order to ensure staff fully prepared for their role.
Removal of an unused sink has ensured it could not present an infection control risk in the future.
Action taken to standardise procedures for management of clinical waste within health centres.
Review of cleaning specification to ensure general cleaning of a treatment room is maintained to a high standard.
Executive Safety Visits have really helped me as a non
patient-facing employee get a clearer picture of the
challenges and great work that BCHC manage on a daily
basis. It has also helped me better understand the relationship
between funding and quality of care on the ground.
I would like to add that my experiences to date on the
visits have all been very positive.
Peter Axon, Director of Finance
Quality Account 2010-11 [24]
safety
Reducing patient falls (former HOB PCT)
The Norman Power Centre has focused upon reducing the number of patient falls during 2010-11.
Incident reports were analysed in order to obtain a greater understanding of the factors that had
contributed to patients falling.
Staff identified practical steps they could take to help to minimise the number of falls and introduced
a system of routine ward rounds checking that
• patients are wearing glasses where needed and have slippers that fit correctly
• items such as remote controls and drinks are within easy reach
• objects with the potential to be a hazard and cause a trip or fall are stored safely
As a result of this work the number of falls reported has reduced by more than 50% when compared
to the original baseline data.
Number of patient falls incidents
Norman Power Centre
[25] Quality Account 2010 -11
11
0
20
Ja
n-
Ma
rch
c2
Oc
t-
De
01
t2
ep
-S
ly
Ju
01
0
0
01
e2
Ju
n
ril
Ap
Ma
nJa
Oc
t-
De
rch
c2
20
00
9
10
70
60
50
40
30
20
10
0
effectiveness
Community diabetes service review (former HOB PCT)
An incident in January 2010 identified a problem in the community diabetes service in meeting our
target to see all patients within 18 weeks or less. This led to a review of how the service is delivered in
order to identify opportunities for improving access and as a result improve the experience of patients.
A multidisciplinary diabetes improvement group (DIG) was established in order to lead some of the
service developments described below:
•
The group completed a mapping exercise which involved identifying the steps a patient takes through the healthcare system in order to access the diabetes service. Standard procedures were introduced to ensure that unnecessary delays within the system could be avoided. A range of staff have been engaged in the development of the procedures and their ongoing review.
•
Improvements have been made to the way in which diabetes clinics are provided in order to ensure the service model is reflective of patterns of demand. Specific examples have included doubling the number of oral glucose tolerance testing clinics provided for a nine month period and the introduction of Saturday clinics, which has enhanced access to the service.
•
Clinical documentation and record keeping was reviewed and the new multidisciplinary documentation has had a number of benefits for clinicians. Documentation systems have been developed to enhance the triage process, allowing high risk, urgent patients to be prioritised appropriately.
•
The development of a ‘how are we doing?’ board has promoted staff engagement and an increased awareness of how we are progressing against performance targets. This is updated monthly to encourage ownership of the service and to promote continuous quality improvement.
The DIG has continued to meet on an ongoing basis to monitor actions and outcomes and identify any
further service changes.
The learning gained form this experience has been shared with and adopted by other services as a
model of good practice.
Quality Account 2010-11 [26]
effectiveness
Essential care indicators (former SBCH)
Birmingham Community Healthcare is committed to ensuring that the care delivered to people using
our services is of a high standard. The introduction of essential care indicators (ECIs) has been one of
a number of approaches use by the Board to embed ‘ward to board’ reporting.
Essential care indicators are a set of standards relating to care assessment, planning and delivery.
Services are audited against these indicators on a monthly basis and results are reported directly to
the Trust Board. They include:
• patient observations
• assessments and care planning relating to falls, nutrition, tissue viability, medication and infection control
Benefits of this system include real time feedback for clinical teams as well as providing feedback to
the Board. ECIs have also exposed inefficiencies in systems and processes which have been improved
as a result of the feedback.
Results:
Performance against the indicators is traffic light rated according to level of achievement and services
must obtain a score of over 95% in order to achieve a green rating. The ambition is that any areas
identified as amber will be returned to green within a two month period.
[27] Quality Account 2010 -11
Some of our key achievements have been:
Nutritional assessments:
Consistently high levels of performance against the
following indicators:
Baseline result May 2010
Overall score
January 2011
98%
95.4%
Overall score
Baseline May 2010
Overall score
January 2011
90.2%
97.3%
Overall score
Patient details on documentation
Assessment on admission
Weighed within 12 hours of admission
Care plans for ‘at risk’ patients
Reassessment in accordance with care plan
Care plans for special dietetic (MUST score)
Falls assessments:
Improvement from amber to green rating by Jan 2011
Patient details on documentation
Risk assessment on admission
Care plan for ‘at risk’ patients
Further assessment for ‘at risk’ patients
Bed rail assessment for ‘at risk’ patients
Improving our practice:
Results have shown that we need to improve prevention of pressure ulcers (sores).
Actions taken include training our staff and improving the design of our care plans.
Quality Account 2010-11 [28]
effectiveness
Community physiotherapy - shorter waiting times for patients (former NHS BEN)
In September 2010, the referral rate to community physiotherapy peaked at an all-time high.
Waiting times increased across the service and were a particular problem at the Richmond Primary
Care Centre.
It was acknowledged that both clinical working patterns and administration processes needed
redesign and a working group was formed with clinical, managerial and adults and community
representatives in order to take forward a number of changes. Alongside this, a clinically driven
mentoring, competency and professional development training programme was implemented for all
physiotherapists and assistants.
As a result, waiting times have reduced throughout the service. Benefits to service users can be seen
most dramatically at the Richmond Primary Care Centre.
[29] Quality Account 2010 -11
Waiting list figures chart and table:
rch
y
Ma
ar
ru
ar
Fe
b
nu
Ja
be
m
ce
De
y
r
r
be
m
r
ve
be
No
Oc
to
be
r
t
Se
pt
em
us
ly
Au
g
Ap
Ju
Ma
y
Ju
ne
700
600
500
400
300
200
100
0
ril
Number of
people waiting
Waiting list figures for
Richmond Primary Care Centre
Months
Number of people
on waiting list
Number of
weeks waited
September 2010
659
10
February 2011
139
2
Quality Account 2010-11 [30]
experience
Patient survey results
Result
Data Source
98.9% of patients reported they were satisfied with the service
SBCH
94.55% of patients felt staff treated them with dignity and respect
BEN COMM
92.73% of patients felt involved in decisions about their care and treatment
BEN COMM
91.89% of patients felt hospital staff took their family or home situation into account when planning discharge from hospital
BEN INP
81.08% of patients felt they were given enough time to discuss their condition,
worries and fears with healthcare professionals
BEN INP
80% of patients were given enough information and time to discuss their
condition with healthcare professionals.
HOBT
64% of patients knew what number or who to contact if they needed support out
of hours.
HOBT
97% of patients said staff respected their privacy and dignity.
HOBT
97% of patients were satisfied with the personal care and treatment they received
from community services.
HOBT
Key to data sources
Data source
Key
CQUIN survey 2010-11 - Former BEN PCT community services
BEN COMM
CQUIN survey 2010-11 - Former BEN PCT inpatient services
BEN INP
Former HOBt PCT services patient survey results 2010-11
HOBT
CQUIN survey 2010-11 - South Birmingham Community Health
SBCH
[31] Quality Account 2010 -11
experience
Action taken
Some of the actions we are taking in response to feedback from a number of patient surveys and your
experiences include:
• survey results have been discussed at team meetings in order to reflect on patients’ individual experiences
•
a number of community services have taken specific action to ensure people using our services know who to contact out of hours. Some services have provided patients with information cards on discharge giving details of their medication, their after care and who to contact should they have concerns following discharge
• work has taken place across a number of services to raise awareness of the importance of effective customer care. The Trust has offered a Neuro Linguistic Programming Diploma and Practitioner courses and customer care / Patient Experience courses to staff
• staff have been made aware of the importance of explaining to their patients the purpose of any medication and any potential side effects and ensuring this is done consistently
• operational policies for some bedded units are being reviewed to reflect the importance of effective communication, including communication of the purpose of medication and any associated side effects.
Quality Account 2010-11 [32]
experience
My 94 year old mother was transferred from the new Queen Elizabeth Hospital to
Ward 5 at Moseley Hall where she spent over six weeks. At all times she was treated
with the utmost care, and most importantly, dignity by all of the ward team. She was
never made to feel a nuisance and although obviously busy, the staff took the time to talk and
listen to her. The family received the same level of consideration and understanding, with time
taken to answer any questions or concerns we had and we cannot thank them enough for
their professionalism and high standards of care. A final note of acknowledgement must also
be made to the young lady in the small shop who was always so ready with a smile and friendly
greeting and who sums up the whole feeling of care we experienced from everyone at
this hospital.
Service user
[33] Quality Account 2010 -11
Section 9: Engaging, listening, learning, improving
The Patient Advice and Liaison Service (PALS)
PALS focuses on improving the service to NHS patients. It
provides confidential, impartial, on-the-spot advice and
support, helping to sort out any concerns patients may
have about the care and treatment provided and guiding
them through the diverse services available from the
organisation.
The PALS service is part of the patient experience team
and there are three designated PALS officers who each
cover a clinical division within BCHC - specialist services,
adults and community and children and families. In the year April 2010 - March 2011, 536 calls
were received on the freephone helpline.
Service
Number of enquiries
Rehabilitation Services
51
Learning Disabilities Services
15
Adults & Communities
317
Children & Families
153
Below are a few examples of the type of calls received from each division / service
Call received
Response
Patient rang to say her GP had referred her
to Birmingham Wheelchair Service for a new
assessment for provision of a motorised chair.
This was some months ago and patient wanted
to check current position.
The caller was given the direct number
for Birmingham Wheelchair Service and
hours of opening. The service were able
to explain the current position.
Caller phoned PALS because she was not
informed by Central Booking Service that her
son’s appointment was cancelled and rebooked.
An appointment was made for child and
if there is an earlier appointment due to
cancellation the centre will contact
parent. Parent is happy with the outcome.
The contact number for the PALS helpline is: 0800 917 2855
E-mail: Bham.PALS@bhamcommunity.nhs.uk Text: 07540 702477
Quality Account 2010-11 [34]
How BCHC engages with patients and the public
In March, patients, carers, members of the public and stakeholders attended
a workshop at Moseley Hall Hospital to discuss the future of engagement and
involvement now that the Trust is a citywide organisation.
Patient and public engagement and involvement is an integral part of how BCHC looks to
improve the services we provide. We actively listen to and work with the people we serve.
We use a variety of formal and informal techniques to ensure that your views are obtained.
These include public meetings, focus groups, specific events, and questionnaires. We obtain
these views when planning, designing, delivering and evaluating services. An example of this
is that patients and their carers told us that the discharge process was often a difficult and
concerning time. Through these comments a new discharge information leaflet has been
developed.
Our aim over the next 12 months is to ensure that our engagement work reflects the
Birmingham community. We will be making efforts to ensure that we successfully engage with
hard to reach groups, make contact and begin to engage with new individuals and groups to
establish their priorities when accessing our services, while maintaining our excellent relationship
with patients and the public with whom we already engage.
The views of patients, carers, members of the public and key stakeholders will influence our
organisation as we move forward towards Community Foundation Trust status. By becoming a
Foundation Trust we can involve and engage local people, patients and our partners fully in the
development of our strategic plans and services to be more accessible and responsive.
[35] Quality Account 2010 -11
Message from the chair of the Patient Involvement Action Group (PIAG)
The involvement of patients, the public and
carers in decisions regarding healthcare is very
important and is, in fact, laid down by law.
BCHC has made efforts to demonstrate its commitment
to this principle by involving representatives from the
local community in various forums and activities essential
to the process of continual evaluation, reflection and
improvement.
For example, two members of the public sit on the Trust’s
clinical governance committee, ensuring that not only
are they aware of developments in the Trust but also that
they are able to make valuable contributions based on
their experience in private industry.
An important role is performed by the long-standing
PIAG, consisting of representatives of a number of local healthcare organisations. PIAG meets
on a bi-monthly basis to discuss issues about how the Trust is being run and provides a forum to
voice both compliments and complaints alike. The meetings also provide an opportunity to listen
to presentations about particular aspects of service provision.
A range of staff from all levels of the Trust attend these meetings, with progress on actions
arising reported on at the following session. Additionally, regular contact is made with the chair
and chief executive of the Trust so that the up- to-date situation in the organisation can be
discussed and reported to the other members of the group.
Both formally and informally, members of the community are encouraged to be involved from offering opinions in service user forums or editing a patients’ newsletter right through to
PEAT inspections (see article on page 49) and committees determining the future shape of the
evolving organisation, the public plays an active, valued and diverse role in the work of BCHC.
If you are interested in joining the Public Involvement Action Group, or would like further
information about the meeting or on other ways in which you can have your say on BCHC
services, please contact the patient experience team on
tel: 0121 465 7810 or email: adam.dandy@bhamcommunity.nhs.uk.
Brian Hanson Chair, Patient Involvement Action Group
Quality Account 2010-11 [36]
Staff survey
Each year the Care Quality Commission undertakes a survey of NHS Staff. The results help trusts to
review and improve the work experiences of their staff so that they can provide better care to patients.
The results of the survey will be used to:
• inform patients and the public of each trust’s results
• supports the Care Quality Commission activities such as the monitoring of ongoing compliance and reviews
The Department of Health will also use the results to inform commissioning, service improvement and
performance measurement, and to review and inform NHS policies
The key findings for Birmingham Community Healthcare NHS Trust, as compared with other PCTs,
have been mapped against the four pledges to staff that set out what the NHS expects from its staff
and what staff can expect from the NHS as as an employer:
1. To provide all staff with clear role and responsibilities and rewarding jobs for teams
and individuals that make a difference to patients, their families and carers, and to
communities.
The Trust scored in the highest 20% or above average with regard to staff feeling satisfied with
the quality of their work and the patient care they are able to deliver, staff agreeing that their role
makes a difference to patients, quality of job design and effective team working. The organisation
scored below average for staff working extra hours (for this indicator the lower the score the
better).
Areas where the Trust scored less favourably included percentage of staff feeling valued by their
colleagues and staff who use flexible working options. In context, the results indicate that 71%
of staff are using flexible working options as compared to a median score of 78% for all PCTs
nationally.
2. To provide all staff with personal development plans, access to appropriate training
for their jobs and the support of line management to succeed.
The Trust scored in the highest 20% or above average with regard to percentages of staff feeling
there are good opportunities to develop their potential at work, staff who have received relevant
job training, learning or development in the last 12 months, staff who have been appraised in the
last 12 months including those with personal development plans in place.
Support from immediate line managers was a below average score.
[37] Quality Account 2010 -11
3. To provide support and opportunities for staff to maintain their health,
wellbeing and safety.
The Trust scored in the highest 20% or above average in regards to staff who have received health
and safety training in the last 12 months and fairness and effectiveness of incident reporting
procedures.
Percentages of staff suffering work-place injury and work-related stress in the last 12 months
is below average as is that relating to staff who have experienced physical abuse, harassment,
bullying or abuse from staff, patients, relatives or the public. Those witnessing potentially harmful
errors, near misses or incidents in the last month together with the reporting of such incidents are
also below the average, although this is still 95%.
The impact of health and wellbeing on staff’s ability to perform work or daily activities, the
percentage of staff feeling pressure in the last three months to attend work when feeling unwell
and the availability of hand washing materials being always available were also below average.
4. To engage staff in decisions that affect them and the services they provide, individually,
through representative organisations and through local partnership working
arrangements. All staff will be empowered to put forward ways to deliver better
and safer services for patients and their families.
The Trust is above average with regard to percentage of staff feeling able to contribute towards
improvements at work. However, the percentage of staff reporting good communication between
senior management and staff was below average.
Quality Account 2010-11 [38]
• Our actions to improve the perception of communication between senior managers and staff and the support received from line managers increases
•
•
•
Inclusion in management and leadership training programmes Roll out of managers code of practice in line with cultural development work programme
Ensure ongoing promotion of senior teams with back to floor visits
• Our actions to support staff who feel harassed and promote a culture where bullying, harassment and discrimination is not acceptable
•
•
•
Launch of new Dignity at Work Policy
Raise awareness of advisors
Include within review and roll out of equality and diversity training, management behaviours and managers code of conduct
• Our actions to support mental wellbeing and management of stress:
• Provide information to managers and team
• Raise awareness through communications
• Develop training programmes for staff and managers
• Our actions to improve hand washing materials
• Information is promoted through communications and staff briefings
• Ensure Information is included in training opportunities such as induction
[39] Quality Account 2010 -11
Privacy and dignity
BCHC prides itself on offering services that
prioritise patients’ dignity and that are
responsive to individual needs and wishes.
But it is not so common for patients
themselves to set an example for others
to follow.
Emily Ockford and Margaret Baker are
exceptions. The friends met two years
ago while inpatients at Riverside Lodge
intermediate care centre in Small Heath
as they recovered from injuries and trauma following accidents. And, even as their rehabilitation
continued, they became invaluable additions to the team.
87-year-old Emily of Ladywood, says their involvement came about quite spontaneously:
The staff were wonderful but it’s still an upsetting experience having to be away from
your own home while you’re ill or injured. So, we got talking and said ‘look, let’s help
each other along and try and give something back as a thank you for the wonderful care
we had received.
66-year-old Margaret of Winson Green, adds that there’s no secret to what the ladies offer - just
a sharp eye for people in need of support; a sympathetic ear to listen and help identify patients’
needs; and the fresh perspective of people with recent experience of being in the same position.
We were just so grateful, we wanted to show our appreciation. At first, it was one day
a week - it started with a bit of bingo, Then, after a few weeks, we were both well
enough to go home but we wanted to stay involved. So we met up each week to think
of different activities we could help run. That has grown to three days a week - two at the
Norman Power centre as well as a morning at Riverside. We love it - it’s great for us to be active
and involved and hopefully we’re really adding some benefit for the patients.
Emily and Margaret conduct a regular, informal patient forum to feed back
to staff and have also become trained dignity champions. And Emily was asked to act as a
patient representative on the PEAT inspection panel for Riverside Lodge and Norman Power.
Angie Martin, modern matron of Norman Power and Riverside Lodge, said:
Margaret and Emily have become much-valued members of our team.
They have such generous personalities; all the patients and staff
really appreciate their contribution.
Quality Account 2010-11 [40]
Feedback tool designed by young people for young people
Nearly 1,000 Birmingham school pupils took part in a
ground-breaking project to develop an appealing way for
young people to give their views on healthcare services.
Fifteen primary and secondary schools took part in the
project, which gave children aged between seven and 14
the opportunity to contribute to the content and design of
interactive, computer-based tools enabling young people
to feed back to healthcare professionals immediately after
accessing a BCHC service.
Through role play, design work and discussion, pupils described and explained their experiences
as healthcare service users and the type of features, such as touch screen inputting and special
applications for pupils with learning difficulties, that would encourage them to give immediate
feedback via portable gadgets such as computer notebooks and tablets.
The initiative was led by Prof Tony Ghaye, director of non-profit social enterprise Reflective
Learning-UK, on behalf of the children and families division in the east and north of
Birmingham.
Tony believes the core objective is to empower young people by involving them right from the
initial conception.
The aim was to find a systematic and confidential way to encourage young people to tell
us about their experience of healthcare services and then use the information to drive
improvement. The core principle was that the design and content of the tools should be
based upon what children and young people wanted to tell us, which could be quite different
from what we think we want to know.
As a result, the whole look, feel and content of the tools reflect what young people want to tell
adults. It’s the real voices of young people. Each tool is quick to use, fun to do and gives adults
vital information.
Among the participants were Year 7 pupils of Stockland Green School in Erdington, whose views
were instrumental in the tool’s development.
School liaison officer Linda Wootton said: School liaison officer Linda Wootton said:
We were really pleased to be invited to take part. The strength of it was that the project
was based on the principle of giving each child a voice and creating an engaging way in
which it can be heard. The pupils were really engaged and enthusiastic.
School nurse team leader Seye Obadina said:
We aim to provide a service that is led by the needs of the pupils and responsive to their
wishes so this was an extremely useful project to engage with them and demonstrate
that ethos.
Discussions are now taking place to progress the project to full implementation in schools and
other clinical settings.
[41] Quality Account 2010 -11
Complaints data
BCHC services number of complaints expressed as percentage of activity
Activity
No. of
complaints
No. of complaints shown as %
of activity provided by BCHC
Inpatient occupied bed days 163746
18
0%
Outpatient appointments 47134
31
0%
Community contacts 641663
54
0%
Total
91*
Complaints acknowledgment
Complaints acknowledged within 3 days
96%
Complaints responded to within 6 months
100%
Number of complaints
Upheld
12
Partially upheld
27
Not upheld
18
Ongoing
23
Closed
2
No action required
1
No outcome recorded
8
Please note: BCHC complaints data in this Quality Account is reflective of:
• Former South Birmingham PCT Complaints figures 2010-11.
• Former HOB and BEN PCTs data from 1st Dec 2010 - end March 2011
• Combined Community Dental Service data
Total BCHC complaints data in this Quality Account excludes:
• Complaints data for services provided by BCHC from Birmingham Dental Hospital as this has been presented separately in the corresponding Quality Account for Birmingham Dental Hospital.
*
Twelve complaints which relate to HMP Birmingham which will officially be reported in Birmingham and Solihull Mental Health Trust’s Quality Account.
Quality Account 2010-11 [42]
Further action taken following patient experience feedback include:
Top three complaints themes
Care and treatment
Appointments
Attitude
Themes
Action taken
Appointments cancellation, waiting times / delay,
difficulty contacting the service to
arrange
Services have taken action to review how
appointments are booked and how patients are informed of
likely timescales between appointments - many enquiries relate
to patient unmet expectations.
Communication and staff attitude
Work has taken place across a number of services to raise
awareness of the importance of effective customer care. The
Trust has offered a Neuro Linguistic Programming Diploma and
Practitioner courses and customer care / Patient
Experience courses to staff. and the Trust has been working
towards achievement of the Customer Service excellence award.
Patient falls
The organisation’s highest number of incidents
relates to falls and complaints can often follow such incidents.
Where temporary staff are employed there is a risk that they
may not know patients well and may take unnecessary risks
(e.g. when transferring or mobilising). This will be addressed as
part of the Care Planning Working Group and the Productive
Ward Programme.
Manual Handling training will raise awareness to staff of the
importance of checking / knowing a patient’s status and any
relevant professional recommendations prior to handling.
Care and treatment - discharge /
transfer expectations
for patients and relatives
An example of our work to improve our care and treatment
relates to our discharge and transfer procedures. Discharge /
transfer expectations for patients and relatives can be raised if
incorrect information is provided about our
services by other organisations. A Directory of Services and a
single point of enquiry would help to reduce the risk of this
happening. This matter will be discussed further by the Trust’s
Documentation Review Group.
Complaints processes
Work is taking place to ensure managers within Divisions are
fully aware of actions required when they receive any form of
complaint.
[43] Quality Account 2010 -11
Incidents recorded
Incidents* by incident type
Confidentiality, data and
information governance
South
(excluding
Dental)
BEN
HOBT
110
41
93
49
2
3
Infrastructure
171
86
101
Medication, medical gas,
medication delivery system
264
109
52
2907
1380
827
Security
105
27
108
Staff, visitor, contractor incident
663
145
128
Other
0
100
95
Totals:
4269
1890
1407
Fire safety
Patient incident
*An Incident is any event which has given rise to actual harm or injury or to damage / loss of property
(Ref: NHS Executive).
This definition includes patient or client injury, fire, theft, vandalism, assault and employee accident.
It includes incidents resulting from negligent acts, deliberate or unforeseen.
Quality Account 2010-11 [44]
Top 3 incident types
Incident type
Top 3 categories
South
(excluding
Dental)
Slips Trips and Falls
Patient Incident
Staff, Visitor, Contractor Incident Medication, Medical Gas,
Medication Delivery System
BEN
HOBT
1119
611
327
Care Delivery
508
338
225
Accident
397
73
94
Violence Abuse
291
58
28
Slips Trips and Falls
72
26
28
Contact Injury
58
31
25
Administration
109
*
*
Preparation/Dispensing
50
*
*
Storage
38
*
*
* HOBT and BEN all listed under medication, no separate categories
Serious Incidents**
Reported 01/04/10-31/03/11
Number
South
BEN
28
HoB
19
Total
16
45
**A Serious Incident (SI) is
•
An accident or incident when a patient, member of staff (including those working in the community), or a member of the public (including contractors) suffers serious injury, major permanent harm or unexpected death (or the risk of death or serious injury) on either premises where health care is provided, or whilst in receipt of health care, or.
• Any event where actions of health service staff are likely to cause significant public concern.
• Any event that might seriously impact upon the delivery of services and / or which is likely to produce significant legal, media or other interest and which, if not properly managed, may result in loss of the Trust’s reputation or assets.
• Damage or loss to property by fire, flood, theft or negligent, deliberate or unforeseen act.
[45] Quality Account 2010 -11
Understanding and learning from our incidents
Patient incidents
Slips, trips and falls are the highest number of recorded incidents, which is due to the relatively
high proportion of elderly and rehabilitation patients cared for within our services i.e. elderly and
rehabilitation patients. Significant work has been undertaken across all services to ensure that patients
are appropriately assessed for their risk of falling on admission to hospital or on initial community
services contact and that a suitable plan of care is implemented should patients be identified as being
at risk. This work has been supported and monitored throughout the year through the CQUIN schemes
and through Essential Care Indicators.
Incidents that occur at the point of care delivery.
Further interrogation of these incidents shows that the majority of incident reported under this
category are incidents of pressure sore development. The CQUIN scheme has significantly raised
awareness of the need to report this type of incident and reporting figures have risen significantly
throughout the year as a consequence. Clinical staff have worked consistently hard across our
inpatient services to ensure that these incidents are identified and appropriate care and treatment
plans are in place. Effectiveness of these measures is monitored through the CQUIN scheme and
essential care indicators which have shown a significant reduction in the number of incidents where
patients have developed pressure ulcers while in our care.
Staff, visitor, contractor incidents
Violence and abuse incidents against staff remain the highest reported incidents affecting staff. The
majority of these incidents occur within either learning disability services or within elderly inpatient
services and are often related to the nature of illness / disability affecting our patients. Staff receive
training appropriate to their service areas and client groups to help them to effectively manage this
type of incident and much work has taken place within Learning Disability Services to demonstrably
reduce the number and frequency of this type of incident.
Where malicious violence is targeted against our staff, BCHC takes a strong stance. Staff are supported
in a number of ways including counselling and occupational health services and by the local security
management specialist should more formal action be required.
Medication incidents
The majority of incidents in this category relate to issues at the point that medication is / should be
administered. Many of the incidents recorded report that medication has not been administered at
the time it is due. The medicine management committee maintains an oversight of medication related
incidents in order to identify any themes. The committee works closely with services to identify lessons
that can be learned and to prevent reoccurrence.
Quality Account 2010-11 [46]
Working with the National Patient Safety Agency
The National Patient Safety Agency (NPSA) manage a national database used by the NHS as a tool for
reporting and learning from incidents. NHS Trusts use this information to improve patient safety ad
compare safety incident reporting trends with other organisations.
NPSA data for April to October 2010 for the three Trusts that combined to form BCHC is indicative of
a positive reporting culture. Experience in other industries has shown that staff are more likely to report
incidents as the organisations reporting culture matures. This reflects a safer organisation where staff
collectively have safety at the forefront of their minds and know they will be fairly treated if they report
an incident. Learning from incidents is shared with staff throughout the Trust to improve safety and
prevent harm.
Following an analysis of incidents and a range of other data including risk assessments, audit feedback
and information obtained through trust wide initiatives described elsewhere in this document (essential
care indicators and the CQUIN scheme) clinical teams have prioritised patient safety improvement work
in the following areas:
• reducing harm from falls • administration and prescribing of medicines • pressure ulcer prevention and care
Slips, trips and falls
We acknowledge that, due to the nature of our client group, and rehabilitative care provided by the
Trust a large percentage of incidents reported relates to trips slips and falls. In order to minimise the
potential for patient falls clinical teams have reviewed best practice guidance in relation to the causes
and prevention of falls while seeking to maintain a balance between patient safety and the promotion
of independence as part of the rehabilitation process. Teams have taken active steps to minimise
the potential for falling in their clinical areas and improvements have been reflected within incident
reporting data.
Pressure ulcers
The prevention of pressure ulcers is a priority for the Trust. Staff are required to report any occasion
where patients have acquired a pressure ulcer or their pressure ulcer has deteriorated while they were
under the care of BCHC services. This type of incident is reported through our incident reporting
procedures and the potential causes are thoroughly investigated each time in order to review practice.
Learning from incidents is shared across the Trust.
[47] Quality Account 2010 -11
Some of the actions taken as part of this safety programme include:
•
•
•
•
development of a tool to support staff in analysing the root causes of this type of incident
reviewing pressure ulcer related incident data at ward level to demonstrate where improvements have been made
ensuring consistency in the use of pressure ulcer risk assessments and care plans
ensuring pressure relieving equipment is available and used appropriately.
Medication incidents
Our medicines management team has made changes to the methods used for prescribing and
administering medicine following an analysis of medication related incidents. Further details of patient
safety related information are reflected elsewhere in this Account.
Control of infection
BCHC is committed to taking all possible measures to minimise
infection in all settings where services are delivered - and our
extended range of specialist community dental services is a
shining example of what can be achieved in a wide range of
locations.
In 2010 -11, the range of community dental services was
significantly extended, with the transfer-in of teams from
neighbouring trusts in localities in Birmingham and the Black
Country.
Rigorous standards are applied in all clinical facilities where
community dental services are provided, which includes mobile
units that deliver care in the most convenient place for patients
with particular access issues, such as children and young people attending special schools.
Using a handheld device to measure bacterial contamination, hygiene levels are now accurately
assessed within seconds - and all community dental service sites measured during 2010-11 were
found to be in the highest category of decontamination standards.
The dental teams have extremely effective decontamination procedures in place and
that is reflected by these excellent results.
Of course, moving forward the Trust offer community dental services in an even wider
range of settings, including HMP Birmingham so our commitment is to maintain our excellent
record across all our locations.
Infection control lead Kath Hughes (pictured above) conducting tests in a mobile dental unit.
Quality Account 2010-11 [48]
Section 10: National targets
South target for
2010-2011
South provider indicators
Total
2010-2011
(or end of year
status where
appropriate)
<5
1
< 88
22
% compliance with CQC standards
100%
100%
18 week admitted pathway
> 90%
93%
18 week non-admitted pathway
> 95%
98%
< 09/10 (601 cases)
783
< 09/10 (11.6%)
16.90%
Community matrons
15
15
Case managers
21
21
Percentage of SIs reported within 2 working days
100%
100%
% sickness absence (12 months rolling average)*
5.27%
5.62%
Spend on temporary staff as a % of total pay
< 5%
9.20%
VSA 14 - Quality of stroke care - Part 90% of time on
a stroke unit at SBCH
90%
100%
Breastfeeding prevalence (total % breast exclusive and
supplemented)
42%
43%
Breastfeeding coverage: The number of children with
a breastfeeding status recording as a percentage of all
infants due for a 6-8 check.
95%
98%
Obesity prevalence at reception (2009-10) participation
(status recorded)
94%
97.40%
Obesity prevalence at Year 6 (2009-10) participation
(status recorded)
87%
93.20%
MRSA new bacteraemias.
Cdiff new cases.
Delayed transfers of care (numbers)
Delayed transfers of care (%)
[49] Quality Account 2010 -11
BEN provider indicators
% compliance with CQC standards
18 week non-admitted pathway
Delayed Transfers of Care (numbers)
% of SIs reported within 2 working days
% sickness absence (12 months rolling average)
100%
95.87%
12
80%
5.11%
Breastfeeding Prevalence (Total % Breast Exclusive
and Supplemented)
40%
Breastfeeding Coverage: The number of children with
a breastfeeding status recording as a percentage of all
infants due for a 6-8 check.
96%
HOBT provider indicators
MRSA new bacteraemias.
0
Cdiff new cases.
0
% compliance with CQC standards
18 week non-admitted pathway
Delayed transfers of care (numbers)
100%
99.80%
5
% of SIs reported within 2 working days
100%
% sickness absence (12 months rolling average)
5.22%
Spend on temporary staff as a % of total pay
8%
Quality Account 2010-11 [50]
Public Involvement Action Group member Rob Rijckborst was part of the team
that carried out the PEAT inspection at West Heath Hospital.
Our inspection visit was unannounced but the smell
of cleanliness was everywhere - a lot of ‘dustpinching’ by our team failed to find evidence of
unsatisfactory standards. Chairs, showers, curtains, toilets
and bathrooms; beds, including wheels and under-mattress
frames - all spotlessly clean.
A daily deep clean takes place on a room-by-room rota basis
- delivering massive benefit but minimal impact for patients
- wherever the task is carried out, patients are well looked
after in bright, hospitable foyers.
Talking with several patients, all were content with the care
on offer - hospitality in a hospital, where members of staff
are committed to providing high quality care in a homely, personalised atmosphere.
Leaflets containing important patient information are everywhere, from reception area to
the bedside. We inspected the provision of medication and the prudence exercised in its
administration and the storage of dressings and bandages - all to a good standard.
Remarkably, in a building of this age, there is no significant sign of wear and tear. Maintenance
and upkeep is an ongoing effort and we witnessed how engineers respect patients’ dignity as
they do their jobs on the wards. And there is a real sense of camaraderie among colleagues,
further promoting a welcoming environment.
Last, but by no means least, we sampled some of the food choices available to patients. Not
only was it extremely tasty, it was promptly delivered and served; and therefore piping hot.
A hospital stay can be an isolating experience. But such effort goes into creating a welcoming
environment that West Heath Hospital minimises the negative effects. Huge windows on
the wards create a light, airy environment and afford clear views of the surrounding area
- maintaining clear contact with the community outside, the very leitmotif of Birmingham
Community Healthcare’s approach.
Dr Rob Ryckborst
[51] Quality Account 2010 -11
Patient Environment Action Team (PEAT) assessment team scores for 2010
PEAT is an annual assessment of inpatient healthcare sites in England with more than ten beds.
PEAT is self assessed and inspects standards across a range of services including food, cleanliness,
infection control and patient environment (including bathroom areas, décor, lighting, floors and
patient areas).
Each inspection is carried out by a team of PEAT assessors which includes patients, patient
representatives and members of the public.
Former
South
Former BEN
Former
HOBT
Location
Environment
Food
Privacy and
dignity
Moseley Hall Hospital
Good
Excellent
Excellent
Sheldon Nursing Home
Good
Excellent
Excellent
West Heath Hospital
Excellent
Excellent
Excellent
Ann Marie Howes Centre
Acceptable
Good
Excellent
John Taylor Hospice, Erdington
Excellent
Good
Excellent
Perry Tree Centre
Acceptable
Good
Good
Ward 29, Heartlands Hospital
Acceptable
Good
Good
Ward 3, Good Hope Hospital
Poor
Good
Acceptable
Norman Power Centre
Good
Excellent
Excellent
Riverside Lodge
Good
Excellent
Excellent
The PEAT scores for 2010-11 continue to demonstrate our commitment to providing the
highest standards for the patient environment.
The high scores for the quality of the food provided by our bedded units were reinforced
by positive comments from patients during mealtimes we observed on the PEAT inspection visits.
One of our bedded areas has scored poor for environment. This ward is sat in a large acute trust
and we will work with the Trust to put in place a rectification plan to improve this score.
Lisa Eden, Associate Director of Therapies.
Quality Account 2010-11 [52]
Section 11: Statutory data
During 2010-11 BCHC provided and / or sub-contracted 109 NHS services.
The BCHC has reviewed all the data available to them on the quality of care in all of these
NHS services.
The income generated by the NHS services reviewed in 2010-11 represents 100 per cent of the
total income generated from the provision of NHS services by the BCHC for 2010-11.
Reviewing our services
The Rapid Response Service and Urgent Care Bureau have spearheaded a new model of
community service delivery across Birmingham by creating an easily accessible alternative
to hospital admission for acutely ill patients. The service began in April 2009, integrating
the expertise of Advanced Nurse Practitioners with community nurse assessors, physiotherapists,
occupational therapists, podiatrists, community psychiatric nurses and social workers. The Rapid
Response Service provides assessment and treatment within 2 hours in patients’ own homes.
Pivotal in its’ success the single point of access to the service is the Urgent Care Bureau, which
provides the ‘bed bureau’ function for secondary care in South Birmingham thus allowing the
clinicians answering all calls the ability to offer, at the point of referral, alternatives to acute
admissions; these including community hospital admissions and care in the community.
A growing number of these medically unwell patients are now treated in their homes, which has
delivered an 11% reduction in acute hospital admissions for GP-referred patients at University
Hospital Birmingham during 2010-11.
Most importantly, following the implementation of the new model of care the Rapid Response
Service is able to evidence an increase in patient and referrer satisfaction and improvements in
the patient experience.
Lorraine Thomas, Director of Service Transformation
[53] Quality Account 2010 -11
Registration with the Care Quality Commission
Birmingham Community Healthcare NHS Trust is required to register with the Care Quality Commission
and its current registration status is unconditional
The Care Quality Commission has not taken enforcement action against Birmingham Community
Healthcare NHS Trust during 2010-11.
Birmingham Community Healthcare NHS Trust has participated in special reviews or investigations by
the Care Quality Commission relating to the following areas during June (7-18th) 2010.
Joint Inspection of Safeguarding and Looked After Children’s Services in Birmingham, carried out
jointly with OFSTED. The inspection looked at services for children within and across the City, of
which Birmingham Community Health at the time of the Inspection, provided a number of city wide
specialist children’s health services including a nurse and community paediatric health led service for
Looked After Children, and the universal health services of health visiting and school nursing for those
children and families living in the south of the City. At the time of the inspection, the organisation was
at ‘an arms length’ provider, known as South Birmingham Community Health, but was still part of
South Birmingham PCT.
Birmingham Community Healthcare has continued to actively engage with the City’s Improvement Plan
which was developed as a response to the Improvement Notice served on the Local Authority post
Inspection. A Senior Manager has been commissioned for 12 months to work with the Local Authority
and to jointly lead one of the work streams within the plan. In respect of the organisations actions
post inspection, we can confirm these have been actioned and successfully concluded. All have been
reported formally to the Improvement Board (chaired by an Independent Chair and attended by Lead
Council members, PCT commissioners, Senior managers within the LA including Director of Children’s
Services and Deputy and the organisation). The Board formally monitors the plan and progress and the
Chair is responsible for updating the Minister for Children, Young People and Families on a quarterly
basis. The organisation is represented on the Improvement Board, Children’s Trust Board and the
Safeguarding Children’s Board and regularly attends these meetings.
Specific health actions post joint CQC and Ofsted Inspection have been undertaken in partnership
with health commissioners as additional resource was required to enable some of these actions to be
successfully delivered or required commissioner endorsement as a result of organisational change.
Necessary actions were identified as follows:
• within three months - Clarify the roles and capacity of the designated professionals across the three PCTs
• within 6 months- Ensure that health care workers are enabled to apply fully the requirements of the common assessment framework
• within 3 months - Develop a strategic plan for the health care of looked after children and care leavers and ensure that current serious deficiencies in health checks are rectified
Quality Account 2010-11 [54]
Birmingham Community Healthcare Trust has made the following progress by 31st March 2011:
The organisation can now confirm that following re-organisation of services post acquisition of former
BEN PCT and HOBt PCT, Provider services that the former named and designated nursing teams have
been re-organised which have enabled designated nurse capacity to be strengthened. There is now
3.4 whole time equivalent designated nurses as opposed to 1.8 whole time equivalent at the time of
inspection with clarity regarding roles and responsibilities. In respect of Designated Doctor capacity, an
additional four PAs was committed by the health commissioners to increase capacity within the service
which has been delivered.
Significant progress has been made in respect of CAF (Common Assessment Framework). Joint
training has been delivered with partners and a city wide group meets monthly including partners from
across the health sector in attendance. Within BCHC, the healthcare needs assessment used within
health visiting and school nursing has been reviewed and updated to include the pre CAF checklist
as part of the assessment process and all staff have received training on the Birmingham Windscreen
model which underpins CAF in the city. Other children’s specialist services are also exploring ways of
integrating the CAF into their assessments and are committed to delivering this.
There is now an updated strategic plan for the healthcare of looked after children. Additional
administration capacity was provided by health commissioners to enable the timely entry of health
data to be inputted within the health team directly onto CareFirst (the local authority database).
This has been successful with an end of year return of 86.56% against the national return C19.
The National Health Service Litigation Authority (NHSLA) membership status
The National Health Service Litigation Authority handles negligence claims and works to improve
risk management practices in the NHS. This is achieved through an extensive risk management
programme. The core of this programme is provided by NHSLA standards and assessments.
BCHC is compliant with Level One NHSLA standards. This means the process for managing risks has
been described and documented.
[55] Quality Account 2010 -11
Our commitment to data quality
BCHC will be taking the following actions to improve data quality:
Provide a framework for the reporting of data quality performance to national and local standards
throughout all levels of the organisation. This framework will be supported through improvement
planning, guidance, and training to all users to drive and maintain improvement in all identified data
quality areas. All actions will be fully documented, agreed with the Trust where appropriate. These
actions will include, but are not limited to:
•
•
•
•
•
agreed data quality reporting suite and schedule
board monitored Key Performance Indicators (KPIs)
development and governance of a Trust data quality policy, clinical system usage policy
standard system and data quality training (including update training)
service level support and guidance
By developing a program of data quality metrics, measurement and regular reporting, the Trust
can build increased awareness of what data quality means for the business. Metrics can help
demonstrate what risks or issues might be presented by any decline in data quality levels as well as
what opportunities might be gained by investing in improvement. Metrics also support objective
judgment and reduce the influence of assumptions, politics, emotions and vested interests. Trust KPIs
and the executive decisions aligned with them will most likely relate to cost, revenue, profitability,
procurement, logistics, products, customers, suppliers and other important assets. Identifying the
processes supporting these KPIs, the data required for these to operate effectively and the quality of
that data enables the Trust to determine the impact of poor quality in tangible terms. The result is an
improved ability to gain business understanding and support for building the business case for data
quality. All actions will be fully documented, agreed with the Trust where appropriate. These actions
will include, but are not limited to:
•
•
•
•
•
agreed data quality reporting suite and schedule
board monitored KPIs
development and governance of a Trust data quality policy, clinical system usage policy
standard system and data quality training (including update training)
service level support and guidance
Information governance assessment
BCHC information governance assessment report score overall score for 1st December 2010 to 31st
March 2011 was 59% and was graded not satisfactory.
The Information Governance Toolkit has significantly changed from self assessment to mandatory
evidence based submission which includes upload of evidence for each requirement. The evidence
type relates to agreed and approved strategies, policies, procedures, circulation, staff awareness and
compliance audits.
Action plans are being developed, together with information governance divisional leads from across
the organisation, to include objectives and time frames to support the delivery of evidence for next
baseline assessment at end of July 2011.
Quality Account 2010-11 [56]
NHS numbers and general practice codes
The information shown here is split by the three former organisations as the data streams remained
separate to the end of the financial year. For 2011-12 the figures will be shown as one for the new
organisation.
South Birmingham Community Health submitted records during 2010-11 to the Secondary
Uses service for inclusion in the Hospital Episode Statistics which are included in the latest published
data. The percentage of records in the published data which included the patient’s valid NHS number was:
99.8% for admitted patient care;
99.6% for out patient care
included the patient’s valid General Medical Practice Code was:
98.9%for admitted patient care;
99% for out patient care
Heart of Birmingham Primary Care Trust submitted records during 2010-11 to the Secondary
Uses service for inclusion in the Hospital Episode Statistics which are included in the latest published
data. The percentage of records in the published data which included the patient’s valid NHS number was:
100% for admitted patient care;
100% for out patient care
included the patient’s valid General Medical Practice Code was:
100%for admitted patient care;
100% for out patient care
Heart of Birmingham Primary Care Trust submitted records during 2010-11 to the Secondary
Uses service for inclusion in the Hospital Episode Statistics which are included in the latest published
data. The percentage of records in the published data which included the patient’s valid NHS number was:
100% for admitted patient care;
100% for out patient care
included the patient’s valid General Medical Practice Code was:
100%for admitted patient care;
100% for out patient care
Birmingham East and North Primary Care Trust submitted records during 2010-11 to the Secondary
Uses service for inclusion in the Hospital Episode Statistics which are included in the latest published
data. The percentage of records in the published data which included the patient’s valid NHS number was:
96% for out patient care
included the patient’s valid General Medical Practice Code was:
99.2% for out patient care
BCHC is not subject to the Payment by Results clinical coding audit during 2010-11 by the Audit
Commission.
[57] Quality Account 2010 -11
Section 12: Feedback from our stakeholders
Comments from Heart of Birmingham Teaching Primary Care Trust
The Heart of Birmingham Teaching PCT welcomes the first Quality Account from
Birmingham Community Healthcare NHS Trust and the opportunity to provide this
statement. In our role as Lead Commissioner we strive to ensure that the services
provided are safe, effective and provide positive experiences for patients. In accordance with
the vision set out in ‘High Quality Care for All’ Heart of Birmingham Teaching PCT, associate
commissioners NHS Birmingham East & North and NHS South Birmingham, and Birmingham
Community Healthcare NHS Trust agreed a CQUIN Framework for 2011-12 which reflected local
priority areas. These CQUIN schemes have been included within this publication as the quality
indicators for 2011-12.
We have discussed the development of this Quality Account with Birmingham Community
Healthcare NHS Trust and have been able to contribute our views on consultation and content.
The PCT recognises that this is the first Quality Account of the new organisation and that
the Trust has tried to balance anecdotes about patients, staff and services from all of the PCT
Provider Services that transferred into the Trust in December 2010. The Quality Indicators chosen
for this year therefore represent a baseline that will be reviewed against data sources as part of
contract / performance monitoring discussions throughout 2011-12.
Overall we welcome the vision described within the Quality Account, agree on the priority areas
and will continue to work with Birmingham Community Healthcare NHS Trust to continually
improve the quality of services provided to patients.
Denise McLellan, Chief Executive
Birmingham and Solihull Cluster
BCHC has complied with your statutory requirements in sending its Quality Account to the health and adults overview and scrutiny committee but the committee declined to provide a statement for inclusion in the accounts.
Group Overview and Scrutiny Manager
Birmingham City Council.
Quality Account 2010-11 [58]
Comments from Birmingham LINks
Members of LINks together with PIAG have been completely involved and engaged
with the Trust, within South Birmingham, since its conception. A tremendous amount
of engagement with the public and service users has been done and is still carrying on
in order to gain the views of all the population of Birmingham as to what they require and what
they can expect in respect of their healthcare since the integration of all the services from the
rest of Birmingham, into one community healthcare trust.
Throughout all of the public consultations and engagements it has been beneficial to have staff
at all levels discussing the changes and the future
The integration of the services from both BEN and HOB PCTs did cause some concerns for LINks
- due to the fact that both PCT’s failed to consult with their patients and public locally before the
transfer of services and Staff. This does not reflect on Birmingham Community Healthcare NHS Trust.
Whilst these accounts reflect on some of the priorities for the communities, it is difficult to
quantify that every priority is being met due to the fact that Birmingham has a large and diverse
population with differing needs in different areas, but a great deal of work is being done to
ensure that all needs are met.
With the professionalism that there is within Birmingham Community Healthcare and the
work - consultations and involvement with the service users and the public - that is continually
undertaken, there is no doubt that this Trust can become the foremost healthcare provider in the
country.
Whilst these accounts appear to be a rather large document for the service users and
public to read, of necessity it has to reflect the whole of Birmingham and beyond. The
layout and presentation however does make it easy reading for all.
Birmingham LINks
Section 13: Contributors and acknowledgements
This Quality Account has been written using the guidance Quality Accounts toolkit 2010 - 11
(Advisory guidance for providers of NHS services producing Quality Accounts for the year 2010 -11
published by the Department of Health and Quality Accounts Guide 2010 - 11 published by the
West Midlands Quality Observatory.
Editorial team
Adam Dandy
Public Engagement and Patient Information Lead
David Disley-Jones Communication Manager
Lisa Eden
Associate Director of Therapies
Colin Graham
Head of Clinical Governance
Brian Hanson
Chair of PIAG
Alison Last
Associate Director of Patient Experience
Tracy Millar
Clinical Quality Assurance Programme Manager
Angie Villers
Clinical Quality Assurance Lead
[59] Quality Account 2010 -11
Thank you to all those who provided a story, article or information and who are acknowledged in the
main body of this report. Thank you also to the following members of staff who have contributed an
article or information for the Quality Account:
James Bassinder
Head of Information
Mark Chapman
Head of Performance
Donna Darbyshire
Director of Children and Families Division
Derek DeFaye
PALS Officer
Rachel Fellows
Operational Support Manager, Community Physiotherapy
Pat Field
Janet Fox
Senior Information Specialist, Adults and Communities / Children and Families
Divisions
Head of Equality and Organisational Development
Susie Harrison
CLRM-RM&G Operational Manager
Karl Henderson
Deputy Finance Director
Andrea Hill
Senior Information Specialist for Specialist Divisions
Debbie Hughes
Risk Management Facilitator
Bev Ingram
Director of Nursing and Therapies
Julie Jones
Patient Safety Lead
Angie Martin
Jane McKears
Modern Matron for Inpatient services Norman Power Care Centre and Riverside
Lodge
Patient Safety Programme Manager
Diane Motteram
Patient Experience Lead
Leigh Peplow
Information Governance Manager
Michelle Pillay
Associate Director of Risk and Performance
Carolyn Rogers
Consultant Physiotherapist
Sam Warner
Complaints Manager
Sheena Wilkes
Clinical Effectiveness and Audit Lead
Year 7 Pupils
Stockland Green School
Clinical Illustration and Information Design
Claire Hatchell
Graphic Designer
Disability Advisory Group members
Sandra Wood
Ann Yeomans
Maireade Bird
Quality Account 2010-11 [60]
Section 14: Glossary of terms
BCHC
Birmingham Community Healthcare NHS Trust
C. Dif Clostridium An infection causing vomiting and diarrhoea
Difficile
CAF
Shared assessment and planning framework for children’s services
CQC
Care Quality Commission
The independent regulator of heath and social care in England
CQUINS
Commissioning for Quality and Innovation (CQUINs)
Projects agreed between commissioners who buy our services and the Trust
to improve quality standards
ECIs
Essential Care Indicators
A set of care standards used within the Trust
HOBt
Heart of Birmingham teaching Primary Care Trust
KPIs
Key Performance Indicators
Standards which are used to measure performance
LINks
Local Involvement Network A network of local people and groups
which work to improve health and social care services
MRSA
Methicillin resistant staphylococcus aureus bacteraemia
An infection caused by the staph bacteria which is resistant to most penicillin
based antibiotics
Methicillin sensitive staphylococcus aureus bacteraemia
An infection caused by the staph bacteria which is able to be treated
with most penicillin based antibiotics
Malnutrition Universal Screening Tool
A national tool used to identify if people are at risk of malnutrition
MSSA
MUST
NCEPOD
National Confidential Enquiries of Patient Outcomes
and Death Review Organisation which reviews the management of patients
and makes recommendations for the improvement of clinical practice
NHS BEN
NHS Birmingham East and North
[61] Quality Account 2010 -11
NHSLA
National Health Service Litigation Authority Handles negligence claims
and works to improve risk management practices in the NHS
NICE
National Institute of Clinical Excellence
Provides guidance to the NHS on medicines and treatments
NPSA
National Patient Safety Agency
Does research and produces guidance on how to keep patients safe
OFSTED
Office for Standards in Education, Children’s Services and Skills
Government department that regulates providers of education and
providers of care for children and young people
PALS
Patients’ Advice and Liaison Service
Provides information, support and advice to patients
PEAT
Patient Environment Action Team
An annual assessment of patient care including cleanliness, infection control,
patient environment and privacy and dignity.
PIAG
Public Involvement Action Group
Longstanding public involvement group
VTE
Venous Thromboembolism
A condition in which a blood clot (thrombus) forms in the vein
Quality Account 2010-11 [62]
Or write to:
Communications Team
Moseley Hall Hospital
Alcester Road
Moseley
Birmingham
B13 8JL
Or follow us on Twitter @bhamcommunity
The report is also available at www.bhamcommunity.nhs.uk
Or you can speak to a PALS representative on tel: 0800 917 2855
Accessible, Responsive
Community Healthcare
Produced by Clinical Illustration, South Birmingham Community Health Tel: 0121 237 2775 Ref: 41341 06/11
If you would like to request a copy of this document in an
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please contact the Birmingham Community Healthcare NHS Trust
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