Birmingham Community Healthcare
NHS Trust
Birmingham Community Healthcare NHS Trust
Dental Services
Birmingham Dental Hospital
Quality Account
2010-11
It gives me great pleasure to introduce the second Quality Account for Birmingham Dental Hospital,
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 continue to place great importance on the experience of service users and therefore our focus on quality
moves beyond measurement; to encompass work that strives to ensure all experiences are good, demonstrate
best outcomes and make patient care safe.
Over the past year, we have ensured quality of care is at the top of the Trust Board agenda. To ensure a joined-up
approach from services 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 and have
participated in a programme of Executive Safety visits described in further detail in this document.
Throughout this account you will see many examples of the Trust’s commitment to delivering the highest quality
clinical care. This is reflected in the Trust’s use of innovative techniques to support people to access dental
services and positive feedback from patients about the care and skill demonstrated by staff. The Trust has
continued to be partner of choice for the training of new entrants to the dental profession. Infection control
and decontamination continue to remain a high priority. Exciting developments, including the building of a new
dental hospital facility, will further improve the experience of service users.
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 2012-13.
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 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 Accounts is accurate.
Tracy Taylor, Chief Executive Birmingham Community Healthcare NHS Trust
[1]
Dental Quality Account 2010 -11
Contents
Section 1: Our values
page 3
Section 2: Our region
page 4
Section 3: Putting quality first
page 5
Section 4: Our targets CQUINs 2010-11
page 6
Section 5: Going forward CQUINs 2011-12
page 8
Section 6: Safety
page 9
Section 7: Clinical effectiveness and measuring quality
page 13
Section 8: Engaging, listening, learning, improving
page 21
Section 9: Statutory declaration
page 31
Section 10: Feedback from our stakeholders
page 34
Section 11: Contributors and acknowledgements
page 35
Section 12: Glossary of terms
page 37
The information contained in the Quality Account refers to Birmingham Dental Hospital
Services only. The Quality Account for all other Birmingham Community Healthcare NHS
Trust (BCHC) services is published separately and is available on the BCHC website.
Dental 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]
Dental Quality Account 2010 -11
Section 2: Our region
Solihull Care Trust is the host commissioner on behalf of 17 Primary Care Trust associates.
Wolverhampton
Birmingham
Coventry
Key
Service
Coverage
Population
Birmingham
Dental Hospital
West Midlands
5.5 million
Dental Quality Account 2010-11 [4]
Section 3: Putting quality first
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.
Birmingham Dental Hospital which operates in partnership with the University of Birmingham School
of Dentistry is the sole dental hospital and school in the West Midlands and one of only 10 in England.
Service provision, education and research form key components, with consultant-led dental specialties
providing treatment for around 115,000 attendances each year, together with undergraduate and
postgraduate training for dental students, dentists, dental nurses and dental hygienists and therapists.
The NHS identifies three fundamental elements of quality care:
safety
[5]
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.
Dental Quality Account 2010 -11
Section 4: Our targets CQUINs 2010-11
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.
A proportion of BCHC’s income in 2010-11 was conditional on achieving quality improvement
and innovation goals agreed between BCHC and commissioners 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
Patient Experience
Description:
Undertake a patient satisfaction survey and show where and how
improvements can be made.
experience
Achievement:
A patient satisfaction survey has been conducted by the Picker Institute Europe. It showed
above-average results on all aspects when compared with similar national outpatient surveys. It
contained valuable information about what patients liked, thereby reminding staff of the benefits
of their good practice, which include involving the patient in their treatment planning. Further
improvements informed by our patients are in development.
Data Quality
Description:
Improve the quality of our data about where referrals are received from
and the reason for referral.
effectiveness
Achievement:
The Audit Commission completed the survey and overall concluded that the Dental Hospital has
effective arrangements in place to ensure good quality record keeping for appointments and quality
data. An action plan has been agreed with commissioners for implementation during 2011-12.
Dental Quality Account 2010-11 [6]
Smoking
Description:
Identifying the number of smokers in our outpatient areas and offering
them support to quit smoking.
effectiveness
Achievement:
New documentation was introduced in November 2010, and an audit of compliance undertaken.
Targets in this area have been achieved and we have a plan in place to continue provision of this
information to patients.
Alcohol
Description:
Identifying number of people attending our outpatient services who drink more
than the recommended number of units of alcohol and offering them drink
awareness information and support.
Achievement:
safety
effectiveness
New documentation was introduced in November 2010 and an audit of compliance undertaken in
January 2011. Targets in this area have been achieved and plans are in place to continue provision of
this information to patients.
Decontamination
Description:
Undertake a decontamination audit to evidence good practice and identify
where improvements can be made.
safety
Achievement:
A baseline audit has been undertaken and the results discussed with our commissioners.
Improvements have been agreed and a re-audit is scheduled.
Plans are in place to decontaminate all instruments in a new off site decontamination facility,
as part of the Pan-Birmingham Decontamination Project.
[7]
Dental Quality Account 2010 -11
Section 5: Going forward CQUINs 2011-12
Birmingham Community Healthcare NHS Trust board has 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 these areas.
The results of these initiatives will be reported in the quality accounts for 2011-12.
Dental CQUINs 2011-12
• improve information for patients and referring dentists
• review elements of the paediatric dental service
• patient experience in the Dental Hospital
• development of a clinical network for oral medicine
Improve information for patients and referring dentists
Description: The Dental Hospital staff in conjunction
with the Trust’s corporate patient experience team
experience
effectiveness
will develop information for patients to increase
their understanding of their dental health. It will also
produce information on the practice of the Dental Hospital so that referrers can be sure that they are
referring appropriate patients for treatment. Information will be published on a specific section of the
Trust website, with a clear distinction between information for professionals and patients.
Review elements of the paediatric dental service
Description: In collaboration with commissioners
review the patient experience and service provision to
optimise the current paediatric service,
and help provide guidance for a redesign for when
the new Dental Hospital and School opens.
experience
effectiveness
Patient experience in the Dental Hospital
Description: The extensive survey in 2010-11 has provided much
information which will form the basis for service change in 2011-12.
This will be developed with commissioners, the Trust patient experience team,
and all Birmingham Dental Hospital staff and students who will work to enhance
the patient experience.
experience
Development of a clinical
network for oral medicine
safety
experience
Description: The Trust will
develop a clinical network in
oral medicine to share good practice and improve outcomes for patients.
This should provide a platform for further networks in subsequent years.
effectiveness
Dental Quality Account 2010-11 [8]
Section 6: Safety
Executive safety visits
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. The visits provide an opportunity
for Board members and frontline staff to jointly discuss quality and safety matters, identify good
practice and reduce the potential for future harm.
Executive directors (including the chief executive), non executive directors and senior members of the
nursing and therapies directorate participated in a programme of safety visits to the 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 good practice identified and areas for further action following
visits in 2010-11:
Good practice identified:
• Good professional teamwork between dentists, nurses and staff.
• Good working working relationships with the University of Birmingham School of Dentistry.
• Staff had good ideas about how systems could be improved to release time to further improve productivity.
• A small study has been undertaken to investigate how patients may self medicate.
Actions identified as a result of the executive safety visits:
•
Current formal working arrangements mean that one prescription cupboard key is available and is held by a designated person. A medicines management audit identified that at times a delay was incurred when nurses needed to locate the prescription cupboard keyholder. Appropriate alternative safe options to address this have been implemented in each clinic.
• Feedback from near misses and incidents is to be included as part of the senior nurse forum to ensure feedback for staff and trainees on lessons learned from adverse events.
• Estate issues related to the existing building were acknowledged and are being addressed by the planned replacement build of the dental hospital and school.
• Tracking of patient records continues to be a high priority to ensure that clinical notes are always available when required, which is an important patient safety issue.
[9]
Dental Quality Account 2010 -11
Peter Axon BCHC Director of Finance has taken part in the BCHC Executive Safety programme:
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.
Dental Hospital unannounced visit March 2011
The commissioners visited Birmingham Dental Hospital for an unannounced visit in March 2011.
The visit was a positive experience from which a very constructive report was published.
The commissioners thanked staff for their willingness to interact with the visiting team and for their
openness during the visit. They reported that the majority of staff stated a high level of satisfaction
with both their work and the Trust, citing career progression and training opportunities as a positive.
Staff reported a system of reminders about mandatory training, adding that they would like training
to be more tailored to dentistry.
The commissioners identified many areas of good practice in addition to other areas for
improvement. Overall the standard of infection prevention practice observed was good, staff were
aware of the Trust zero tolerance policy and of the incident reporting process.
Key actions as a result of this visit include:
1.Hand hygiene being reinforced with all clinical staff communicated through team meetings and clinical effectiveness group, and empty alcohol gel dispensers being filled within
three days of the visit.
2.Uncovered linen in a clinical area is now covered.
3.The appropriateness of personal protective equipment (PPE) in one area was questioned. This was already under review by clinical staff and following extensive redesign new PPE is now developed and ready for use.
4. The care pathway for children in primary care is being reviewed as part of the service development for 2011-12.
Dental Quality Account 2010-11 [10]
Safety audits
Listed below are a few examples of just some of the work which has taken place at Birmingham
Dental Hospital to promote safety during 2010-11.
Trust-wide record keeping audit
Accurate recording of allergies in patients’ records ensures staff are aware of individuals needs and
take these into account when planning the delivery of clinical care and treatment, therefore promoting
patient safety.
An independent audit undertaken at Birmingham Dental Hospital confirmed 96% of entries audited
contained a record of known patient allergies.
Infection control audit - hand hygiene
Birmingham Dental Hospital conducted a local self-assessment audit in 2010 which compared current
practice against nationally agreed infection control standards including the implementation of Health
Technical Memorandum (HTM) 01-05 Decontamination in Primary Care Dental Practice.
The audit confirmed Birmingham Dental Hospital is 100% compliant in all clinical areas for providing
a separate dedicated hand basin for hand hygiene. At each hand basin there is mild liquid soap with
absorbent paper towels.
The improvements made to date:
1. Dental Nurses have taken over the responsibility for dental unit water flushing in clinical practice.
2. The wearing of blue tunics has been reinforced with clinicians.
3. Monthly cleanliness monitoring checks are undertaken with regular interim checks.
4. All decontamination areas have been reviewed for the move to off-site decontamination.
Incidents data
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.
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.
[11] Dental Quality Account 2010 -11
The total number of incidents reported in Birmingham Dental Hospital April 2010 - March 2011
Confidentiality, Data and Information Governance
7
Fire Safety
2
Infrastructure
0
Medication, Medical Gas, Medication Delivery System
7
Patient Incident
57
Security
56
Staff, Visitor, Contractor Incident
128
Other
0
Totals for Birmingham Dental Hospital
257
Dental Hospital Serious Incidents Reported
3
Top 3 Incident Types Dental
Staff, Visitor, Contractor Incident
Patient Incident
Top 3 Categories
Needlestick (Sharps) Incidents
75
Contact Injury
28
Slip Trip and Falls
14
Accident
16
Treatment
16
Medical Device (non- medication)
Security
Theft or Loss
7
56
The numbers of patient incidents are thankfully very small. All treatments are provided through a
consultant-led service with treatment plans agreed for each patient prior to treatment being undertaken.
The Dental Hospital provides a training environment for undergraduate dental students, postgraduate
dentists, student hygienists and therapists and trainee dental nurses. All students are very closely
supervised, however the risk of needle stick injury has been found to be highest in this group. Part
of the Dental Hospital induction programme highlights the risk of needle stick injuries to staff and
students, and local procedures are in place to minimise the number of incidents that may occur.
The second highest recorded incident types at the Dental Hospital are security incidents,
predominantly related to theft or damage of NHS property. Local procedures and arrangements
have been implemented following risk assessment to reduce the number of incidents resulting
in the loss or damage to personal and organisational property.
Dental Quality Account 2010-11 [12]
Section 7: Clinical effectiveness and measuring quality
The Dental Hospital is committed to delivering high quality patient-centred care. A recent development
is the establishment of the clinical effectiveness group. The prime function of this group is to develop,
test and implement initiatives to improve patient care. Focus has been on the development of robust
clinical quality indicators of patient care, the expansion of patient recorded outcome and experience
measures and the advancement of methods of dental treatment to enhance the service.
One of the prime components of the work is to strengthen clinical audit plans and processes during
the year. The majority of audits undertaken within the hospital are consultant led, leading to service
and operational changes to improve clinical care. Other audits reflect Trust priorities for example
record keeping and infection control. The clinical audit programme is overseen by the hospital’s clinical
effectiveness group.
The following are examples of initial audits that have taken place at Birmingham Dental Hospital in
2010-11:
Mapping patients journey time through the radiography department
The Dental Hospital radiography department participated in a rapid improvement event facilitated
by the Lean Healthcare Academy to identify how patient flow could be improved through the
department. The aim of the project was to reduce waiting times and subsequently reduce the number
of complaints received, improving the patient experience.
A process mapping exercise was undertaken over a two-week period. As a result of the exercise
working practices were changed and communication improved with the patients. A colour card system
has been introduced to make patients aware of the various rooms used for X-rays and explain the
different patient flows. Waiting times have reduced from an average of over an hour to 30 minutes.
Radiographers reported that:
Since the new working patterns have been implemented, there was an immediate good
response from the Department, a reduction in the number of complaints from
patients and no phone calls from clinics looking for patients.
[13] Dental Quality Account 2010 -11
Time spent adjusting indirect restorations in clinical practice
It became apparent that the time taken to fit cast restorations (such as crowns) was taking a
considerable amount of time. An audit was undertaken to ascertain if this was correct and what
could be identified as contributing factors to enable the time to be reduced.
The audit confirmed the perception that considerable time was spent in adjusting these restorations
at the time of fitting.
As a result of the audit the following actions were implemented:
1.Preparations sent to the laboratory without room for the crown are returned to the supervising clinician for reassessment.
2.Prostheses are adjusted in the laboratory to ensure they are not sent out to the clinics
high on the models.
These changes have helped save time and in doing so ensure effective use of resources.
Extraction of first permanent molars of poor prognosis - are we complying with the
Royal College of Surgeons of England guidelines?
This audit was to assess if the paediatric dentistry department at Birmingham Dental Hospital was
compliant with the Royal College of Surgeons guidelines on treatment planning for the extraction
of first permanent molars.
Data was collected on 50 patients who required removal of first permanent molars.
The results of the audit confirmed that patients were referred at the ideal time and had
extractions carried out at the correct dental age.
In summary, the audit confirmed Birmingham Dental Hospital complies with Royal College of Surgeons
guidelines in the timing of extraction of first permanent molars. The new patient assessment sheet in
the paediatric dentistry department has been modified to further improve compliance.
Dental Quality Account 2010-11 [14]
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 Birmingham Community Healthcare Trust 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.
Please note that while all of the nationally proposed audits and NCEPOD enquiries were
actively reviewed by BCHC none applied directly to Birmingham Dental Hospital.
The national clinical audits that Birmingham Community Healthcare Trust was eligible to participate
in during 2010-11 are 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)
[15] Dental Quality Account 2010 -11
The national confidential enquiry that Birmingham Community Healthcare Trust NHS Trust participated
in during 2010-11 was 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
The reports of 38 local clinical audits were reviewed by the provider in 2010-11 and examples of
actions BCHC Dental Hospital intends to take to improve the quality of healthcare provided are cited
elsewhere within this document.
All registered audits are monitored through the divisions and by the corporate workstreams. For a
full report on action plans for local audits across Birmingham Dental Hospital, please refer to BCHC’s
Clinical Audit Annual Report available July 2011.
In 2011-12 Birmingham Community Healthcare 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, to 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 will 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
Dental Quality Account 2010-11 [16]
Why research is important at Birmingham Dental Hospital
Excellence in clinical service and patient care is founded upon innovation, enquiry, questioning what
we do, why we do it and what the evidence base is for what we do, and striving to improve the
quality and quantum of life for our patients by advancing care through research.
On the 25 January 2006 the government coined the phrase “Best research for best health”
(Gateway ref. 6050). Birmingham Dental Hospital simply regards research as part of our core business,
because we want to provide the best care for our patients and we can only do this by engaging in
internationally excellent research.
Our research programmes have a strong translational focus, being driven by clinical questions,
and aim to provide novel diagnostic and therapeutic solutions to the most common oral and
general health problems. We employ cutting-edge technologies within state-of-the-art laboratories
to explore disease mechanisms, improve our understanding of pathogenic processes, and formulate
new healthcare solutions based upon this new knowledge. Our clinician-basic science partnerships
provide broad expertise and allow us to exploit our findings through clinical trials of novel diagnostic
and therapeutic approaches.
[17] Dental Quality Account 2010 -11
Here are some recent outcomes from our research:
•
We have shown the importance of bioactive molecules hidden within dental tissues in driving tissue responses to disease and clinical outcomes for the tooth.
•
We have pioneered the development of assays for biomarkers of gum diseases, allowing the development of diagnostic technologies that are in routine clinical use.
•
Our strong expertise in biological imaging has provided novel solutions for colour blindness, cancer diagnosis and spans exciting activities across the biomedical sciences.
•
Our involvement in national epidemiological oral health surveys is informing UK government policy on primary dental care delivery.
•
Researchers at Birmingham have developed novel dental and orthopaedic materials that will improve the longevity of dental restorations and the outcome of many orthopaedic procedures.
•
Researchers in Birmingham have helped establish the world’s largest database for longevity of fillings and are informing future NHS policy on treatment decisions.
•
Our researchers are world leaders in the impact of nutrition in oral diseases and how micronutritional strategies can regulate oral inflammation. This has resulted in new toothpaste formulations, some of which are already on sale globally, touching the lives of millions of people.
•
Our ultrasonics research has influenced the design and development of ultrasound dental instruments (e.g. scaling devices), leading to improvements in patient care.
•
We have spearheaded Practice-Based Research Network (PBRN) approaches in dentistry and established UK and European research networks of dental practitioners to assess newly-
developed restorative materials in the primary care setting.
These are just some highlights from our dynamic research programs and our students are trained
by research leaders, enriching their knowledge and ensuring we provide the best equipped dental
workforce for the Midlands and beyond.
Dental Quality Account 2010-11 [18]
Participation in clinical research *
Commitment to research as a driver for improving the quality of care and patient experience.
Birmingham Community Healthcare NHS Trust 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 Birmingham Community Healthcare NHS Trust’s
commitment to improving the quality of care we offer and to making our contribution to wider health
improvement. Our clinical staff stay abreast of the latest 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 Birmingham Community
Healthcare NHS Trust dental services 1st April 2010 to 31st March 2011 that were recruited during
that period to participate in research approved by a research ethics committee was 24. Confirmed
recruitment figures are only available for UKCRN Portfolio Research. This is an increase on last year’s
(2009-10) participant recruitment when 12 participants were recruited to clinical studies.
Ongoing research
Birmingham Community Healthcare NHS Trust dental services were involved in conducting
17 (3 [18%] UKCRN Portfolio; 14 Non-Portfolio [82%]) clinical research studies that had received a
favourable opinion from a research ethics committee during 1st April 2010 to 31st March 2011.
An additional seven student evaluation projects were also registered with the Trust, which did not
require a favourable opinion from a research ethics committee.
*The data here refers to dental services excluding all other BCHC services as these are
recorded in the BCHC Quality Account.
[19] Dental Quality Account 2010 -11
The Trust has also undertaken a number of initiatives which have improved the experience of people
using our services and has helped us to make the most effective use of available resources:
Patient access
Ensuring a high number of patients attend their appointments helps Birmingham Dental Hospital to
make the best possible use of staff time and resources. Several initiatives were put in place aimed at
improving patient attendance rates which included a dedicated email address for those who wished to
change appointments; telephoning and text messaging reminders of appointments and the inclusion
of a letter with appointments advising of the importance of attendance.
These initiatives have made a small improvement to the attendance rate which is not as good as had
been anticipated. Further initiatives and reinforcement of the importance of attending appointments
will be a focus for 2011-12.
Clinical letters
The Medical Secretariat participated in a rapid improvement event led by the Lean Healthcare
Academy. All medical secretaries took part in the final presentation meeting with the senior
management team. This event involved consultants and secretaries reviewing procedures and agreeing
changes that resulted in improvements to the referral administrative process. Work is continuing to
further improve letter turnaround time.
Patient information
All leaflets were reviewed in 2010 by the patient experience team. It showed that over 95% of leaflets
were up-to-date, well presented and easily understood. The remaining 5% which had not met this
high standard have been replaced.
Dental Quality Account 2010-11 [20]
Section 8: Engaging, listening, learning, improving
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 Birmingham Community
Healthcare NHS Trust 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 in-patient 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.
[21] Dental 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.
Birmingham Community Healthcare 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
public involvement action group (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 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
Dental Quality Account 2010-11 [22]
Dental anxiety
Most people generally do not look forward to a visit to their dentist. For some these visits cause
such extreme anxiety that they cannot even walk into a dental surgery. To help address this problem
Birmingham Dental Hospital developed clinics specifically designed for these people to be seen in a
more relaxed and sympathetic environment. Staff here have received specialist training and are able to
better support these peoples’ needs.
Additional developments include:
• Offering forms of conscious sedation.
• Allowing more time for their appointments.
• Depending on levels of anxiety and in consultation with individual patients, they can have someone sit in with them to offer support or can listen to music on headsets.
• Patients who are very nervous can have their first assessment away from a dental chair if this would be more comfortable for them.
Staff have commented on the fact that they very much enjoy seeing people move forward in their
confidence and obtain the treatment they need.
Some of the positive comments received from patients include:
I am an absolute dental phobic, with an absolute horror of visiting the dentist, and
hadn’t done so for many years. The staff were absolutely marvellous, calming my fears,
explaining every step of the procedure, and advising me that I could stop any
action at any time; the choice was in my hands… all the staff were great, thanks so much.
What I liked: The caring and considerate attitudes of all the staff… The dentist who
worked on my mouth was exceptional… I was so nervous before my treatment that I
considered doing a runner (at least three times) whilst waiting to be seen. The gentle
and calming manner of my dentist managed to get me into the room to begin with (which was
a big thing for me). .. As a result of my treatment at the dental hospital I would say my dentist
phobia (15 years of it) has been pretty much cured. I don’t think I will lose sleep or be nervous
about returning for my next set of treatment.
I went to the dental hospital for an extraction of my wisdom tooth. .. those at the Dental
Hospital were fantastic... I can’t tell you how pleased I was with the result...especially for a very
anxious and nervous patient. I wouldn’t have any problem going there again... Thank you Dental
Hospital, my experience was a good one!
[23] Dental Quality Account 2010 -11
PALS support for people using our services
The Patient Advice & Liaison Service (PALS) focuses on improving the service received by 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.
Derrick de Faye is the designated PALS officer for the specialist division, which encompasses
Birmingham Dental Hospital.
In the year April 2010 - March 2011, 124 calls were received on the telephone helpline.
Below are some examples of the type of calls received relating to dental hospital services.
Call received
Response
A patient contacted PALS
expressing concern about what
he considered a delay in the
provision of dentures.
PALS facilitated a meeting with the patient, clinician
and manager to discuss this. A plan on how the
service could be provided to meet his personal
needs was agreed.
Caller wanted the number for
Birmingham Dental Hospital and
wanted to know if he could go
to the walk-in centre and if he
needed an appointment.
Informed caller that he needs to be there at 7.30am in
the morning to be seen and a ticket queuing system
is in operation. On arrival patients are given further
information about how the clinic operates.
The contact number for the PALS helpline is: 0800 917 2855
email: Bham.PALS@bhamcommunity.nhs.uk
text: 07540 702477
Dental Quality Account 2010-11 [24]
Birmingham Dental Hospital has been involved in a number of patient surveys during 2010-11.
Detailed below are our results and the actions we are taking to continue to ensure people enjoy a
positive experience at the hospital.
Patient Survey
All dental specialities were surveyed using a postal questionnaire as part of the CQUIN scheme agreed
with the Dental Hospital commissioners. The results provided valuable information showing very
positive comments about services. There are areas for improvement which include advising patients
when appointments are running behind schedule. An action planning workshop with staff will be led
by Picker Institute Europe to determine further changes to improve services.
The Dental Hospital’s results were above the national average in a number of areas including
appointments starting on time or early and providing patients with a choice of appointment times.
Others are highlighted in the table below.
Patient definitely had enough time to discuss condition and ask any questions
80%
Health professional definitely listened to what the patient had to say
83%
Health professional knew enough about patient’s medical and dental history
86%
[25] Dental Quality Account 2010 -11
Patient satisfaction of new patient clinic in the restorative dentistry department
at Birmingham Dental Hospital
A patient satisfaction survey was undertaken of patients who attended a new patient clinic in the
restorative dentistry department.
The results identified that patients were very satisfied with the clinical care. Concern was raised over
delays in being able to get through by telephone and the cleanliness of the window sills.
The new telephone system being introduced in 2011 will make it easier to contact hospital
departments. In order to improve communication, a new email address has been added to patient letters.
The cleanliness of window sills has been addressed as part of the infection control audit and the
cleanliness checks that regularly occur in the building.
Comments from respondents:
Staff very pleasant and helpful. Consultant kind and efficient with clear diagnosis
and explanation.
Level of care and explanation excellent. Procedures fully explained, kind caring
staff, dentist very nice, staff very helpful and understanding, very efficient service.
The child and their parents’ outpatient experience questionnaire in the paediatric
department of Birmingham Dental Hospital
The survey was undertaken to assess both the patient and parent satisfaction of the paediatric
department at Birmingham Dental Hospital. There were two questionnaires designed, one specifically
for patients and the other for parents.
The survey highlighted a very positive response from patients and parents regarding the standard of
the service provided by the paediatric department. Key areas of the survey are as follows:
• 100% of parents and 96% of patients were very satisfied with their visit
• 97% of the dentists, dental nurses and the reception staff were very polite, friendly, and well organised • 90% of parents had no problem in booking an appointment
• 40% of parents had difficulty in parking
• 40% of patients were waiting between 10 and 45 minutes • 50% of patients did not like the waiting room
In response to this:
• An information leaflet is sent with all new patient appointments that includes information on accessing the hospital by public transport or by car with details of car parking.
• There is a television with appropriate age programmes in the waiting room.
• A further survey is planned to specifically look at the waiting times and the flow of patients.
Dental Quality Account 2010-11 [26]
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 the results for each trust
• 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 an employer:
1. To provide all staff with clear roles 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 in regards 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 use 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 in regards 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 worse than average score.
[27] Dental 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.
Percentage of staff suffering work place injury and work-related stress in the last 12 months is
worse than 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 worse than the average, although this is still 95%.
The impact of health and wellbeing on staff’s ability to perform work or daily activities and the
percentage of staff feeling pressure in the last three months to attend work when feeling unwell
were also worse than 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 was above average in regards 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 worse than average.
Staff survey - our actions
1.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 and drop in information events
2.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
3.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
4.Our actions to continue to improve hand-washing materials
• Information is promoted through communications and staff briefings
• Ensure information is included in training opportunities such as induction
Dental Quality Account 2010-11 [28]
BCHC Birmingham Dental Hospital services
Number of complaints expressed as percentage of activity
Activity
Total Inpatient Day Cases and
Outpatient appointments 115,000
Number of
complaints
28
Number of complaints shown as
% of activity provided by BCHC
Birmingham Dental Hospital
0.02%
Complaints acknowledgment
Complaints acknowledged within 3 days
Complaints responded to within 6 months
96%
100%
Number of complaints
Upheld
Partially upheld
Not upheld
Ongoing
Closed
(transferred to Human Resources to action)
[29] Dental Quality Account 2010 -11
3
11
3
10
One case for Birmingham Dental Hospital was closed
- the complainant was contacted to ascertain if she
was happy with the response from member of staff,
but no response has been received.
Top three complaints themes
Appointments
Communication
and staff attitude
Care and treatment
Themes
Action taken
Appointments cancellation, waiting times / delay,
difficulty contacting the service to
arrange
Many of the complaints in this area relate to the difficulty
patients have getting through to our appointments team.
Our outdated telephone system is being replaced late 2011.
We are also introducing SMS texting service for patients to
help remind them of their appointment and patients
can then text back with queries.
An email account has also been set up providing another
means of contacting departments.
Communication and staff attitude
Work has taken place across Birmingham Dental Hospital 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.
Birmingham Dental Hospital staff are working towards
achievement of the Customer Service Excellence award.
Care and treatment
Patients often experienced delays while waiting in the X-ray
department because of peaks in referrals. We are addressing
this by providing additional X-ray equipment and clinic
accommodation which means our patients will be seen
more quickly.
This is an example of the lean management approach being used
extensively in Birmingham Dental Hospital.
Dental Quality Account 2010-11 [30]
Section 9: Statutory declaration
During 2010-11 BCHC provided and / or sub-contracted nine NHS services.
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% of the total income
generated from the provision of NHS services by BCHC for 2010-11.
Care Quality Commission (CQC)
Birmingham Community Healthcare NHS Trust and Birmingham Dental Hospital in particular as a
provider of services is required to register with the Care Quality Commission and its current registration
status is registered in full without conditions.
The Care Quality Commission has not taken enforcement action against Birmingham Community
Healthcare NHS Trust during 1 April 2010 - 31 March 2011.
Birmingham Community Healthcare NHS Trust has not participated in any special reviews or
investigations by the CQC during the reporting period.
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.
Payment by Results coding
Birmingham Dental Hospital was subject to a ‘payment by results’ clinical coding audit for outpatients
during the reporting period by the Audit Commission. Case notes contain detailed information on the
procedures carried out in outpatient clinics.
However, Birmingham Dental Hospital does not currently collect or submit electronic data on the
procedures that take place in outpatients due to the limitations of the patient administration system
for recording dental procedures. This limitation has been recognised at a national level and a new
dental IT system is being implemented.
[31] Dental Quality Account 2010 -11
Data quality
Birmingham Dental Hospital submitted records during 2010-11 to the national database
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:
99.4% for admitted patient care; and
98.6% for outpatient care.
- which included the patient’s valid General Medical Practice Code was:
98.9% for admitted patient care; and
98.0% for outpatient care.
Our commitment to data quality
BCHC will be taking the following actions to further 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.
Dental Quality Account 2010-11 [32]
Information governance assessment
BCHC information governance assessment report 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
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 timeframes to support the delivery of evidence for the next
baseline assessment at the end of July 2011.
[33] Dental Quality Account 2010 -11
Section 10: Feedback from our stakeholders
Formal statement from commissioner
The Commissioner recognises that a series of improvements have been made through
the Dental Hospital over 2010-11. They have completed a high quality audit throughout
the facility regarding experiences of patients using the services. The dental teams are
in the process of developing actions plans to implement within these services, which
will result in improved patient satisfaction. Improvements have been made in control of
infection over the last 12 months and Birmingham Dental Hospital infection prevention
action plan continues to improve standards throughout the Dental Hospital.
Margot Warner
Executive Nurse Head of Contracting & Quality Assurance
Solihull Primary Care Trust
Formal statement from Health & Adults Overview and Scrutiny Committee
BCHC has complied with your statutory requirements in sending Quality Account to the Health & Adults Overview and Scrutiny Committee who declined to provide a
statement for inclusion in the accounts.
Group Overview and Scrutiny Manager
Birmingham City Council
Comment from Local Involvement Network
Local Involvement Network received a copy of the draft Quality Account and were invited
to comment. In their response no comments were specifically made in relation to the
Dental Services Account.
Dental Quality Account 2010-11 [34]
Section 11: Contributors and acknowledgements
Contributors:
Editorial team
Adam Dandy
Public Engagement and Patient Information Lead
David Disley-Jones
External Communications Lead
Lisa Eden
Associate Director of Therapies
Colin Graham
Head of Clinical Governance
Kath Jakeman
Associate Director, Dental Services, Birmingham Dental Hospital
Alison Last
Associate Director of Patient Experience
Tracy Millar
Clinical Quality Assurance Programme Manager
Angie Villers
Clinical Quality Assurance Lead
Chair of Patient Involvement Action Group (PIAG)
Brian Hanson
Chair of PIAG
Disability Advisory Group members
Sandra Wood
Ann Yeomans
Maireade Bird
Clinical Illustration and Information Design
Claire Hatchell
Graphic Designer
[35] Dental 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 who are listed below.
We would also like to acknowledge staff who have indirectly contributed to the production of this
document.
James Bassinder
Head of Information
Mark Chapman
Head of Performance
Iain Chapple
Professor of Periodontology & Consultant in Restorative Dentistry
Frances Clarke
Associate Director of Nursing
Derek DeFaye
PALS Officer
Sue Ellis
Service Operational Manager, Birmingham Dental Hospital
Kevin Fairbrother
Clinical Lead Birmingham Dental Hospital and Consultant in Restorative
Dentistry
Pat Field
Senior Information Specialist, Adults and Communities / Children and Families
Divisions
Janet Fox
Head of Equality and Organisational Development
Vicki Gledhill
Associate Director of IM&T
Jenny Grant
Clinical Research and Development Manager
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
Kirsty Hughes
Complaints Manager
Bev Ingram
Director of Nursing and Therapies
Diane Motteram
Patient Experience Lead
Leigh Peplow
Information Governance Manager
Michelle Pillay
Associate Director of Risk and Performance
Anne Smith
Governance Manager
Sam Warner
Complaints Manager
Sheena Wilkes
Clinical Effectiveness and Audit Lead
Dental Quality Account 2010-11 [36]
Section 12: Glossary of terms
BCHC
Birmingham Community Healthcare NHS Trust
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.
HTM
Health Technical Memorandum
A series of publications which set Department of Health best practise standards
for planning and designing healthcare premises.
LINks
Local Involvement Network
A network of local people and groups which work to improve health
and social care services.
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.
. 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.
NIHR
National Institute for Health Research
An organisation which aims to support and promote research within the NHS.
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.
[37] Dental Quality Account 2010 -11
Dental Quality Account 2010-11 [38]
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: 41340 06/11
If you would like to request a copy of this document in an
alternative format, or have any other queries about its content,
please contact the Birmingham Community Healthcare NHS Trust
communications team:
Tel: 0121 442 3600
Email: info@bhamcommunity.nhs.uk