NHS Blackburn with
Darwen Provider
Services Unit
Quality
Account
2010/11
1
Contents
Contents
2
Who We Are
3
Part 1 – Introductory Statement from the Managing Director of
NHS Blackburn with Darwen Provider Services Unit
4
Part 2
2a – Looking Forward, Priorities for Improvement
2b – Statements of Assurance
6
6
7
Part 3 - Review of Quality Performance 2010/2011
Safety
Experience
Effectiveness
14
16
28
37
Local Stakeholder Statements
55
2
Who We Are
Our services are based within community locations such as health centres,
community centres, schools and children’s centres or will attend your home.
Who we are
 Nurses who visit your home such as District Nurse or Community Matron
 Treatment Room including:
Minor Injuries
Ear Care
 Podiatry/Chiropody
 Specialist Clinics including:
Dermatology
Community Diabetes (X-pert programme)
Wound Care
Continence
Healthy Legs (skin care)
Lymphoedema
 Rehabilitation Services including:
Pulmonary Rehabilitation
Specialist Community Stroke Team inc. upper and lower Limb Clinics
Intermediate Care
 Child and Family Health Service including:
Health Visitors
Family Health Nurses
School Nurses
Nurses for Children with Complex Needs
 Speech and Language Therapy
 Sexual Health ( including family planning and b-sure)
 Harm Reduction, including Needle Exchange
 Psychosexual Services
Who we are not
 GP Services
 Hospital Services
 Ambulance Services
 Dentists
3
Part 1 – Introductory Statement from
the Managing Director of NHS
Blackburn with Darwen Provider
Services Unit
This is the first Quality Account produced by NHS Blackburn with Darwen
Provider Services. The Quality Account is designed to share with you progress
made during 2010/11.
We have for several years been working to a clear vision with established drivers
to make us a „First Class Provider of Choice.‟
Our quality improvement objectives for 2010/11 were to:
Listen to what our patients and staff have to say
Understand what we do well
Identify and act on what we need to improve
Staff to lead our success
The patient‟s experience is at the centre of all we do and in 2010/11 we worked
hard to ensure all patients were:
Cared for as an individual
Received well co-ordinated care
Had their carers views taken into account
Had care plans that worked for them
Supported to feel independent and in control
Our staff have led our success through innovation and we received National
recognition. Awards for some of our successes are described in part 3 of this
Quality Account.
We have worked in partnership with Commissioners through the Commissioning
for Quality and Innovation (CQUIN) framework. In 2010/11 the CQUIN payment
framework made a proportion of our income conditional on our service quality and
innovation.
We are very proud of the services we deliver and hope you find our quality
account interesting and informative. We hope that it gives you confidence that we
are putting safety, effectiveness and experience at the heart of everything we do.
The Department of Health has granted approval for the majority of community
services currently delivered by NHS Central Lancashire, some of those delivered
by NHS East Lancashire and all of those delivered by Blackburn with Darwen
Care Trust Plus to be transferred to Lancashire Care NHS Foundation Trust. This
will bring together the delivery of children‟s and health and wellbeing services
4
across Central Lancashire, East Lancashire and Blackburn with Darwen. It will
also bring together an adult community-based service across Central Lancashire
and Blackburn with Darwen. This is an exciting time for community services and
we will continue to share the learning and build upon our previous successes
across the three provider organisations in the coming year as part of Lancashire
Care NHS Foundation Trust.
Mark Hindle
Managing Director
20 June 2011
5
Part 2
2a – Looking Forward, Priorities for
Improvement
NHS Blackburn with Darwen Provider Services Unit to be referred to hereafter as
NHS BwD will cease to exist in its current form from 1st June 2011. As part of the
national agenda to „Transform Community Services‟ the Provider arm of NHS
Blackburn with Darwen will join Lancashire Care NHS Foundation Trust along
with two other Community Providers namely NHS Central Lancashire and part of
NHS East Lancashire. Together these four organisations will work together as
one new larger Foundation Trust. Lancashire Care NHS Foundation Trust
priorities will include the priorities for improvement chosen for the people cared
for in Blackburn with Darwen.
6
2b – Statements of Assurance
This section of the Quality Account is governed by regulations which require the
content to include statements in a specified format. These statements serve to
offer assurance to the public that NHS BwD is performing to Care Quality
Commission quality standards, measuring clinical processes and involved in
national cross cutting projects.
Review of Services
During 2010/11 NHS BwD provided 12 NHS Services. NHS BwD reviewed all of
the data available to them on the quality of care in all 12 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 the NHS services by
NHS BwD for 2010/11.
National Clinical Audits
During 2010/11, 3 national clinical audits and 0 national confidential enquiries
covered NHS services that NHS BwD provides.
During that period NHS BwD participated in 100% national clinical audits and 0%
national confidential enquiries of the national clinical audits and national
confidential enquiries which it was eligible to participate in.
The national clinical audits and national confidential enquiries that NHS BwD was
eligible to participate in during 2010/11 are as follows:
COPD (British Thoracic Society/European Audit)
Stroke care (National Sentinel Stroke Audit)
Falls and non-hip fractures (National Falls & Bone Health Audit)
The national clinical audits and national confidential enquiries that NHS BwD
participated in during 2010/11 are as follows:
COPD (British Thoracic Society/European Audit)
Stroke care (National Sentinel Stroke Audit)
Falls and non-hip fractures (National Falls & Bone Health Audit)
7
The national clinical audits and national confidential enquiries that NHS BwD
participated in, and for which data collection was completed during 2010/11, are
listed below alongside the number of cases submitted to each audit or enquiry as
a percentage of the number of registered cases required by the terms of that
audit or enquiry.
Name of Audit/Enquiry
Participation
% Cases submitted
COPD (British Thoracic
Society/European Audit)
Yes
Stroke care (National Sentinel
Stroke Audit)
Yes
Falls and non-hip fractures
(National Audit of Falls and
Bone Health in Older People)
Yes
N/A - provided data to
East Lancashire Hospitals
NHS Trust
N/A - provided data to
East Lancashire Hospitals
NHS Trust
N/A - completed Primary
Care Provider
sections.4/4.
Participation in national audits is actively encouraged in NHS BwD. The results of
the national audits for the period 2010/11 will be examined and acted upon when
published.
Local Clinical Audit
NHS BwD had an annual programme of planned audits which spanned services
provided. For each audit a formal summary report was produced which contained
recommendations. These were developed into action plans giving improvements
both to clinical care and process. All NHS BwD clinical audits are undertaken
using the Healthcare Quality Improvement Partnership (HQIP) guidance tools.
The reports of 21 local clinical audits were reviewed by the provider in
2010/11 and NHS BwD intends to take the following actions to improve the
quality of healthcare provided:
Examples of improvements to care:
Individualised health care plans are now in place for all
children/young people with complex needs
Many services have amended and improved documentation to
ensure accurate appropriate information is recorded at all contacts
with patients
Health events have been held with volunteer agencies in response
to audit findings
Closer monitoring of patients with long term conditions to ensure
appropriate prophylaxis
8
Participation in Clinical Research
The number of patients receiving NHS services provided or sub-contracted by
NHS BwD in 2010/11 that were recruited during that period to participate in
research approved by a research ethics committee was 12.
Commissioning for Quality and Innovation (CQUIN)
A proportion of NHS BwD income in 2010/11 was conditional on achieving quality
improvement and innovation goals agreed between Blackburn with Darwen Care
Trust Plus 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 and for the following 12 month
period are available electronically at
http://www.institute.nhs.uk/world_class_commissioning/pct_portal/cquin.html
Care Quality Commission (CQC)
NHS BwD is required to register with the Care Quality Commission and its current
registration status is registered without conditions. NHS BwD has the following
conditions on registration: none.
The Care Quality Commission has not taken enforcement action against NHS
BwD during 2010/11.
NHS BwD has participated in special reviews or investigations by the Care
Quality Commission relating to the following areas during 2010/11:
Support for Families with Disabled Children
Supporting Life After Stroke
The report for the Support for Families with Disabled Children is expected to be
published later in 2011.
The report for Supporting Life After Stroke described NHS BwD Community
Stroke Services as an exemplar of best practice achieving a performance score
in the top 5% in the country.
9
Data Quality
NHS BwD will be taking the following actions to improve data quality:
CPAS and iPM national computer systems rollout programme to
improve data collection
Improvements made to existing data collection systems
Standard set of metrics in the form of a dashboard report provided to
all clinical services to support in service delivery and improvement
Monthly reporting of validated data to commissioners to support the
commissioning process
NHS Number and General Medical Practice Code Validity
NHS BwD did not submit records during 2010/11 to the Secondary Uses service
for inclusion in the Hospital Episode Statistics which are included in the latest
published data.
IG Toolkit
NHS BwD Information Governance Assessment Report score overall score for
2010/11 was 70% and was graded green.
10
Internal Audit
As part of the annual audit programme undertaken by Audit North West, below
are the outcomes of internal audit reports received for NHS BwD in 2010/11.
Board Assurance Framework
Previous Review
Current Review
Opinion on the Control Design
FULL
FULL
Opinion on the Operation of the Controls
FULL
FULL
Overall Assurance Opinion for this Review
FULL
FULL
Information Governance Toolkit
Opinion on Control Design
Current Review
FULL
Opinion on the Operation of the Controls
Significant
Overall Assurance Opinion for this Review
Significant
CQC Outcome 9 – Management of
Medicines
Opinion on the Control Design
Current Review
FULL
Opinion on the Operation of the Controls
Significant
Overall Assurance Opinion for this Review
Significant
CQC Outcome 21 - Records
Current Review
Opinion on the Control Design
FULL
Opinion on the Operation of the Controls
Significant
Overall Assurance Opinion for this Review
Significant
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Mandatory Training Compliance 2010/11
Rating Key
Green
≥95%
Amber
75-94%
Red
<75%
Annual %
Target
%
Achieved
Fire Awareness
95%
92%
Infection Control
95%
92%
Information Governance
(all staff via e-learning from 1 July)
95%
98%
Basic Life Support
95%
92%
Moving & Handling people
95%
99%
Medicines Management (PCT delivery) e-learning
new starters and refresher
95%
100%
For the period 2010/11 NHS BwD have achieved the target for 3 of the mandatory
training requirements and 3 have been almost met.
12
CQC Stroke Review 2010
A Care Quality Commission 2010 review of services for people who have had a
stroke and their carers. „Supporting Life After Stroke Local Assessment Report‟.
CQC looked at 15 aspects of care and gave each a score from 1 to 5.
Overall Assessment
Best Performing
NHS BwD Community Stroke Services were described as an exemplar of best
practice achieving a performance score in the top 5% in the country.
13
Part 3 - Review of Quality Performance
2010/2011
In the period 2010/11 NHS BwD has worked hard to become the „First Class
Provider of Choice‟ for the people of Blackburn with Darwen. Patient experience
formed the core of our quality improvement objectives.
2010/11 Quality Improvement Objectives:
Listen to what our patients and staff have to say
Understand what we do well
Identify and act on what we need to improve
Support staff to lead our success
The scope of our quality improvement was shaped by the themes of safety,
effectiveness and patient experience. Sections in part 3 of this account align to
these themes.
It would be impossible to include details about everything we have achieved
across each service but this section provides information to demonstrate where
we have been effective, improved and responded to feedback.
Following discussion with staff and agreement by the Quality Committee, targets
for improvement were set at the beginning of 2010. These are a mixture of
national and local indicators, as shown on the following page.
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Table showing agreed outcome measures for 2010/11
Themes
Actual Outcome Measures
Safety
Safeguarding
Children in Our Care receive
Children in our
health assessments on time.
Care
The target includes assessments
completed in our area and also
assessments completed for our
children that are placed out of area
Infection
To reduce the incidence of
Prevention and healthcare associated infection
Control
and strive to maintain a below
expected rate of community
acquired Clostridium difficile and
meticillin-resistant Staphylococcus
aureus bacteraemia infections
through good clinical practice and
maintaining a safe, clean
environment.
Patient Experience
Being treated
When asked respondents felt they
as if they matter were treated with dignity and
respect
Communication When asked respondents felt they
receive information which helps
them understand their condition
Effectiveness
HPV
HPV vaccine uptake for year 8
girls (12/13 years old)
Falls Audit
All patients over 65 years admitted
onto the rehabilitation service will
have a falls risk assessment tool
(FRAT) completed as part of a
comprehensive overview.
Target
Actual
80%
80%
Zero
„avoidable‟
infections
100%
85%
98%
85%
94%
91%
89%
100%
100%
The above table shows that for 5 indicators we are able to demonstrate
achievement. However we acknowledge that for 1 indicator we have missed the
agreed target. This is disappointing and a variety of factors have to be considered
when analysing why this has happened. In some instances the target is a shared
one across all health providers in Blackburn with Darwen.
Having clear performance measures is an area we recognise a need to focus
attention. We will utilise the newly published tool from the Department of Health
„Transforming Community Health Services‟ Guidance „Demonstrating and
Measuring Achievement: Community Indicators for Quality Improvement.‟(DH
2011 Gateway reference 15485). This will assist us to select those indicators that
measure what we value and what matters to the people who use our services,
and which instigate and inform dialogue about where improvement is needed.
15
Safety
16
Safety
Patient Safety Team
Patient safety is about delivering a high quality service which is safe and effective
in that it minimises the risks to patients receiving healthcare and to the staff
delivering that care. NHS BWD places safety high on its agenda and has
developed a Patient Safety Team whose role covers:
Infection Prevention and Control
Moving and Handling
Medical Devices
Community Equipment
Goal:
Creating a culture of safety which minimises the risks to patients, staff and
others
Actions:
Review of services - align to one effective patient safety team
Review and develop policies/procedures
Review and develop training programmes
Audit implementation/effectiveness of the patient safety team
Achievements:
Close working with District Nurses to review training needs for community
equipment - prescribing/fitting/risk assessment/reassessment
Further development of Link Practitioner role - ensure key expert worker in
each team - increasing competency, confidence to prescribe, reducing
potential risk/harm to clients
Development of working group to review „back to work‟ assessments to
ensure staff are supported to get back to work following a leave of
absence which is related to moving and handling issues
Development of working group to review pathways for referral/discharge
criteria across the health economy for community equipment. This project
is aimed at ensuring equipment is prescribed by the most competent team
or as a multidisciplinary effort
Development of working group to devise „falls flow chart‟ in relation to
moving and handling when a client has fallen within the healthcare setting.
This will be further developed to work with the Falls Prevention Team
(Social Care), the ambulance service and other relevant partner
organisations. This links with the Safety Express Work which is being
hosted by East Lancashire Hospital NHS Trust (ELHT)
Joint working with Social Care to review equipment provision to Care
Homes
17
Safety
Participate in the development of a procurement strategy to achieve
efficiencies across all services (Head of Service, Patient Safety Team is
the clinical lead for procurement for PSU)
Introduction of Executive Patient Safety Walkabouts. Strong effective
leadership is essential in building a safety-orientated organisational
structure. Patient Safety Walkabouts are a way of ensuring that executives
are informed first hand regarding the safety concerns of frontline staff.
They are also a visible commitment by the executive team by listening to
and supporting frontline staff. Walkabouts are also instrumental in
developing an open culture where the safety of patients is seen as a
priority for the organisation
Infection Prevention & Control
Joint working with East Lancashire Hospitals NHS Trust (ELHT) in
reviewing community acquired MRSA bacteraemia by joint Root Cause
Analysis process ensuring lessons learnt are shared across the health
economy
Joint working with ELHT to implement the Safety Express Work to reduce
catheter associated urinary tract infections
Chart above shows the number of community acquired Clostridium difficile (C.
difficile) and meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia
infections for the reporting period 2010/11 and the previous two years.
In 2010/11 there was a 5% reduction in community acquired infections compared to
the previous year.
NB. This graph reflects Blackburn with Darwen as a health economy therefore
figures not solely attributable to NHS BwD.
18
Safety
Providing a Safer Environment for Lone Workers
NHS BwD has a duty of care and a legal
responsibility to tackle violence against its
staff, under the Health and Safety at Work
Act 1974, the Management of Health and
Safety at Work Regulations 1999 and the
Corporate Manslaughter and Corporate
Homicide Act 2007. Failure to comply with
these obligations is a criminal offence and
employers are not insured against this.
In 2009/10 there was 1 physical assault on
NHS BwD staff and 6 incidents of threatening behaviour. The recommendation
from the NHS Security Management Service is to use the Identicom device.
The Identicom device, which is worn by staff, helps to deter, prevent, detect and
investigate incidents and provides evidence to help take action against offenders.
It operates in conjunction with robust Lone Worker procedures and is supported
by good monitoring arrangements and user training.
A pilot use of the device was introduced into NHS BwD in 2007 and then further
rolled-out in 2009. An evaluation of the device roll-out programme within NHS
BwD was completed in August 2010. The purpose of the evaluation was to
establish the effectiveness of the Identicom device. All staff using the device were
invited to take part in the evaluation and 36% responded. The evaluation
questions related to the design of device, the service desk, training provided on
the device, using the device including the benefits and how it could be improved.
The evaluation demonstrated that a safer environment has been provided and
lone workers can access assistance if needed.
Staff comments about the benefits of using Identicom:
- “Feel safer when attending home visits. Knowing there is
support if a situation should arise”
- “If visiting a client alone at weekends or evenings I feel safer”
- “Feel safer. Know help will be available if requested”
- “You feel safer and more confident”
- “Peace of mind knowing help is there should you require it”
19
Safety
Management of Incidents and Risk
We take the safety of our patients and staff very seriously. One of the ways we do
this is through incident management. Staff are able to report incidents via an online
system and the information collected is used to improve services and learn lessons
to prevent recurrence. The flowchart below outlines how reported incidents are dealt
with at each stage and includes the Governance team‟s monitoring processes.
PSU Process for Incident Management
20
Safety
The Risk Team cascade monthly
Risk Management bulletins to staff
as a vehicle for cascading lessons
learnt. The initial bulletin was
launched in December 2009 and
monthly updates have continued to
be cascaded. Feedback received
has been excellent with many
reporting that the bulletins are a
great way to deliver key risk
messages.
“I cascade the risk
bulletins at staff meetings,
they are very useful.” – Staff
Member Comment
21
Safety
Serious Untoward Incidents (SUIs)
Serious Untoward Incidents (SUIs) are classified as such according to their
severity and likelihood of recurrence.
In some cases, SUIs need to be reported to the Strategic Health Authority where
strict deadlines for reporting must be adhered to. In all cases, incidents that have
been classified as SUIs are subject to a Root Cause Analysis (RCA) Review.
The RCA reviews result in recommendations and action plans which ensure that
improvements to services are demonstrable. Lessons learnt and service
improvements are reported into the Integrated Governance Committee.
The table below shows the number of SUIs and their status for 2010/2011.
NHS BwD takes seriously the need to respond quickly both in reporting and
investigating any serious incidents.
In 2010/11 a serious untoward incident involving a service user occurred which was
reported to Care Quality Commission (CQC) in August 2010. An internal investigation
was held to identify which outcomes the incident had impacted on, including a full
Root Cause Analysis investigation. The CQC published their final report 3/2/2011,
which reached the conclusion that overall, all of the required essential standards
were now being met, with suggestions for improvements in one area, which have
now been implemented.
These improvements included a review and re-design of wound management
documentation and process complemented with a targeted training programme for
clinicians delivering wound care management.
22
Safety
Child and Family Health Service (CFHS)
Safety First Scheme
The Safety First Scheme was selected to
present at the 2010 Community Practitioner
and Health Visitor Association Conference
held in Harrogate. It represented an
outstanding example of good practice by
helping reduce child home accidents in
Blackburn with Darwen working in
partnership with the Local Borough Council.
As recognition for the work and efforts from
Blackburn with Darwen's Safety First
Scheme, a presentation was delivered by CFHS and one of our partners at the
Borough Council. The panel were interviewed for an article in the Family Health
Journal which was published in January 2011.
In the first 12 months of the scheme 1500 families were fitted with home safety
equipment. Over a two year period more than 2000 families have been fitted with
home safety equipment and have received a home visit focused on safety and
accident prevention by one of the health Nursery Nurses.
Greater knowledge for both health professionals and private childminders came
about due to a piece of training provided by Royal Society for the Prevention of
Accidents and the schemes Safety First Coordinator.
"I am greatful to Blackburn with Darwen that they have
introduced this Safety First service, it has made a lot of
difference to my family." - Service User Comment
23
Safety
'Room to Breathe' Safer Sleeping Campaign
Blackburn with Darwen has higher than average infant mortality rates. As part of
the infant mortality action plan our service led on the roll out of the 'Room to
Breathe' (safer sleeping) campaign. The aim of this was to raise awareness
around sudden infant death and to ensure consistent messages around safer
sleeping. All staff within CFHS working with families with a child up to the age of 4
years and staff from a range of partner agencies i.e. midwifery, children‟s centres,
social care were involved in the work.
Key actions:
Standardised practice developed within the service around safer sleeping
and 'where does your baby sleep'
Purchase of 'Room to Breathe' resources which give well researched
messages and were developed using a social marketing approach.
Messages have also been adapted based on serious case review
feedback
Ratification of the 'Safer Sleeping Guidelines' by the Children's Trust and
Blackburn with Darwen Teaching Care Trust Plus. These guidelines were
developed by a Lancashire wide group including NHS BwD
Train the trainers took place for key partners around safer sleeping. This
was delivered by 3 external speakers: Local Nurse for Sudden Infant
Deaths; Coroner from Lancashire police and the Northern Coordinator for
the Foundation of Sudden Infant Deaths
Cascade training rolled out by the 'train the trainers'
Roll out of 'Room to Breathe' once key staff trained
Cluster events were also held as an opportunity to develop strong and robust
partnerships with other professionals and the local communities to meet the
needs of all the children and families in the geographical area and provide the
opportunity to promote current health initiatives. The event in October 2010 was
focused on the 'Room to Breathe' campaign and its purpose was to deliver
training to ensure that staff and stakeholders were familiar with the most current
guidelines around safer sleeping and minimising the risk of cot death. The teams
worked in partnership with the local Children‟s Centres in their geographical area
and they delivered the 'Room to Breathe' training to Children‟s Centre staff and all
local stakeholders.
24
Safety
Harm Reduction Service
Needle and Syringe Programme
The aim of the Needle and Syringe Programme (NSP) is to reduce and minimise
the transmission of HIV and other blood borne viruses amongst injecting drug
users and their communities. It is a drop-in service providing information, advice
and, where necessary, sterile injecting equipment to people who inject drugs, or
are considering injecting drugs. The NSP also receives used injecting equipment
so it can be safely disposed of.
The NSP is based at the Jarman Centre in Blackburn and its staff includes nurses
who can test for blood borne viruses, vaccinate against Hepatitis A and B,
perform basic health checks and ensure that people are able to access other
health and social care.
The NSP is visited by over 1200 injecting drug users on at least one occasion per
year. Injecting drug users include those who are injecting drugs identified in the
Misuse of Drugs Act, those who are injecting some prescribed drugs and those
who inject steroids and other image and/or performance enhancing drugs. The
youngest injecting drug user in contact with the service is 17 years of age, and
the oldest is over 60 years of age. Injecting drug use is not confined to a
particular type of person or group of people; it is extremely diverse.
The NSP recognises the nature and complexities of injecting drug use and
understands that injecting behaviour, in and of itself, can be as addictive as the
drugs that are being injected. One of the ways it has sought to address this is by
providing non-drug focused activities for its clients. These have included jewellery
making sessions and establishing a small “library”. The introduction, even reintroduction, of alternative activities can have a profound impact on some
peoples‟ lives.
In a recent Patient and Public Involvement exercise, it was reported that over
90% of NSP clients who took part, stated that they were “always treated with
respect” by NSP staff, always received the information and other necessary
resources from the NSP and rated the overall service as “excellent”.
Alongside this client feedback, there have been no new, recorded HIV diagnoses
amongst injecting drug users in the borough for several years, and of those who
are tested for Hepatitis C by the NSP the positive ratio is lower than the national
average.
25
Safety
Street Sex Work Support Programme
The Street Sex Work Support Programme (SSWSP) has been operating since
April 2010 with the aim of reducing harm to street sex workers. The SSWSP
works in tandem with those local initiatives which aim to reduce the incidence of
street sex work in Blackburn.
The SSWSP operates both an outreach and an office-based service providing
information, advice, support and resources regarding sexual health and safer sex,
personal safety and developing social inclusion.
In its first 6 months, the programme has made contact with 27 street sex workers;
26 female and 1 male. Alongside the provision of information and advice as
described above, the SSWSP has made significant interventions including
facilitating access to domestic violence support, rapid access to the substance
misuse service and the implementation of an “Ugly Mug” initiative which involved
distributing information about an assault on one street sex worker to others in
order to prevent further attacks.
With regard to the ages of the street sex workers, the youngest is 18 years old.
During conversations with the street sex workers they have disclosed that
enquiries about, and requests for information about, younger sex workers have
been made albeit very rarely. The street sex workers state that they are unaware
of any under-18 year olds working in the commercial sex trade and would not,
themselves, “allow” any person who looked under-18 to work the beat as:
They are as principled and protective of young people as the vast majority
of the population. Those customers who do make such requests are
refused business by all the street sex workers and told never to approach
again
The presence of young people on the beat would very quickly attract the
attention of the authorities and, therefore, have a negative impact on
business
The issues of street sex work and the sexual exploitation of young people are
totally separate and distinct in the street sex workers‟ and the SSWSP Workers‟
experiences.
Of the interventions by the SSWSP to date:
1400 condoms have been distributed
20 sets of sterile injecting equipment have been distributed
25 personal alarms have been distributed
A number of street sex workers reported that customers had paid with
forged bank notes. From a harm reduction perspective this:
- Increases the time that a street sex worker has to spend on the
beat making the money to replace the forged money, thereby
increasing the potential for harm
26
Safety
-
Increases the potential for arrest if there is an attempt to spend the
money
- Increases the risk of violence from, for example, partner and/or
drug dealer
- In order to address this, a number of „Note Checker‟ pens were
purchased and distributed. No further reports of forged bank notes
have been received
An „Ugly Mug‟ initiative was implemented in July 2010. This related to the
self-reporting of an assault on a street sex worker to the SSWSP Worker.
The street sex worker insisted, for several reasons (including previous
experience of reporting, not wanting to upset others with the possibility of
an increased police presence, etc), that police were not to be informed. A
description of the assailant was given to the SSWSP Worker to distribute
to other street sex workers in order to help prevent further attacks
The SSWSP has experienced excellent working relationships with a number of
other local services and a growing number of street sex workers are accessing,
with support and encouragement, these services to begin to address some of
their problems and life circumstances.
27
Experience
28
Experience
Child and Family Health Services (CFHS), Early Start Team
Foundation of Nursing Studies (FONS) Patients First Award
This award involves project work facilitated by the Foundation of Nursing, based
in London. The Early Start Team Leader and one Health Visitor are in the
process of attending 4 study days looking into the "patient experience",
undertaking user consultation, and evaluating their work, with a focus on nurse
led innovation and practice development. The award includes £3000 to facilitate
the work.
Positive evaluations have been received so far from a focus group held on 18th
March 2011 and patient interviews are yet to be completed. The focus group
have given feedback on new ideas for the programme which can be developed
as part of the FONS work
Lady x is a 45 year old first time mother with a 20 year history of
chronic poor mental health, who has been supported by the Early Start
programme. She attended the Patients First focus group and provided
a written testimony, photographs and verbal feedback as part of her
input. She recommended that the Early Start Programme include
patient groups, and that families supported by the programme may
wish to support newly referred clients, to use their own experiences for
the benefit of others.
Case Study
I would tell my friend that the Early Start Programme is… "Ace
recommended!" - Service User Comment
My Early Start Health Visitor makes me feel…"Happy
parent.” – Service User Comment
and highly
and confident as a
29
Experience
Contraception and Sexual Health (CaSH) Team
“Do you know your choices”
Campaign - Urdu Poetry Evening
The Contraception and Sexual Health
(CaSH) Team held a Poetry Evening in
English & Urdu to highlight the "Do you
know your choices" campaign.
In 2008 following Department of Health
monies allocated to increase access to
contraception; the "Do you know your
choices" campaign was developed. This was in response to the high abortion rate
especially with in the Asian population within Blackburn with Darwen. In 2008
within Blackburn with Darwen 484 legal abortions were carried out, 387 in 2005.
In 2008, nearly a third of all abortions were from Asian communities, with 39% of
abortions in the age range 29-44; in 2005 this was 19%. The Community CaSH
team look for innovative ways in which to engage with the diverse community of
Blackburn with Darwen. We felt art and literature transcends boundaries and
unites cultures, enabling us to inform and highlight important issues sensitively.
Those involved included the Community CaSH team, Clinical CaSH team
members, Gujarati Writers Guild, Youth Action, Shama Women's Group, The
institute of Urdu Culture & Literature (Blackburn) Blackburn College staff and
pupils - In attendance on the evening over 70 members of the public including
Black and Minority Ethnic (BME) members.
National abortion data from the Office of
National Statistics for the first two quarters
of 2009 indicates a significant decrease in
the Asian community and a slight decrease
in the overall number of abortions in
Blackburn and Darwen. The poems written
for the event have now been included in a
publication to further promote the “Do you
know your choices” campaign.
“I thank you for the invitation and warm welcome to your
wonderful poetry evenings to raise awareness around
abortions and contraception choices. It is your dedication and
commitment that makes it so successful. Congratulations!”
- Prof. Abdulgaffar Shaikh, Blackburn.
30
Experience
“With the central theme of the Mushaira (poetry event) is the
issue related to prevention of unwanted pregnancy, abortion,
contraception, sexually transmitted diseases, rape, safe sex,
forced marriages, domestic violence etc. has been well
addressed through creative writing workshops and events.
Well done.” - Mr Siraj Patel (General Secretary, Gujarati Writers‟ Guild-UK).
“Thanks for your invite with regards to do you know your
choices campaign. I think it is about time that organisations
like yourselves discuss issues such as contraception and
abortion with the BME community. As you will be aware Imtiaz
it is a very sensitive topic to discuss within our community.”
- Faz Patel MBE
31
Experience
Psychosexual Therapy Service
Service User Case Study
This lady was referred from her GP
when the need and impetus to seek help
escalated after marriage and the
couples desire to have a child. The
marriage of 8 years had not been
consummated due to a condition known
as Vaginismus. The condition is often
related to fear of intercourse and in this
case precipitated by fear of sexual intercourse on the wedding night developed by
poor education, myths and storytelling from elders in the community regarding
loss of virginity being painful and causing significant blood loss. The couple had
been married for over eight years, under tremendous family pressure to be
providing grandchildren and witnessing younger family members marrying and
having children. On presentation the female partner was clinically depressed with
poor general and sexual self confidence. She believed herself to be abnormal
and felt she was the only person who was unable to have sex.
Within one psychosexual therapy session she felt relieved to discover that this is
a common problem with treatments that are effective. The couple attended
therapy together and their goal was to develop their intimate relationship.
Therapy included many elements such as education of the condition, anatomy
and physiology of sexual responses to enable increased communication within
the relationship and education re fertility and pre-conception care.
The couple achieved their goal after fifteen sessions and informed the service
shortly after discharge that they were expecting their first child. In addition the
couple attended the Psychosexual Service Conference on Female Sexual
Dysfunction and shared their story with 70 delegates as an example of the impact
of sexual dysfunction for the individual and the couple within a presentation about
vaginismus.
"Thank you so much for all your help and support. I love
being a mum-it would not have been possible without your
service…” – Service User Comment
32
Experience
Pulmonary Rehabilitation, Rehabilitation Services
“Breathable”
Breathe Easy Blackburn
with Darwen was launched
in August 2010 and with
help from patients, it is now
thriving. The initiative is a
partnership between NHS
BwD Pulmonary
Rehabilitation Staff, British
Lung Foundation and our
Breathe Easy Patient
Support Group.
The team shared their
initiative on Radio Lancashire thus improving awareness of Chronic Obstructive
Pulmonary Disease (COPD) and Respiratory Services within local community. It
also raised funds for our local Breathe Easy Patient Support Group. The Breathe
Easy Support Group also received Nat West Community Fund success. The
group won first prize from the Nat West Bank Community Fund and has been
awarded £3,000 to help it on its way.
"It helps being around people who suffer the same as you
because they understand what you are going through. We're
trying to build a community" - Breathe Easy Group Member
33
Experience
Tissue Viability, Vascular and Lymphoedema Service
Tissue Viability Link Group
The Tissue Viability, Vascular and Lymphoedema service facilitate 2 link groups,
an established Wound Management Link Group and a newly developed
Lymphoedema Link Group to support and develop staff whilst sharing and
promoting best practice, and raising awareness. The groups consist of a variety
of allied health professionals promoting multi disciplinary working.
Before I had the help from the Lymphoedema nurses, my life was a misery
of pain, uncertainty, depression etc. I had not been able to get any
answers from my GP who could only shrug his shoulders and give me
more water tablets. I was really suffering with all the fluid retention etc. I
ended up being bedridden and house bound for over two years, plus the
extra pressure and weight of the fluid was adding unbearable strain to my
already arthritic joints, culminating in my virtual complete immobility which
nearly killed me.
Whilst in hospital, I still could not get any answers, so, once I came home
we decided to try the internet for information.
We found out that there was in fact something that could be done for me
via a clinic in Clitheroe, so I rang them. The lady I spoke to was very
helpful but did say that if I had to go privately it would bankrupt me and
that she did referrals via the NHS so to go back to my GP and ask about a
referral.
When I did finally get to speak to my GP he didn‟t know anything about it
and admitted that I‟d got him on the back foot so to speak and that he
would look into it and get back to me.
The next thing that happened completely changed my life. I received an
appointment to go and see the Lymphoedema nurse at clinic, as I was
house bound they came out to me and that‟s how I first met Lorraine, my
nurse. I finally had answers and hope. It was like a huge weight had been
lifted off my shoulders and the depression eased up as well. It has made
my life worth living again and all I can say is that without having this
ongoing treatment, I probably would have committed suicide months ago. I
have been with Lorraine for just about 5 or so months and my condition
has now started to show definite signs of improving. All I can say is that
without this invaluable help, my life might well have been over.
Patient Story
In response to this service user feedback the Lymphoedema team undertook an
awareness raising campaign linking with stakeholders including GPs. Provision of
written information about the service included contact details and methods of
accessing care.
34
Experience
New Wound Care Documentation
Since May 2010, the service has developed, piloted and launched new wound
care documentation, incorporating the national Pressure Ulcer Score for Healing
(PUSH tool version 3.0, NPUAP, 1998). The documentation strives for quality,
effective and safe practice, supporting holistic wound assessment and accurate
record keeping.
Prior to the launch of the new paperwork a baseline audit was undertaken to
enable standards to be re-measured post launch of documents. The pilot of the
new documentation began in August 2010. Following the pilot, the documents
were adjusted to incorporate feedback from clinicians.
The documentation was then launched in December 2010- January 2011. An
intense training programme was designed to capture as many clinicians as
possible. 162 clinicians were trained in the completion of the wound care
documentation to promote standardised good practice across NHS BwD.
Through evaluations 100% of staff felt able to adopt the new methods of working
and documentation after the training.
Pressure Ulcer Audit
Pressure ulcer prevalence audits were undertaken in April and August 2010 and
continue 6 monthly, the table below shows a gradual reduction in pressure ulcer
prevalence across patients in the community across NHS BwD.
Percentage
of patients
surveyed
with a
single
pressure
sore
Apr 2010
Percentage
of patients
surveyed
with a
single
pressure
sore
Aug 2010
Difference
Apr to Aug
2010
Percentage
of patients
surveyed
with more
than one
pressure
sore
Apr 2010
Percentage
of patients
surveyed
with more
than one
pressure
sore
Aug 2010
Difference
Apr to Aug
2010
3.73%
3.57%
 0.16%
0.86%
0.58%
 0.28%
The Tissue Viability service constantly strives to reduce pressure ulcer
occurrence by providing training tailored to nurses and allied health professionals
across NHS BwD. A programme of training is also underway for care staff in
residential homes; this will be completed by December 2011, when 36 care
homes will have been trained in pressure ulcer prevention and awareness.
References: National Pressure Ulcer Advisory Panel (NPUAP), Pressure Ulcer
Scale for Healing (PUSH) Tool, Version 3.0: 9/15/98
35
Experience
Customer Care
NHS BwD patients report any complaints, concerns, compliments and enquiries
to the Customer Care Department of the Care Trust Plus (CTP).
Compliments are recorded and reported to Integrated Governance Committee.
In respect of the other categories, PSU staff are informed of any such reports and
assist the CTP to resolve any issues as soon as possible. In the majority of
cases, concerns that are raised result in a Local resolution which is agreed by all
parties. Where a local resolution does not meet the requirements of the
complainant, robust processes are in place to ensure that the complaint is dealt
with openly and fairly. Lessons learnt and service improvements are reported
into the Integrated Governance Committee.
The table below shows the number of complaints, concerns, compliments and
enquiries and their status for 2010/2011:
All contacts into Customer Care (1st April 2010 - 31st March 2011)
202
Total number of complaints, concerns, enquiries, compliments
Total number of Compliments
138
Total number of Concerns
22
Total number of Enquiries
16
Complaints
26
Total no. complaints this financial year
25
No. responded within agreed timeframe from this period
26
No. acknowledged within 3 days from this period
19
Local resolution from this period
36
Effectiveness
37
Effectiveness
Child and Family Health Service (CFHS)
Student Health Visitor Award
A Student Health Visitor from the CFHS has been awarded the Jenny Humphries
Award for persevering and being successful under stressful circumstances
throughout her course.
This is an award that has been accredited for her attitude and dedication to her
studies and is an acknowledgement of a students' attitude to her studies.
Safeguarding Supervision
Safeguarding Supervision was carried out in partnership working for staff from
Health and The Borough Council (Health Visitors and Family Support).
The work was carried out as a result of close partnership working between the
Borough Council Geographical Manager and the Team Leader for Child and
Family Health Services following removal of children from a family that both
agencies were involved with. It was identified that although both agencies had
been involved for quite some time there had been little impact or improvement for
the children concerned and that the family had not been escalated into the social
care arena. At that time there was not any planned, structured robust joint
supervision for practitioners from different agencies.
As a result of this initiative, staff across both agencies attended supervision
together. Objective questioning assisted the practitioners with their analysis and
joint planning for future care. As a result some families had a reduction in input;
some had greater input or were referred into social care. Staff reported to have
benefited from the supervision sessions and that it provided the objectivity
needed to enable clarity to inform their analysis. The process focused on
outcomes of interventions with an emphasis on improved case management.
Service Restructure
Service restructure, moving from having two separate services (Early Years and
Children and Young People) to an integrated Child and Family Health Service
working with children and young people aged 0-19 years and their families.
Teams are working to a geographical footprint aligned to 5 borough boundaries in
6 teams to enable 'think family' approach and closer partnership working.
There is a requirement in the NHS to work efficiently and effectively and
streamlining how we work with families at all levels of safeguarding. There was a
need to develop a 'think family' approach which is a key national and local priority
to aid closer partnership working. There is also a need to identify named Health
Visitor from 0-4 years in response to recent staff, partner and user consultation.
38
Effectiveness
The service restructure took place in January 2011. For staff, impacts include
strengthening of the service position in view of a planned move to a new
organisation - Lancashire Care NHS Foundation Trust. Families are now
experiencing the positive outcome of a named Health Visitor that they link with.
Health Care Plan Staff Sessions, Children with Complex Needs Team.
All staff should be aware that children with additional or complex health needs in
a mainstream educational setting must have a health care plan in place.
This will prevent children being delayed in commencing school in the September
term. Three training sessions on the subject of completing health care plans have
been provided to staff across all areas, the last session being on the 17th
February 2011.
Feedback was obtained from members of the Public Health Group that some staff
members felt unsure about completing a Health Care Plan, particularly in the
Health Visiting teams as this was a new area for them. It was decided that
specific sessions around certain medical conditions would be discussed in formal
teaching sessions and this would allow the staff to complete a Health Care Plan
as they now had more knowledge and understanding.
Staff in all areas now feel more confident in writing a health care plan and can
feel confident that they can ask staff for advice. A number of folders have been
added to the shared drive on the computer that we all have access to. There is a
folder entitled health care plans where staff can print off plans that have been
written for certain conditions and they can add details that relate to the family they
have input with.
Post Natal Depression (PND) Audit
Improvements in audit re: maternal mental health (links to NICE guidelines).The
purpose of the audit was to ensure that mood assessments were completed as
per core programme and that all correct and relevant data was collected and
recorded on every patient's record. The main objectives of the audit were to
review if the Post Natal Maternal Mental Health pathway was being followed as
per policy May 2007, to identify areas for further development/training, to ensure
that records are kept in line with Record Keeping Policies and Nursing and
Midwifery Guidelines and also to identify if there were any improvements
following the audit recommendations in 2009/10.
Observations from the audit were an overall improvement in all criteria when
compared to the previous audit in 2009/10 with some criterion showing a
dramatic increase. For example the evidence of observation and promotion of
mother/child bond at 3-4 months had increased from 3% to 66%. This
39
Effectiveness
demonstrated that the training for staff 'The Power of the First Interaction' had
been highly effective and had improved staff‟s observational skills regarding
mother/child bond. All criteria had improved thus demonstrating that there was a
better quality of mood assessment for postnatal mothers and better record
keeping. Areas identified which required some improvement were: a clear plan of
action for listening visits to be included in the records and clear evidence of
communication with GPs when PND was identified.
Multi Agency Disability Awareness Day
The annual event was held to provide families with information they required to
ensure effective care.
Groups involved in the event included children/young people with complex needs
and their families, a large number of statutory and voluntary services, disability
links members and coordinator, Health Visitors, School Nurses and the Specialist
Nurses team for Children/Young People with Complex Needs.
Services including Change 4 Life, The Healthy Child Programme and the work of the
Specialist Nurses were all promoted and staff manning the stand were encouraged to
seek information from other stalls in order to extend their knowledge of services.
Families were provided with information they required to ensure effective care
and they appreciated the range of information in one place.
“I was able to network with many organisations I haven’t
previously.” – Staff Comment
“Excellent for networking.” – Staff Comment
“Opportunity to find out about other useful services in the
area and make contacts.” – Staff Comment
40
Effectiveness
Achievement of the UNICEF Stage 2 Baby Friendly Award April 2010
This award involves external assessors interviewing key personnel around a
number of key criteria related to breastfeeding i.e. positioning, hand expressing,
supporting mothers returning to work.
The expected standard for each criterion is 80% and we achieved between 93%
to 100% for each criterion which was a tremendous achievement.
To achieve Baby Friendly status demonstrates specific standards around breast
feeding and ensures a consistent and standardised approach to care, which has
enabled a shift in culture within our service around supporting mothers to breast
feed.
Stage 3 of Baby Friendly Initiative (BFI) has been achieved in April 2011. We are
the first community provider to achieve this.
“A high standard was demonstrated by all staff who took part
in the assessment. What impressed us was that staff knew the
information and they were anxious about the assessment not
because of their lack of knowledge but of the possibility of
letting the side down. This showed great team work” External
Assessor
“We have worked hard as a team to achieve this award and
have supported each other to improve our practice” Staff
Member
Lady X is a twenty five year old single parent with a history of mental
health issues including anorexia nervosa. She engaged with the Early
Start Programme during pregnancy and, in line with current midwifery
guidelines, was supported both ante-natally in preparation for breast
feeding and postnatally with further advice. Her baby is now 5 months old
and is fully breast fed.
Lady X submitted a written feedback statement commenting "people kept
telling me that my baby was breast feeding too much and I should maybe
introduce formula to fill her up more- but the Early Start Team was a
constant reminder that I was doing a perfect job and that my baby was
perfectly healthy and the feeding pattern was normal….this also made me
feel proud as a mother, to know so much about what I was doing for my
baby as if I had become some sort of expert!"
Case Study
41
Effectiveness
Early Start contribution to achieving BFI Stage 3 and Audit (UNICEF breast
feeding status Award)
In preparation for the BFI Stage 3
award the infant feeding team
completed 2 internal audits in the last
6 months in preparation for the BFI
stage 3 audits April 2011. The audit
involved contacting mothers to review
key advice given by Health Visitors to
ensure key messages have been
given consistently by staff members
and understood by mothers.
As a result of the audit the infant feeding team were able to identify the key
messages that are being well received by mothers and those that need greater
clarity / reinforcement.
Key areas identified that need greater clarity with mothers which were cascaded
to Health Visitors for them to focus upon during contact with mothers.
42
Effectiveness
Contraceptive and Sexual Health Service (CaSH)
Patient Experience Survey
All clinics delivered by the CaSH service were included in the patient experience
survey.
In order to minimise bias community CaSH workers, who do not work clinically in
the service, were scheduled to be present at each clinic run during the timeframe
of the fieldwork (November 2010). These staff facilitated completion of the
survey; offered language support or support in completing the questionnaire.
All patients attending the clinic within the scheduled sessions were invited by staff
to take part in this survey. Posters were displayed outlining the purpose of the
survey during the two weeks while this was being completed.
Summary of Key findings
226 patients were approached, 201 of whom completed the survey. This gives a
response rate of 89%.
 95% strongly agree or agree that it was easy to make an appointment for the
CaSH service
 94% strongly agree or agree that they got an appointment for when they
wanted to be seen
 85% strongly agree or agree that they were happy with the time they had to
wait to be seen in clinic
 80% strongly agree or agree that an explanation was given if they had to wait
10 minutes past their appointment time
 86% mostly disagree or disagree that they could overhear other patient‟s
personal details
 100% strongly agree or agree that staff were polite and professional
 100% strongly agree or agree that staff checked they understood the
procedure/treatment
 100% strongly agree or agree that they were given an opportunity to ask
questions
 100% strongly agree or agree that the information given to them helped them
make decisions about their contraception choices
The picture shows the most commonly reported
words used to describe the service (the larger the
word, the more frequently used):
Actions taken to improve the service:
Ensure people are informed if they wait over
10 minutes past their appointment time
Ensure all publicity materials are up to date on web sites
43
Effectiveness
Podiatry Service
Training of Podiatry Assistants
As a result of a service review, improving efficiency within the service and
following an accredited training programme, the podiatry assistants have been
treating a range of nail conditions on low risk patients for a number of years.
Building on this experience and to develop their skills and competence, the
assistants have undertaken further training in order to monitor the feet and treat
nail conditions in high risk patients. This is a more effective use of staff time as it
enables podiatrists to safely delegate the care of patients to podiatry assistants.
Ultrasound Training for Podiatry Assistants
Therapeutic ultrasound as a treatment has been used by therapists over the last
50 years to treat soft tissue injuries. Ultrasound works by using high frequency
sound waves to stimulate body tissues produced by means of mechanical
vibration of the metal treatment head of the ultrasound machine. The treatment
head is then moved over the surface of the skin in the region of the injury. When
applied to the skin, heat is produced within the tissues which leads to an increase
in circulation, a reduction in inflammation, fibrosed tissues become loosened and
an analgesic effect is also achieved - pain relief. Ultrasound has also been
effective in the treatment of muscle injury, local swellings, torn muscle fibres,
chronic ligament and tendon lesions and many sports injuries.
The ultrasound training provided the staff with the knowledge and skills to extend
their role within the podiatry service. The podiatry assistants can now safely
deliver ultrasound to the patient once the diagnosis and treatment plan has been
developed, thus supporting the service to deliver cost effective and clinically
effective service. There has been a positive impact, staff are motivated to learn
and develop and making more effective use of staff time has had a positive
impact on the biomechanic waiting list.
44
Effectiveness
Patient Experience Surveys
The Podiatry Service have
completed two Public and
Patient Involvement (PPI)
surveys in 2010/11. This
work was carried out as a
long period of time had
elapsed since the podiatry
service users had been
asked for their opinion
regarding the service they
receive. The PPI work was
also a driver within the
organisation and allowed
the department to engage with the patient during a time of service review. We
hoped that by completing these surveys we would have a good representation of
the podiatry service users in order to shape our service delivery.
The first survey was to target the housebound service users of the podiatry
service. The Older Peoples Forum were commissioned to support this survey.
The Older Peoples Forum recruited volunteers to perform the survey. NHS BwD
provided training for the volunteers to ensure they had background knowledge of
the service.
“Certainly been well treated. I would like to be called by my first
name” – Service User Comment
“I am satisfied in knowing my feet are being cared for” – Service User
Comment
“If I knew when the next appointment was going to be, I could
arrange it at each visit instead of having to remember to phone
myself every 10 weeks” – Service User Comment
Actions taken as a result of the survey:
Complete a care plan audit within podiatry service to monitor evidence of
service user involvement with planning of their care
Communicate to staff the need to ask service users for their „preferred name‟
Amend podiatry records to allow „preferred name‟ to be recorded
Improve communication to patients regarding appointments system
45
Effectiveness
The second PPI survey was based upon patient satisfaction. The patient
satisfaction survey engaged service users that access podiatry in a clinic setting.
The summary findings below are from a sample of patients who were asked to
complete the questionnaire.
1. 100% of patients who expressed an opinion agreed/mostly agreed that staff
paid attention to what they were saying
2. 98% of patients who expressed an opinion agreed/mostly agreed that they
had their questions answered fully and helpfully
3. 100% of patients who expressed an opinion agreed /mostly agreed that
staff made them feel at ease
4. 100% of patients who expressed an opinion agreed/mostly agreed that
their privacy was respected
5. 100% of patients who expressed an opinion agreed/mostly agreed that
their dignity was respected
6. 100% of patients who expressed an opinion agreed/mostly agreed that
care was delivered in a calm and reassuring way
7. 100% of patients who expressed an opinion agreed /mostly agreed that
staff spent an appropriate amount of time with them during their visit
8. 100% agreed/mostly agreed that their care wasn‟t disrupted by staff not
having the equipment or stock they needed
9. 95% of patients agreed/mostly agreed that the appointment offered was at
a convenient date /time
10. 99% of patients agreed/mostly agreed that they were not kept waiting.
46
Effectiveness
Community Diabetes Service and X-Pert Patient
Structured Education Programme
Community Diabetes Service was chosen to be
showcased at the 2010 NHS Alliance Conference
in Bournemouth and an ITN film was made for
this purpose.
Anne Greenwood, Head of Clinical Services was
invited to raise awareness of Type 2 diabetes on
Radio Ramadan, to discuss winning the Nursing
in Practice award on Radio
Lancashire/Manchester and how patients with Type 2 diabetes are supported in
the Blackburn with Darwen community.
The team won the 2010 National Nursing in Practice Award for innovation and
improved patient outcomes.
The X-Pert patient partnership has been established to support patients after
completion of the 6 week X-Pert structured education programme and is in
partnership between NHS BwD and the Borough Council.
As diabetes touches the lives of so many local people a partnership initiative took
place with the Community Diabetes Team, Lancashire Constabulary and
Accrington Academy supporting local community cohesion through the production
of a DVD (Roshni).
The Blackburn with Darwen Community Diabetes team which includes GP with
Special Interest, Diabetes Specialist Nurses, Podiatrist, Vascular Treatment
Room Nurses, Link Worker, X-Pert Educator, Dietician from East Lancashire
Hospitals NHS Trust (ELHT), administrative support, Learning and Partnership
Officer from the Borough Council, Lancashire Council of Mosques and
Volunteers, Lancashire Constabulary and Accrington Academy were involved in
the production of the DVD promoting community cohesion. The multi-disciplinary
diabetes team was developed to provide an innovative one stop shop for patients.
The innovative partnership model has lead to improved clinical outcomes for
patients improving quality of life, which in turn reduces long term complications
from diabetes and costs for the NHS. The one-stop shop model has reduced the
Did Not Attend rate, resulting in improved efficiencies with more patients being
seen with the same financial resources. Patients can be seen by any number of
team members often in one visit reducing the need for multiple referrals and
appointments.
Patients can now attend the diabetes service at a choice of local venues to
receive holistic assessments and personalised care by a range of professionals in
one visit. The model supports self care and empowerment of patients through the
X-Pert structured education programme delivered in Urdu, Guajarati and English.
47
Effectiveness
The integrated team has enabled staff
development to take place and provided new
learning opportunities. The use of volunteers
has been successful both from the support to
patients and the team but also for their own
personal development. They have spent more
than 1,500 volunteer hours learning how to
develop drama scripts and perform a diabetes
drama at numerous locations across the
Borough which has been aimed at raising the
awareness of diabetes, its complications and
impact on health of the individual and family.
Community Nursing Services
Telehealth
NHS BwD purchased 16 Genesis monitors at the end of 2008 each with weigh
scales, blood pressure cuff, infrared thermometer and oximeter. The criteria was
set for patients who have had frequent re-admissions to hospital and require a
high level of Community Matron input but not in the terminal phase of life.
The drive is to maintain the individual‟s health in their home. Blackburn with
Darwen has higher than average incidents of people suffering from long term
conditions, with mortality rates 8 years less than the national average. It is
important that we are proactive and innovative in the way we provide care for the
local community, in order to reduce this inequitable gap and telehealth technology
can support this.
Community Matron and General Practitioner home visits had reduced and the
number of phone calls requesting an emergency ambulance had reduced.
Although this was only an initial baseline evaluation, the results do suggest that
patients having the equipment and ability to monitor their health closely has a
positive impact on both their physical and psychological health. This could be that
patients felt more secure in self monitoring and the ability to pick up any changes
in their health earlier, taking early preventative action as necessary thereby
encouraging a „self care‟ model.
Community Matron visits could be triaged more effectively, ensuring that those
patients with the most need receive a timely visit. Financially, the early warning
signs that the patients‟ health is deteriorating and the ability for rescue
prescriptions to be accessed at the appropriate time has in effect prevented 9
crisis hospital admissions. The estimated cost of a COPD admission is £1849.00
therefore the total saving is £16641.00.
48
Effectiveness
“Showed that I had low oxygen levels and needed long term
oxygen therapy.” – Service User Comment
“Confidence that I am ok” – Service User Comment
“Reduced anxiety when I see readings are ok – I know I will
get a call if not.” – Service User Comment
“Enable to check when feeling a little off.” – Service User Comment
“Feel more reassured about chest condition and general
health.” – Service User Comment
Mental Health Assessment & Intervention Service
Implementation of a Brief Mental Health Trigger Tool
The Mental Health Trigger Tool is an integral component of the organisations
overview assessment. In addition the development of practice protocol guidelines
supported its implementation.
It is estimated that over fifteen million people in the United Kingdom live with long
term conditions (LTC) such as chronic obstructive pulmonary disease (COPD),
heart disease, diabetes, stroke and cancer. This group account for 69% of total
health and social care spending, and 72% of hospital in-patient bed days (DoH,
2008a). This group have a significant risk of developing mental health needs, with
depression affecting 20% of this client group (Egede, 2007). Left untreated,
depression leads to substantial distress, reduced quality of life and long term
disability as well as adversely affecting the management of long-term conditions
(Care Services Improvement Partnership, 2006).
The provision of and access to psychological therapies was enhanced (DH,
2008b) with special reference made to the treatment of people with co-existing
needs in depression and long term conditions. In addition NICE (2009a) have
produced guidance to support the management and treatment of depression in
clients with chronic physical health problems. However, results of a
documentation audit (BwD, 2009b) highlighted that documented focused heavily
on the biological approach to case management, with little or no reference to
mental health factors. In addition, no standardised screening instrument for
detecting mental health needs was being utilised. Furthermore the detection rate
for cognitive impairment in this locality was 50% below the national average.
49
Effectiveness
Additional guidance from NICE on the Clinical Guidelines for The Management of
anxiety in adults in primary, secondary and community care and the Department
of Health Living Well With Dementia: A National Dementia Strategy, 2009.
Service users and care groups have been involved in the development,
implementation and evaluation of this innovation.
Outcomes:
To integrate the mental health trigger tool into the organisations overview
assessment, ensuring a standardised and consistent approach across the
organisation to mental health detection in clients with LTC. Clients‟ needs
in mental health are detected and access to assessment and treatment
made accessible
To integrate the mental health trigger tool into a practice protocol
guideline. To support and guide the actions of practitioners (referral to the
mental health assessment & Intervention Service) thereby reducing
practice variation and ensuring safe management of clients with mental
health needs which are compliant with NICE guidance
To increase detection of mental health needs in clients with LTC by 20%
To increase client access to mental health assessment (NICE 2009a) to
identify risks and planning interventions to reduce risks
To improve client access to a range of NICE approved interventions
(NICE, 2009a)
To obtain client views on the their assessment and treatment reflecting
CQC
Monitor client outcomes by using validated symptom scales:
PHQ-9
GAD-7
START
Middle
End
15 (severe)
11 (moderate)
2 (none)
10 (moderate)
7 (moderate)
3 (none)
14 (moderate)
10 (mild)
4 (none)
8 (mild)
6 (mild)
4 (none)
6 (mild)
6 (mild)
2 (none)
9 (mild)
7 (mild)
5 (none)
Client outcomes for those receiving CBTI
50
Effectiveness
Case Study - A client receiving assessment from a staff member
for primarily chronic breathing difficulties was frequently calling
999 and being admitted to hospital. During the assessment which
included the trigger tool the client was detected with anxiety. This
trigger tool supported by the practice guidelines directed the staff
member to take safe and consistent action to obtain a timely
mental health assessment from the Mental Health Assessment &
Intervention Service which confirmed the client to be experiencing
panic disorder. Following interventions to treat the panic the
clients‟ previous calls and hospital admissions reduced
significantly.
References:
Care Services Improvement Partnership (2006) Long -term conditions and
depression: considerations for best -practice in practice based commissioning.
Department of Health (2008a) Raising the profile of long term conditions care: A
compendium of information. London: HMSO
Department of Health (2008b) Improving access to psychological therapies (IAPT):
long-term conditions positive practice guide London: HMSO
Egede, L.E. (2007) Major depression in individuals with chronic medical disorders;
prevalence, correlates and association with health resource utilisation, lost
productivity and functional disability General Hospital Psychiatry Vol. 29, pp.409-416.
National Institute of Clinical Excellence (NICE) (2009) Depression in adults with
chronic physical health problem [on line] last accessed 5 February 2009 at URL
www.nice.org.uk
51
Effectiveness
Health Outreach Team
The Health Outreach Team is dedicated to working with the homeless, temporary
or insecurely housed and Asylum Seekers within Blackburn with Darwen.
The main aim of the team is to engage with these hard to reach groups to
increase their access to mainstream health care and reduce health inequalities.
Research evidence suggests that this cohort of people experience poorer
physical and mental health than the general population, which is exacerbated by
their poor living conditions. A number of studies have found a high prevalence of
mental health issues, drug or alcohol dependency and increased rates of
Tuberculosis and blood borne viruses within this population. The diversity of this
group, often with multiple needs, can combine and perpetuate their situation,
making diagnosis, treatment and compliance a challenge for health care services.
As a group they are known to have poor access to primary care services, often
presenting to secondary care, which neither addresses their need nor is costeffective.
The primary objective of the team is to enable equitable access to health care for
groups, who frequently dismiss health issues or do not know how to access the
services offered within the Borough, the team act as an advocate for its service
users.
Ensuring that disadvantaged groups receive the healthcare they require is an
essential part in reducing health inequalities.
Improving quality:
There have been significant developments within the Health Outreach Team
since 2009/10. The team has expanded and now consists of 1 General Nurse, 1
Assistant Practitioner, 2 Outreach Support Workers and an Administrative Officer
all of which work on a full time basis. The Team have moved offices to absorb
the expansion, still based at Larkhill Health Centre. A “quiet” client room is
located next to the main office for interviewing service users in private.
Health drop in clinics have been established within all the homeless hostels /
guest houses on a weekly basis.
A “Drop In” health clinic is held at the local “Soup Kitchen” three times a week
and health “drop in” sessions for Asylum Seekers run daily.
The Team was awarded £1000 from Dragons Apprentice money in 2010; an 8
week holistic care course for Asylum Seeking Women was delivered.
The Team was also awarded £250 by the Queens Nursing Institute to develop a
service user network for the homeless. The service user forum is now underway
52
Effectiveness
and meets on a monthly basis. The aim of the group is to be a “Voice” for other
service users with regards to aspects of health and wellbeing in order to influence
future service delivery.
“Multi agency engagement” events are held quarterly at the Salvation Army.
Health professionals from Oral Health, Condom Distribution, Podiatry, Healthy
Legs, Harm Reduction and Creative Support attend to promote their individual
services and act as a point for advice & support for service users.
Rehabilitation Services - Pulmonary Rehabilitation
"Breathable”
In early 2010 the Pulmonary
Rehabilitation Team along with service
users and the British Lung Foundation
were awarded the Pat on the Back
2010 by The Local Strategic
Partnership (LSP) for long term health
conditions/chronic disease
management.
The Pat on the Back rewards people or
teams who have demonstrated
outstanding achievement or excellence
which has been of such a high standard that it has made a real difference to
customers, colleagues, the organisation or the LSP as a whole.
Recently in 2011 the rehabilitation team is celebrating winning a top regional
award for transforming the lives of people suffering lung disease.
Chronic Obstructive Pulmonary Disease (COPD) is the kind of long term
condition that can leave sufferers too breathless to carry out simple, everyday
tasks such as washing their hair or changing a duvet cover by themselves.
But thanks to the team‟s Breathable programme (breathing education and
exercise) over 600 people are now enjoying better health and even taking part in
exercise which initially seemed beyond them.
The pioneering work of the team, which was set up in 2008, was recognised at
the first ever NHS North West awards set up to recognise and share best practice
in the care of respiratory conditions by winning the pulmonary rehabilitation
category.
Will Sullivan, team leader said “The lung improvement programme is a national
campaign to improve diagnosis, treatment and care for people who suffer from
respiratory conditions. Our work was judged by national experts from that
programme before our entry was even submitted to the awards so we have been
judged by the best in our profession.”
53
Effectiveness
“To achieve that in just two and
a half years is amazing but
nothing compares to knowing
we‟ve made a real difference to
over 600 people‟s lives locally.
We have patients who can now
walk further and have the
confidence to go shopping or
can take a shower without help
when, before our service
started, that was completely
beyond them.”
“Our aim is to help people
manage their breathing which
reduces their anxiety and
improves the quality of their
lives. We work with Blackburn
with Darwen Council‟s active
living team to encourage
patients to build up their lungs
through exercise which means
they can enjoy everyday life
more, recover more quickly
from any setbacks and
hopefully avoid hospital
admissions which is better for
them and their families and
saves the NHS money.”
Just under 4,000 people or two per cent of the population in Blackburn with
Darwen have been diagnosed with COPD compared to just over one per cent
nationally but health experts believe as many as 1500 people locally have the
early stages of the disease but dismiss their symptoms as just signs of ageing.
54
Local Stakeholder Statements
Local Involvement Network (LINk)
Blackburn with Darwen LINk welcomes this opportunity to comment on these first
Quality Accounts produced by Blackburn with Darwen Teaching Care Trust Plus
Provider Services Unit. We have found the layout and more accessible format helpful
and a vast improvement on Accounts forwarded to the LINk from other areas of the
NHS and the easiest to read of those we have received this year.
In relation to the CQC Stroke Review we are pleased to note the high score for
supporting carers. Whilst we recognise this report is focussed around the care
provided by health professionals, we feel this is also indicative of the quality of the
Carers Service in Blackburn, involvement of the voluntary sector and the level of
investment in this area of work that is not fully reflected in this report. While
recognising there is a Partnership section to these accounts that is in itself
progressive in terms of other reports we have received, LINk feels the overall logic of
Quality Accounts does not always ensure they fully state the reliance on partnerships
or contributions from community resources so important to the success of many
mainstream services.
LINk recognises that provision of stroke care is a pathway approach and as such is a
shared responsibility between several organisations. However in relation to the low
CQC score for early supported discharge for stroke patients and the high score for
managing transfer home from hospital , LINk would refer to our recent survey of Care
and Nursing Homes where problems at discharge such as a lack of information
accompanying the patient were highlighted. LINk requests that collectively all
involved work together to improve early supported discharge.
We note in particular the low score for involving stroke survivors and carers in
planning and developing services as we feel involving patients and carers in planning
services is an area in which the Commissioners of services and Providers of care
could work together to improve. For example when the LINk requested the
specification for the Stroke Communications Service in 2009/10 when this service
was being reconfigured we received no response from the Care Trust Plus. While
this was over a year ago we have found with the recent reconfiguration of Podiatry
services a similar „behind closed doors‟ approach with a reluctance to involve service
users in perhaps difficult service planning. Decisions made by Commissioners have
shaped the provision of care which then impacted on service users. LINk note and
welcome the development of service user groups by the Trust we feel the Quality
Accounts should in future provide more evidence of how these groups have
participated in mainstream service planning, for example the Breath Easy Group
with COPD services.
We earlier referred to changes in the Podiatry services in relation to service user
involvement in planning of services and here we refer to the Accounts inclusion of the
Podiatry Service patient/public survey. LINk recognises that this survey was around
patient experience and was not related to the reconfiguration, however would like to
suggest that future surveys are utilised by the Care Trust Plus to elicit views about
55
any impending reconfiguration of the Service as local people felt they were not
involved in the changes.
The East Lancashire Podiatry Service transferred to East Lancashire Hospitals NHS
Trust from this April and the Hospital Trust also covers the footprint of NHS BwD
Teaching Care Trust Plus Provider Services it might be helpful to indicate how the
Trusts will work together to avoid patient confusion and service integration across the
patch that we feel is the intention of Care Trust Plus
In summary LINk view local Health Care provision through the eyes of the service
user i.e. without any organisational, commissioner or provider barriers. Whilst
acknowledging NHS Blackburn with Darwen Care Trust Plus Provider Service is only
responsible for certain aspects of care provision it is difficult to view these in isolation.
We feel that high quality care in Blackburn with Darwen is dependent all parts of the
NHS working together with partners and stakeholders for the benefit of the local
population.
56
Commissioners
NHS Blackburn with Darwen, as a commissioning organisation, is responsible for
coordinating the commissioning of services provided by NHS Blackburn with Darwen
Provider Services Unit.
The Care Trust Plus commissions (buys) services from the provider services unit on
behalf of the people living within Blackburn with Darwen, as well as coordinating the
commissioning of services on behalf of other Primary Care Trusts (who are known as
associate commissioners).
Throughout the year the commissioners and Trust have met on a regular basis to
monitor, review and discuss the quality of services and quality improvements. In the
light of these discussions and in reviewing information on services available to
commissioners, it is our belief that the information contained within the Trust‟s quality
account gives a representative view of the quality of services provided over the last
twelve months.
NHS Blackburn with Darwen can confirm that NHS Blackburn with Darwen Provider
Services achieved completion of the schemes included in the CQUIN framework and
the efforts of staff in this attainment should be complimented.
The account also highlights many examples of programmes and initiatives that have
been used to improve the quality of care provided to patients, such as participation in
the national audit programmes and the efforts taken to gain feedback from patients
and their carers.
In those areas where performance has been identified as requiring strengthening, the
commissioning organisations have seen evidence of action plans and progress to
address these areas.
A welcome addition to the Quality Account would be inclusion of benchmarking with
comparator Trusts to provide assurance that the Trust is constantly reviewing its
achievement against similar services within the North West and beyond.
NHS Blackburn with Darwen as coordinating commissioner would like to see the
priorities for 2011-12 identified within the report, notwithstanding the knowledge that
the services will be transferred to Lancashire Care NHS Foundation Trust, indicating
aspirations for continuous improvement building on achievements demonstrated in
2010-11.
The commissioner is aware that the provider services unit is proactive in identifying
areas of concern and reporting incidents and that positive steps are taken to improve
quality and safety. It is felt that this has not demonstrated in the document to provide
reassurance to the wider audience.
NHS Blackburn with Darwen values the positive relationship with the Provider
Services Unit and looks forward to seeing improvements to the quality of services
provided in the future. We feel confident that Lancashire Care NHS Foundation Trust
will continue to build on these achievements, and deliver successfully against
priorities to improve the safety, effectiveness and experience for patients over the
coming year.
57
Overview and Scrutiny Committee
The Overview and Scrutiny Committee of Blackburn with Darwen Borough Council
were provided with a draft copy of this quality account and formally asked to provide
a statement for inclusion. A response was received informing us that they are unable
to provide a written commentary about this quality account 2010/11.
58
Amendments following comments received on initial draft
from 3rd party stakeholders
The following additions to the contents were made to the draft quality account
2010/11:
P15 – amended title and sequence of content
P20 – added details to demonstrate improvements:
In BwD we take seriously the need to respond quickly both in reporting and
investigating any serious incidents.
In 2010/11 a serious untoward incident involving a service user occurred which was
reported to Care Quality Commission (CQC) in August 2010. An internal investigation
was held to identify which outcomes the incident had impacted on, including a full
Root Cause Analysis investigation. The CQC published their final report 3/2/2011,
which reached the conclusion that overall, all of the required essential standards
were now being met, with suggestions for improvements in one area, which have
now been implemented.
These improvements included a review and re-design of wound management
documentation and process complemented with a targeted training programme for
clinicians delivering wound care management.
P29 – added information to illustrate response to service user feedback:
In response to this service user feedback the Lymphoedema team undertook an
awareness raising campaign linking with stakeholders including GPs. Provision of
written information about the service included contact details and methods of
accessing care.
59