Quality Account
2010/11
1
Contents
Quality Narrative
3
Commissioning PCT Statement
4
Review of 2010/2011
NHS Stockport Commissioning for Quality
5
Care Quality Commission
Data Quality
6
Information Governance
7
Review of Services
Service Reviews
8
Patient Safety
9
Patient Experience
13
Clinical Effectiveness
17
Continuous Quality Improvement and Innovation
19
Workforce
21
Stockport LINKs Statement
Contact Us
26
2
Statement of Quality
In 2008, former Health Minister Lord Darzi published the ‘High Quality Care for All’ report. The aim of the
report was to ensure the NHS provided high quality and effective patient care by making it publicly
accountable for the services it delivers.
The report also proposed that all organisations providing services for the NHS should be required to
publish annual ‘Quality Accounts’ - a yearly report to the public about the quality of services delivered.
Community Health Stockport (CHS) is an NHS organisation which delivers
healthcare, early intervention and health improvement outside of hospital
and within the communities of Stockport.
Legally, we are part of NHS Stockport but we operate as an Autonomous
Provider Organisation. This enables us to concentrate on providing high
quality services to patients, while the commissioners of NHS Stockport focus
on securing the best healthcare for the population of Stockport.
We have made our commitment to the population of Stockport through:
Improving health and providing services no matter who you are or
where you live in Stockport;
Organising our services to reduce the length of time you have to wait, Gill Frame
involve you, your family and carers in your care, and include other
Director of Community
services when needed;
Health Stockport
Improving and providing high quality services that meet or exceed NHS
standards;
Ensuring that we keep you safe by making sure the environment in which we provide care is clean and
safe, that our staff are well trained, that we use the available evidence to provide the best care and
that we continuously monitor standards and look for areas to improve;
Listening to people who use our services so that we can continuously improve them and develop the
services based on their needs.
Community Health Stockport provides a comprehensive range of services to care for everyone in our
communities throughout their lives. Services like Health Visiting and Children’s Therapy support children,
young people and their families including those with disabilities. Services like District Nursing and
Palliative Care provide care for adults and older people including those with a long term illnesses, those
requiring ongoing treatment or rehabilitation following a hospital admission, those requiring short term
treatment for an injury or illness and those requiring support and care at the end of life.
The health inequalities between Stockport’s most and least deprived neighbourhoods present us with a
real challenge with the gap in life expectancy between these communities being 12 years for men and 9
for women. It is vital we continue to work with our partners to redress the balance whilst continuing to
offer high quality care to all of Stockport’s 285,000 residents.
Community Health Stockport has a good track record of working well with our partners like the Local
Authority, Stepping Hill Hospital and General Practitioners to ensure that the care we provide is ‘joined
up’ and we are able to deliver the right care, in the right way and in the right place.
3
NHS Stockport Statement
Quality Accounts are annual reports to the public from providers of NHS health care about the quality of
the services they deliver. By publishing quality information this way, Community Health Stockport is
offering up our approach to scrutiny, debate and reflection and will enable the people of Stockport to
have a picture of the quality of services we deliver and what our improvement plans are.
NHS Stockport recognises and Community Health Stockport’s commitment to improve their services over
the last year building as they do on already good quality provision. The Quality Account is a well
presented and balanced view of service quality in 2010-11.
NHS Stockport receives a detailed quality report, serious untoward incident reports and patient
complaints data and reviews these with CHS at a quarterly contract meeting to discuss the quality of
services provided. We also meet regularly with clinicians and managers through a network of clinical
boards covering areas such as cancer, maternity, urgent care etc.
As a consequence of the full participation of Community Health Stockport in these structures and the
routine information they provide we believe the facts and evidence as submitted in this report are
correct. We detail below examples of improvements and quality in areas we have tracked over the year
and areas where we wish to support their desire for further improvement.
NHS Stockport commends CHS for its system of service reviews and the generally high level of compliance
with national standards and good practice this demonstrates. Another area in which we believe CHS has
significantly improved over the last few years is in understanding its patients’ experience and responding
to this. The generally high net promoter scores are an outcome of this approach. Similarly the roll-out of
an electronic incident reporting system has improved the reporting and learning from incidents and
thereby improving safety.
NHS Stockport measures 18 specific quality indicators. CHS performance in achieving in full 17 of these
was excellent and again demonstrates not only the quality of services but the level of commitment to
quality improvement within the service as a whole. Leadership is critical to this and the process of
leadership walk rounds is also to be commended.
Another important element of continual quality improvement is benchmarking with other organisations
and shared learning. In this respect NHS Stockport is pleased to note CHS’ membership of Safety Express
with its focus on reducing Falls and Pressure Ulcers and the sharing of information and learning with
other healthcare providers.
We wish to encourage CHS to continue on its drive for quality improvement. In particular we would
expect to see considerable effort to go in to reducing pressure ulcers, improving the management of
patient information, and responding to complaints in a timely manner; exacerbating a service failure with
poor complaint response times needs addressing. Having improved the level of incident reporting we
would ask them to give more consideration to the quality of investigation and developing an integrated
understanding of the key root causes across the organisation as a whole.
In the view of the commissioners CHS is a good quality community healthcare provider with a genuine
commitment to improvement. With all the changes it is facing during 2011-12 in terms of leadership and
ownership we ask that it ensures this focus is not lost.
4
NHS Stockport Commissioning for Quality
NHS Stockport (Stockport PCT) buy Community Health Stockport services on behalf of the people of
Stockport. A proportion of Community Health Stockport income in 2010-11 was conditional on achieving
quality improvement and innovation goals which were agreed between Community Health Stockport and
NHS Stockport (the PCT Commissioner) through the Commissioning for Quality and Innovation (CQUIN)
element of the NHS contract.
The use of CQUIN reflects the discussions between the PCT Commissioners and Community Health Stockport in striving to continually improve the quality of care and services we provide. The 18 CQUIN quality
indicators for 2010-11 were in 6 goal areas
Area
Achieved
Improving the quality of our data
Delivering the Health Child Programme
Reducing waiting times for clinics
End of life care
Measuring the healing rates of wounds
Infection prevention and control






17 out of the 18 indicators were achieved, with one
indicator relating to end of life care being missed by 1%.
The Palliative Care Team already has an action plan in
place to demonstrate improvement in this indicator. The
district nursing service is also changing their working
hours to be able to make contact with palliative care
patients earlier in the day.
Each year, new CQUIN indicators will be negotiated and
will reflect the aim to continuously improve our services and the outcomes for the people we work with.
Further details of the agreed goals for 2010-11 and for the following 12 month period are available by
writing to our customer care email address sto-pct.customercare@nhs.net Also see contact details at the
rear of this publication.
5
Care Quality Commission
The Care Quality Commission (CQC) regulates all health and
adult social care services in England, including services
provided by the NHS, Local Authorities, private companies and
voluntary organisations. The CQC make sure that essential
common standards are being met where care is provided.
Community Health Stockport is required to register with the
Care Quality Commission and our application for registration
was approved with no additional conditions required.
The Care Quality Commission has not taken any enforcement action against Community Health Stockport,
nor has Community Health Stockport participated in any special reviews or investigations by the CQC
during 2010-11.
Data Quality
CHS is committed to improving patient care and to support this we are taking a proactive approach to
improve the quality of the data that is recorded on our electronic systems.
Since the implementation of Lorenzo (an Electronic Patient Record) in 2008 this has enabled us to obtain
daily information about the types of contacts and the completeness of those records. Which is one
aspect of patient safety.
During 2010/11 we introduced a reporting system which allowed us to make considerable progress in
producing internal and external reporting of performance data. The reporting system provides managers
and directors with daily up to date information about their service. This enables high quality clinical care
which is cost effective and identifies where efficiencies can be made without compromising patient’s
safety.
For 2011/12, we have set a key business objective of making sure that all services are in a position to
record, report and analyse their activity and performance data to enable them to manage capacity and
demand, ensure delivery of contractual requirements, increase quality of services and measure the
outcomes from service improvement initiatives.
The chart shows some of our key data quality indicators. We are looking at an action plan to start to
improve the collection of ethnicity information throughout 2011/12 which will help us to provide
culturally sensitive community services.
6
Key data quality indicators
Quality Indicators 2010/11
Ethinicity recorded
51.90%
Appointment type field
completed
99.90%
Populated specialty field
99.68%
Authorised Referral
95.47%
NHS number recorded
97.81%
0
10
20
30
40
50
60
70
80
90
100
Information Governance
Information governance is the term used to describe the set of
standards that the NHS must follow to make sure that it carries out its
duty to:
maintain full and accurate records of the care provided
to service users
keep records about service users confidential, secure
and accurate.
Although all NHS staff are aware of the confidential nature of their work, the Department of Health have
introduced an Information Governance Toolkit for all NHS providers to complete. This also includes an
e-learning staff training package. Stockport PCT has declared an overall training score of 46% for 2010/11
on the Information Governance Toolkit.
The scores are lower than anticipated however and a detailed action plan has been developed which
includes reports by service on their achievement of the e-learning training targets.
Both the Internal Audit department and NHS North West have approved our action plan for 2011/12 and
our intention is to meet all requirements by March 2012. We are aware of the challenge this will
represent..
With senior management support we will continue to raise the importance of Information Governance
training and ensure the engagement of key staff members.
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Review of Services
During 2010-11, Community Health Stockport provided 31 NHS services. Community Health Stockport has
reviewed all the data available to them on the quality of care of these 31 NHS services. This report will
focus on our quality measure of ‘Service Reviews’, followed by the three areas within the national
definition of quality in the NHS:
Patient Safety
Patient Experience
Clinical Effectiveness
Service Reviews
The Service review process focuses on each individual service provided by Community Health Stockport
and measures it against the national quality standards. Each service has to present their evidence about
how they have met the quality standards and the process has been updated to reflect the 16 Essential
standards of quality and safety produced by the Care Quality Commission (CQC) in 2010.
In deciding which of the 16 CQC outcomes services needed to provide evidence for, the following criteria
were used:
Number of patient safety incidents
Number of complaints
Number of risks
This was completed so that the outcomes allocated to each service were the most appropriate ones. The
services which had not previously undertaken a service review or had scored below 80 percent in a
previous service review, are required to produce evidence for all 16 of the outcomes.
There are only 2 services whose results
fell short of the 80% target. The District
Nursing service was one of these
services and being the largest service
within Community Health Stockport it is
important to acknowledge that the
collecting of evidence is much more
difficult than those smaller services that
tend to score much higher. However, it
is an area where the Head of Service is
working hard to improve upon. The
second service was the Nutrition and
Dietetic service and they too have an
action plan to improve their
achievements for this year.
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Patient Safety
Benchmark Incidents National Patient Safety Agency Report
The National Reporting and Learning System (NRLS) is a central database of patient safety incident
reports. The following report shows incidents submitted by Community Health Stockport between 1st
April and 30th September 2010 and is a benchmark with other organisations.
The report shows that:
as an organisation we report incidents in a timely way
showing effective reporting systems
as an organisation we report incidents on a regular basis
showing a positive patient safety culture
as an organisation there are low numbers of staff
accidents
The 2 categories that require further work in order to
improve safety of patients are:
Medication Errors
Pressure Ulcers
Volume of Reporting
Community Health Stockport reports the average number of incidents per head of population and we are
the second fastest in England to report our incidents
Comparative reporting rate, per 10,000 population, for 68 primary care organisations with no
in-patient provision
65
61
57
53
49
45
41
? Top 25% of reporters
37
33
? Middle 50% of reporters
29
25
? Lowest 25% of reporters
21
17
13
9
5
1
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
9
What do we report?
The top 3 categories that we report on are:
1.
2.
3.
Medication Errors: Improving safety for patients and learning from incidents is a priority for the
organisation and this includes learning from incidents. Considerable work has been done over the
year focusing on reducing the number of medication errors. This has included a project that looked
at the whole process of medication administration. Following this project, there has been close
analysis of medication errors within the district nursing service. Another area now in development is
the electronic patient index which will reduce patients being accidentally missed off visiting lists.
Pressure Ulcers: Pressure ulcer incidents are individually investigated in order to learn lessons and
to continuously improve patient care. As part of the Safety Express initiative, developed by the
Advancing Quality Alliance (AQuA), CHS are looking to reduce pressure ulcer numbers by 30% (of
the 2010/11 total) during the next2 years.
Medical Devices: All medical device incidents are analysed at the Medical Devices Advisory Group in
order to learn how to improve our services.
Safety Express
Community Health Stockport is currently taking part in the Safety Express programme as the host
organisation. This means that we are the lead organisation for the programme working in partnership
with Stockport NHS Foundation Trust and a number of care homes. This work is across the whole
health economy.
Safety Express is a national improvement programme which aims to achieve significant reductions in
four avoidable harms: pressure ulcers, serious harm from falls, catheter acquired urinary tract
infections and Venous Thrombo Embolism (VTE). It also supports improvements in efficiency.
The specific aims for the programme are:
Category III & IV pressure ulcers reduced by
80% in hospital
Category III & IV pressure ulcers reduced by
30% in community
Catheter acquired urinary tract infection
reduced by 50%
Serious injury from falls reduced by 50%
Venous Thrombo Embolism reduced by 50%
Achievements so far
Executive sponsor for the programme identified
Working groups for each of the harm areas have commenced the work
Falls learning day hosted in Stockport
Data collection commenced using the NHS Safety Thermometer
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Leadership walk rounds
As an organisation we are registered with the Patient Safety First Campaign to show our commitment to
patient safety. Community Health Stockport has implemented the leadership walk rounds which are led
by either the Director or an Associate Director accompanied by a patient safety lead. It is an opportunity
for staff to voice any patient safety concerns they may have, directly to senior staff.
Leadership walk rounds have been completed at the following community bases:
Hazel Grove
Cheadle Hulme
Bramhall
Marple
Kingsgate
Shaw Heath
Heaton Norris
Gatley
Woodley
The visits have been embraced positively by front line staff. Action plans have been developed from each
visit and this has encouraged staff to share their innovative ideas. This is an important point as
Community Health Stockport want staff to feel able to share new ideas.
The Leadership walk rounds will be reviewed for the coming year to ensure suggestions are taken on
board from front line staff.
Infection Prevention and Control
Good infection prevention and control help to ensure the provision of
safe care.
The Health and Social Care Act (2008) Code of Practice on the
prevention and control of infections sets out 10 criteria which
Community Health Stockport has to comply with in relation to
cleanliness and infection control.
Following the Code of Practice helps to demonstrate that we meet
essential levels of quality and safety, as set by the Care Quality
Commission, who require assurance that standards are being met.
The Code of Practice is available on the Department of Health website and provides information for users
of services as well as guidance for organisations that provide care.
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_122604
There are a number of activities which demonstrate our commitment to promoting infection prevention.
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Hand Hygiene
Good hand hygiene is the single most important measure to
avoid the transmission of harmful germs and prevent the
spread of
infections. The Clean your hands campaign, aimed at improving
hand hygiene nationally, was launched in community settings
in 2008. Community Health Stockport has been a part of the
campaign since it was launched. Posters and information
leaflets are available in all of our clinics. We have 21 staff who
champion hand hygiene in the workplace and who meet
regularly to ensure hand
Essential Steps to Safe, Clean Care
The Department of Health introduced Essential Steps in 2006 with the aim of reducing infections. When
caring for patients, staff use the best practice and national guidance Essential Steps recommends. They
are assessed regularly to ensure they are competent to deliver safe care.
Staff Training
Infection prevention and control training is mandatory for all
new staff employed by Community Health Stockport and for all
clinical staff on a regular basis. As well as hand hygiene, staff
receive training about how infections are transmitted, when
protective equipment should be used, what policies and
procedures are available and how to reduce the risks of
transmitting and developing infections.
Clinics and Health Centres
Over a period of three weeks, in April 2010, all of our clinics and health centres
were assessed to see if they met standards of cleanliness and infection
control. These assessments were performed by staff from the Health Protection
and Control of Infection Unit at NHS Stockport. All the premises assessed achieved
the required standard. Where there were any areas of concern, for example ,
building repairs or stock rotation, action plans were devised to ensure problems
would be addressed. It is expected that assessment of premises will continue
to ensure care is provided in clean, safe environments.
Advancing Quality Alliance (AQuA)
Community Health Stockport is involved in a national programme aimed at improving patient safety. We
have a collaborative working group looking at reducing harm for patients with urinary catheters who may
be at risk of developing urinary tract infections. The group includes nurses and representatives from
Community Health Stockport, NHS Stockport, Stockport NHS Foundation Trust and Borough Care.
Specialist input from the microbiology team at Stepping Hill Hospital, pharmacists and GP’s is available
when required. The group is looking at standardising information and care related to urinary catheters
across Stockport in order to improve patient safety. This programme is ongoing until December 2012.
Further information is available from www.advancingqualityalliance.nhs.uk
12
Patient Experience
Customer Care
Community Health Stockport (CHS) is committed to;
Putting patients and service users at the heart of all we do,
Listening to local people,
Making sure our services meet their needs and preferences,
Actively encouraging them to express their views and experiences of our services,
Improving the way we deliver services as a direct result of feedback,
Informing them how their feedback has been used,
Giving people a say on how services are planned, delivered and evaluated.
We are working hard to achieve these progressive aims
through the introduction of a number of initiatives:
People’s Champions
All CHS services have a nominated Champion who is the link person for Customer Care. Their role
involves:
Planning patient experience surveys for the service,
Disseminating customer care information to colleagues and
Ensuring that patient experience is considered at all team meetings.
Dignity in care Champions
CHS supports the Dignity in care agenda and is committed to
providing high quality services that respect people’s dignity.
This has been achieved by;
People’s Champions working within their teams to
promote the dignity challenge and encouraging
colleagues to sign-up,
Presentations to groups of staff including Clinic
Administrators and students on placement in
Stockport,
CHS Director and Associate Directors registering
themselves and wearing the Dignity pin-badge,
We currently have approximately sixty staff
registered on the national data-base. Our target is
to continue to increase the numbers over the next
year.
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Patient Experience Surveys
Capturing the experiences of the patients and public who use CHS services is very important. Our
Customer care Strategy sets out the direction for the engagement work.
During the past year CHS has undertaken Patient Experience Surveys in a number of services. In the
second half of the year, electronic touch-screen devices have been used which has made collecting
patient experience much easier.
Ten services used the devices during 2010/11 and all have produced individual reports and actions/
recommendations. A small number of services used paper-based surveys and one service produced a
DVD of a carer talking about their experiences to use as a training tool.
Recommendations have included services looking at their appointment systems and also communication
with patients regarding explanation and apologies for any delays.
CHS have also used the Net-promoter Score in all surveys. This asks the person to rate how likely it is that
they would recommend the service to a friend, relative or neighbour. It captures what people say in
terms of ‘word of mouth’ locally and tells us if they are talking positively about the service.
Levels of satisfaction are generally very high.
A Net-promoter score above 50% is classed as a good score as there will be more promoters than
critics!
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Patient Written Information
The quality of our patient written information has been addressed. A Patient
Written Information Group operates as a virtual group to review and quality
check all leaflets, resulting in faster use in practice (usually within one month).
We have also standardised our service information leaflets to comply with the
Care Quality Commission (CQC) recommendations and ensure the
information is relevant, accurate and consistent.
How do we let you know how we are doing?
This has been achieved through local radio broadcasts as well as newspaper releases, via the website and
clinic notice boards. All survey results are shared with LINks and there is a patient representative on the
Patient Safety & Experience Governance Committee. In addition, LINk’s have a representative on
Community Health Stockport Committee.
Staff are informed of customer care work through their People’s Champion, via Team Brief and the
quarterly Customer Care Newsletter.
Complaints
There has been an increase of 2 in the number of Community Health Stockport complaints this year. A
total of 47 complaints were recorded from 1st April 2010 to 31st March 2011 compared to 45 complaints
received for the previous year. Each year, Community Health Stockport staff have almost 500,000
contacts with patients and service users.
The table below shows all complaints received by quarter during 2009/10 and 2010/11:
Complaints 2010/11
Total complaints 2010/11
No. not responded to in time frames
Q1
15
5
Q2
16
5
Q3
6
2
Q4
10
5
Total
47
17
Some complaints are very complicated and can involve other services such as General Practitioners or
Stockport Foundation Trust, therefore investigating across a number of organisations can take additional
time. However, it is recognised that we do need to improve on reporting back to complainants within
agreed timeframes.
All complaints by quarter
2009/2010 compared to 2010/2011
15
The chart to the left shows the number of complaints against each category, the two highest being Clinical
treatment and Access to service &
waiting times.
Responding to and resolving complaints
All complaints in 2010/11 were resolved locally, with no requests for an Independent Review or referral
onto the Health Service Ombudsman.
Learning from complaints and improving services
We are keen to learn how we can do better when we receive a complaint. Most people do not complain
lightly so when they do, it not only gives us a chance to apologise but it also enables us to review the
service to see where improvements can be achieved. As a result of the complaints received by
Community Health Stockport, the following examples of service improvements have been made.
Weight Management
Recruiting extra staff to avoid appointments being cancelled.
When producing leaflets consideration will be given to the language used, particularly
when referring to the weight of the potential service user.
District Nursing (DN)
Treatment Room booking line now have additional staff to cover peak periods
Central booking system updated and admin staff can now book follow up appointments.
Change to DN leaflet to highlight to patients that a student may accompany staff and
that consent will be sought .
Community Equipment
Service has developed guidance around equipment failure out of hours.
Children’s Physiotherapy
Patient information leaflet to be devised to describe the role of each clinician in
the Footsteps clinic.
Health Visitors
Process in place to ensure answer machine messages as responded to in a timely
manner.
Podiatry
Staff reminded that clinic is a’ Walk In’ and is for emergency and urgent care.
Staff reminded that prescriptions for pre booked appointments to be given priority.
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Clinical Effectiveness
Community Health Stockport is committed to ensuring that everything we do is safe, effective and provides the best possible outcomes for our patients and clients. This involves using the best possible evidence to shape all that we do and opening our practice to scrutiny by reviewing and assessing all that we
do and, where possible, comparing our practice with similar healthcare providers. These activities come
under the umbrella term of Clinical Effectiveness.
NICE Guidance
The National Institute for Health and Clinical
Excellence (NICE) is an independent organisation
which was set up to ensure everyone has equal
access to medical treatments and high quality
care from the NHS, regardless of where they live
in England and Wales. Guidance from NICE exists
to provide advice to NHS clinical staff,
commissioners and patients as to those
treatments that are clinically and cost effective.
Community Health Stockport is committed to
the implementation of NICE guidance and
works closely with Commissioners to ensure that the healthcare we provide is in line with the NICE
recommendations.
New NICE guidance is reviewed by each service. Where current practice is not in line with guidance the
service develops a plan to ensure that where possible, the guidance is implemented within a specific time
frame. Our commissioners are involved in discussions where services may not be able to fully meet the
guidance without additional resources.
In 2010/11, 17 new or revised Clinical Guidelines issued by NICE which were of relevance to services provided by Community Health Stockport. Examples include
Constipation in children and young people
Chronic Heart Failure
Hypertension in pregnancy
Nocturnal enuresis (night-time bed wetting)
Community Health Stockport support the implementation of NICE
guidance and will audit services on two areas of compliance in
2011/12.
Further information about NICE guidance can be obtained from
www.nice.org.uk
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Audit
Community Health Stockport aim to deliver high quality care which is measured through Clinical
Audit. This includes Community Health Stockport audits which we devise and implement ourselves and
internal audits where we are audited by independent auditors.
The purpose of an audit is to check whether we are actually doing what guidance says we should be
doing. This covers every aspect of being a healthcare provider and can range from how we manage
patient information and records to how we carry out a clinical procedure.
In 2010/11 Community Health Stockport completed 15 audits. These were a combination of National
and local audits
The National Audits included a review of falls practice and continence care. Locally we covered areas of practice as diverse as
record keeping, leg ulcers and medication induced constipation.
Following each audit, services are required to produce a Service
Improvement Action Plan in order to guide and demonstrate
continuous quality improvement.
What we have learnt through audit:
We have learnt that our Contraception and Sexual health Service is 92% compliant with NICE guidance
in relation to heavy menstrual bleeding and that, 87% of their clients were offered chlamydia screening.
This is an increase of 22% on the findings in 2008.
We have learnt that all mothers received an assessment of their emotional health 4-6 weeks after giving
birth and that 94% received another assessment at 3-4 months.
We have learnt that 53% of patients with lower leg wounds, in the care of district nurses, were treated
in line with best practice guidance for the management of leg ulcers. Services are required to implement an action plan for practice development when an audit demonstrates that there is scope to improve the care our patients receive. Such action plans often include extra training for staff and closer
monitoring of practice.
2011/12
The audit plan for the coming year is now in
development and will include National Audits
and local audits as prioritised by the leaders
of each service.
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Continuous Quality Improvement & Innovation
Essential Public Health:
Over 1000 Health and Social Care Staff in Stockport have undertaken our innovative practical training.
This has lead to a 70% improvement in knowledge and confidence in discussing significant lifestyle issues
such as smoking, obesity and alcohol.
The training package has now become nationally recognised as a practical effective method of achieving
level 1 competency in public health. Over the past year it has income generated over £40,000 to date in
national sales to other PCTs and Strategic Health Authorities.
Electronic Master Patient Index: District Nursing Patient Allocation System
In December 2010 a £5000 grant was awarded to aid the development of an electronic scheduling system
to improve safety and quality. The main aims were to the reduce the incidence of errors relating to
missed visits, as well as improving patient choice and involvement in planning their own care. We have
successfully piloted the system in Cheadle Health and hope to introduce it to all teams during 2011/12.
Wellsprings
A project aimed at steering Stockport’s homeless away from harmful drinking has won a prestigious
award and won a major cash injection. The scheme, to be set up at the town’s Wellspring Centre, was up
against 12 other teams bidding, in front of a Dragon’s Den-style panel, for the £50,000 funding.
An ex service user “rapped” about his experiences of the centre and how the scheme could have helped
him. The successful pitch was to get funding to buy a blood test machine that measures the amount of
deterioration of the liver. Unlike other machines, this one gives the results in minutes so clients can see
instantly how alcohol is damaging their livers.
Dr Mian, of Mastercall Healthcare, said “Previous studies have shown that using liver function tests to
motivate people to reduce their alcohol intake really works. With this machine, we can improve the
quality of care we offer homeless and vulnerable people and hopefully reduce the number of times they
end up at A&E.” Nurse Practitioner Lucy McJannett, of Community Health Stockport, added “We’re
delighted at winning this award as it gives official recognition to the importance of the work being done.
“The Wellspring Centre, which is open 365 days a year, provides homeless and people in need in
Stockport with food, shelter, clothing and companionship as well as access to health care, education and
life skills.
19
Speech and language therapy service (SLT)
The Speech and Language Therapy service were awarded £25,000 from the ‘Innovate Now’ award
scheme, which is a regional innovation fund from the North West. The funding will allow us to
develop and deliver a specially designed training and intervention package within local schools.
The project aims to set up pre-referral clinics in schools where teachers can discuss concerns about
children without having to make a referral to the specialist SLT caseload. The SLT school therapist
provides universal training across schools and targeted advice for intervention packages with
the aim to support teachers and children in early speech and language therapy work, therefore
preventing the need for a referral to the specialist SLT service at a later date.
The vision is to support schools in meeting more children's needs in the early stages. As a result
children who do require specialist SLT intervention will have more opportunity to receive direct
intervention from specialist practitioners.
Productive Community Services
Community Health Stockport has embraced the opportunities the Productive Community Series,
which is underpinned by Lean methodology, has provided us with. It has given us the tools and
techniques required for our staff to get involved , make a difference and meet some of the
efficiency targets. A number of projects are underway and some examples of completed activities
this year include:
Aims to:
Clinical Stock Control Project
Community Rehab Team
Review
Reduce waste due to out of date stock.
Increase nursing time by minimising time spent looking for items.
Standardise and improve the current paper based ordering process.
Improve time efficiency, particularly surrounding referrals.
Audit patient outcomes.
Reduce travel time and related costs.
Hazel Grove Area
District Nursing Team Merger Improve the office and clinic environment to support effectiveness.
Address lone working and safety issues.
Pre Registration Student
To improve the complete process of allocation (400 students per year).
Allocation Project
Reduce administration.
Ensure all students receive timely correct information.
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Workforce Factors
Student Placements
At Community Health Stockport we are committed to
delivering a high standard of care for all our patients and
clients, and understand the important role that students
bring to this process. We work in close partnership with
our local universities in order to provide high quality
placements for all students and we value the contributions
that students bring to our team.
In 2010, we supported over 240 placements for pre-registration students within our services. During
these placements, students are invited to nominate an individual or team for a “Certificate of Excellence”,
for those staff who have provided particularly excellent learning experiences. During 2010, 78 teams or
individuals were nominated for this award.
At CHS we are also committed to ‘Inter-Professional Learning’ (IPL). This means we actively promote
opportunities for students from all professions to come together and learn with, and about each other;
and where students can learn together about other important areas of care, such as palliative care,
safe-guarding adults, and child protection.
Last year we carried out a survey with service-users, to see what they felt students should be learning,
particularly regarding other professions. Feedback from the survey included the following comments:
Students should be taught
about the importance of
working together, to help
patients.
What matters most?…
That they tell each
other about me!
What matters is that
they listen to me…
and have good communication with me
and each other.
CHS have therefore developed an ‘IPL toolkit’ which will help students to learn about other professions
and to understand the importance of working closely together with the patient/client, and all health and
social care colleagues. The aim of the toolkit is to help students to develop effective team working skills,
which will enhance the quality of care they provide.
We actively promote primary care as a potential future career for students, and since 2004, have
recruited over 36 newly qualified staff into the organisation. We welcome constructive feedback from
students regarding their learning experiences, and will use this information to inform and enhance the
future learning experiences we offer. Here is some feedback from some of our recent students:-
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“I have had a brilliant
first placement and the
best start I could have
for my nurse training!”
“The placement was
invaluable! – I’m glad
I had the opportunity
to come to the
community and see
the vast amount of
services”.
“All staff were extremely
helpful and taught me really
well… both mentors were
fantastic! I would recommend
both for future students”.
“Excellent! An
encouraging and
supportive team, who
enabled me to undertake
tasks and be given
responsibilities that 3rd
year students need and
should be given”.
“I couldn’t have asked for
a better mentor!
Supportive, encouraging
and knowledgeable
about all areas”.
“It has increased my
confidence and will
help tremendously
in my future role”.
Our People
Community Health Stockport (CHS) continues to be proud of the skill, dedication and professionalism of
all its staff who deliver high quality health care for the community of Stockport. The organisation
continually strives to improve the experience of our staff and engage them in all the important decisions
which affect them and the care they deliver.
As an NHS employer we remain fully committed to the 4 staff pledges outlined in the NHS Constitution
which sets out a framework for how we treat our people at work to ensure that all our staff are trained
and empowered to deliver safe and respectful care.
Workforce Strategy
The Workforce Strategy is currently being updated to ensure we continue to deliver high quality, effective
health care to all our service users through the planning and developing of a highly skilled and up to date
workforce.
The key parts of the strategy are:
Developing the right size diverse workforce
Recruiting and retaining the right people
Developing the right people in the right way
Supporting and engaging the workforce
Developing and measuring excellent performance
Developing excellent leadership
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Staff Survey results 2010
The results of the latest NHS National Staff Survey (2010) demonstrated our commitment to giving all
staff good development, training and support.
●88% of CHS staff feel that their role makes a difference to patients
●82% of CHS staff have had an appraisal (compared to a national average of 79%)
●82% of CHS staff reported that they have received job relevant training, learning or development (compared to a national average of 79%)
●77% of CHS staff reported they have a personal development plan (compared to a national average of 69%)
●94% of CHS staff reported they believe that the organisation provides equal opportunities for
career progression or promotion (compared with a national average of 92%)
●78% of workers reported being able to use flexible working options
●83% of staff report having Health and Safety Training (compared to 78% nationally)
However, there are areas that we need to improve upon, for example, we are above the national average
for work related stress and below the national average for staff reporting good communications between
senior management and staff. 2010/11 has been a challenging year due to organisational changes , where
a range of options were explored for our future organisational home. We need to learn from the findings
of the staff survey and ensure that communications are more effective and timely for staff. Further
exploration of this finding will be done with staff groups to get their ideas about what would improve
communications.
Staff Engagement and Communication
A range of events and initiatives have taken place over the past 12 months to ensure that staff are
engaged in decisions that effect them and feel empowered to put forward improved ways to deliver
better and safer services for patients and their families.
Our approach has been both formal and informal working on an individual and group basis with staff, as
well as through local partnership working with trade union and professional bodies.
This has included: a series of road shows which
the Executive Director led personally; the issuing
of a monthly team newsletter to all staff; the
running of the annual employee awards which
recognises good practice; innovation and
contribution; podcasts; the setting up of a
dedicated communications
email account;
senior management team drop-in sessions around
all clinics and health centres and patient safety
drop in clinics when senior managers have met
informally with groups of staff to discuss ways of
improving the patient
experience.
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We also have established a “champion” framework where staff are invited to nominate themselves to
highlight important issues by volunteering to become a champion for example green champions for the
environment, dignity champions, and clean your hands champions.
Wellbeing
10.3 million working days are lost in the NHS in England each year
(CIPD Annual Survey of Absence Management). This is the equivalent
of 45,000 whole time equivalent (WTE) staff costing 1.7 billion a
year to the NHS. The proportion of working days lost to sickness
absence varies widely between trusts, the average rate of sickness
absence is 4.96% . There is a direct relationship between the quality
of care provided, as measured by a range of factors, and the levels of
sickness absence within departments and wards. The average
sickness absence for CHS during 2010/11 was 4.6%, slightly lower than average. However, one of the
Institute for Innovation and Improvement’s 10 high impact actions relates to being ‘Fit and well to care’
which aims to reduce sickness absence in the nursing and midwifery workforce to no more than 3%. A
team across CHS will work together during 2011/12 towards this aim.
The organisation continues to actively work to support staff in maintaining good health and wellbeing and
has a range of policies and procedures in place to identify potential hazards and difficulties and
proactively promote well being for example an annual entitlement of 10 hours “health bank” time per
year.
All Line Managers are trained to manage staff attendance in a supportive framework which includes
stress risk assessments and referrals to occupational health where appropriate. The organisation also
operates a “fast track” physiotherapy service for employees to encourage a speedy return to work, in
addition to a confidential employee assistance programme which can be accessed by all employees.
Leadership
Dynamic, professional and skilled clinical leaders are essential in being able to provide high quality services. CHS staff have a range of leadership opportunities depending on an individuals needs, for example
Key skills for
managers
Alliance
Clinical leaders
Aspiring Directors
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Action Learning
sets
Degree and
Masters
360 degree
assessments
The direct link between leadership capability and sustained high performance is now widely
acknowledged. No amount of infrastructure and financial investment are guarantees of success if there is
a lack of talent and leadership within the organisation. Community Health Stockport is committed to
facing the challenge of continuing to provide healthcare services within budget and at the same time,
increase productivity, improve quality and achieve greater patient satisfaction. This aspirational goal can
not be achieved without robust and effective leadership at all levels throughout the organisation.
By supporting leadership opportunities, of Community Health Stockport want to encourage a culture of
creativity and innovation at all levels within the organisation which recognises, values and develops leadership and talent.
Community Health Stockport continue to support staff in their
professional and academic development. Clinical staff can use
opportunities to extend and develop their clinical knowledge at
different academic levels and CHS support additional study and
learning in order to keep providing up to date, research based and
clinically effective practice. During 2010/11, CHS supported a
range of clinicians (nurse and therapists) to study at the following
levels
Diploma
16 places
Degree
5 places
Masters
16 places
Education and Training
In addition, central funding from NHS North West allowed us to support 52 staff in accessing clinical
education updates, conferences or courses and for us to buy in training for larger groups of staff, for
example, ear care for district nurses, basic life support for training for all front line staff and neonatal
behaviour assessment training for health visitors.
We will continue to actively support staff development and learning opportunities to ensure both the
quality and effectiveness of care we provide. It is vital for staff to remain up to date with developments in
clinical healthcare, as research knowledge about healthcare is expanding constantly.
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LINks Statement
The Stockport Local Involvement Network (LINk) expresses its appreciation
for the efforts and achievements of Community Health Stockport (CHS) in
such a demanding and unsettling year.
CHS has considerable success in maintaining standards and making
improvements against all the uncertainties of the organisational changes
towards Transforming Community Services.
LINk is pleased to note that where measures show a service is below standard corrective actions have
been put in place promptly.
Of particular importance must be Speech and Language Therapy – the needs of young people to be able
to express themselves easily and clearly must be paramount.
The overall achievements by the staff can be clearly seen in the Patient Satisfaction Survey.
LINk is particularly pleased to note the initiatives and the successes as demonstrated by:
System to improve reliability of visits through scheduling system
Achieving a grant for a blood test machine for the Wellspring Centre.
We are pleased to have been able to co-operate with Community Health Stockport when changes have
been planned and we have been able to contribute.
Feedback on QA
We hope you have found this publication useful and that it has given you an understanding of some of
our mechanisms for measuring quality care and how we engage service users in measuring the quality of
the care they receive. If you have any comments or suggestions to make about this Quality Account,
please e-mail:
sto-pct.customercare@nhs.net
Telephone:
0161 426 5631
Write to:
Customer Care
Community Health Stockport
Floor 10 Regent House
Heaton Lane
Stockport
SK4 1 BS
Future Plan.
As part of the government policy ‘Transforming Community Services’ NHS Stockport is currently in negotiation with Stockport Foundation Trust about the integration of Community Health Stockport into Stockport
Foundation Trust. Guidance on Quality Accounts suggests that once community providers have integrated,
only one Quality Account will need to be produced, with the community provider element as a sub section
of the main report.
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