Quality Account
2010 - 2011
“In the community - For the community”
1
Foreword by Josie Spencer - Managing Director
I would like to extend my thanks to all staff with in Coventry Community Health Services
for their hard work and dedication through out the last year.
In 2009 we published our strategic plan for 2009 - 2012 “In the Community, for the
Community” which set out an ambitious road-map for the delivery of community
healthcare services to the people of Coventry.
Our vision statement recognised the need for improving quality through a period of rapid
change, it simply states that:
“We will work in partnership to provide high quality, responsive and
dependable community health services for the population we serve. Our
services shall encourage recovery from illness and promotion of healthy
independent living. Our services shall be - in the community, for the
community.”
Coventry Community Health Services takes pride in:
• being a good steward of healthcare services within the City of Coventry, and
providing the public with the services it expects and deserves. In order to achieve
this, we will operate as efficiently and effectively as possible;
•
being held accountable by our patients and users for our performance and the
continued development of services that meet the needs of the local population;
•
our ability to identify and use innovative tools, approaches and solutions to
address local healthcare challenges, and to engage extensively with our
partners, stakeholders, patients and the public;
•
ensuring we have the best community healthcare information available to
anticipate potential changing needs – evaluate risks, identify solutions, to
enhance the safety, experience and outcomes for patients.
This report looks back on the year 2010 – 2011 and presents a balanced picture of our
performance, highlighting our achievements and where we still have work to do; it looks
forward to future quality improvements and developments for 2011- 2012.
I am satisfied that the performance information reported in the Quality Account is reliable
and accurate and that there are proper internal controls applied to the collecting and
reporting of the performance measures and that the data underpinning the measures is
robust and reliable, conforms to data quality standards and is the subject of scrutiny and
review.
The Quality Account has been prepared in accordance with Department of Health
guidance.
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On 1st April 20011 Coventry Community Health Services merged with Coventry and
Warwickshire Partnership Trust and the quality developments for the future are
particularly exciting as we work to integrate services from the larger organisation in the
community. The forward looking part of this document has been prepared in conjunction
with Coventry and Warwickshire Partnership Trust. We aim to work in partnership with
patients, staff and other stakeholders, as the basis for embedding a culture of quality
improvement. The improvements we plan to make in 2011 – 2012 are covered in the
Priorities for Improvement section.
Josie Spencer
Managing Director
3
Services provided by CCHS
Coventry Community Health Services (CCHS) provides community health services to
adults and children within Coventry. Some of our specialist services accept referrals
from across the UK. We employ more than 1285 staff, working in a range of facilities
including community clinics, GP practices and in peoples’ homes.
The table below outlines the services we provide:
Specialist and lifestyle
Services
Sexual Health Services
including HIV & GUM
Walk in Centre & Urgent
Care including Out of Hours
Rehabilitation Services –
Speech and Language
Therapy, Occupational
Therapy, Physiotherapy,
Wheelchair Service
Services for Children &
Young People
Health Visiting
Adult & Community
HPV Vaccinations
Long Term Conditions &
End of Life services
(including District Nursing,
Community Matrons,
Complex Care, Family
Support Service
Children’s Therapies
Specialist Nursing
Complex Community
Children’s Nursing
Tissue Viability
Special & Mainstream
School Nursing
Continence
Clinical Assessment
Services
Learning Disability
Paediatric Medical Services
Complex Care
End of Life Team
Community Dental Services
Smoking cessation
Health trainers
Expert Patient Programme
Quality Accounts are a key component of “Transforming Community Services Quality
Framework: community guidance for community services” (DH June 2009) and all NHS
community service providers are required to publish Quality Accounts for the year 2010/
2011. CCHS are proud of the services they provide and welcome the opportunity to
share information on quality with interested parties.
CCHS has reviewed all of the data available on the quality of care in these services.
This report is an honest reflection of the quality of services we provide and considers
where we could have done better as well as our successes.
Feedback and comments from the public, patients, staff and wider stakeholders have
provided a significant contribution to the content of this report.
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Care Quality Commission (CQC)
CCHS, as the provider arm for NHS Coventry, is required to register with the Care
Quality Commission (CQC). Our current registration status is “Registered without Safety
and Quality compliance conditions”.
We have declared full compliance with all outcomes. This means that our Board has
been assured that we have sufficient evidence to demonstrate that we perform to the
required standards and that the CQC has accepted this assessment.
The CQC has not taken any enforcement action against CCHS in 2010/11
Participation in Clinical Audit
During 2010/ 2011, 6 national clinical audits and no national confidential enquiries
encompassed NHS services that Coventry Community Health Services provides.
During that period Coventry Community Health Services participated in one of the
national clinical audits in which it was eligible to participate (17%).
The national clinical audits that Coventry Community Health Services was eligible to
participate in during 2010/2011 are as follows:
Childhood epilepsy
Diabetes
Chronic pain
Parkinson’s disease
Heart failure
National audit of falls and bone health in older people
There were no relevant confidential enquiries in which the Trust could have participated
The one national clinical audit that Coventry Community Health Services participated in
during 2010/2011 was the National audit of falls and bone health in older people
A summary of the national clinical audits that Coventry Community Health Services
participated in and/or was eligible to participate in is shown in the table below:
Audit
Participation
Cases submitted
Children
Childhood epilepsy
No
NA
Long-term conditions
Diabetes
Chronic pain
Parkinson’s disease
No
No
No
NA
NA
NA
Cardiovascular disease
Heart failure
No
NA
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Audit
Trauma
Falls & non-hip fractures
Participation
Cases submitted
Yes
None
(only
organisational data
was provided as
no patients were
identified for audit)
The reports of 48 local clinical audits were reviewed by the provider in 2010/2011 these
are listed below with an overview of the resulting actions:
Title of audit
Summary of actions
2362
Partner notification of HIV-positive
patients
Ensure Health Advisor presence at all HIV
clinic sessions to obtain contact details.
2368
Patient survey of Physiotherapy in
Intermediate Care
Reinforce staff training to remind staff about
appointment time/date options and discussion
of treatment options.
2370
Increase continence awareness
among Coventry GPs
Target those GPs where referral numbers are
low. Remind all GPs of age profile for clients
of Continence Service.
2399
Referrals to Occupational Therapy of
children with handwriting difficulties
Simplify referral form. Consider training of
school staff.
2402
Quality of service by staff providing
speech and language reviews
Investigate how to improve communication
with nursery and school staff.
2403
Patient satisfaction with toenail
surgery
Podiatry peer review system to be set up.
2404
Toenail surgery healing rates (reaudit)
Healing rates unchanged since 2003.
Produce post-operative advice sheet for
patients.
2411
On-call service for Children’s
Community Nursing Team
Reinforce parent education (of when to call
Team) for tube replacement – discuss
involving acute Trust in handling routine tube
replacement.
2423
Non-attending of children at Fostering
Clinics
Create post of Co-ordinator to handle all
routine administration. Set up formal
communication route with Social Care.
2424
Child Protection Standards #3 (note
keeping) and #6 (documentation of
Conferences)
Initiatives on improving record keeping to be
co-ordinated by Health Visiting Leads.
6
Title of audit
Summary of actions
2426
Child Protection Standards ~5 (deregistration from Child Protection
Plan) and #7 (Clinical Supervision)
Initiatives on improving record keeping to be
co-ordinated by School Nursing and Health
Visiting Leads.
2430
Domestic violence notifications
Follow-ups of notifications to be handled by
qualified Health Visitor which should be
actioned within 3 days of receipt. Remind
Police to report domestic violence incidents in
a timely manner.
2431
Hepatitis B testing among black
African population
Local guidelines to be written to include
routine offer of injection to non-immune clients
and their contacts.
2433
Patient survey of Wound Clinics (reaudit)
Review patient information leaflets and raise
awareness of pain assessments. Use
patients’ preferred names and introduce “Do
not disturb” signs to reduce intrusions during
treatment.
2434
Nutritional risk assessments
Staff training to be introduced to trigger
referrals.
2437
Satisfaction and outcomes survey for
clients of Biomechanics Clinic
(Podiatry)
Improve patient information leaflets.
2444
Reporting of Cdiff cases to Infection
Control
Review Root Cause Analysis tool for
relevance and make staff aware of national
guidance.
2446
Client satisfaction survey at Meridian
Treatment Centre
Consider extending opening hours and
investigate client waiting times.
2447
Safeguarding Children Policy (reaudit)
Ensure consent is always obtained and
documented and other note-keeping
improvements required.
2449
Policy for high velocity thrusts in
treatment of musculoskeletal pain
(Physiotherapy)
No actions required – Policy being followed.
2451
Audit of British Association for
Adoption and Fostering forms for
looked-after children
Liaise with all external agencies to ensure
they know what information to provide.
2453
Client satisfaction survey at Anchor
Centre
Ensure staff introduce themselves fully to all
clients.
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Title of audit
Summary of actions
2454
Asepsis Policy
Carry out risk assessments to determine
which types of gloves should be used and for
non-latex types to be available. Staff to be
reminded to decontaminate hands between
glove changes.
2455
Subcutaneous infusion of
Apomorphine
Devise documentation for GPs to authorise
use of APO-GO Pump, this to be suitable for
monitoring pump use by Nurses.
2456
Injection of Apomorphine via APO-GO
Pen
Devise chart for monitoring use of pens.
2457
Assessment of foot examination for
patients with type 2 diabetes (NICE
CG010)
Review all record-keeping within Team and
take up shortcomings with individual
defaulters. Investigate method of booking
review appointments.
2460
Patient survey of Speech & Language
Therapy’s Head & Neck Cancer
Service
Investigate further why some patients believe
waiting times are too long.
2461
Dysphagia management – does it
comply with National Care Pathway?
Ensure diagnosis date and duration of
disease are recoded.
2462
Review of ex-dwelling voice prosthesis
– information and training
Improve written documentation for patients.
Increase awareness of ex-dwelling prostheses
before patients have surgery.
2463
Privacy & dignity survey at Meridian
Treatment Centre
Investigate waiting times and look at ways of
improving privacy.
2465
Mattress cleaning and inspection
Obtain information posters and display at
appropriate locations. Obtain mattress
information leaflets to establish cleaning
regimes.
2468
Policy for Personal Protective
Equipment
Specific departments to be targeted where
results are poor.
2470
Infection Control Link Worker training
evaluation
None – as training is acceptable.
2471
Infection Control Mandatory Training
evaluation
None – as training is acceptable.
2474
Issue of Nicotine Replacement
Therapy vouchers to patients who
may be contra-indicated
Medical questionnaire to be re-written to avoid
ambiguities and ensure all questions are
answered.
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Title of audit
Summary of actions
2482
Hand Decontamination Policy
Provide posters of preferred washing
technique to all locations.
2483
Sharps Policy
Individual meetings top discuss issues around
transportation of filled sharps boxes.
2484
Completion of Home Visit Sheet by
Therapists in Community
Rehabilitation Team
Individual discussions with those staff
identified as not meeting required notekeeping standards.
2487
Diagnostic work-up for newlydiagnosed HIV-positive patients
(National Audit)
No Action Plan as actions will be in individual
report from British HIV Association.
2490
Patient satisfaction with Acupuncture
Clinic
Improve information given to patients and
investigate different clinic times.
2491
Documentation in Acupuncture Clinic
Feedback (and get confirmation) of new clinic
guidelines to staff.
2494
Infection Control training within
Continence Team (hand hygiene)
None – as training is acceptable.
2495
Training for Infection Control clinical
skills
Training is acceptable, but consider local
team-based training.
2496
Assessment of patients for smoking
cessation who may fall into “Cautions”
category
Improve recording of pregnancy etc data.
Individual discussions with those staff who do
not meet standards through Clinical
Supervision.
2497
Documentation of patients receiving
diagnostic ultrasound (Physiotherapy)
None (quality is acceptable), but continue to
monitor.
2500
Consent for Speech & Language
Therapy
Re-design consent form.
2502
Hand decontamination by Vaccination
& Immunisation Team staff during
school vaccination sessions
Provide each member with a copy of 8-step
decontamination method. Staff to take own
towels etc to future sessions.
2511
Completion of joint OT/Physiotherapy
assessment sheet in Community
Rehabilitation Team
Re-design documentation to ensure only
necessary data are recorded.
9
Participation in Clinical Research
40 patients receiving NHS services provided or sub-contracted by Coventry Community
Health Services in 2010/2011 were recruited to participate in research approved by a
research ethics committee. Six projects were in progress during the period 2010/2011.
The projects under consideration were:
Protease Inhibitor Monotherapy vs Ongoing TripleTherapy (PIVOT)
Sexual Health
Long-term follow-up of HIV-infected persons seen since
1996 in seven major UK centres (UK CHIC)
Sexual Health
Study of transmission risk between HIV discordant
partners (PARTNER STUDY)
Sexual Health
Improving Patient Choice in Treating Low Back Pain
(IMPACT – LBP)
Physiotherapy
Investigating the Potential for Occupational Performance
Passports
Coordination of care for people affected by an illness
(coPAI)
Occupational Therapy
Palliative Care
Participation in research demonstrates the Trust’s commitment to improving quality of
care to making a contribution to wider health improvement. It helps clinical staff to
remain aware of the latest possible treatment possibilities and participation in research
leads to successful patient outcomes
Information Governance Toolkit attainment levels
CCHS was part of NHS Coventry Information Governance Assessment Report for
2010/11. The overall a “satisfactory” score at a minimum of level 2 for each of the 45
standards included in the Toolkit was attainment with three of the standards scoring 3.
This is equivalent to achieving 68%, where 65% is the minimum requirement for passing
the Information Governance Toolkit.
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Statement on relevance of Data Quality and our actions to improve our Data
Quality
High quality information and data is critical to CCHS being able to provide high quality
clinical services, to enable the effective monitoring of the services and for the continuous
improvement of services.
CCHS recognises that data is not just statistics but includes the recording of both
numerical data and text, such as that recorded in service user records or other corporate
documents. Data quality is essential for both clinical and non clinical record keeping
enabling high quality care and robust business and performance reporting processes.
CCHS also recognises the importance of reliable information in the day-to-day delivery
and management of front line services and their management. Poor information quality
leads to poor decision-making both operationally and strategically and to a poor
understanding of performance.
Data quality is everyone’s responsibility whether at the clinical/ care level, support
functions or higher management level. Thus from initial data collection to the analysis
and application of data/ information within the organisation the approach must be
consistent and meet the essential criteria for data quality.
CCHS was not registered to submit data to the Secondary Users Systems (SUS) for
inclusion in the Hospital Episode Statistics. The majority of CCHS services being
community based are not part of this process; however Genito-Urethral Medicine (GUM)
and Child & Family Services, should provide this data. The merger of CCHS with
Coventry & Warwickshire Partnership Trust (CWPT) in April 2011 will enable CCHS to
gain expertise and to submit this data for 2011/2012 under CWPT registration.
Across all CCHS Services using iPM, 91.56% of records have the NHS number
included.
The percentage of records which included the patient’s valid General Medical Practice
code was 97.1%.
Within CCHS the Information Team work is ongoing to improve systems/ processes for
the collection, monitoring and reviewing of the information available ensuring good
quality data is made available to all services in a timely manner. Performance and Data
Quality reports – are sent monthly to each service team for information and action as
appropriate. The quantity information is used to manage and improve performance,
enabling the efficient use of resources and planning the development of future service
delivery, therefore improving waiting times and patient care.
Due to the ongoing relationship between operational teams and Information, the quality
of data submitted nationally via UNIFY has dramatically improved with operational teams
taking full ownership of their data.
The Trust was not subject to the Payment by Results clinical coding audit during
2010/11 and was not required to submit a clinical coding error rate to the Audit
Commission.
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Review of Quality Performance 2010 - 2011
Structure for Developing and Ensuring Quality
In order for CCHS to provide the highest quality care to patients, quality must be at the
heart of everything that we do at every level of the organisation.
NHS Coventry commissions the services that we provide and monitor quality standards
and improvements through the monthly Contract Quality Review process.
The Integrated Governance Committee which is a formal sub committee of the Provider
Board had two NHS Coventry Non Executive Directors within its membership, one of
whom is the Chair of this committee and of the Provider Board. All aspects of patient
safety, effectiveness, patient experience and governance are discussed at this
committee.
All Heads of Service attend the Operational Integrated Governance Group which is
chaired by the Medical Director and which provides a forum for sharing learning and
messages between the Board and frontline service.
Each service area has a local governance group where service specific quality and
governance issues are discussed and learning is shared within and across teams.
In 2010/11 CCHS developed a performance reporting framework which enabled safety and
quality indicators, collected at service level to be reported to the Board enabling a shared
understanding of our performance throughout the organisation, from frontline team to Board.
Priorities for quality improvements are determined through a number of different
processes.
•
•
•
•
•
NHS Coventry, as commissioners of the services we provide, agreed with CCHS,
areas for quality improvement under the Commissioning for Quality and
Innovation scheme (CQUIN). A proportion of income in 2010/11 was conditional
on achieving these goals.
A wide range of quality and performance indicators are monitored by NHS
Coventry on a monthly basis.
Feedback from patients in surveys and complaints inform changes that we need
to make to our services.
Considering the causes of clinical incidents enables us to learn lessons and
make changes to reduce the likely hood of reoccurrences.
Changes recommended as a result of external reviews
Achievements have been grouped under the categories patient safety, clinical
effectiveness and patient experience.
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1. Review of Patient Safety
The NHS Institute for Innovation and Improvement launched High Impact Actions for
Nursing and Midwifery in June 2010. Four of these actions formed the basis of CCHS
CQUIN scheme for 2010-2011:
•
•
•
•
Reduce the number of people whose pressure ulcers get worse in the care of
organisation
Preventing falls
Improving nutrition and hydration
Dying in your place of choice when the time comes.
The High Impact Actions were designed for inpatient services and aimed to improve care
within the care setting. CCHS does not have any hospital beds and reducing the risks of
pressure ulcers, improving nutrition within the patient’s own home set us an additional
challenge.
In order to improve care we needed to make sure
that nurses always had the right tools to assess risk,
advise patients and carers and record patient’s
preferences in a single document that was concise,
universal and auditable. This led to a complete
remodelling of our patient held care plans and has
been welcomed by staff.
The new care plans
really help us to
focus on the patient
as a whole
CQUIN Indicator 1: Reduction in the incidence of Pressure Ulcers
Intended
outcome:
Narrative
Patients identified at risk of pressure ulceration have a risk assessment
preventative action and pressure ulcers are reported as incidents or
serious incidents depending on the grade.
Pressure ulcers can occur in any patient but are more likely in high risk
groups such as the obese, elderly, malnourished and those with certain
underlying conditions. Pressure ulcers can be acquired in any setting for
example patient’s home, nursing or residential home or hospital and risk
assessment and management need to be considered across
organisational boundaries.
A significant amount of work has been undertaken with other health
providers and with Coventry City Council to analyse the causes of each
pressure ulcer, where and how it occurred, and what else could have
been done to prevent it. By undertaking this work learning from clinical
incidents is realised within the team where the incident happened and
changes to practice are implemented and shared across teams.
Actual
Outcome:
Following the remodelling implementation of the new care plan, audits
have demonstrated and increase in the number and quality of risk
assessments and an increase in the number and appropriateness of
preventative actions.
100% of grade 2 pressure ulcers are reported as incidents and 100%
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grade 3 and grade 4 pressure ulcers are reported as serious incidents.
As the awareness of pressure ulcers has increased, reporting has
increased and this is seen as a positive result which contributes to the
understanding of the impact of pressure ulcers in the health economy.
The proportion of more severe (grade 3 and 4) pressure ulcers has
decreased
Pathways for sharing of information and referral into safeguarding
processes where there are concerns have been developed and a
greater understanding of the issues and the solutions has resulted.
A considerable amount of sustainable quality improvement has been made this year
which include changes to clinical practice, documentation, relationships with other
organisations as partners, identification and analysis of risk and the ongoing applications
of lessons learned. Work will continue to ensure that the improvements seen are built
on and not lost.
CQUIN Indicator 3: Improving nutrition and hydration
Intended
outcome:
Narrative
Actual
Outcome
Patients identified at risk of poor nutrition and hydration have a risk
assessment and preventative action taken.
Dehydration and malnutrition represent a major burden of sickness and
quality of life for patients and are costly to the NHS. Their presence is
associated with an increased risk of infection, confusion, constipation,
pressure ulcers and falls particularly in the over 65 age group. As
district nurses visit patients in their own homes or in residential settings
they are only able to refer on to other professionals where necessary
and advise relatives and carers of actions that should be taken to
improve hydration and nutrition.
The implementation of the new care plan which included an overview
risk assessment and a nutritional risk assessment lead to a significant
rise in the number of patients assessed as being at risk of dehydration
and malnutrition (from 4% to 73%). Evidence of preventative actions
being taken was available in the care plans though it is clear that not all
advice given is being recorded fully. Evidence based information to give
to patients and their care and this rs is being developed.
A considerable amount of sustainable quality improvement has been made this year and
will continue to ensure that the improvements seen are built on and not lost.
CQUIN Indicator 4: Increase in advanced care planning for patients on an end of
life pathway
Intended
outcome:
Narrative:
Patients on an end of life pathway have an advanced care plan in place
and followed.
That services reflect the needs and preferences of patients and their
carers is one of the principles of the NHS (NHS Constitution, DH 2009).
Enabling patients to die in their place of choice is an important
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Actual
Outcome
consideration.
Establishing a baseline for this indicator at the beginning of the year
proved difficult as although audit showed that 100% patients involved
with the Family Support Service had an advanced care plan there was
no way of identifying which patients on the district nursing caseload were
end of life patients.
The implementation of the new care plan which contained an explicit
advanced care planning section for end of life patients enabled us to
demonstrate at follow up audit that at least 70% of end of life patients on
the district nursing case load had a care plan and 93% of those were
managed according to that care plan.
CCHS considers that a considerable amount of sustainable quality improvement has
been made this year and that this indicator has been fully achieved.
CQUIN Indicator 5: Reduction in falls
Intended
outcome:
Narrative:
Actual
Outcome
Patients identified at risk of falling have a risk assessment, brief
intervention and preventative action taken.
When baseline data was collected it became obvious that although
therapy teams routinely assessed, advised and treated patients who
were at risk of falling, district nursing teams had no risk assessment
tools or patient information to support the advice they gave to patients.
In order for this indicator to have the biggest impact and to be
sustainable we decided to work with the nursing teams to raise
awareness and develop the tools that they needed
The implementation of the new care plan provided nursing teams an
assessment tool for fallers and the follow up audit shows an increase in
completed risk assessment from 0% to 74%.
Evidence of preventative actions being taken was available in the care
plans though it is clear that not all advice given is being recorded fully.
Evidence based information to give to patients and their carers is being
developed.
A considerable amount of sustainable quality improvement has been made this year and
will continue to ensure that the improvements seen are built on and not lost.
Themed reviews
During the year NHS Coventry under took 2 themed reviews of community services one
related to risk management and one to safeguarding.
Themed Review of Risk Management
Managing risk is an important part of maintaining patient safety. In November and
December 2010 NHS Coventry undertook a themed review of risk management
15
The fundamental principle of this risk management quality review was to evaluate the
underpinning processes to ensure that care delivery is safe, effective and ultimately
improves patient experience. This can only be achieved with true collaboration and
feedback from staff and stakeholders who need to be made aware of the changes
effective as a result of lessons learnt.
In conclusion the review panel reported that:
“The findings of the review did not reveal areas of immediate concern or risk and
confirmed that the organisation has basic systems and processes in place for the
management of incident and complaints. Coventry Community Health services
will be merging with Coventry &Warwickshire Partnership Trust and therefore the
challenge for the team is the integration of the two organisational processes.”
Themed Review of Safeguarding
Maintaining the safety of young people and vulnerable adults is an inherent part of the
role of staff in the community.
In May and October 2010 NHS Coventry undertook a themed review of safeguarding
covering the whole range of adult and children’s services provided by CCHS.
The aims of the themed review were to:
• Support Coventry Community Health Services (CCHS) to review Safeguarding
Children and Young People systems, processes and practice to improve
outcomes for children and young people.
• Understand, measure and examine variation in the quality and safety of
safeguarding children and young people practice within and between CCHS,
other health providers and across other agencies.
• Promote communication and collaboration with other health
providers/commissioners and other agencies involved in Safeguarding Children
& Young People.
The conclusion of the review was:
“Overall the panel was delighted with the exemplar progress made. The openness
and transparency of CCHS and its safeguarding team, the quality and presentation
of the evidence provided was of an exceptionally high standard. Ensuring front
line staff are aware of relevant safeguarding children issues for each service
remains a challenge given the diversity of services provided.”
The panel made some recommendations for improvement which have been
implemented by CCHS and monitored by NHS Coventry through the contract quality
review process.
External reviews
Review of Urgent Care, Critical Care, Stroke (Acute Phase) & TIA, and Vascular
Services by West Midlands Quality Review Service (WMQRS)
In September 2010 the WMQRS undertook a review of these services across Coventry
and Rugby Health Economy. The review involved the Coventry GP out of hours service
which is run by CCHS.
16
The review team findings were:
Immediate Risks:
Concerns
None
Several clinical guidelines were not documented. In practice, local
GPs who usually staff the service were aware of locally agreed
guidelines. This issue would be a risk if locums were used and it
did not enable adherence to guidelines to be audited.
Good Practice
There was a good, formal interview process for all GPs which
linked well to training and development programmes and to
appraisal. There were also good links between appraisal and
clinical governance arrangements.
Actions have been put in place to address the concern.
Review of Services for People who have had a stroke by the Care Quality
Commissions (CQC)
Some services provided by CCHS were involved in the CQC review of services for
people who have had a stroke and their carers for Coventry PCT area. The report,
“Supporting life after stroke” which was published in January 2011, assessed the
Coventry Health Economy as ‘Fair performing’ – with more areas of weakness than
strength.
The review highlighted areas of good practice identified such as the use of a community
rehabilitation team, patient information, specially trained staff and community allied
health professional support.
NHS Coventry has had a primary focus on improving care for Stoke patients on acute
services and as it moves to focusing on community provision CCHS will work with them
to further develop community and rehabilitation services for Coventry.
Management of serious incidents requiring investigation (SIRI)
CCHS adopts the definition of serious incidents as set out by the National
Patient Safety Agency (NPSA) in the National Framework for Reporting and
Learning from Serious Incidents Requiring Investigation (2010) and as adopted by NHS
West Midlands.
A serious incident requiring investigation is defined as an incident that occurred in
relation to our services resulting in one of the following: -
Unexpected or avoidable death of one or more patients, staff, visitors or
members of the public;
Serious harm to one or more patients, staff, visitors or members of the public or
where the outcome requires life-saving intervention, major surgical/medical
intervention, permanent harm or will shorten life expectancy or result in
prolonged pain or psychological harm;
17
-
-
A scenario that prevents or threatens to prevent the Trusts ability to continue to
deliver healthcare services, for example, actual or potential loss of
personal/organisational information, damage to property, reputation or the
environment, or IT failure;
Allegations of abuse;
Adverse media coverage or public concern about the organisation or the wider
NHS;
One of the core set of ‘Never Events’ as updated on an annual basis by the
Department of Health
NHS West Midlands requires all providers of healthcare to report and investigate
pressure ulcers of grade 3 and 4 as serious incidents.
In the year April 2010 – 2011 CCHS reported and investigated 60 serious incidents of
these 56 were pressure ulcers, 3 confidentiality information leaks and 1 delayed
diagnosis. Frequency of serious incidents through the year is reported in the graph
below.
14
12
12
10
9
8
8
7
7
6
7
6
6
4
4
2
2
2
1
0
Apr-10
May10
Jun-10
Jul-10
Aug10
Sep10
Oct-10
Nov-10
Dec10
Jan-11
Feb-11
Mar-11
CCHS is continuously learning lessons from serious incident investigations. Actions
resulting from learning are outlined below:
Serious incident
Pressure Ulcer
Documentation loss
Delayed diagnosis
Action
Education and training including documentation, pressure ulcer
identification and grading.
Named tissue viability specialist assigned to each clinical team
to provide expert support and clinical supervision
Additional training provided for staff
Improvement in internal referral systems
Increased clinical supervision
Clinical education
18
2. Review of Clinical Effectiveness
CQUIN Indicator 6: Caring for people with long term conditions in the community
Intended
Outcome
Reduction in the number of patients admitted to hospital within the
month who are on a specialist nurse and community matron caseload
with a long term condition
Narrative
Numbers of admissions, planned, unplanned, avoidable and
unavoidable have fluctuated throughout the year. It was agreed with the
PCT to focus on the qualitative improvements and to initiate a process
for peer review and sharing learning across the Community Matron and
specialist nursing teams. The unplanned avoidable admissions are
reviewed by the Community Matrons and Specialist Nurses on a regular
basis with a view to sharing and identifying trends and learning points.
Following this a new initiative is being implemented to peer review all
admissions to ensure learning from the experience of actions in others.
It is hard to evidence a direct reduction in admissions to hospital at this
point but a considerable amount of progress has been achieved in
understanding why some avoidable admissions happen and systems are
being put in place with GPs and the acute hospital to reduce this number
in the future.
Actual
Outcome
CCHS considers that a considerable amount of sustainable quality improvement has
been made this year which provides a better understanding across the health economy
as to why some patients are admitted unnecessarily and which will progressively impact
on numbers of patients admitted.
Quality Performance Indicators
CCHS reports to NHS Coventry on a monthly basis on a large number of quality and
performance indicators. Some of these have been consistently achieved all year, some
have shown improvement and some are still not being achieved.
In quarter 1 (April 2010 – June 2010) the performance target was met in 51% of
indicators by quarter 4 (Jan 2011 – March 2011) this has risen to 71% of indicators met.
A selection of indicators is discussed below:
Assessment time for integrated musculo-skeletal service
A target was agreed with NHS Coventry that 80% of new attendances to the integrated
musculo-skeletal service (a specialist physiotherapy service involving staff with
additional skills, extended scope practitioners) would be assessed within 21 days of
receiving the referral.
19
The results were
Period
Quarter 1
(April 10 – June 10)
Quarter 2
(July 10 – Sept 10)
Quarter 3
(Oct 10 – Dec 10)
Quarter 4
(Jan 11 – March 11)
Performance
75%
100
90
80
78%
70
60
91%
Performance
50
Target
40
92%
30
20
10
0
Q1
Q2
Q3
Q4
Achievement of lifestyle goals
Health trainers work with people to help them make healthy lifestyle choices and to
achieve goals that they set. A target was agreed with NHS Coventry that 80% of clients
of Health trainers should achieve or part achieve goals contained in Personal Health
Plan within an agreed timescale.
The results were
Period
Quarter 1
(April 10 – June 10)
Quarter 2
(July 10 – Sept 10)
Quarter 3
(Oct 10 – Dec 10)
Quarter 4
(Jan 11 – March 11)
Performance
56%
90
80
78%
70
60
82%
50
Performance
Target
40
85%
30
20
10
0
Q1
Q2
Q3
Q4
Uptake of Children’s Developmental reviews
Parents of young children are invited to developmental reviews at specific ages,
although all children are offered an appointment for the reviews uptake is not as high as
it should be. Targets were agreed with NHS Coventry that CCHS would try to achieve
95% uptake at both the 8 month to 1 year and the 2 1/2 year developmental review.
20
Results for the 8 month to 1 year review were:
Period
Quarter 1
(April 10 – June 10)
Quarter 2
(July 10 – Sept 10)
Quarter 3
(Oct 10 – Dec 10)
Quarter 4
(Jan 11 – March 11)
Performance
57%
100
90
80
46%
70
60
62%
Performance
50
Target
40
78%
30
20
10
0
Q1
Q2
Q3
Q4
Results for the 2 ½ year review were:
Period
Quarter 1
(April 10 – June 10)
Quarter 2
(July 10 – Sept 10)
Quarter 3
(Oct 10 – Dec 10)
Quarter 4
(Jan 11 – March 11)
Performance
36%
100
90
80
32%
70
60
44%
Performance
50
Target
40
61%
30
20
10
0
Q1
Q2
Q3
Q4
Although improvements have been shown against both of these indicators neither has
achieved the target. In order to address this and to respond to Government initiatives to
expand and strengthen health visiting services (Health visitor implementation plan 201115: a call to action, Department of Health, February 2011), CCHS is undertaking a
radical service redesign within its health visiting service. Working with Children’s
Centres and other partner organisations will be strengthened and services will be
provided within the communities where parents of young children live.
Allied Health Professionals (AHP) Referral To Treatment Times
The recording of Referral to Treatment (RTT) for Allied Health Professional (AHP)
Services was to become mandatory nationally from 1 April 2011. National guidance was
issued in April 2010, which identified the rules for AHP RTT as well as indication of
agreements to be established with commissioners.
21
Coventry Community Health Services established a QIPP Project in order to improve the
patient booking pathway and to support the reporting and achievement of the AHP RTT.
At the beginning of the project the organisation was unable to report confidently on RTT
times and many AHP services were experiencing long waiting times from initial referral
to treatment.
The work undertaken by the organisation involved individual AHP services redesigning
their referral pathways, the utilisation by services of the patient administration system
and the establishment of a centralised patient booking process.
Key Achievements:
The charts below demonstrates the great strides that have been made over the past
twelve months in referral to treatment times and how many AHP services have both
achieved, and in many cases exceeded referral to treatment in less that 18 weeks
AHP Services Referral to Treatment (RTT) targets
% S een w ith in 18 w eeks
100
89.8
97.9
93.5
98.1
98.3
97.8
95.2
95.8
98.7
95.2
96.897.3
99.299.1
99.199.3
81.7
80.5
80
57.1
60
60.5
59
Children's
50.5
44.1
Adults
43.2
40
Target
20
0
Apr-10
May-10
Jun-10
Jul-10
Aug-10 Sep-10
Oct-10
Nov-10 Dec-10
Jan-11
Feb-11
Mar-11
Other key achievements include the publication of a number of CCHS services on
Choose and Book, the launch of direct booking and a consistent approach to data
collection and reporting by the organisation.
Feedback from patients and other users of
the service:
•
•
•
“Given that acute trusts
had three years to
achieve this, what CCHS
has achieved in one year
is stunning”
- NHS Coventry
GP’s are now finding it easier to
access those services now published
on Choose and Book
Patients are being seen quicker and
waiting times are being managed.
Patients also have more choice of venue and appointment times, which has
resulted in some reallocation of resources in some services in response to
reduced demand in localities and increased demand centrally.
22
Children and Young People’s Occupational Therapy Services re-design
The Children and Young People’s Occupational Therapy Service works with those aged
0 – 19 years who have a physical and/or learning disability or other developmental
disability affecting performance of daily occupations of childhood.
The service has experienced considerable increase in demand that has outstripped
capacity over the last few years leading to increasing referral to treatment times that
peaked at 80 weeks during 2009/ 2010. This led to a significant growth in complaints
from families who clearly expressed their concern regarding the impact of long waiting
times. Parents articulated specific problems relating to managing the long term needs of
their child/ young person in everyday activities of daily living whether in promoting
greater independence and participation or meeting specific care needs.
This situation was responded to through completion of a service review and throughout
2010, the Children and Young Peoples Occupational Therapy Service undertook a
significant service re-design project with the aims of improving access times, productivity
and patient experience. This was carried out under the auspices of the Department of
Health’s Allied Health Professional Service Improvement Project. The redesign process
encompassed national benchmarking, local stakeholder consultation and commissioner
engagement.
From this a new three tier model of service was derived which focuses resources where
they are most effective and promotes self management and healthy living through an
interactive website and education packages.
The outcomes of the process have been profound. Access times from referral to
treatment have been reduced from an average of 14 months to 1 - 2 weeks. Productivity
has increased with the number of families accessing the service each month having
tripled. The overall patient experience has improved both in terms of satisfaction with
shorter access times and the way that services are delivered through new and
contemporary mediums.
Productive Community Services
In 2009 CCHS was chosen as one of two national pilots for the Productive Community
Services programme. During 2010 - 2011 we have continued to roll out the programme
across community teams with significant benefit to patients, staff and the organisation.
Productive Community Services (PCS) is a programme designed to deliver
improvements in quality and better efficiency, releasing more time to care for patients by
mobilising front line staff to deliver change.
Through a series of modules and activities Staff are enabled to analyse their current
performance, identify changes from their perspective and from that of patients and are
empowered to make the changes happen developing a culture of enquiry and
improvement.
23
Status at a Glance
“One of the problems that we faced
was not being able to identify patient
status without looking in the patient’s
notes which are kept within the
patient’s home, or asking the member
of staff who visited previously” Nursing team
To solve this problem 2 ‘status at a
glance’ boards were created:
• the diabetic board, which
enables us to see the
patient’s type of insulin,
frequency given, hba1c due,
and any recent action
• A palliative board which
allows us to review patient
progress and update patient
information in a format that
is accessible for all to staff.
We find that it is easy to review the information when liaising with the multi-disciplinary
team. We have found this to be very successful.
Knowing how you are doing
Teams develop a board to give them instant feedback on performance on agreed
targets.
“We now have control of our own
performance.”- Nursing team
The picture below illustrates how the team can see their performance and shows the sort
of things they are measuring.
Care Plan Audit
Patient Facing Time
Patient Satisfaction
Unplanned Absence
Well organised working environment
One team recognised that the cluttered store room meant that stock was hard to find and
staff were wasting time trying to find the equipment/ dressings they required.
24
Stock which was unused or over ordered was removed and redistributed across other
teams in the city, equating to an immediate saving of £1,327.40.
New shelving was put up and the stock was re-organised, labelled, photographed as a
visual aid, and finally minimum and maximum stock levels agreed to ensure adequate
stock levels were always maintained. Now items are always available, easy to find, and
costs will be reduced over the long term due to a reduction in over ordering.
Before
After
3. Review of Patient experience
CQUIN Indicator 2: Composite Indicator on responsiveness to patient
experience of patients receiving community based healthcare
Intended
Outcome
An improvement in scores across using a survey to establish a baseline and as a
follow up.
Narrative
The methodology required the survey sample to be divided across 5 services,
Wound care, Diabetes, Continence, COPD and a further early intervention agreed
with the PCT as children on the health visiting caseload identified as receiving a
service on Pathway 2 of the Healthy Child Programme, in the North East locality of
the City.
Actual
Outcome
The results for both surveys cumulatively and for each pathway are detailed below
Baseline survey
Pathway
Wound Care
Diabetes
Continence
COPD
Early Intervention ∗
Positive Score by Question
Q1
Q2
Q3
89%
88%
90%
88%
86%
92%
93%
93%
87%
92%
96%
96%
100%
100%
100%
Q4
48%
64%
51%
82%
0
Q5
97%
96%
95%
98%
100%
Q6
94%
92%
96%
98%
100%
CUMMULATIVE TOTAL
90.57%
60.27%
96.97%
94.61%
90.91%
91.81%
25
Follow up survey
Pathway
Wound Care
Diabetes
Continence
COPD
Early Intervention ∗
Positive Score by Question
Q1
Q2
Q3
88%
91%
92%
88%
90%
95%
88%
83%
90%
92%
92%
83%
93%
93%
100%
Q4
69%
46%
54%
68%
100%
Q5
100%
99%
96%
89%
93%
Q6
100%
83%
96%
84%
93%
CUMMULATIVE TOTAL
88.16%
89.76%
91.50%
62.65%
93.37%
90.36%
Comparison follow up to
baseline
-1.42%
-1.15%
-0.31%
2.38%
-3.60%
-4.25%
Services scored very highly in the baseline questionnaire and it was recognised
that it may be difficult to show any improvement on these scores.
Overall the follow up survey results, although still high, appear to show a small drop
in performance since the baseline survey, in 5 of the 6 questions. Some errors in
calculation introduced by the spreadsheet designed to collect the data for the
survey have been noted and reported to the designers. There are also concerns
that comments given by some patients did not refer to services provided by CCHS
but to other health care providers. The results of the survey and the scoring of it
should not be treated as absolute as they may reflect views on services not
provided by CCHS.
Patients were given the opportunity to comment on “how could this be improved” for
all questions. Comments were largely positive and supportive but did also include
some negative feelings. The comments relate to individual experiences and
therefore trends are not obvious. All comments and results have been fed back to
the services for consideration and to inform changes in practice.
It will be noted that in the baseline survey there was a very low return from the
health visiting pathway. The methodology for collecting information was changed to
use personal contact, face to face or by telephone and this resulted in a higher rate
of return in the follow up survey (2% - 23%).
The survey results are very pleasing and demonstrate an overall appreciation of
services by patients.
CCHS considers that a high standard of patient satisfaction has been achieved and
maintained across the year and that this indicator has been achieved.
Learning through Complaints
When patients and carers report concerns about our services, frontline staff and heads
of service try to resolve the issues as soon as they occur. If it not possible for staff to
26
resolve the issue immediately further support and advice is available from the NHS
Coventry Patient Advice and Liaison Service (PALS) and where the issue remains
unresolved through the formal complaints process.
Our complaints process aims to address complaints in a fair, open and transparent
manner and where fault is found, to put this right and ensure that lessons are learnt
across the whole organisation.
In 2010/11 54 formal complaints were registered with CCHS and we also contributed to
9 joint complaint responses, with other agencies including social care, University
Hospitals Coventry and Warwickshire and NHS Coventry.
The table below shows the breakdown of complaints by type. A complainant may
register more than one issue.
Theme of complaint
Waiting time
Care and treatment provided
Attitude of staff
Medical
Nursing
AHP
Receptionist
Inappropriate comment in
records
Confidentiality
Communication
Number of
complaints
6
32
5
6
1
2
1
3
5
The complaints process applies the Health Ombudsman’s key principles and sets out
our approach to handling complaints, from ensuring that complainants are informed
about how their complaint will be dealt with to the identification of where we need to
improve our services as a result of the complaints we receive. At the end of each
complaint, the complainant is invited to feed back on the handling of their complaint.
27
Innovation Projects
1 The living legends project
Young people with life limiting or threatening conditions often lose support from their
peers and experience a sense of isolation
The Community Children’s Nursing team
Youth Group (CCNTYG) helps to reduce
these feelings of isolation by providing an
opportunity for young people to have fun
whilst supporting each other.
Members of the group said that they
wanted to help others in their position by
producing a short film. 8 young people
were helped to produce the film.
Outcomes
• Development of a valuable education resource to help staff understand the
needs of young people.
• Patient empowerment and involvement was strengthened.
• Staff improved their understanding of the importance of the CCNTYG
• The team is exploring other opportunities to engage young patients in shaping
their service.
• The film has been shared with the regional children’s community nursing network
to inform service provision across the West Midlands and beyond
2 Stop cyber bullying project
Cyber bullying is when one or more people try to threaten or embarrass someone else
using a mobile phone or the internet and usually involves children or young people
In this project staff worked with children
and young people to raise awareness of
cyber bullying by developing a drama
workshop designed to educate and
provide advice on how to recognise and
stand up to bullying online. The workshop
used peer led discussions to help young
people learn about and debate the issues
in a secure environment.
Education sessions were delivered to
teaching staff and school nurses
28
Outcomes
• 428 school children in 3 schools participated
• Partnership working with young people and schools have been strengthened
• The learning needs of children to maintain their safety in an on line environment
have been identified and shared with schools for them to continue to address the
issues.
3. The Soapy - Soapy Song
Teaching children how to wash their hands properly from a young age is essential for
personal hygiene but for children learning to self care for dressings and catheters the
principles of clinical hand washing are even more important.
Recognising that children learn best
through play staff developed a fun action
learning song aimed at children between
2 and 7 years.
A learning pack was developed
comprising CD, poster, lyrics, piano
music and colouring in sheets providing
teachers with the basic tools to make the
song a class room activity
Outcomes
• The pack has been implemented into 4 schools to date strengthening
relationships
• A positive response from the children who enjoy the song and understand its
messages.
The funding of these
projects was provided be
the Coventry and
Warwickshire Locality
Stakeholder Board
Innovation fund for which
CCHS and the young
people affected are
grateful.
“In addition to improving the quality of
their service, individuals have learnt to use
new software, to produce films, to develop
educational tools, and to promote their
achievements through local press,
publication in journals and presenting at
conferences – skills which will help to
build a culture of innovation in driving for
better care.”
Jo Guy, Innovation Fund lead
29
Patient and the public engagement
Involving patients, carers and the public in feedback on the services we provide is an
essential way of identifying improvements. A wide range if Patient and Public
Involvement activities have been undertaken across CCHS in 2010/11 and some
examples of what we were told and what we did are given here.
Activity 1: The Anchor Centre is a health resource provided by CCHS for the homeless
population of Coventry. In May 2010 an event was held with the aim of sharing
experiences and encouraging dialogue between health policy makers and the
disadvantaged. Local shops were approached to provide contributions for a BBQ which
was held in the grounds of the Anchor Centre. Senior staff from CCHS and NHS
Coventry were invited to meet with homeless people. The event was very well attended
by homeless people across a wide age range and by senior representatives of NHS
Coventry and CCHS.
The senior staff reported a much greater understanding and awareness of homeless
people and how they get to be in that situation.
The homeless population felt that they had had the opportunity to highlight some of the
problems they have when accessing health care. They raised a number of mental
health issues were raised, which identified a shortfall in provision which was
subsequently brought to the attention of staff at Coventry and Warwickshire Partnership
Trust.
A user focus group was set up in June 2010 to give the users of the Anchor Centre the
opportunity of continuing to influence change within the service.
Activity 2: Between April and June 2010 the podiatry service asked patients and their
carers who had participated in diabetes awareness sessions to give feedback on their
experience. The feedback was largely positive with patients particularly welcoming the
targets set with then to improve their ability to self manage their condition and care. The
service is using this evidence to encourage greater take up of the sessions.
Activity 3: the school nursing service consulted with pupils in the school council at
President Kennedy School about the provision of a drop in service. The young people
suggested a venue, how to advertise the service and advised on potential barriers. The
service was established on the basis of what they said.
Staff Satisfaction Survey
CCHS participated in the national Annual NHS Staff Survey between September 2010
and January 2011, with a sample survey undertaken within CCHS of 700 staff. The
response rate this year was 53%, in line with the overall national response rate of 54%.
Overall, the survey results were positively in line with national comparative rates for
similar organisations, and as outlined below, better than the national average in most
key question areas linked to Vital Sign monitoring.
30
The survey includes 9 key questions linked to Vital Signs monitoring. Of these, CCHS
scored above the national response rate in 6, these being:•
•
•
•
•
•
Helping staff achieve the correct ‘work-life balance’
Staff able to meet conflicting demands
Staff satisfied their work is valued by the organisation
Senior managers involve staff in making important decisions
The care of patients is the organisation’s top priority
Communications between managers and staff are satisfactory
The 3 Vital Signs indicators which fell below the national average however were:•
•
•
Only 64% of staff reported having an appraisal in the last 12 months (national
average 79%). This is disappointing given that the 2009 CCHS appraisal rate
was 70% (and the 2008 figure 74%) and the national trend has shown an
increased uptake of appraisals.
‘Staff have planned clear goals and objectives’; 68% reported positively here
against 71% nationally. This appears to be linked to the relatively low appraisal
rate.
Work related stress experienced by staff (34% against the national rate of 31%).
The rate in 2009 in CCHS was 31%. The upward trend was also reflected in the
national figures.
The results are summarised below:
Key Scores Comparison
The
Trust has recently established a ‘Social Partnership Forum’, which brings
100%
together some of the Staff Side Representatives, some members of staff with an
90%
interest
in organisational culture, staff engagement and involvement and some of
the Executive Directors. This forum provides an important place to reflect on and
80%
consider
both what the issues are that the organisation faces in terms of the
culture
and
those things that we may all be able to contribute to in order to make
70%
sure we learn from the best in the Trust and elsewhere; and think about how we
60%
ensure
that all staff have a positive experience when working in the Trust.
The
overall
picture would suggest that most indicators show an overall
50%
improvement, compared to last year and we continue to ensure that staff are
encouraged
to participate in developing ideas to improve the Trust for example
40%
through ‘Lets Talk’ sessions whereby front line staff can meet with senior
30%
members
of the Trust to ensure that their views and thoughts are captured.
20%
10%
0%
Trust help staff Appraisal/review Have planned
achieve work life
in last year
clear goals
balance
Disagree cannot Satisfied with Senior managers Care of patients Management / No work related meet conflicting extent Trust involve staff
top priority
staff stress in last year
demands
values work
communication effective
National average
CCHS
31
The overall survey outcome this year for CCHS has been very positive. However,
the following key areas for improvement are highlighted:•
•
•
The systematic process for annual appraisals needs to be reviewed and
strengthened. This requires a review of the appraisal hierarchy in each
service and the span of review numbers for each manager and
supervisor. Further training may also need to be provided to ensure all
appraisers deliver this process consistently.
Clear processes to help managers identify stress and anxiety at the
earliest opportunity, and take effective action once identified, are needed.
This will be pursued through the Health and Wellbeing work which is
being undertaken and will include a more widespread awareness of the
availability of counselling accessible by both management and selfreferral.
Infection control measures require review and staff training in this area
will need to be expanded in 2011/12.
As CCHS integrates with Coventry and Warwickshire Partnership Trust, a
common approach will be developed to address areas of concern from this
survey, and those identified in the staff survey report relating to CWPT itself.
32
Our Priorities for Improvement in 2011/12
On 1st April 2011 CCHS merged with Coventry and Warwickshire Partnership Trust
(CWPT). In the Quality account for CWPT, Rachel Newson, Chief Executive said,
“The transfer of these services complements our existing portfolio of services. Our
priorities for 2011/12 reflect the important work that these services provide for the local
community and we have reflected these in our Priorities for Improvement section”.
This section has been written to include the priorities of the newly merged organisation
as it moves forward.
A new health care facility is being built near to Coventry City centre which will house
many of the services provided by CCHS. The facility is due for completion at the end of
2011 will enable services to be provided for patients in a modern purpose build facility.
A number of key physical health and mental health services for children and young
people will be co-located within the City Centre Health Facility. Work is underway to
ensure that we capitalise on the opportunity that this presents for strengthened
integrated working. We are aiming to enhance patient experience through the provision
of a joint reception for these services, we are moving towards a more integrated
approach to health assessments and we are also exploring better approaches to
information management and sharing.
The Trust has undertaken a series of workshops with our Commissioners to develop, in
line with the NHS Operating Framework 2011/12, a number of Commissioning for
Quality Innovation (CQUIN) indicators. These indicators will be implemented over the
course of the year and progress will be monitored, on a quarterly basis, through the
Trusts Clinical Quality and Contractual Meetings held between the Trust and the
Commissioning PCT’s.
The objectives of the CQUIN indicators that the Trust will concentrate on in 2011/12 are
as follows:
33
Patient Safety Objectives
Description
Rationale
To support the national initiative
to reduce the number of
Suicides.
Demonstrate full compliance with
the National Patient Safety Agency
(NPSA) 'Preventing Suicide Toolkit'
in inpatient mental health settings
that provide services to working age
adults.
Promoting Safe, Rational, and
Cost Effective Prescribing within
Mental Health: A co-ordinated
approach between primary and
secondary care.
This indicator has five individual,
but inter-linked components, that
will be managed via appropriate
networks and supported by
appropriate governing
arrangements. The development of
these indicators ensures that the
important features of patient choice,
side effects, individualising therapy
in line with NICE guidance, and
previous patient response to
therapy is not lost. The indicators
respond to the Department of
Health National guidance on
Medicines Use & Procurement.
The safety of inpatients on mental
health wards is a priority for all staff
and service users. To maintain
safety, regular audits should take
place to monitor and reduce any
dangers in the design, equipment
and organisation of the ward, care
interventions, and the service user’s
experience.
An agreed approach to prescribing
across mental health and primary
care supports safe, rational and
cost effective prescribing in both
sectors.
Intended Outcome
The Trust has agreed to works towards
achieving 70% compliance in all within
the toolkit at year end.
Development, implementation and
monitoring of the Preferred Prescribing
List.
The development and implementation of
joint prescribing guidance.
Development of Prescribing Cost Charts
to aid clinical decision making.
Provision of comparative prescribing
information.
Development of a monitoring mechanism
to support appropriate use of
escitalopram and pregabalin.
34
Clinical Effectiveness Objectives
To improve the transition from
Child and Adolescent Mental
Health Services (CAMHS) to
Adult Mental Health Services
(AMHS) for service users.
To develop a health economy
wide Eating Disorder Pathway.
Description
Rationale
Intended Outcome
Improved Transitions - All Coventry
and Warwickshire 16 and 17 year
olds who require mental health
services have access to services
appropriate to their age and level of
maturity. When these services
transfer from CAMHS to AMHS
services it is important to ensure
that a Robust Care Plan is in place.
The Trust will support the
development and implementation of
a health economy Eating Disorder
pathway.
Promoting an explicit connection
between CAMHS (child and
adolescent mental health) and
AMHS (adult mental health
services) and mark the formal
handover of responsibility for young
people with mental illness for care
co-ordination and planning to adult
services.
Eating Disorder patients across the
health economy do not currently
have a seamless pathway of care
and individuals presenting at early
stages do not routinely receive early
intervention to support them with
their condition.
Development and implementation of a
successful structured face to face
handover meeting initiated and facilitated
by CAMHS with AMHS in a minimum of
75% of transition cases.
Implementation of Case
Management for out of area
placements
The development of clear
assessment, review criteria and
case management for all out of area
clients with clearly established
review periods.
Development and delivery of a
clinical supervision programme
Development of a clinical
supervision programme for the
health visiting service (Healthy
Child Programme).
The delivery of Healthy Child
Programme using an agreed
Family Assessment Tool
To develop and pilot the use of a
family assessment tool within the
Health Visiting Service
The delivery of the Healthy Child
Programme with Children’s
Health Visitors will lead on the
development and delivery of the
To ensure and enhance assurance
to the commissioners of the quality
and governance arrangements of
the services commissioned for their
clients whether this be provided by
CWPT or other providers
To ensure safe, competent
practitioners and supporting
workforce and to support the
delivery of the Healthy Child
Programme and ' A Call to Action'
The Health Visiting Implementation
Plan (Department of Heath 2011)
To support the use of an evidenced
based tool for providing a
standardised approach to
assessment.
To support the delivery of the
Health Visiting Implementation Plan
Improved support for services users with
eating disorders, prompt access to
improved community based interventions
and reduced in-patient care requirements.
All services users requiring a review of
care will have a care coordinator
allocated.
All service Users on the Out of Area
Client list will be allocated a Care
Coordinator and will be reviewed to bring
service users into local services or where
this is not possible review the provision of
care currently being provided.
All staff within the health visiting service
will participate in structured supervision
programmes.
Development of a ‘good practice'
assessment tool in conjunction with
commissioners and partners and
incorporated into the 6-8 weeks checks.
Development and delivery of an agreed
health action plan for the targeted
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Centre’s
Long Term Conditions – Case
Management
Long Term Conditions - Coordination/integration of all
clinical care interventions to
support avoidance of admissions
Long Term Conditions Improving integrated work with
primary care
Healthy Child Programme. This will
be targeted at 3 Children’s Centres
(Hillfields, Woodend, Willenhall).
Roll out of a root cause analysis
process (RCA) for all the case
managed patients of the community
nurses, community matrons and
specialist nurses who attend
hospital or are admitted to hospital
due to an exacerbation of their Long
Term Condition.
All LTC patients known to
Community Services have an
integrated care plan for all nursing
and therapy services. Patient plans
are to be contained in the same file
and updates contemporaneously
written in continuation notes.
Establish multi-disciplinary
meetings between Community
Matrons/Care Co-ordinator and
GP/Primary Care Clinicians for
patients with Long Term Conditions
to support review of case load and
ongoing patient management.
(Department of Health 2011)
centres.
Reducing admissions to hospital is
a key priority for the Trust and it is
recognised that learning the causes
of how attendances and admissions
may be avoided is key.
Root Cause Analysis undertaken in 80%
of attendances/admissions where an
exacerbation of a patients Long Term
Condition has occurred.
95% of patients with a long term condition
will have an integrated clinical care plan
in place.
Development and implementation of an
agreed approach and communication
plan.
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Patient Experience Objectives
Description
Improvement in patient feedback
to support the development of
the delivery of care and treatment
Delivery of an enhanced 6-8 week
development review service
Development and delivery of the
maternal mental health pathway
The Trust will develop its
arrangements for the routine
collection of patient feedback
through use of a survey.
The survey will focus on both
community and inpatient services
and will provide information that will
enable the Trust to take action to
improve services.
Pilot of an enhanced 6-8 week
assessment, through the home
visiting programme.
Pilot of a maternal mental health
pathway
Rationale
This indicator helps ensure that all
service activities and improvements
are oriented towards improving the
experience of service users. The
survey questions are based upon
the service user experience
questions set by the Care Quality
Commission and have been
extended to add additional
questions to focus on local issues.
To increase access and positive
family satisfaction with the service
by reducing DNA rates, maximising
continuity of care and increasing
opportunities for Health Visitors.
To increase access and positive
family satisfaction with the service
by reducing DNA rates, maximising
continuity of care and increasing
opportunities for Health Visitors.
Intended Outcome
It is intended that the survey be
conducted at least twice during the year,
with actions taken as a result of the first
survey leading to a demonstrable
improvement in service users
experiences.
Develop, implement and evaluate a pilot
6-8 week assessment review service and
commence roll-out across all appropriate
services.
Develop, implement and evaluate a pilot
maternal mental health pathway and
commence roll-out across all appropriate
services.
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Who has been involved in the development of the Quality Account?
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The Director Management team and the Provider Board discussed the
process for development of the Quality Account and its content.
A development team which included representatives from corporate
and operational services was formed to advance the project.
Progress was monitored through the Directorate Management Team
and the Quality Account approved by the Board of NHS Coventry
Heads of service were invited to provide contributions
NHS Coventry led the Clinical Quality and Contract Review meetings
and have been invited to comment on the quality account
Local Involvement Networks (LINks) have contributed as part of a wider
programme of user and carer engagement. The Trust has jointly
organised a ‘LINk up for Quality’ event at which the development of the
Quality Account was debated;
The draft Quality Account was shared with Coventry Link who have
provided a written response (see below)
The Quality Account has been submitted to Coventry Health Overview
and Scrutiny Committee and senior managers from the Trust attended
a formal session to answer questions.
Response to Coventry Community Health Services Quality Account
2010-11
NHS Coventry, the commissioners of CCHS have provided a statement of verification
which has been included in the document verbatim.
Statement of Verification by NHS Coventry
NHS Coventry welcomes the opportunity to comment on the 2010/11 Quality Account
provided by Coventry Community Health Services (CCHS). This account is the first
and last NHS Coventry will receive from CCHS as it formally merged with Coventry
and Warwickshire Partnership NHS Trust on 1 April 2011. In reading this account we
understand the ongoing commitment to improving patient quality and experience
which is reflected in the ‘Our Priorities for Improvement in 2011/12’ section of the
account.
The Account highlights achievements, priorities and planned actions to drive forward
quality improvements focusing on areas that are important to patients and in
achieving national, regional and local priorities. There is evidence to support quality
as a theme through all of the strategic developments within the account, inclusive of
audit, performance and quality improvement and examples of how this has led to
service improvements.
As commissioners we commend CCHS patient-centred philosophy and commitment
to build upon their excellent work to date in driving up quality and improving patient
experience.
We would commend CCHS on several key areas of improvement during 2010/11:
ƒ
Introduction of the new care plan and audit tool.
ƒ
Improving the responsiveness to patients receiving community based
healthcare.
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Implementing a falls prevention service to include risk assessment and
clarification of appropriate interventions.
ƒ
Improving the nutrition and hydration of patients in the community.
ƒ
Improving end of life options thus enabling patients to die in their place of
choice when the time comes.
CCHS have worked hard to ensure that these have been given priority and
improvements to patient care made. We also acknowledge that an enormous
amount of work has been done through CQUIN, themed reviews and audit. Some
CQUIN targets have not been fully met in year, which is disappointing for all. We
would suggest it would be beneficial to see this work continue through 2011/12, as it
took some time to establish systems to collect the data and validate changes in
practice. The implementation of a new care plan commenced in November 2010 and
will provide a strong foundation and a real legacy with changed systems and
sustainable processes for continued improvement in the quality of patient care within
the community.
Monthly contract meetings, quality reviews and themed visits provide the PCT with a
good understanding of the issues facing CCHS. Internal systems and processes are
in place to provide assurance. Attendance and participation from CCHS at the
monthly quality reviews continues to be excellent throughout the year.
The quality of care at CCHS, as discussed in contractual quality meetings, is good.
An open approach to quality monitoring included themed reviews (risk management
and safeguarding) by the two commissioners and visits by the CQC and WMQRS.
Such visits have demonstrated a positive ongoing relationship that is necessary to
ensure that we can validate the information provided by CCHS.
In summary, NHS Coventry is satisfied that the document contains accurate data and
information where related to items contractually discussed throughout the year with
commissioners. Information provided within this Account that does not form part of
those quality and performance review meetings cannot be corroborated by NHS
Coventry.
We look forward to continuing the well established clinical partnership working to
drive up quality and innovation for our community services as part of the newly
merged Coventry and Warwickshire Partnership Trust as it moves forward in the
coming year.
Coventry Link has provided a response to the Quality account which is included
verbatim. CCHS thank them for their comments and look forward to developing
the relationship that as part of Coventry and Warwickshire Partnership Trust to
the benefit of patients.
Coventry LINk’s comments
Coventry LINk welcomes the role all LINks have of providing a short comment on the
quality of services within local Trusts.
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The Coventry Community Health Services Quality Account details a range of work
which has been undertaken over the past year to improve the quality of services.
Coventry LINk is heartened to see examples of where patient/service user surveys
and input, especially rated to clinical audit, has led to planned changes to how
services are delivered. The examples of patient and public engagement given are
also good practice.
LINk has found that LINk work often leads to recommendations regarding improving
information for patients/services users and is pleased to see that Coventry
Community Health Services has identified steps to improve information for some of
its service users.
This quality account identifies a number of local priorities for work to address quality.
For the work undertaken this year Coventry LINk is aware that areas detailed have
been areas where there is concern locally especially: improving hydration and
nutrition and increasing advanced care planning for patients in the end of life
pathway. Pressure ulcers have also been picked up as an issue by the local Scrutiny
Board.
The steps to ensure that Coventry Community Health services are listed on Choose
and Book is very important as LINk has found that Choose and Book is a key
mechanism for patients to access services. The awareness of GPs of services and
how to operate Choose and Book with regard to these services is vitally important
and we hope that CCHS will follow this up.
The patient and public involvement section would have been strengthened by further
examples of involvement activities. Coventry LINk would have liked to have seen
more evidence of how patients and the public have been involved in the production of
this Quality Account. We wonder how patients and the public have been able to
influence the areas identified for work in the coming year (which are focused on
CQUIN priorities).
LINk supports the inclusion of work to improve patient feedback in the coming year.
The focus on long term conditions also seems worthwhile as ensuring effective care
and support for people with long term conditions is very important. Points of transition
between services are often identified as problematic for patients therefore work to
improve the transition from Child and Adolescent Mental Health Services to Adult
Mental Health Services is important.
LINk finds the report to be clearly presented, although a glossary of terms would be
useful.
LINk supports CCHS aim of putting quality at the heart of everything they do. We
hope that as the management of Coventry Community Health Services is now being
transferred from NHS Coventry to Coventry and Warwickshire Partnership Trust that
the drive for quality continues. We will be interested to see what structures for
developing and ensuring quality are put in place.
LINk looks forward the opening of the City Centre Health facility and to further
building relationships with CCHS as we begin our work to transition into Local
HealthWatch as per the Government’s NHS plans.
The Health and Social Care Overview and Scrutiny Board have provided a response
which is included verbatim. CCHS thank them for their comments and look forward
to developing the relationship that as part of Coventry and Warwickshire
Partnership Trust to the benefit of patients.
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Scrutiny Board Commentary
The Health and Social Care Scrutiny Board (5) of Coventry City Council welcomes
the opportunity to comment on the draft Quality Account of the Coventry and
Warwickshire Partnership NHS Trust.
The Board considered the draft Quality Account at their meeting held on 22nd June
2011 and wish the following points to be noted:
The Board welcomes the merger of NHS Coventry's former provider arm with the
Trust and looks forward to integration of these services into existing community
services.
Broadly the Board welcomes the Trust's commitment to quality and continuous
improvement and has no evidence to suggest the Trust should have chosen
alternative priorities for its Quality Account. Data included in the Quality Account
demonstrates good progress last year.
Clearly in the current financial climate for the Trust the CQUIN targets are particularly
important and need to be referred to in the Quality Account. The concentration on
these issues does make the document less user friendly to non-medical readers than
might be the case.
Further it would be useful if the Trust articulated more clearly how service users,
carers and patients had been involved in selecting the priorities within the Quality
Account as opposed to commissioners or regulators.
It may be helpful for future Quality Accounts if the Trust included trend data over
longer periods of time, and tried to benchmark its services with comparable trusts.
The Board welcomes the commitment of the Trust to working with Coventry and
Warwickshire LINk and the event held in May was a positive step towards greater
engagement.
The Board welcomes the inclusion of reference to the Healthy Child Programme. The
Trust's contribution to delivery of the Healthy Child Programme is significant and at
the April meeting of the Scrutiny Board it was clear that much improvement and
partnership working is needed to deliver better outcomes for Coventry young people.
In considering the draft Quality Account the Trust has been requested to provide
further information regarding the arrangements for patients delayed in their discharge
from hospital care. Whilst understanding the complexities of arrangements for users
of the Trust's services, the Scrutiny Board would like to better understand the barriers
to achieving better outcomes in this area. Trend data over the last few years has also
been requested.
The Scrutiny Board has also requested further information from commissioners
regarding the dementia care pathway and particularly around the arrangements for
the support of carers of patients with dementia.
The timetable and process for local authorities such as Coventry to participate in
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Quality Accounts is particularly inconvenient (falling over the election period and
subsequent annual general meeting period) however this is a national timetable and
outside the Trusts control. However the earlier Members are able to engage in a
future dialogue regarding the priorities in the Quality Account the more meaningful
will be the contribution of the Scrutiny Board.
The Board would like to express its thanks to Coventry and Warwickshire Partnership
Trust for the support it provides to the Scrutiny Board, and for it responding to
queries and requests for information promptly and efficiently.
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