Dorset Community Health Services
Quality Account
2010 / 2011
Delivering the Highest Standards of Patient Care in the
Safest Environments
Version
1
Date
June 2011
1
Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
Dorset Community Health Services
Quality Account 2010/2011
CONTENTS
PART 1....................................................................................................................... 3
Foreword .................................................................................................................... 3
Statement on Quality from the Chief Operating Officer/Chief Executive .................... 3
1.1
What Does Dorset Community Health Services Provide? ........................... 4
1.2
Reflection on our Quality Performance During 2010/11 ............................... 4
1.3
Our vision for Quality ................................................................................... 5
PART 2....................................................................................................................... 6
2.1
Priorities for Improvement In 2011-12 and Statements of Assurance .......... 6
2.2
Statements of Assurance from the Board .................................................. 16
PART 3..................................................................................................................... 28
3.1
Review of Quality Performance in 2010-11 ................................................ 28
3.1.1 Priorities for Improvement 2010-11 ............................................................ 28
3.1.2 Other Measures of Quality 2010-11 ........................................................... 37
Summary .............................................................................................................. 47
To request this report in another format or language, please telephone the Communications
Office on 01305 368040 or e-mail Communications@dorset-pct.nhs.uk. For details of Trust
services and patient information leaflets, please log on to www.dorset.nhs.uk
INTRODUCTION TO OUR QUALITY ACCOUNT
How is Our Quality Account Structured?
A Quality Account consists of three separate parts.
Parts 1 and 2 are set out in Health Service (Quality Accounts) Regulations 2010 which can
be found on the Office of Public Sector Information website: www.opsi.gov.uk.
Part 3 is where we have the opportunity to make the Quality Accounts most meaningful to
our readers, with information relevant to our particular services, based on discussions with
service users, staff and others with an interest.
We welcome comments in relation to our Quality Account. Should you wish to
comment please forward your views to:
-Susan Whitehead
Clinical Practice Development and Quality Improvement Manager
Forston Clinic, DORCHESTER, Dorset DT1 9TB
e-mail: susan.whitehead@dorset-pct.nhs.uk
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Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
PART 1
FOREWORD
This is the second Dorset Community Health Services Quality Account.
As an organisation we take our responsibilities and obligations for providing high quality
health services to the people of Dorset seriously and we are proud of the high quality care
we provide for our patients, service users and carers. We expect that all of our staff
approach quality as a defining feature of their work .
Through this document we are pleased to demonstrate our commitment to quality in all that
we do.
We strive to provide the best standards of care and service and we monitor and measure our
success in order to continually improve and develop. We are also conscientious in meeting
our commitments regarding external quality and performance assessments and obligations
to the commissioners of our services, healthcare regulators and other stakeholders.
In this way we are accountable to the public. On a daily basis, our front line staff meet and
work with the public to deliver high quality care and we have a workforce that is committed to
ensuring the best standards in order to deliver care that is in the best interest of patients,
services users and their carers.
Within our organisational and individual processes we are reflective, critical and challenging
of our own practices and take seriously the challenges or concerns of others. We seek to
use every opportunity to evaluate and learn from our performance, to identify and recognise
any shortcomings and take action to improve.
We are committed to continuing to develop and improve our services in the future. During
2011 Dorset Community Health Services will become part of Dorset Healthcare University
Foundation Trust and our services will continue to develop within that organisation. In future
years our Quality Account will be produced within Dorset Healthcare University Foundation
Trust.
STATEMENT ON QUALITY FROM THE CHIEF OPERATING OFFICER
Ultimately the quality of our services will be measured by the experience of the people whom
we serve. The challenge we face is maintaining and improving across a broad range of
services across a dispersed and varied geography supporting a range of communities.
DCHS has demonstrated consistently its willingness to be proactive and forward thinking in
embracing the quality challenge and will continue to do so as we Transform Community
Services.
Tim Archer
Chief Operating Officer
Dorset Community Health Services
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Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
1.1
WHAT DOES DORSET COMMUNITY HEALTH SERVICES PROVIDE?
Dorset Community Health Services provides a wide range of clinical services to the
population of Dorset including:
Community Nursing Services Including District Nurses
Children and Family Health Services
Dorset wide Services (Dorset Orthopeadic Treatment service, Wheelchair Services,
Community Equipment and Anticoagulation Services
Community Hospitals and intermediate Care
Minor Injuries Units
Adult Community Mental Health Services
Primary Care Mental health -Increasing Access to Psychological Therapies (IAPT)
Older People‟s Mental Health Services
Mental Health Inpatient Services
Prison Healthcare
To support front line service delivery we have clinical support services such as:
Medicines Management
Infection Control
Risk Management
Clinical Governance
In addition we provide further support services for example:
Information Management and Technology Services
Human Resources
Finance
Estates
Further information on the range of services we deliver can be found in our “Service Portfolio
2010-11” document on our website http://www.dorset.nhs.uk
1.2
REFLECTION ON OUR QUALITY PERFORMANCE DURING 2010/11
Quality of patient care is of paramount importance to Dorset Community Health Services. It
is our primary objective and we constantly seek to make our services even better for
everyone, patients, staff, partners and stakeholders. We believe we offer high quality care
and are vigilant in maintaining and improving our services to meet the expectations of the
public and our partners.
Our aim is to make Dorset Community Health Services the best and achieve excellence in
the quality and safety of its services. We will achieve this by having in place excellent
governance and assurance systems, excellence and quality in leadership and management,
a fair and just culture that promotes openness and positive safety.
Our ambition is to succeed and become a leader of organisations in delivering excellence in
quality patient centred services.
Dorset Community Health Services has set out its vision of delivering high quality care to
people in Dorset based upon a commitment to the „NHS High Quality Care for All” (2008)1
organising principles of promoting quality based on Safety, Effectiveness and Patient
1
Department of Health, NHS High Quality Care for All (2008)
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Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
Experience and we continue to work towards the vision set out in “Equity and Excellence:
Liberating the NHS” (2010)2.
The current national agenda for health care providers is complex and rapidly changing.
Within this context Dorset Community Health Services seek to address challenges positively
and to build on its strengths to meet these demands.
1.3
OUR VISION FOR QUALITY
Our values are important to our organisational culture and to how we ensure we deliver high
quality, patient centred and safe services and succeed in delivering our aim and ambitions.
Our Core Values to deliver the highest standard of care are:
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Patient centred care
Having caring and compassionate staff and services
Learning and seeking to improve our services
Using evidence and best practice to underpin our services
Working closely with local partner organisations
Our Quality Account is a reflection of the ongoing cycle of quality improvement in our
organisation that occurs throughout each year, working closely in partnerships with our
patients, service users, carers, other stakeholders and our staff. Views gathered as part of
this ongoing dialogue and learning process have informed the thinking and development of
this quality account and have influenced its contents.
Our Quality Account demonstrates our continuing commitment to achieving high quality care
for our patients, service users and their carers and our responsibilities to the general public,
our commissioners and other stakeholders.
2
Equity and Excellence- Liberating the NHS, Department of Health (2010)
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Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
PART 2
2.1
PRIORITIES FOR IMPROVEMENT IN 2011-12 AND STATEMENTS OF
ASSURANCE
During 2011-12 Dorset Community Health Services will become part of Dorset Healthcare
University Foundation Trust. This is due to the national centrally-led NHS reorganisation
agenda.
In the light of this change, our priorities for improvement in 2011-12 will reflect our new
organisational priorities and will focus on:



To further extend the use of patient focused outcomes
Development and implementation of an acute care pathway/enhanced
recovery pathway for mental health
To continue to take forward patients, services user and carer involvement and
introduction of real time patient feedback at key locations.
To complement the overarching Quality Account priorities described above, within Dorset
Community Health Services as a directorate within the new organisation, a number of quality
objectives were identified for 2011-12.
These quality objectives have been agreed in relation to ensure we deliver:

Patient Safety

Patient Experience

Clinical Effectiveness
Our consultation process involved staff across our organisation in considering views and
evidence to support the development and subsequent agreement of our quality objectives
and took into account the valuable feedback and important contributions to our service
improvement processes from the public and our stakeholders throughout the year. The
quality objectives have been carefully considered at our committee, management and
professional forums.
Quality Objective
1. To increase patient
involvement in how
we shape, design
and deliver our
services.
Reason for inclusion
Whilst some aspects of patient experience activity has shown
improvement, especially over the last year due to the
implementation of our patient experience strategy, patient
involvement in service delivery and design, across all services,
requires further attention as a key quality objective in delivering
patient focussed services and improving the patient‟s experience of
healthcare. This is an important part of our patient experience
strategy and needs to be strengthened by ensuring a specific focus
on this area of work. Increasing patient involvement is also a
fundamental feature of the current national agenda for the NHS.
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Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
Quality Objective
Reason for inclusion
2. To reduce the harm
caused by patient
falls across all our
services.
This was a quality improvement priority for 2010-11. Although
considerable valuable work has taken place, a significant impact on
reducing avoidable falls is yet to be achieved.
This work area is a key target within the NHS South West Quality
and Patient Safety Programme - health community.
3. Improve the
medicines
management
processes across all
our services.
A reduction in recurrence by improving the management and
learning from legal, clinical and administrative medication errors is
sought.
This work area is a key target within the NHS South West quality
and patient safety programme – mental health
3b.
To assure the
safety and
effectiveness of Non
Medical Prescribing
practice across all
our services
Considerable valuable work has taken place during 2010-11 and
Non medical prescriber‟s have been seen to be safe and effective
during the past year. Every Non medical Prescriber will participate
in the national e-audit tool by March 2012.
4. Improve the care
and management of
dementia patients
across physical
community health
services by
implementing the
hospital standards
published for
dementia and
improve early
identification of
dementia in mental
health services.
We offer high quality of care for patients who have dementia and
their carers, with skills particularly developed in our Older Peoples
Mental Health services. We need to ensure that this standard of
care is shared and disseminated across other services , as the
health needs of patients becomes more complex and multifaceted.
The hospital standards provide a comprehensive and structured
way forward to drive quality up for these patients and their carers
and families. Early identification of dementia in mental health
services will enable early intervention and support.
5. To improve access
to end of life care
across mental
health, prisons and
in community health
services
We aim to ensure that patients at the end of life receive the best
evidence based care across all of our services. This will include
adhering to national standards, local policy and learning from best
practice.
These priorities are detailed in the following section.
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Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
Quality Objective 1
To Increase Patient Involvement in How we Shape,
Design and Deliver Our Services
Description
The emphasis on patient experience and involvement is rapidly increasing within the NHS
and in line with our organisational strategy on Quality and Patient Safety, it is vital that this
aspect is strengthened within Dorset Community Health Services. This will include patient
involvement in decision making from individual/personal levels to strategic/organisational
levels.
Aim/Goal
We will develop a systematic approach to involving patients in service delivery and design
and will ensure that patients views are considered in relation this. This system will be
monitored and show improvement from baseline throughout the year.
Current Status
Dorset Community Health Services already actively seek the views of its patients, service
users and their carers in order to improve the patient experience. Although important and
very effective work has occurred in relation to involvement in some of our services, we need
to ensure that all of our services demonstrate best practice and where we have well
developed patient involvement that this learning is shared and implemented .
Please see section 3.1.1 for further details of how we have addressed aspects of patient
involvement within our patient experience work.
Current Initiatives 2010-11
Dorset Community Mental Health Services have continued to work in partnership with Dorset
Mental Health Forum. We have involvement with the Local Involvement Network (Dorset
LINk), for example in relation to partnership working on a malnutrition/nutrition review. We
have established contacts with patient involvement leads in neighbouring organisations. We
access patient views on decisions about service delivery and design at an operational level.
New Initiatives to be implemented in 2011-12
To strength our emphasis on patient involvement in the patient experience strategy and to
fully implement a systematic approach to patient involvement at different levels of service
delivery and design.
To review and address learning needs relating to patient involvement approaches to enable
our staff to feel confident and be effective in involving patients in service delivery and design.
To adopt and spread good practice from our existing areas of excellence in partnership
working, e.g. with Dorset Mental Health Forum.
To monitor levels of patient involvement across all services, providing ward to board
assurance system for reporting patient involvement.
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Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
How will this quality objective be monitored, measured and reported?
This work will be monitored through our existing clinical governance, quality and patient
safety processes, for example, quarterly matrons and service managers regular reporting,
our quality dashboards, patient experience strategy progress reports.
Key indicators will be agreed as measures of progress, for example questions in patient
surveys, audit of standards of practice, documentation audits.
These reports will reviewed by the Clinical Governance, Quality and Patient Safety structure
of the new organisation.
Quality Objective 2
To Reduce the Harm Caused by Patient Falls Across
all our Services
Description
Falls have a significant impact on quality of life and health, being a factor in disability and
mortality. Dorset Community Health Service provides care across all its services to people
who may be likely to fall, so reduction in harm caused by patient falls is a significant issue for
our organisation. This work will link to High Impact Actions for nursing and midwifery and
NHS South West Quality and Patient Safety programmes - Health Community and Mental
Health.
Aim/Goal
The aim is to achieve a year on year reduction of harm caused by patient falls.
Current Status
Please see section 3.1.1 for details of work undertaken to date in this area.
Current Initiatives 2010-11
Although considerable valuable work has taken place, a significant impact on reducing
avoidable falls is yet to be achieved. Please see section 3.1.1.
New Initiatives to be implemented in 2011-12
This work area is a key target within the NHS South West Quality and Patient Safety
Programme - Health Community and Mental Health and High Impact Changes for Nursing
and Midwifery. These initiatives will form the basis of quality improvement developments,
monitoring and best practice spread in this area.
Intentional rounding will be introduced in community hospitals and older people‟s mental
health units. This is a term used for a method of observation and care intervention which
has been shown to successfully reduce fall rates.
Mental health strategies will be developed for application in our community hospitals in order
to enhance the care experience for patients with cognitive impairments and mental health
needs and aid falls prevention
Equitable evidence based practice will be developed throughout the organisation in relation
to the delivery of exercise and balance interventions.
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Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
Medicines reconciliations will be carried out for patients who fall.
Falls and Bone Health workshops will be developed in order improve patient care by
increasing knowledge and staff skills.
How will this quality objective be monitored measured and reported?
This work will be monitored through our existing clinical governance, quality and patient
safety processes, for example, quarterly matrons and service managers regular reporting ,
our quality dashboards, reports by the falls lead, progress reports relating to NHS South
West Quality and Patient Safety improvement programme.
Key indicators will be agreed as measures of progress, for example audit of standards of
practice, documentation audits.
These reports will reviewed by the Clinical Governance, Quality and Patient Safety structure
in the new organisation.
Quality Objective 3
Improve the Medicines Management Processes
Across All Our Services
Description:
Medicines management is about “…enabling people to make the best possible use of
medicines.” Medicines are an integral part of modern disease management, whether they
are used for prevention, treatment or alleviation of symptoms. Patient safety is of paramount
importance. Good medicines management can help reduce the likelihood of medication
errors and hence patient harm. In addition good Medicines management can improve the
quality of care that patients receive whilst reducing costs. Members of the pharmacy team
are experts on medicines and their use and can provide advice on a wide range of topics.
However medicines management is everybody‟s business and not just that of the pharmacy
team.
Aim/Goal
To improve the quality of medicines management services to both patients and outpatients
in the community services, prisons and mental health.
Current Status
Medicines management service to all inpatient wards
Medicines reconciliation on admission
Clinical pharmacy service re interactions, renal impairment, quality of service provided.
Guideline and PGD development
A.I.R.s forms
Financial Planning, Cost effective prescribing advice and cost projection of medication.
Facilitating discharge
Education of medical and nursing staff
Educating patients and their carers on their medication
Adherence to security regarding the provision of supplies and security of medication
including Controlled drugs.
Non Medical Prescribers across all areas of practice are engaged in medicines
management.
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Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
Current Initiatives 2010-11
To improve medicines reconciliation in inpatient units
To ensure guidance in relation to Controlled drugs is adhered to
To ensure NICE guidelines are followed
To ensure that CQC standards are met
To introduce Preceptorship for all new Non Medical Prescribers upon successful completion
of the course.
New Initiatives to be implemented in 2011-12
This work area is a key target within the NHS South West Quality and Patient Safety
Programme. These initiatives will form the basis of quality improvement developments,
monitoring and best practice spread in this area. We will work towards:
Increasing the amount of people who have their medication reconciled within 24 hours to
80%.
Producing quarterly financial reports for each care group to improve accountability for drug
expenditure
Reducing medicines waste by introducing “One Stop dispensing schemes” where
appropriate
Demonstrate safety and effectiveness of Non Medical Prescribing by the introduction and
use of an e-audit tool.
How will this quality objective be monitored, measured and reported?
Via audit.
Via data analysis to see if drug expenditure is inline with predicted values and that non
medical prescribing is cost effective.
Reports will be reviewed within the Clinical Governance, Quality and Patient Safety structure
of the new organisation.
Quality Objective 4
Improve the Care and Management of Dementia
Patients Across Physical Community Health Services
by Implementing the Hospital Standards Published
for Dementia and Improve Early Identification of
Dementia in Mental Health Services
Description
Patients who have dementia have specific and complex health needs when admitted to
hospital. Appropriate skilled care is critical in ensuring that patients and their carers and
families have a positive experience whilst receiving hospital care. The South West Hospital
standards for dementia care, produced by the South West Dementia Partnership 2010,
provide a framework for focussing and improving care that is offered in our community
Hospitals. Early identification will allow early intervention and support to be offered .
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Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
Aim/Goal
To demonstrate an improvement in the quality of care for patients and carers experience of
inpatient care in our community hospitals by implementing the South West Hospital
Standards.
Current Status
In the West of the county there are some formal and some informal processes in place
regarding access by patients and their carers to specialist mental health liaison services. In
the East of Dorset there is some liaison associated with the Royal Bournemouth Hospital.
The experience in community hospitals has been identified as an area for improvement.
Some informal arrangements through the Dorset Community Health Services Dementia and
Person Centred Care Network are being developed to improve this situation.
Although managed well and maintained, our hospital and ward environments can be variable
in terms of dementia-friendly facilities. Also there is variation in accessing and utilising the
contribution of volunteers from hospital to hospital.
Current Initiatives 2010-11
Staff training is in place and continues to develop so that people with dementia receive
care from staff appropriately trained in dementia care. This training has been expanded
to cover our Community Hospitals as well as our Older Peoples Mental Health services.
The implementation of the dementia strategy is being led by NHS Dorset as commissioners
of services. There is a series of co-ordinated work streams being started. Dorset Community
Health Services has nominated staff involved where appropriate.
An audit is underway of anti-psychotic prescribing for dementia within our Older Peoples
Mental Health services which is recommended in the NICE Quality standard for dementia. A
NICE Quality standard is a set of statements, devised by the National Institute for Clinical
Excellence, that are markers of high-quality, clinical and cost-effective patient care across a
pathway or clinical area. These markers are derived from the best available evidence such
as NICE guidance or other NHS Evidence accredited sources and are produced
collaboratively with the NHS and social care, along with their partners and service users.
There is a Dorset Community Health Services Dementia and Person Centred Care Network
established reviewing sharing best practice across our organisation, for example


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Implementation of life books /personal profiles
Activity roles, toolkits and notice boards and timetables
Reminiscence work
Music and movement groups
Environmental and garden development
Carers time
Working with volunteers
Improving team working across disciplines
Reflective case reviews
Establishing and maintaining regional and national links
Shadowing in different clinical areas
A Dorset Community Health Service policy is being developed in relation to nutrition and
hydration.
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Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
Dorset Community Health Services Older Peoples Mental Health services have been reaccredited as a Practice Development Unit for a further 3 years. This is the 3rd successful
accreditation and was awarded with no restrictions and feedback from the assessment team
was very positive (Bournemouth University). A practice development unit is geared to
ensuring better care for patients based on clinical excellence, evidence based practice and
empowerment of the team, their services users/patients and carers. It is recognised as a
marker for the quality of care delivered.
A process of gathering information about activity currently underway in Dorset Community
Health Services relation to NICE Quality standard on Dementia has occurred.
New Initiatives to be implemented 2011-12
A review of processes and policies/guidelines/standards to confirm that the needs of patients
with dementia and their carers are addressed.
Work towards the development of consistent formal liaison structures around access by
patients and their carers to specialist mental health liaison services across Dorset to be a
focus of strategic development.
A group will focus on improving the dementia friendly environment.
Full implementation of a nutrition and hydration policy.
Best practice in the contribution of volunteers will be explored and shared across inpatient
services.
A review of training needs and action to address these needs in relation to ensuring quality
of care at the end of life. This will include development of training packages and a training
pathway and co-ordination of training across the healthcare community and social care
where possible .
How will this quality objective be monitored, measured and reported?
This work will be monitored through our clinical governance, quality and patient safety
processes, for example , quarterly matrons and service managers regular reporting , our
quality dashboards, patient/carer experience survey reports.
Key indicators will be agreed as measures of progress, for example audit of standards,
questions in surveys, documentation audits.
These reports will reviewed by the Clinical Governance, Quality and Patient Safety structure
in the new organisation.
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Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
Quality Objective 5
To Improve Access to End of Life Care Across Mental
Health, Prisons and in Community Health Services
Description
Patients nearing the end of their lives and their carers and families require high quality
sensitive care. This requires staff who are highly skilled and competent at managing this
care, working in partnerships with the patient, carers and families. End of life care is well
established in our services and as a key quality improvement area we wish to build on this
and to enhance the best practice and highest standards across our mental health, prisons
and community services.
Aim/Goal
We will improve access to End of life care across mental health, prisons and in community
services , enhancing and sharing best practice.
Current Status
Dorset Community Health Service staff are trained and aware of quality markers relating to
end of life care ie Liverpool Care Pathway, which is an evidence based pathway bringing
together different disciplines of those involved in the care of patients who are moving
towards the end of life, and the Gold Standard Framework which is a framework aimed at
ensuring that quality end of life care becomes the standard for all patients and their families.
Community hospital teams and community based staff have action plans re end of life care
which aims to drive up and monitor quality.
Current Initiatives 2010-11
There is ongoing education and training in use of Liverpool Care Pathway version 12 for all
appropriate DCHS staff and staff working in nursing/residential care.
There is current Monitoring and Measurement, ie:

District nursing to ascertain frequency of use against locally agreed quality
targets

Hospital standardised mortality rate audits to ascertain frequency of use
against locally agreed quality targets. This is a tool to analyse every death in
our community hospitals in order to learn from and improve practice.

Annual audit of Liverpool Care Pathway documents within community
hospitals and District nursing teams

Evidence against End of Life Care Quality Markers
Dorset Community Health Service staff have access to training relevant to end of life care
eg:

Workshops in Advance Care Planning delivered by Weldmar & Christchurch
Macmillan Unit. These are local palliative care services.

Liverpool Care Pathway– ongoing training on monthly basis
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Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments

Syringe driver training – to all appropriate nurses within Dorset Community
Health Services
Dorset Community Health Service district nurses and community matrons participate in
regular Gold Standard Framework meetings in GP practices, to promote best practice in end
of life care.
There is partnership working across Dorset regarding end of life care.
New Initiatives to be implemented 2011-2012
District nurses and community matrons will be involved with activities to improve Gold
Standard Framework in primary care in particular with two practices who are implementing a
locally enhanced service agreement ”Going for gold”, which commits GP‟s to raise the
standard of Gold Standard Framework and end of life care.
Work is underway to explore a Gold Standard Framework pilot to commence in all
community hospitals including mental health units, to commence in May 2011.
Staff will continue to access training and education in Liverpool Care Pathway and Advance
Care Planning
Hospital Standardised Mortality Rate audits will continue to develop (to include Mental
Health Units).
There will be an annual Liverpool Care Pathway audit.
A training package for End of Life care medication ,to ensure all nurses administering end of
life care drugs have knowledge regarding appropriate drugs and doses. is being developed
by end of life care leads.
How will this quality objective be monitored, measured and reported?
This work will be monitored through our clinical governance, quality and patient safety
processes for example via quarterly matrons and service manager regular reports and
audits. Measures will be agreed against standards of care . Reports will be reviewed by our
End of Life Care Lead for Dorset Community Health Services and via the clinical governance
Quality and patient safety structure of the new organisation.
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Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
2.2
2.2.1
STATEMENTS OF ASSURANCE FROM THE BOARD
Review of Services
During 2010-11 Dorset Community Health Services provided and/or sub-contracted three
NHS services (Community Services, Prison, Mental Health).
Dorset Community Health Services has reviewed all the data available to them on the quality
of care in three of these NHS services.
The income generated by the NHS services reviewed in 2010-11 represents 100% of the
total income generated from the provision of NHS services by Dorset Community Health
Services for 2010-11.
2.2.2
Participation in Clinical Audits
During 2010-11, 3 national clinical audits and 2 national confidential enquiries covered NHS
services that Dorset Community Health Services provides.
During that period Dorset Community Health Services participated in 66% national clinical
audits and 100% national confidential enquiries of the national clinical audits and national
confidential enquiries which it was eligible to participate in.
The national clinical audits and national confidential enquiries that Dorset Community Health
Services was eligible to participate in during 2010-11 are as follows:
National Confidential Enquiry into Patient Outcome and Death (NCEPOD)
National Confidential Inquiry (NCI) into Suicide and Homicide by People with Mental
Illness.
National Falls and Bone Health for Older People.
Patient Reported Outcome Measures.
National Audit of Schizophrenia.
The national clinical audits and national confidential enquiries that Dorset Community Health
Services participated in during 2010-11 are as follows:
National Confidential Enquiry into Patient Outcome and Death (NCEPOD)
National Confidential Inquiry (NCI) into Suicide and Homicide by People with Mental
Illness
National Falls and Bone Health for Older People
Patient Reported Outcome Measures
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Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
Participation
% Cases
Submitted
Perinatal mortality (CEMACH)
No
N/A
Neonatal intensive and special care (NNAP)
No
N/A
Paediatric pneumonia (British Thoracic Society)
No
N/A
Paediatric asthma (British Thoracic Society)
No
N/A
Paediatric fever (College of Emergency Medicine)
No
N/A
Childhood epilepsy (RCPH National Childhood Epilepsy Audit)
No
N/A
Paediatric intensive care (PICANet)
No
N/A
Paediatric cardiac surgery (NICOR Congenital Heart Disease
Audit)
No
N/A
Diabetes (RCPH National Paediatric Diabetes Audit)
No
N/A
Emergency use of oxygen (British Thoracic Society)
No
N/A
Adult community acquired pneumonia (British Thoracic Society)
No
N/A
Non invasive ventilation (NIV) - adults (British Thoracic Society)
No
N/A
Pleural procedures (British Thoracic Society)
No
N/A
Cardiac arrest (National Cardiac Arrest Audit)
No
N/A
Vital signs in majors (College of Emergency Medicine)
No
N/A
Adult critical care (ICNARC CMPD)
No
N/A
Potential donor audit (NHS Blood & Transplant)
No
N/A
Diabetes (National Adult Diabetes Audit)
No
N/A
Heavy menstrual bleeding (RCOG National Audit of HMB)
No
N/A
Chronic pain (National Pain Audit)
No
N/A
Ulcerative colitis & Crohn‟s disease (National IBD Audit)
No
N/A
Parkinson‟s disease (National Parkinson‟s Audit)
No
N/A
COPD (British Thoracic Society/European Audit)
No
N/A
Adult asthma (British Thoracic Society)
No
N/A
Bronchiectasis (British Thoracic Society)
No
N/A
Hip, knee and ankle replacements (National Joint Registry)
No
N/A
Elective surgery (National PROMs Programme)
Yes
93.2%
Cardiothoracic transplantation (NHSBT UK Transplant Registry)
No
N/A
Liver transplantation (NHSBT UK Transplant Registry)
No
N/A
Coronary angioplasty (NICOR Adult cardiac interventions audit)
No
N/A
Peripheral vascular surgery (VSGBI Vascular Surgery
Database)
No
N/A
Audit
Peri- and Neonatal
Children
Acute care
Long term conditions
Elective procedures
17
Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
Participation
% Cases
Submitted
Carotid interventions (Carotid Intervention Audit)
No
N/A
CABG and valvular surgery (Adult cardiac surgery audit)
No
N/A
Familial hypercholesterolaemia (National Clinical Audit of Mgt of
FH)
No
N/A
Acute Myocardial Infarction & other ACS (MINAP)
No
N/A
Heart failure (Heart Failure Audit)
No
N/A
Pulmonary hypertension (Pulmonary Hypertension Audit)
No
N/A
Acute stroke (SINAP)
No
N/A
Stroke care (National Sentinel Stroke Audit)
No
N/A
Renal replacement therapy (Renal Registry)
No
N/A
Renal transplantation (NHSBT UK Transplant Registry)
No
N/A
Patient transport (National Kidney Care Audit)
No
N/A
Renal colic (College of Emergency Medicine)
No
N/A
Lung cancer (National Lung Cancer Audit)
No
N/A
Bowel cancer (National Bowel Cancer Audit Programme)
No
N/A
Head & neck cancer (DAHNO)
No
N/A
Hip fracture (National Hip Fracture Database)
No
N/A
Severe trauma (Trauma Audit & Research Network)
No
N/A
Falls and non-hip fractures (National Falls & Bone Health Audit)
Yes
*
Depression & anxiety (National Audit of Psychological
Therapies)
No
N/A
Prescribing in mental health services (POMH)
No
N/A
National Audit of Schizophrenia (NAS)
No
N/A
O neg blood use (National Comparative Audit of Blood
Transfusion)
No
N/A
Platelet use (National Comparative Audit of Blood Transfusion)
No
N/A
Audit
Cardiovascular disease
Renal disease
Cancer
Trauma
Psychological conditions
Blood transfusion
*
Participation within Dorset-wide falls strategy. Organisational section of audit
completed. Clinical element completed by Acute trusts.
18
Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
The national clinical audits and national confidential enquiries that Dorset Community
Health services participated in, and for which data collection was completed during
2010-11 are listed below alongside the number of cases submitted to each audit or
enquiry as a percentage of the number of registered cases required by the terms of
that audit or enquiry.
Audit Title
National Confidential Enquiry on
Suicide and Homicide
National Falls and Bone Health for
Older People
Number as a
Percentage
100%
Comments
N/A
Participation within Dorset-wide falls
strategy. Organisational section of
audit completed. Clinical element
completed by Acute trusts.
Local data reconciliation.
No cases meeting admission criteria
in the reporting period.
Patient Reported Outcome Measures
National Confidential Enquiry into
Patient Outcome and Death, Elective
and Emergency Surgery in the
Elderly: An Age Old Problem
National Audit of Continence Care
93.2%
0%
41.3%
The reports of 5 national clinical audits were reviewed by the provider in 2010-11 and Dorset
Community Health Services intends to take the following actions to improve the quality of
healthcare provided:
Audit Title
National Confidential Enquiry on Suicide and
Homicide
National Falls and Bone Health for Older
People
Patient Reported Outcome Measures
National Confidential Enquiry into Patient
Outcome and Death, Elective and
Emergency Surgery in the Elderly: An Age
Old Problem
National Audit of Continence Care
Actions
Local suicide prevention action plan updated.
Development work in progress through Falls
Lead to address organisational and clinical
key indicators including NPSA/2011/RRR001
Data reviewed subject to continual
monitoring.
Finding relevant to DCHS services being
operationalised.
Action Plan being implemented.
19
Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
The reports of 21 local clinical audits were reviewed by the provider in 2010-11 and Dorset
Community Health Services intends to take the following actions to improve the quality of
healthcare provided.
Local Clinical Audits
Pressure Ulcer Prevalence (Quarterly)
Leg Ulcer healing
Medical devices – mattress audit
Safe bathing (Six monthly)
Prescriptions chart audit
Clinical supervision
Discharge planning and arrangements
Clinical coding – Mental Health
Record keeping in community hospitals,
children and family services and community
services
Ligature Audit in Inpatient Units
Audit of MUST Tool in Community Hospitals
Hospital Standardised Mortality Ratio Audit
WHO Surgical Safety Checklist
Infection Control Audit (Quarterly)
2.2.3
Actions TBC
Rolling out best practice across community
hospitals and community services
Rolling out best practice across community
hospitals and community services
Agreed standard and procurement procedure
set in place
Agreed assessment tool and water
temperature monitoring by estates
New chart designed and implemented
Policy updated and best practice
implemented
Review of discharge planning process and
implementation of process recording sheet.
Improved record keeping
Best practice, guidance implementation
Task and finish group established to oversee
action plan implementation
Improvement target set. Action plan in place
Action report/recommendations in place and
being implemented
Action plan in place and being implemented
Action plans are implemented locally and
monitored to ensure compliance
Participation in Clinical Research
The number of patients receiving NHS treatment provided or subcontracted by Dorset
Community Health Services in 2009-2010 that were recruited to participate in research
approved by a research ethics committee was 22.
Participation in clinical research demonstrates Dorset Community Health Services
commitment to improving the quality of care we offer and to making our contribution to wider
health improvement. Our clinical staff stay abreast of the latest possible treatment
possibilities and active participation in research leads to successful patient outcomes.
Dorset Community Health Services was involved in conducting eight clinical research
studies in mental health and neurodegenerative and dementia during 2009-2010.
There were six clinical staff participating in research approved by a research ethics
committee at Dorset Community Health Services during 2009-2010. These staff participated
in research covering two medical specialties.
As well, in the last three years, one publication has resulted from our involvement in NIHR
research, which shows our commitment to transparency and desire to improve patient
outcomes and experience across the NHS.
20
Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
2.2.4
o
Goals Agreed with Commissioners
Use of the CQUIN Payment Framework
A proportion of Dorset Community Health Services income in 2010-11 was conditional on
achieving quality improvement and innovation goals agreed between Dorset Community
Health Services and any person or body they entered into a contract, agreement or
arrangement with for the provision of NHS services, through the Commissioning for Quality
and Innovation payment framework.
Further details of the agreed goals for 2010-2011and for the following 12 month period are
available electronically at
http://www.institute.nhs.uk/world_class_commissioning/pct_portal/cquin.html
2.2.5
o
What Others Say About the Provider
Statements from the CQC
Dorset Community Health Services is required to register with the Care Quality Commission
and its current registration status is compliant with CQC essential standards of quality and
safety, under the health and social care act 2008 and CQC registration regulations 2009.
Dorset Community Health Services has no conditions on registration.
The Care Quality Commission has not taken enforcement action against Dorset Community
Health services during 2010-11.
Dorset Community Health Services has not participated in any special reviews or
investigations by the CQC during the reporting period.
2.2.6
o
Statement on Relevance of Data Quality and Actions to
Improve Data Quality
NHS Number and General Medical Practice Code Validity Data Quality
Dorset Community Health Services submitted records during the year ended 31 March 2011
to the Secondary Uses service for inclusion in the Hospital Episode Statistics which are
included in the latest published data.
The percentage of records in the published data which included the patient‟s valid NHS
number was:
Admitted Patient Care
Outpatient
Accident and Emergency
100%
99.9%
99.2%
The percentage of records in the published data which included a valid GP Medical Practice
Code was:
Admitted Patient Care
Outpatient
Accident and Emergency
100%
100%
100%
Dorset Community Health Services reviews the SUS data quality dash boards on a monthly
basis. A lead has been established during 2010/11 to take forward the use of the NHS
21
Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
number and a programme of training has been run out across the trust. All returns submitted
go through a process of validating data and feeding back to teams where improvements can
be made. Ethnicity coding is actively being taken forward to improve percentage rates for
future months.
Dorset Community Health Services will be taking the following actions to improve data
quality:
2.2.7

We will continue to apply rigorous standards to, managing our data quality

We will continue to monitor that improvement is made against our SUS data
quality

We will train staff on how fields shall be entered to ensure that improvements
are made.
Information Governance Toolkit Attainment Levels
DCHS does not have an individual toolkit score as it is legally part of NHS Dorset until the
transfer to Dorset Healthcare.
NHS Dorset Information Governance Assessment Report score overall score for 2010-11
was 70% and was graded Unsatisfactory.
2.2.8
Clinical Coding Error Rate
Dorset Community Health Services was not subject to the Payment by Results clinical
coding audit during 2010-11 by the Audit Commission.
2.2.9
How do we Build Capacity and Capability for Quality
Improvement?
Dorset Community Health Services is committed to developing capacity and capability to
deliver quality improvements.
Within Dorset Community Health Services our main, and most valuable resource is our staff,
who work consistently to ensure the quality of the services we deliver.
We employ a wide range and number of staff who are engaged either directly, or in a
support capacity, with the delivery of our clinical services. Our staff have a critical role in
ensuring that we deliver a high quality of service and a positive patient experience to the
public.
Our staff are supported by ensuring strong clinical leadership and management with visible
and accessible high level leaders at director level within our organisation and clinical
leadership throughout the different levels that work towards the organisation‟s vision for
quality improvements and safeguard professional standards of practice.
One example of our leadership approach is our Nursing and Allied Health Professional
strategy which focuses on the theme of delivering care and services based on humanity,
dignity and respect. Within this strategy, the established structure of professional leadership
within is described where all Nursing and Allied Health Professional groups are represented.
22
Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
PROFESSIONAL LEADERSHIP STRUCTURE
Head of Professional Practice, Quality and
Children‟s and Family Services
Nursing
Community
Hospitals
Representative
Nursing
Community
Health Visiting
Representative
School Nursing
Representative
Physiotherapy
Representative
Community
Matrons
Twilight Nurses
Representative
Occupational
Therapy
Representative
Mental Health/
Prisons
Community Mental Health
Older Peoples –
Mental Health
Representative
Specialist Nurses
Continence
Contraception
Diabetes
Infection Control
Safeguarding Children
Pharmacists/
Medicines Management
Technicians
Non Medical Prescribing
Nurse Consultant
Urgent/Unscheduled Care
Professional Network Frequency of Meeting Structure









Professional Practice Advisory Group – All – Monthly
Health Visitors Professional Development Group - Monthly
Community Matrons Meeting – Monthly
Professional Development Group, Community Nurses – Monthly
Community Hospital Matrons - Monthly
Occupational Therapists – Monthly
Physiotherapist Team Leaders – Monthly
Senior Physiotherapists/Extended Scope Practitioners – Bimonthly
Pharmacist, Medicines Management Team - Monthly
23
Dorset Community Health Services, Quality Account 2010/11
Advanced Nursing Practice/
Nurse Practitioner Urgent Care
Professional
Head of
Occupational
Therapy
Mental Health
Delivering the Highest Standards of Patient Care in the Safest Environments
The following are key actions to ensure leadership and management are proactive in
supporting service and practice developments and empowering the workforce to deliver high
quality care.
Key actions for the future of strong clinical leadership and management

All levels of Nursing and Allied Health Professional leadership will be active,
accessible and accountable.

Nursing and Allied Health Professional staff will be engaged fully with
influencing and driving change and developing practice at a level appropriate
to their role as accountable practitioners. This will include constructive
challenge in order to safeguard clinical quality where required.

Professionals will be ambitious and creative in their aim for high quality
practice, using validated pathways and initiatives to support their practice
goals.

Practice will be supported by the implementation of evidence based tools and
policies.

Professionals will engage with processes designed to learn from practice and
change and share good practice as a result of learning.

Performance management outcome systems will be further developed and
used to capture, monitor, evidence and challenge professional service
delivery.

IT will be increasingly used in order to support service delivery.

Effective management and leadership supervision will be implemented on
regular basis

Further personal development and evaluation of management and
professional leadership skills of professionals at all levels will be promoted.

Excellence in practice and achievement will be recognised and celebrated.
Innovation is another essential component of building capacity and capability. In a changing
world development is inevitable and provides opportunities for improvement and innovation.
Dorset Community Health Care encourages it‟s staff in this regard, in order to meet its
organisational priorities, obligations and responsibilities. Innovation and development is
purposeful and well managed, within a clear governance framework to promote effective and
efficient use of resources and improved outcomes for our patients. An examples of this is the
Clinical Practice Development Framework which ensures new ways of clinical working are
considered and evaluated prior to implementation .Dorset Community Health services also
encourages staff to work collaboratively with partners in the local health and social care
community, to develop new approaches to care where appropriate.
Ensuring that our staff are valued and engaged is an essential element of building capacity
and capability for delivering high quality care. All Dorset Community Health Service staff are
required to undertake a minimum level of training each year via mandatory training, in order
to deliver high quality, safe and effective care. This level of training depends on the
responsibility of the respective post holders. This is monitored and reviewed annually, in the
light of an individual annual appraisal. Dorset Community Health Services also engages in
24
Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
the annual staff survey which invites feedback from staff in order to enable the organisation
to reflect on findings and develop action plans for implementation. The results are publicised
internally and work is undertaken to work towards increasing levels of staff satisfaction.
Dorset Community Health Service is committed to accessing and making better use of
information in order to improve the quality of its services. Key challenges are to ensure
appropriate and effective tools are used to help in this process. Challenges also exist in
developing ways of triangulating information to add depth and richness to our understanding
of the quality of our services, and to be able to be more effective in our responses as a
result. As our organisational business intelligence continues to build, we will have greater
opportunities to correlate data which will help with this process and will validate the way we
work in addressing the issues that mean most to our patients and service users.
In addition to accessing and generating information for quality improvement, we are also
keen to ensure that we communicate effectively, sharing information with the public and
other partners. An important element of this is to continue to develop and refine ways that
information can be communicated as a two way process and to ensure the quality of
information provided is accessible and clear to its audience. An example of this is the
development of information displays in community hospitals, to inform the public of progress
on quality targets and feedback on actions taken about what patients and their carers have
said are important to them in respect of their experience of receiving care from our services.
2.2.10
How is our Progress Measured and Monitored?
Dorset Community Health Service‟s main commissioner of services is NHS Dorset . Within
our contractual obligations with our commissioners we are required to demonstrate the
effective delivery of high quality care for our patients. We also have a number of areas of
practice where specific commissioning arrangements designed to improve quality are in
place, these are within the Commissioning for Quality and Innovation framework. This
framework enables commissioners to reward excellence, by linking a proportion of our'
income to the achievement of local quality improvement goals.
In addition we are required to provide evidence of compliance with the Care Quality
Commission‟s Essential Standards of Quality and Safety. These are a series of core
standards and related outcomes which capture the key elements of quality in healthcare
delivery covering :

Involvement and information

Personalised care ,treatment and support

Safeguarding and safety

Suitability of staffing

Quality and management

Suitability of management
In order to ensure that we know we are achieving the outcomes required of us, Dorset
Community Health Services has a robust system in place for measuring and monitoring and
scrutinising our quality and quality improvements. This is focussed around an organisational
structure that ensures that clinical effectiveness, quality and patient safety is embedded
throughout our organisation and is effectively monitored as a continual process.
25
Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
INTEGRATED GOVERNANCE FRAMEWORK
DCHS Committee
Clinical Governance,
Quality and Patient
Safety Committee
Equality and
Diversity
Medicines
Management
Group
Workforce
Development
Committee
Clinical Policy
Review Group
Infection
Prevention and
Control Group
Resources, Finance and
Performance Committee
Prison Health GP and
Lead Nurse Meeting
(inc Clinical
Governance
Prisons
Nurses/Doctors
Meetings
Clinical
Effectiveness and
Audit Group
Clinical Best
Practice and
Standards Group
Tissue Viability
Working Group
Mental Health
Quality and
Practice Group
Children’s
Services and
Safeguarding
Minor Injury Units
Specialist Nurses
Health Visitors
Consultant Nurse
Allied Health
Professionals
Matrons
Working Groups
Mental Health
Team Leads
Project
Education and
Training
Operational Links
Estates
Safety of Equipment/
Environment
31 March 2011
26
Dorset Community Health Services, Quality Account 2010/11
Professional
Practice Advisory
Group
Non Medical
Prescribing Group
Resuscitation Group
Mental Health Act
Hospital Managers
Committee
Community
Hospitals
Community
Services
Delivering the Highest Standards of Patient Care in the Safest Environments
This framework demonstrates the involvement of Dorset Community Health Services staff at
all levels in the organisation and ensures “ward to board “ assurance. Activity relating to
quality monitoring occurs regularly and frequently with meetings and reporting happening ,
monthly, bi-monthly or quarterly. Minutes, reports and actions are recorded and followed up
to ensure that progress is made. Internal processes scrutinise and challenge the evidence
presented in order to confirm validity .Regular (quarterly) reviews of performance with NHS
Dorset takes place and review by the Care Quality Commission is an ongoing process.
27
Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
PART 3
3.1
REVIEW OF QUALITY PERFORMANCE IN 2010-11
This section contains a report on Dorset Community Health Services quality performance
2010-11, offering an opportunity to understand the quality of services in areas specific to our
organisation. It will also outline who has been involved and engaged with to determine the
content and priorities within the Quality Account. Finally it will include statements from
Dorset Community Health Services commissioners, LINks, including an explanation of any
changes made to the final version as a result of these statements
3.1.1 PRIORITIES FOR IMPROVEMENT 2010-11
Last year four quality priorities were identified for specific emphasis within Dorset
Community Health Services. These were:
Priority 1
To improve our in year performance in relation to the number of
Clostridium Difficile infections by 50% from 26 to 13.
Priority 2
To Improve the way we capture our patient experience of our services
and translate patient feedback into quality improvements
Priority 3
To reduce the number of patient falls by 20% in 2010/2011
Priority 4
Improve the management of risk within mental health services
Progress against these priorities will now be reviewed.
28
Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
Priority 1 2010-11 To improve Our in Year Performance in Relation to the
Number of Clostridium Difficile Infections by 50%
o
Description
This was a priority because of the number of patients contracting Clostridium difficile in
2009-10. From monitoring of infection rates the number of patients contracting Clostridium
difficile was 26.
o
Aim/Goal
Our aim was to reduce our Clostridium Difficile infection rate by 50% in 2010/11.
o
Review
This has been achieved.
o
Prevailing Situation in 2010
Rate of Clostridium Difficile year on year 2007 to March 2010
o
How have we achieved this?

The development of induction and core infection prevention and control training, to
be delivered to all staff.

Early and prompt isolation procedures and treatment where possible Clostridium
difficile infection is indicated.

Deep clean of patient environments and investment in hydrogen peroxide sterilisation
machines, to assist in cleaning post outbreaks and for assistance with routine deep
cleaning.

Structured review of care provided to all patients that acquired Clostridium difficile
infection whilst in hospital, and improved prevention through identification of patients
using risk assessment tool.
o
How are high standards being maintained

Regular monitoring and review of antibiotic prescribing.

Continue Robust deep cleaning programme throughout 2010/2011 in all in patient
areas.
29
Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments

Ongoing training for all staff, including prevention and treatment of Clostridium
difficile.

Root cause analyses of clostridium difficile confirmed cases reported via governance
and quality systems
Priority 2 2010-11 To improve how we capture our patient experience and
translate feedback into quality improvements
o
Description
This was a priority because although there was considerable good practice in building
intelligence from our patients, and using this to improve our practice, there was no strategy
in place to order and coordinate our organisation‟s vision and practice. In addition, Dorset
Community Health Services were committed to develop and improve our processes for
gaining feedback and experience in service developments, redesign and making
improvements on what matters to patients.
o
Aim/Goal
The aim was to implement fully our patient experience strategy and timetable for capturing
patient experience across our services and involve patients and the public in the monitoring
and development of services.
o
Review
This has been achieved
o
Prevailing Situation in 2009-10
We were involved in the Local Involvement Network (LINk), which is a network of people
who use Health and Social Care services, and including individuals, groups and local
community representation. The LINk offers local services a valuable connection with the
wider community and their views and priorities for those services. Dorset Community Health
Services continued to work with LINk as a means for establishing effective patient and public
involvement.
Our Mental Health Services had established a real partnership with Dorset Mental Health
Forum, an independent charity employing service users and people with mental health
problems providing information and signposting for mental health service users and their
carers, as well as for other interested parties such as members of the general public and the
statutory services. Members of the Mental Health Forum had been invaluable in feeding in
experiences and advice in the planning and commissioning of mental health services.
o
How have we achieved this?

We have implemented fully our Patient Experience and involvement strategy with a
planned programme and timetable of patient experience surveys.

We have begun to adopt and spread the good practice of the mental health services
working in partnership with the Dorset Mental Health Forum into community services
by identifying similar patient forums and groups.
30
Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments

We have worked towards embedding across all our services key initiatives for patient
care such as the Essence of Care Programme, Confidence in Caring programme and
Patient Safety First Campaign.

We have delivered a ward to committee wide assurance system for reporting overall
patient/service user and carer satisfaction, experience and feedback

We have included patient experience as a component of the organisations induction
programme.

Patient experience awareness raising material has been designed and produced and
is available to managers to cascade to their teams.

Dorset Community Health Service staff have continued to participate in customer
care training which has linked to Confidence in Caring.

Patient safety first campaign has been followed.

We have established a patient experience steering group that includes staff from
physical and mental health services, adult and children‟s community settings,
community hospitals, Dorset wide services, training and development, corporate
functions and service user membership.

We are encouraging staff to share information about patient experience with the
public, in order to demonstrate our commitment and actions to improve patient
experiences e.g. feedback displays in community hospitals.

Monitoring of patient experience indicators has been included onto quality
dashboards
o
How are high standards being maintained?

Patient surveys, questionnaires and other tools are being refined and developed in
order to increase validity and reliability.

Increasing body of evidence on patient perspectives is making trend analysis more
meaningful.

We have reviewed training and development opportunities relating to improving
patient experiences and this is recognised as an area for further work.

Our annual Best Practice Conference, due in May 2011,has an underpinning theme
of patient experience.

Dorset Community Health Services is continuing to participate in national
requirements relating to patient surveys and Patient Related Outcome Measures.

Development of standard relating to patient involvement in their care, which is based
on work developed in our mental health services, is underway. It is anticipated that
this will be rolled out into other services within Dorset Community Health Services.

Development of standards for care underpinned by recognised quality measure,
Essence of Care, is underway.
31
Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments

We are developing ways of correlating patient experience data to strengthen our
evidence base on which to base quality improvements such as patient survey
responses compared with complaints and compliments.

Dorset Community Health Services is committed to The Principles of Nursing
Practice 2010, which includes features relating to the patient experience.

All staff continue to be subject to annual appraisals which include elements relating
to patient experience.
Priority 3 2010-11 To reduce the number of patient falls across all services
o
Description
This was a priority because of the number of adverse incidents relating to falls, and the risk
level on the corporate risk register. Data also indicated an increase from previous years
data.
o
Aim/Goal
The aim was to improve our in year performance in reducing the number of patient falls
across our services.
o
Review
Considerable valuable work has been undertaken with some degree of success. However,
there is more work to do in this area.
o
Prevailing Situation in 2009-10
Falls to patients were the top reporting adverse incident in DCHS. The risks associated with
falls were shown as a significant risk on the Corporate Risk Register.
Chart 1 below shows the numbers of reported injuries from falls, year to date, up to Quarter
3 2009/2010, compared against the same period in 2008/2009, showing an increase in the
overall number of falls from one year to the next.
32
Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
Chart 2 shows a comparison of fracture injuries on year to dates 2008/2009 and 2009/2010,
per 1000 bed days and by actual number.
Patient Falls with fracture injuries YTD Q3 0910 per 1000 bed days
4.5
4
4
3.5
3
3
3
3
2.5
22
2
22
2
2
2
YTD 0809 per 1K Bed Days
YTD 0910 per 1K Bed Days
Sum of YTD 0809
Sum of YTD 0910
1.5
1
1
1
1
1
1
1
1
1
1
1
1
1
0.5
0
0
0
0
0
0
0
0
0
Chalbury North &
South
Betty Highwood
Ward
Melstock House
Hanham Ward &
MIU
Cuthbury Ward
Stanley Purser
Ward
Canford Ward
Ryeberry Ward
Shaston/Ashmore
Ward
Wareham Ward
Willows
Castletown &
Communal areas
Fayrewood Ward
Langdon Ward
Radipole Ward
linden Adult
Inpatient
0
fracture
fracture
fracture
Adult
Mental
Community Hospitals
Older Persons Mental
Health
INJURY
Falls
o
How have we achieved this?

A falls lead with specialist knowledge is in post.

Training programme implemented for staff on falls risk assessment and management
to prevent patient falls.

Improved risk assessment processes by completion of falls screening and risk
assessment with an associated action plan, on admission and whenever the patients
condition changes.

Introduction of Falls and bone health policy and strategy

Work with medicines management team to review medications of inpatients who
have a history of falling.

Identification of factors contributing to falls that can be addressed corporately.

Detailed analysis of falls and preventative action undertaken to enable the
identification of specific themes and issues for individual wards to address.

Continued delivery of the falls and bone health training programme.

Slips Trips and falls campaign completed and Patient Safety first campaign
completed .
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Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments

Falls documentation working group established and currently developing
standardised falls documentation related to exercise and balance provision.

Fourteen events have been completed for National Falls Awareness Day in 2010
working in partnership with Partnership Older Peoples Project.

Continued engagement with the National Falls and Bone Health audit.

Participation in the National Falls Awareness Day campaign.

Continued analysis of all falls and action taken.
o
How are high standards being maintained?

Regular analysis with the falls lead and Matrons/sisters.

The Falls Lead attends in house falls groups to provide expertise.

Data has been provided to each area regarding falls and the trends – with liaison
with Lead as appropriate

Two community hospitals have been successful in securing funding for new, well
designed slippers and stock is in place and being used.

A protocol for falls and bone health has been developed for Nurse Practitioners in
community hospitals to use to ensure best practice guidelines are fully implemented

A comprehensive plan is in place where the Falls Lead visits the community hospitals
bimonthly and offers support advice and informal teaching.

Four half day falls/bone health training sessions are planned for July and September
with approximately 70 places at each session.

National Falls and Bone Health audit completed December 2010 – results available
April 2011.

Falls Lead continues to work closely with Risk Management support team regarding
reporting, identifying trends and monitoring outcomes/ RCA process and actions
specific to each area.

In addition we are undertaking work within the NHS South West Quality and Patient
Safety Programme- health community. This work is providing a framework for
implementing intentional rounding. This is a term used for a method of observation
and care intervention in a hospital setting.

Work is also underway with Partnership Older Peoples Project to develop a
community based „Better balance‟ scheme to encourage activity in older people.
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Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
Priority 4 2010-11 Improving the Management of Risk Across Mental Health
Services
o
Description
This was a priority because there was an identified opportunity to improve the risk
management process within Dorset Community Health Services. The belief was that the key
to effective risk assessment and management was to be achieved through effective
engagement strategies and the development of positive relationships between staff and
patients.
o
Aim/Goal
The aim was to ensure that all risk assessments within mental health services were subject
to timely review and provided a clear and concise plan. The plans would be developed in
collaboration with service users, carers and other relevant individuals or agencies.
o
Review
This has been achieved.
o
Prevailing Situation 2009-10
An audit of risk management plans conducted in late 2009 found that in 80% of cases, a
recent risk assessment of good quality had been carried out. However in 17.5% of cases
there was little helpful information in the risk management plan.
o
How have we achieved this?

Staff supported by team leaders in supervision and through training to develop more
collaborative approaches to risk assessment and management;

To continue to develop the role that recovery plays in Acute Care Recovery Services
– with a focus on development of alternatives to inpatient treatment for those in crisis,
by increasing the use of Crisis Response and Home Treatment services.

The recovery safety agenda is being addressed through the team leads programme
risk group.

The group have developed a statement defining the relationship between risk and
recovery and have also started developing guidelines for staff regarding collaborative
risk planning and how to record this on to SEPIA.

It is anticipated that this work will then dovetail with the risk training and supervision
strategy.

The supervision and governance policy requires direct supervision of risk
management.

Risk network and safeguarding networks are established.

Mental health and learning disability training has been developed and delivered.

Suicide prevention: ligature points audit in inpatient settings has been completed.
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Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments

Suicide review 2009-2010 has been updated 2010-11.
o
How are high standards being maintained?

Work has been undertaken to agree a position statement from the Wellbeing and
Recovery Partnership as follows. Further work is being done to develop this.
Wellbeing and Recovery Partnership: Risk Assessment, Management and Safety
Planning Position Statement
The Department of Health (2007) acknowledges that “the possibility of risk is an inevitable
consequence of empowered people taking decisions about their own lives”. NHS Dorset
Community Health Services recognise and support the importance of positive risk taking.
The key elements of recovery orientated approaches to risk assessment, management and
safety planning are engagement, collaboration, transparency and the promotion of an
individual‟s sense of control, sense of hope, and opportunities for the future (SCMH, 2009).
We believe the key to effective risk assessment and management is achieved through
meaningful engagement strategies and the development of relationships. The recovery
principles give us the approach to enable us to connect with a person‟s story and engage on
an adult to adult basis to develop safety plans whilst aiming to maximise a persons
opportunities to develop and grow.
The assessment and management of risk should be, where possible, a collaborative
undertaking and a sharing of responsibility around the management of risk between the
person, any supportive relationships that they have and the staff team and any other people
or agencies involved with them. It is important that the views of the person and their
supporters regarding risk are acknowledged, and that there is effective information sharing.
There will be times that services may deem that a person is not be able to or wish to make
informed decisions around their own risk management. It is important that in these situations
that any advanced decisions are taken into consideration. People should be encouraged to
develop advanced decisions when they are not in crisis, which outline what an individual
would wish to happen. As a person becomes more able to make effective decisions about
their risk management, that responsibility is shared.
During the process of risk assessment and management conflict and disagreement may
arise. When this occurs our approaches should still be underpinned by the values of
recovery and we should be transparent as far as possible. Disagreements should be noted
and solutions, where possible, are worked towards. It is central that the staff are sufficiently
skilled to support the more effective management and self-management of risk.
Even when people are unable or unwilling to make decisions about protecting their own
safety or the safety of others it is important that services maintain engagement and
proactively aim to maintain and develop relationships and offer relevant choices and uphold
the guiding principles of the Mental Health Act (1983, as amended 2007) and Mental
Capacity Act (2005).
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Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
3.1.2 OTHER MEASURES OF QUALITY 2010-11
Further measures of quality and how we are working to improve across the organisation
includes;
Patient Safety
In order to promote the safety of our patients we engage with a range of national and local
initiatives such as:
o
Patient Safety First Campaign
The National Patient Safety First campaign is a recognised national approach to improving
the safety of patients within NHS organisations. Dorset Community Health Services has
signed up to the campaign and therefore a commitment to taking action to make it the
highest priority.
As part of this commitment a schedule of visits was prepared for the introduction of “safe and
sound” Walkarounds. During the walkaround, the site and leadership team highlight both
strategic and local patient safety issues, developing them into an action plan with immediate
and long-term actions. Initial feedback from those involved was very positive. These
Walkarounds have been in place since April 2010. There has been one event per month.
All our community hospitals have received a visit in this year.
The aim of these leadership safety visits is to ensure a safety partnership culture, paying
attention to staff safety concerns and addressing safety issues demonstrates an
organisation‟s support for staff in implementing safe care and promoting high quality.
o
National Patient Safety Week 15–21 November 2010
Dorset Community Health Services participated fully in the National Patient Safety Week,
which was to make the safety of patients everyone‟s highest priority by encouraging NHS
Trusts to help raise awareness locally about their own commitment to patient safety by
sharing good practices, experiences and providing expertise.
The Patient Safety week was led by the Dorset Community Health Services Patient Safety
and Risk Management Team and focussed on a series of road-show visits to Community
Hospitals based on geographical locations. Safety Advisers, Patient Safety Leads and the
Trust Falls Lead covered the following key topics:

Needlestick and Sharps awareness

Falls awareness

Pressure Ulcer prevention

Online AIRS reporting and Root Cause Analysis

Health and Wellbeing programme for mental health

Infection control: hand washing technique
37
Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
o
NHS South West Quality and Patient Safety Improvement Programme –
Health Community
Dorset Community Health Services is a full member and signed up to the NHS South West
Quality and Patient Safety Improvement Programme. This covers achieving improvements
in patient safety and quality of care building on existing safety initiatives such as the Safer
Patient Initiative, Leading Improvements in Patient Safety, the National Patient Safety First
Campaign and other improvement initiatives.
This programme includes a “health community” programme. This includes dimensions
within the National Quality, Innovation, Productivity and Prevention (QIPP) Safe Care
Strategy (now known as „Safety Express‟), and links with the Institute for Innovation and
Improvement Productive Series, and High Impact Actions, which are all initiatives aimed at
improving quality of care for patients.
Key areas of focus within Dorset Community Health Services are;

Reduction in pressure ulcers

Reduction in catheter associated urinary tract infections

Reduction in avoidable falls

Improved recognition and management of the deteriorating patient

Improved risk management relating to Venous Thromboembolism.
The approach used involves making small changes that affect clinical practice, testing that
the change is effective in making an improvement to patient care and to then spread this
learning to a wider area. This enables rapid evaluation of change in order to ensure that
substantive change is implemented and quality of care improves. Patient involvement and
patient experience is a feature of any improvements, so working with our patients/clients is
an important feature of the programme.
Teams in community services, mental health and community hospitals are participating in
this work.
o
NHS South West Quality and Patient Safety Improvement Programme –
Mental Health
This is a similar approach to that described above, but with areas of work identified as more
relevant to mental health care settings.
Within Dorset Community Health Services priorities for the mental health programme that
have been identified as:

Communication at transition points e.g. discharge or transfer of care

Improving Medicines Management issues

Strengthening leadership and culture to make patient safety a priority.
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Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
Monitoring for both of the above programmes occurs through our internal governance
reporting systems ensuring that progress is made and that tangible quality improvements are
achieved over the coming year.
o
Early Warning Trigger Tool
Dorset Community Health Services has implemented across its community hospitals the
Early Warning Trigger Tool. We were one of the first community health services
organisations to implement this tool and we are a full member of the South West Strategic
Health Authority team developing this tool.
The Early Warning Trigger Tool is designed as an aide to understand and act upon the
precursors of under-performance at ward level, and so safeguard the safety and quality of
care that our patients receive.
The Early Warning Trigger Tool helps organisations identify failing wards and clinical care
and engages the front line clinical team in reflecting on issues that may impact on the quality
of care experienced by patients. Ward Sisters and Matrons use the tool and report their
results up to Board level using governance and quality systems. The tool provides ward to
board assurance on clinical standards of care and potential clinical failures can be mitigated
against.
Patient Experience
Ensuring a positive patient experience is a key feature in our approach to delivering a high
quality service to our patients, service users and their carers. We strive to work closely with
our partners and those who receive our services. We seek a genuine understanding of what
is important, what is good and what needs improvement from feedback and views. We work
hard to ensure that the experience of care is enhanced as a result. There follows some of
the examples of how we do this.
o
The Dorset Wellbeing and Recovery Partnership
The Wellbeing and Recovery Partnership is a partnership between Dorset Community
Health Services, Dorset Healthcare University NHS Foundation Trust, and Dorset Mental
Health Forum. Dorset Mental Health Forum is a third sector organisation run and staffed by
people with lived experience of mental health problems.
The Partnership was started in April 2009 between Dorset Community Health Services and
Dorset Mental health forum, and since October 2010 has included Dorset Healthcare
University NHS Foundation Trust . It is a nationally recognised project which seeks to
develop innovative approaches to healthcare delivery.
The purpose of the Partnership is to put the principles of wellbeing and recovery at the heart
of service provision and design in order to improve the experience of people who access the
service, their supporters (carers) and staff.
This means a move away from traditional approaches to mental health care and focusing on
a person‟s strengths and ability to self-manage, to go on to building the life that they wish to
live. It is about inspiring hope and challenging the stigma associated with mental health
problems. A key part of this is utilising the expertise of those people with lived experience.
This is why the involvement of Dorset Mental Health Forum is so important to the
Partnership as they are able to share their experience and expertise in helping to shape and
deliver services in a way that best meets the needs of people with mental health problems.
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Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
In January 2011, the Partnership was recognised as a national demonstration site for
Implementing Recovery: A Methodology for Organisational Change (ImROC) by the Centre
for Mental Health, the National Mental Health Development Unit, and the NHS
Confederation. The ImROC project team stated:
“There are very strong partnerships with local user groups and genuine ‘co-production’ of
service review and quality improvement. The Partnership has made good progress
regarding several of the ImROC,’10 Key Challenges,’ particularly regarding the development
of peer support workers, the ‘Hidden Talents’ programme to reduce stigma for staff who are
prepared to disclose their own histories of mental distress, and they are in the process of
developing service users as ‘mentors’ for consultant psychiatrists.
o
Complaints and Compliments Management
Dorset Community Health Services welcomes feedback from the public about our services
and care we deliver. As an organisation we recognise this feedback to be an opportunity for
improvement as, by knowing what is important to our patients and service users and hearing
about their experience, we are more able to make improvements for the future.
We have a process for collating and monitoring compliments about our services, so we can
understand what we are doing well and we can build on this.
Although we strive to offer the best care, sometimes we fail to deliver the high standard we
set for ourselves. All complaints about care delivered by Dorset community Health Services
are taken seriously. We always investigate thoroughly and have a process that manages
this, ensuring communication with the complainant and with the staff concerned to ensure
that we learn lessons and take action to improve. Complaints, investigations and action
plans are monitored and reviewed at various levels in the organisation, with due attention to
confidentiality, through our integrated governance framework and, where appropriate,
learning is spread across the organisation.
In 2010-11 77 complaints were received and managed, during the same 1470 compliments
were reported.
o
Community Hospital Inpatient Survey
The Community Hospital Inpatient Survey was developed in summer 2010, in line with
Dorset Community Health Services Patent Experience Strategy. This survey is a
questionnaire targeting patients on the point of discharge from our ten community hospitals,
in order to gather their views on their experiences as patients in our care.
This data is analysed and reported locally to the individual hospitals, so that staff can reflect
on the findings and implement quality improvements to enhance the quality of care and to
learn from what is going well and where improvements are indicated. In addition, an
additional report reflects on the overall patient experience across all of our ten community
hospitals and this enables trend analysis and comparisons with other data, such as the early
warning trigger tool, or patient complaints to add to the overall picture of quality in our
community hospitals.
The questionnaire consists of 31 questions which focus on:

Privacy and Dignity

Cleanliness
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Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments

Food

Care and Treatment
During 2010-11 this survey has been carried out three times and local action plans have
been implemented as a result.
We strive to be honest and open about our performance and so we have begun displaying
our progress on key quality indicators in our community hospitals, and our results for the
patient survey are included in this.
We remain vigilant in seeking to increase our understanding and abilities to capture the
patient experience and to translate this information into tangible improvements in the quality
of care we offer.
o
Quality of the Care Environment
The quality of the care environment is an important issue for our patients and service users
and their carers. The management of the care environment is supported by Dorset
Community Health Services in house Estates and Facilities teams, the Estates team is
managed centrally whereas the Facilities team has a centrally based professional head but
are managed locally by the individual sites matrons.
The quality of the Estates environments is measured in a number of ways both formally and
informally.
Dorset Community Health Services completes an annual Estate return to the Department of
Health called the ERIC (Estates Return Information Collection). This is a mandatory data
collection completed by all NHS organisations the results of which can be used to
benchmark the organisations Estates performance against local and national organisations.
Specific areas of the Trust environment are quality assured by having consultant specialist
retained as „Authorising engineers‟ there role is independently oversee the way that the
Trust Estates team manage risks, one example of this is the water hygiene work (Legionella)
policy. The Authorising Engineer (Water) is currently carrying out an audit of all the Trusts
water systems to ensure compliance and scalding risks.
The Estates team have recently commissioned an updated Asbestos survey in all trust
premises, the results of which will continue to inform the organisations Asbestos policy.
One section of the Estates Department is a team of Painters, this enables the trust to ensure
that the building fabric is maintained to a high standard via a rolling painting program.
As a cross over from the Estates to the Facilities standards the Trust completes its annual
Patient Environment Action Team (PEAT) inspection during January, February and March of
each year, the process is that a group of staff made up from the Facilities Manager, Estates
Manager, Matron (not from the unit being inspected, Infection Control Manager,
Housekeeping Manager (not from the unit being inspected) and a patient representative visit.
This team visit each site with inpatient beds to gain an overview of the cleaning and
environment standards the result of which are published around May/June. The PEAT will
also focus on the patient‟s experience, food, privacy‟s and Dignity and hydration.
41
Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
Patient Environment Action Team results for our organisation for 2010 are as follows:
Environment Score
Food Score
Privacy and
Dignity Score
Good
Excellent
Excellent
Westhaven Hospital
Excellent
Excellent
Excellent
Portland Hospital
Excellent
Good
Excellent
Bridport Community Hospital
Excellent
Excellent
Excellent
Blandford Community Hospital
Excellent
Excellent
Excellent
Forston Clinic, Herrison
Excellent
Excellent
Excellent
Good
Excellent
Excellent
Westminster Memorial Hospital
Excellent
Excellent
Excellent
Yeatman Hospital
Excellent
Excellent
Excellent
Wareham Community Hospital
Good
Excellent
Excellent
Wimborne Community Hospital
Excellent
Good
Excellent
St Leonard‟s Community Hospital
Good
Good
Excellent
Swanage Community Hospital
Good
Excellent
Excellent
Site Name
Weymouth Community Hospital
Linden, Weymouth
This information is fed back to the managers and staff who are responsible for the services
offered to patients and service users in the respective areas, so any actions can be taken to
make improvements.
Six monthly independent cleaning audits are carried out in all inpatient units with the results
tabled at the Infection, Prevention, Control and Decontamination meetings. Each inpatient
unit is also expected to carry out its own monthly cleanliness audits and feed those results
back to the Facilities manager who presents the results the Infection Prevention, Control and
Decontamination meetings.
Clinical Effectiveness
It is imperative that we ensure that Dorset Community Health Services‟ care is clinically
effective. In order to achieve this we ensure that

We implement the best practice

We utilise research based evidence

We monitor our practice to ensure standards are maintained

Our staff are well trained with the competencies to deliver high quality care to
our patients and service users

Our staff are engaged and committed to our organisational values in relation
to delivering high quality person-centred care.
Examples of how we do this follows.
42
Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
o
NICE Quality Standards
The purpose of NICE (National Institute for Clinical Excellence) Quality Standards is to make
it clear what quality care is by providing definitions of high-quality clinical and cost-effective
care. In addition the standards can support benchmarking of performance and provide
information to patients and the public about the quality of care they can expect.
Pilot topics 2009/10 were published in June 2010 covering stroke, dementia and prevention
of venous thromboembolism. NICE aims to develop a library of up to 150 standards over the
next five years.
NICE Quality Standards are not mandatory, but are seen as a tool that can be used to
secure continuous quality improvement. Dorset Community Health Services sees this as a
positive opportunity to consider NICE quality standards that are relevant to the services it
provides as a way of benchmarking and guiding service improvements.
Work in all of these three initial NICE Quality Standard areas is underway. Monitoring of
those standards that are relevant to our services will be managed via the Clinical Audit and
Effectiveness Group and within the Clinical Best Practice and Standards Group working with
others as required. It is intended that this work will compliment and build on activity that
relates to other key initiatives eg implementation of NICE guidance, national strategy
implementation, regional network developments and best practice evidence etc.
o
Hospital Standardised Mortality Rate Audit
The Hospital Standardised Mortality Ratios (HSMR) report produced in 2009 by Dr Foster
has been used as a tool to reduce patient harm and reduce mortality for patients in hospital.
This report provided a statistical calculation to monitor death rates in a healthcare
organisation.
As a result of this report Dorset Community Health Services was asked by its
commissioners, NHS Dorset, to produce an audit tool to review each death in our community
hospitals. This audit tool has been approved by NHS South West, Dorset Community Health
Services‟ Strategic Health Authority.
The audit has been applied quarterly throughout 2010-11 to review all deaths in our
community hospitals. The audit takes the form of a thorough multidisciplinary review of care
given to patients who have died whilst in our care and the purpose is to identify areas for
improvement in care given.
The HSMR audit has produced some valuable learning points for clinical staff. Audits in
2010-11 have helped to crystallise our understanding of where actions can be usefully taken
by highlighting areas for improvement in quality and in reducing mortality.
The quarterly HSMR audit will be continuing and, as the Quality and Patient Safety
Improvement Programme, which is described above, is implemented across the
organisation, improvements in practice, process and outcomes should be noticed and gaps
in practice monitored.
This work has the potential to drive significant improvements in practice and quality of
service to DCHS patients.
43
Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
o
Blues Group
The Blues group is a post natal depression support group which has emerged and
developed in relation to local health needs analysis and the need to improve clinical
effectiveness for a specific client group.
Traditionally Health visiting support for clients suffering from PND has been to offer “listening
visits” at home.
The requirement for ensuring clinical effectiveness encouraged staff to explore and develop
a more collaborative way to address the health needs of this client group, using a sound
evidence base. Research identified new and exciting ways to deliver a universal service
across GP practices using psychological therapies to enable this client group to share
experiences, normalise feelings and rediscover their individual identities.
Since its inception this group has developed, based on further review of the evidence base,
critical reflection on practice and linking with stakeholders, such as other professional groups
and the local Sure Start Centre.
The aims and objectives of the group were to provide an effective and efficient support
service that facilitated recovery from PND.

To use evidence based interventions to improve the outcome of women
suffering from PND.

Provide psychological support within a group setting.

To reduce the adverse effects of PND on the cognitive, emotional and
educational development of children.

Provide peer support.

The mothers to achieve self recovery.
The Group uses a mixture of cognitive behaviour therapy, raising self esteem, strategies for
dealing with stress, communication, challenging presumptions and negative thoughts and
humour, encouraging mothers to express their feelings in a safe and confidential
surrounding. The mothers often bond closely and strong friendships and networks are
maintained.
This work has evolved over time, building on success and continually improving the quality
of the service delivered. The work has been well evaluated with the client group and other
stakeholders.
This initiative was successful in being recognised in NHS Dorset Health and Social Care
Awards 2009-10 and continues to develop and improve with positive client evaluation.
Currently work is underway in relation to auditing outcomes over a longer period , particularly
following subsequent births and if friendships and support made within groups are
maintained.
44
Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
o
A Workforce Fit for Purpose
Within healthcare settings the quality of care has been directly linked to staff engagement
and commitment . Data relating to Dorset Community Healthcare Services from the annual
staff survey, which is part of the national survey across all staff in the NHS, is a useful
indicator of this engagement and commitment.
For 2010 a response rate of 68% was achieved. This is above average for PCTs with Mental
Health / Learning Disability Services in England and improves significantly on the response
rate of 59% for the 2009 survey.
The survey focuses on a series of staff pledges and additional themes:

Staff Pledge 1: To provide all staff with clear roles and responsibilities and
rewarding jobs for teams and individuals that make a difference to patients,
their families and carers and communities.

Staff Pledge 2: To provide all staff with personal development, access to
appropriate training for their jobs and line management support to succeed.

Staff Pledge 3: To provide support and opportunities for staff to maintain their
health, well-being and safety.

Staff Pledge 4: To engage staff in decisions that affect them and the services
they provide, individually, through representative organisations and through
local partnership working arrangements. All staff will be empowered to put
forward ways to deliver better and safer services for patients and their
families.

Additional theme: Staff satisfaction

Additional theme: Equality and diversity
Overall, the results of the NHS National Staff Survey for 2010 for Dorset Community Health
Services show positive improvements in staff experiences.
Those areas with least favourable scores will be included within the action plan templates to
be included within the Manager‟s Briefing Pack and these will be areas for improvement.
This work will be monitored throughout the coming year.
o
Staff Training and Development
The Learning Centre
The activity of Dorset Community Health Services„ Learning Centre is central in providing
and facilitating education and training for our staff, in order to meet DCHS related regulated
outcomes under The Care Quality Commissions (C.Q.C) Essential Standards of Quality and
Safety.
Staff development through education and training is a key part of clinical governance and
ensuring both staff and services are fit for purpose
Staff development is also an important element of the C.Q.C‟s core regulation related
outcomes and Essential quality and patient safety registration standards specifically Core
standard 4 Suitability of Staffing. A number of initiatives have commenced during 2010-11:
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Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments

A Nursery Nurse Workforce Plan for this staff group is currently underway
with a view to developing a competence based in house programme in order
to achieve a standard approach to the development of this role as Assistant
Practitioner.

Safeguarding Adult Training has recently received renewed impetus and is
offered to all trust staff. Ongoing joint work with the Local Authority is well
established, the plan being that by sharing services for this training this will be
will be mutually beneficial to both Health and Social Care in terms of aligning
and creating new ways of working.

The provision of Resuscitation training is a core responsibility of Dorset
Community Health Services and went through a major review in 2010. Plans
are in place to deliver Recognising the Deteriorating Patient which will link to
the existing Basic/Immediate Life support training that is provided to all
Clinical staff.

Dorset Community Health Services has its own NVQ Centre that provides a
comprehensive range of vocational education for our Bands 1-4 staff groups
and currently has in the region of 150 learners on a variety of programmes.
The Learning Centre is now preparing to deliver the new Quality Credit
Framework (QCF) Diploma programmes from this April which has replaced
the NVQ nationally.

Dorset Community Health Services is currently working towards ensuring that
all staff groups receive a minimum of Level 1 training in Safeguarding children
and young people. Those staff who require more in depth training receive this
as a component of their Core Mandatory Training.

The first programmes using the new pre-registration nursing standards will
start in September 2011 and all Universities are expected to be using them by
2013. The timetable for our local university is 2013. The main change is that
new entrants to the nursing profession will need to be qualified to degree level
before they can be registered to practise. DCHS work very closely with the
University around this and many other issues and will be heavily involved with
and influencing changes to the Nurse Training curriculum.

The Dorset Community Health Services Best Practice Conference is a
traditional annual event. The aim of the conference is to provide an
opportunity for the staff of the organisation to come together and showcase
new initiatives in relation to service development/ improvement that they have
been working on within their own areas. This year the theme of the
conference is patient experience, which will highlight our commitment to our
patients and the importance of understanding the patient‟s experience to our
core values and ambitions.

The Non Medical Prescribing Conference is an annual event that attracts not
only those working within Dorset Community health services but also Non
Medical Prescriber‟s across neighbouring Trust areas. The aim of this
conference is to provide an opportunity for staff to meet and discuss current
issues in relation to their prescribing practice. It also serves to assure the
commitment of the Trust to the Continous Professional Development needs of
Non medical prescribers. This year the them of the conference was “into the
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Dorset Community Health Services, Quality Account 2010/11
Delivering the Highest Standards of Patient Care in the Safest Environments
future” with a focus on quality, prevention and effectiveness as has occurred
in the previous four years the conference was over subscribed.

The need for Non Medical Prescriber‟s to receive ongoing support and
supervision during their first year of prescribing practice has been recognised
and a Preceptorship programme has been implemented over a twelve month
period with identifiable Non medical Prescriber mentors to support and offer
guidance to newly qualified non medical prescribers.

As part of the Trusts ongoing commitment to the development of its staff
coupled with the drive to maintain high quality and safe patient care the
annual appraisal process was reviewed in 2009 and a new model launched in
April 2010. Compliance is over 90%. From the appraisals the Learning
Centre is able to extract the Trust Training Needs (TNA) for the following year
which makes planning and budgeting for training more straightforward and
responsive to need and service development

The need for newly qualified nurses and Allied Health Professionals to
receive support in the form of preceptorship in their immediate postregistration period has been widely recognised. Dorset Community Health
Services has developed an in-house competency preceptorship programme
to support the practical application of essential skills in the clinical setting.
This is a twelve month rolling programme and is linked to the Knowledge and
Skills Framework which in turn is linked to accelerated pay points pending
successful completion of the programme.

With the continued requirement for ongoing quality assurance monitoring,
Mandatory Training continues to be of high importance within Dorset
Community Health Services with particular emphasis on uptake and
compliance. The allocation model for Mandatory Training was launched from
the 1 April 2010 whereby senior Managers are provided with their own
specific dates for their staff to attend the above. All Corporate Mandatory
Training provision has been identified as a priority in the first instance. This is
*Fire, Manual Handling, BLS, Infection Control and the Health and Safety
Essentials package. We are on target to achieve a compliance rate over 90%
for the year end.
SUMMARY
Dorset Community Health Services has performed well during 2010-11, setting ambitious
and challenging plans to improve quality and patient safety. In our Quality Account we have
reflected on a series of quality indicators and examples of quality performance achieved in
2010-11.
We look forward to the coming year and the opportunities that will invariably emerge as we
join with Dorset Healthcare University Foundation Trust. We will continue our aim of
achieving highest standards of patient care through working towards our joint quality
priorities for 2011-12 and continuing to embed quality as a core value in our organisation.
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Delivering the Highest Standards of Patient Care in the Safest Environments
Annex to Dorset Community Health Services Quality Account
Comments from our Lead Commissioning Primary Care Trust Local
Involvement Networks, Overview and Scrutiny Committee
The regulations require that Quality accounts must be published by 30 June following the
end of the reporting period. Comments by our lead commissioning PCT (NHS Dorset)
/LINks/Overview and Scrutiny committees are key to the Quality Account assurance
process.
Our draft report was sent to :
1.
Sally Shead, Deputy Director of Quality, NHS Dorset, Second Floor, West,
Vespasian House, Dorchester, Dorset DT1 1TS. The response from NHS Dorset is
as follows:
“NHS Dorset is pleased to comment on this Quality Account. Over the last year the
PCT has seen significant development in Dorset Community Health Services (DCHS)
focus on improving the quality of care provided to individuals accessing its services.
DCHS has focused on a number of key areas to improve the quality of services
provided, including improvements to patient safety and patient experience, and the
PCT acknowledges the improvements that have been made, particularly in reducing
the number of Clostridium difficile infections.
NHS Dorset has been working closely in partnership with the Community Health
Services Management Team to gain assurance that there are robust systems and
processes in place to ensure that quality is continually improved and that services
provided are safe and clinically effective for patients.
The PCT fully supports all of the work the Trust is undertaking to improve service
user feedback and experience as well as the excellent work being undertaken as part
of the NHS South West Quality and Patient Safety Improvement Programme.
The PCT agrees that there are many areas that can still be improved upon, and it
fully supports the Quality Improvement priorities and goals that have been set for
2011/12. NHS Dorset looks forward to working with the Community Services
Directorate within Dorset Healthcare NHS Foundation Trust, during 2011/12, to
deliver further improvement to the quality of services provided to patients within
Dorset.”
2.
Dorset Health Scrutiny Committee in conjunction with Dorset LINk, Dorset County
Council, County Hall, Dorchester, Dorset DT1 1XJ. The response from Dorset
Health Scutiny Committee, in conjunction with Dorset LINk, was as follows:
“The Dorset Health Scrutiny Committee and the Dorset LINk had limited engagement
with Dorset Community Health Services Trust on the Quality Report during 2010-11
and had discussed the Quality Report with them. The inclusion of the improvement of
care and management of dementia patients as a priority for improvement for 2011/12
was welcomed particularly in the light of the recent Dorset Health Scrutiny
Committee‟s review. The process for engagement with the Dorset Healthcare
University NHS Foundation Trust with regard to the Quality Account for 2011/12 had
been agreed as they would be responsible for the delivery of community health
services from June/July 2011. Dorset Community Health Services were
complimented on their patient involvement.”
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Dorset Community Health Services, Quality Account 2010/11