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Contents
Part 1
Page
Statement on Quality for Community Health Services
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Deputy Chief Executive’s Statement of Assurance
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Organisation’s Mission
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Part 2
Local services
8
Regulatory Bodies and Management of Risk
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Risk Management
Clinical Governance Review
Regulatory and Professional Bodies
Declarations
Equality, Diversity and Human Rights Legislation
Leadership and Development
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Key Leadership Priorities
Leadership Development Programme
Management Development Programme
Essential Training Programme
Transforming Community Services Overview
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Quality, Innovation, Productivity and Prevention Framework
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Supporting Statements for Partnership Working
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Links
Halton O&S
St Helens O&S
Patient Safety
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Infection control
Organisational Lessons Learnt
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Effectiveness/Productivity
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Lean Programme
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Service Achievements
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Speech and Language Therapy
Community Nursing Team (Children’s Services)
Halton Paediatric Speech and Language Service
Walk in Centres/Minor Injuries Unit
Halton Healthy Schools
Health Improvement Team
Halton Midwifery Service
Organisational Effectiveness
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National Institute for Health and Clinical Excellence (NICE)
New Policies and Clinical Guidelines
Managing Attendance, Health and Wellbeing in the Workplace
Emergency Preparedness
Patient Experience
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Clinical Audit and Research Programmes
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Clinical Audits
Health Improvement Team Research Overview
Practice Development and Research Partnership
Performance Framework
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Data Quality
CQUIN
Telehealth
Paris Implementation
Quality Improvements for 2011/12
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3
Quality Account 2010/11
Part 1
Statement on Quality for Community Health Services
The purpose of the quality account is to demonstrate the trust’s commitment to
improving quality and safety for the people who use our services.
This is the first Halton and St Helens Community Health Services Quality Account,
which focuses on the quality of service the organisation offers to the population of
our Boroughs. In this document we outline our performance and some of our
achievements during 2010/11 and set out our priorities for quality improvements in
2011/12.
Halton and St Helens Community Heath Services provides services to its resident
population of 295,800 (118,700 in Halton and 177,100 in St Helens according to the
2009 mid year population estimates published by the Office for National Statistics)
and to those who live outside the borough but who are registered with GPs in Halton
and St Helens.
Our gross turnover for 2010/11 was £64.2m (2009/10 £62.0m) and a surplus of
£0.2m (2009/10 £1.4m) was achieved. The contractual income from Halton and St
Helens Primary Care Trust equated to £55.5m with additional income of £8.7m
received from a variety of commissioners including other PCTs and local authorities.
Expenditure on pay equated to £43.33m and the balance of £20.87m was spent on
non pay including estate and informatic costs. The income generated by the NHS
services reviewed in 2010/11 represents 93.5% of the total income generated from
the provision of NHS services by Halton and St Helens Community Health Services
for 2010/11.
We aim to provide excellent care close to, or at home, which is integrated to deliver a
positive patient experience, promote independence and improve health outcomes.
We place a great emphasis on involving patients and the public in designing our
services, and are dedicated to providing dependable, caring, safe and respectful
healthcare to local people.
Our services have delivered a number of recent success stories, including reduced
waiting times, improved access to care and the opening of new state-of-the-art
facilities. We have also enjoyed success at regional and national award ceremonies,
highlighting our forward thinking approach to improving the health of our local
community.
We continue to be impressed by the commitment and dedication shown by our staff
to providing high quality care to patients and service users. The contribution made by
each and every one of them has enabled us to achieve the standards and service
improvements set out in this report, some of which are also highlighted below.
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The adoption of Lean methodology by 18 teams has led to service
improvements within the diabetic retinopathy patient recall centre, St Helens
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cardiac and healthy heart team, school nursing teams and the community
children’s team.
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The recruitment of volunteers by the adult speech and language therapy team
to carry out specific therapeutic and administrative tasks has improved the
delivery of the service.
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The Halton paediatric speech and language service has offered training to
parents to work as Speech and Language Therapy Assistants.
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A targeted social marketing campaign to tackle obesity – ‘Moment of Truth’ has led to the development of a simplified weight management referral system
and increased uptake of weight management services.
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An immunisation campaign by community nurses in St Helens has enabled
300 additional children to be immunised and therefore protected from lifethreatening diseases.
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Halton Healthy Schools Programme has exceeded national targets and all
schools in the area have now been awarded the National Healthy Schools
status.
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The multi-award winning ‘Get checked’ early detection of cancer programme
has continued to deliver significant increases in presentation to GPs with
suspicious cancer symptoms, and has been appointed as a national pilot site
by the Department of Health and Cancer Research UK.
From April 2010, we were required by law to register with the Care Quality
Commission. This system requires organisations to show they are meeting essential
standards of quality and safety across all of the regulated activities they provide and
that people can expect services to meet essential standards of quality and safety
that respect their dignity and protect their rights. We are pleased to report that
Halton and St Helens Community Health Services was granted full registration with
no conditions attached.
We have sought the views of Halton and St Helens PCT, our main commissioner, on
the accuracy of the information provided in this Quality Account and have included
their written statement verbatim. We have also invited voluntary comments from the
Halton and St Helens Local Involvement Network and Overview and Scrutiny
Committees and where these have been provided they are also incorporated
verbatim into this document.
John Jones
Chief of Operations
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Deputy Chief Executive’s Statement of Assurance
The period 1 April 2010 to 31 March 2011 has been challenging for the trust. Halton
and St Helens Community Health Services has performed well during a period of
significant reorganisation and organisational change.
Community Health Services is committed to providing continuous improvement in the
quality of its services for the registered population, and has worked in partnership
with its commissioners, Local Authorities and General Practitioners during this period
to ensure the health needs of the local population are met.
My assessment of the quality of service provision we provided in 2010/11 is informed
through debate and reports received via the Board and its sub-committees, namely
the Clinical Commissioning Committee, Clinical Governance Committee, Audit
Committee and the Finance Performance and Approvals Committee. Alongside this
there have been other independent assessments against key areas of control.
The year 2011/12 continues to present challenges for the PCT with the focus now
being on transition to GP Commissioning Consortia, the development of the PCT
Cluster arrangements and delivery of the sustainability plan whilst retaining focus on
quality services for our local population.
I can confirm on behalf of the Board that to the best of my knowledge and belief the
information contained in this Quality Account is accurate and represents Halton and
St Helens Community Health Services’ performance in 2010/11 and priorities for
continuously improving quality in 2011/12.
Christine Samosa
Director of Workforce & Organisational Development / Deputy Chief Executive
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Organisation’s Mission
“Our Contribution to the wellbeing of the people we serve in Halton and St Helens is
to enable them to have the best possible health and healthcare.”
Our Values
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Patients and public first
Accountable
Respectful and sensitive
Transparent with integrity
Nurturing teamwork
Engaging
Recognition
Successful
Holistic
Innovative
Partnership
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Part 2
Local Services
During 2010/11 the Halton and St Helens Community Health Services provided the
following core services as listed below and subcontracted seven NHS services. For
ease of review they are split into divisions.
Children and Families
Audiology (Halton)
Audiology (St Helens)
Child and Adolescent Mental Health Service (CAMHS) Paediatric Liaison (St Helens)
Child Community Nursing
Child Development Team
Community Paediatrics
Halton Community Midwifery
Health Visiting (Halton)
Health Visiting (St Helens)
Paediatric Speech and Language
Physiotherapy and Occupational Therapy
Primary Child and Adolescent Mental Health (Halton)
Safeguarding
School Nursing (Halton)
School Nursing (St Helens)
Sure Start Parr
Sure Start Phoenix
Community Nursing
Adult Continence
Community Matrons
District Nursing (Halton)
District Nursing (St Helens)
Intermediate Care Assessment Team
Intravenous Therapy
Macmillan Nurses
Out of Hours Nursing
Paediatric Continence
Phlebotomy
Rapid Response (St Helens)
Rapid Access and Rehabilitation Service (RARs) (Halton)
Reablement (St Helens)
Tissue Viability
Treatment Rooms
Health Improvement
Adult Weight Management, Health Trainers and Men’s Health
HIT - Alcohol
Mental and Sexual Health
Older People’s Services
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Paediatrics - Children and Young People
Paediatrics - Early Years
Smoking Cessation
Mental Health and Lifestyles
Alcohol
Cardiac Rehabilitation (St Helens)
Community Stroke
Harm Reduction
Heart Failure (Halton)
Heart Failure (St Helens)
Homeless Health
Open Mind
Primary Care Mental Health
Newton Community Hospital
Newton Community Hospital Inpatient Services
Newton Community Hospital Outpatient Services
Urgent Care and Therapies
Adult Speech and Language Therapy
Chronic Pain Rehabilitation
Dental
Falls Prevention
Halebank Access Centre
Halton Adult Community Therapies
Halton Integrated Community Equipment Services
Halton Podiatry
Neurological Rehabilitation
Occupation Therapy for Assistive Technology
St Helens Walk in Centre/Minor Injuries Unit
Wheelchairs
Widnes Walk in Centre
Windmill Hill Access Centre
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Regulatory Bodies and Management of Risk
Risk Management
The trust has continued to develop and embed its risk management arrangements
during 2010/11. The Board Assurance Framework has been regularly updated and
reviewed by the PCT Board.
Community Health Services has continued to establish its own arrangements for
governing the way it operates and how it manages risks. Risks and performance
issues have been reported to the Transforming Community Services Committee – a
sub committee of the PCT Board – on a monthly basis.
Services have continued to develop and populate risk registers to ensure all their key
risks at an operational level have been identified and appropriate controls
established. The trust utilises a risk management package called Performance
Accelerator to ensure all risks are managed to a common format.
To support the risk management framework within Community Health Services, a
Corporate Performance Group has been established to monitor key performance
issues such as compliance with risks and essential standards of safety and quality.
The health and safety team continues to provide staff with health and safety and fire
safety training both throughout the year and at induction. Our Health and Safety
Advisory Group has met throughout the year to review the effectiveness of the
arrangements we have in place and provide a consultative forum for new policies,
procedures and initiatives.
In response to calls by our staff for greater protection while working alone in the
community we introduced more than 650 lone worker devices. These devices enable
direct monitoring of staff who can raise the alarm if they feel threatened, at risk of
assault or experience difficult situations that put them in danger. We place great
emphasis on staff safety and currently have the highest number of these devices in
use in the North West.
We have continued to provide general health and safety awareness training and
practical manual handling training during the year to both clinical and non-clinical
staff. A programme of refresher training in conflict resolution has been initiated this
year for front line staff and this will continue into 2011/12.
Clinical Governance Review
A clinical governance review took place during 2010/11. The purpose of the review
was to ensure that the organisation delivered safe, well managed interventions and
that patients received the right outcome, at the right time, from staff who were
committed to providing quality care. The main areas covered were:
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Clinical policies, clinical guidelines and operating procedures for each division
Clinical supervision
Clinical audit and effectiveness
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Mandatory/essential training
Quality improvement visit
Quality standards and key performance indicators
During the review the integration into Ashton, Leigh and Wigan Community
Healthcare NHS Trust took place and the areas of work covered by the clinical
governance review are now integrated into the governance arrangements of the new
organisation.
Regulatory and Professional Bodies
Care Quality Commission (CQC) - Registration
The trust maintained its registration with the Care Quality Commission - without any
conditions or restrictions being applied - to deliver the full range of services across
the following regulated activities:
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Treatment of Disease, Disorder or Injury
Nursing Care
Surgical Procedures
Diagnostic or Screening Services
Midwifery or Maternity care
Family Planning Clinics
All our services report on compliance against the 16 essential standards of quality
and safety on a monthly basis. To provide greater assurance to our management
team on the reporting undertaken by services, we introduced an independent
validation process to review the compliance statements made by services. This
information, together with the CQC Quantified Risk Profile, provides us with a greater
level of assurance that we have effective arrangements and processes in place to
protect patients.
Care Quality Commission - Inspection
Each year CQC undertake a series of thematic inspections on specific areas to
ensure that organisations are focused on the key areas that affect the health and
wellbeing of patients. In 2010/11 CQC undertook an inspection of Halton Borough
Council in relation to how well Halton was:
 safeguarding adults whose circumstances made them vulnerable
 improving the health and wellbeing of older people, and
 increasing choice and control for older people.
In November 2010, CQC published its report and commented that Halton was:
 performing well in supporting improved health and wellbeing of older people
 performing excellently in supporting increased choice and control for older people
and that overall, Halton’s capacity to improve was Excellent.
CQC commented:
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‘The council worked well with other agencies in supporting older people and their
carers, including those with complex needs’.
As one of its key partners, the trust was pleased to be able to support the local
authority in demonstrating the collaborative efforts that both agencies had
undertaken to ensure the best outcomes for older people living within Halton.
Patient Safety Incidents
The trust reports all patient safety incidents that arise out of our activities and service
delivery to the National Patient Safety Agency (NPSA). In 2010/11, 458 incidents
were reported to the NPSA, 98% of which were graded either no harm or low harm
(requiring first aid).
Safeguarding Children and Adults
The organisation works in partnership with the two local authorities, Halton Borough
Council and St Helens Metropolitan Borough Council, in delivering the requirements
of the safeguarding agenda. There is integration at all levels of safeguarding from
Board members to front line practitioners.
Ofsted inspection of Children’s Safeguarding and Looked after Children
Service in Halton
This inspection was carried out in February 2011 and Ofsted and CQC judged the
overall effectiveness of safeguarding services and services for children in care as
both being ‘good’ with ‘outstanding’ capacity for improvement.
Health and Safety Executive (HSE)
As an organisation we are required to report all major incidents and dangerous
occurrences that are connected with our activities to the Health and Safety
Executive. In 2010/11 there were no major injuries or dangerous occurrences that
led to us having to inform the HSE.
The organisation was not subject to any enforcement action being applied by the
HSE.
Fire and Rescue Authorities
We operate from over 40 premises which are both visited by patients and the public
for the delivery of healthcare and also provide corporate office space for staff. The
risk of fire is one of our key concerns. There were no major fire incidents within the
trust during 2010/11 and the trust was not subject to any fire enforcement action.
Information Governance Toolkit Attainment Levels
Halton and St Helens Community Health Services’ Information Governance
Assessment Report overall score for 2010/11 was 60% and was graded ‘not
satisfactory’.
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Information Commissioner
As a trust we are required to report to the Information Commissioner any serious
information governance incidents that are categorised at severity level 3 or above.
Although we identified and investigated a number of serious untoward incidents
relating to the management of information that are summarised in the table below,
none of these incidents was categorised at level 3 or above, and therefore no reports
were sent to the Information Commissioner’s Office (ICO).
Summary of Other Personal Data related Incidents in 2010/11
Category
Nature of Incident
I.
Loss/theft of inadequately protected electronic
equipment, devices or paper from secured NHS
premises
II.
Loss/theft of inadequately protected electronic
equipment, devices or paper from outside secured
NHS premises
III.
Insecure disposal of inadequately protected
electronic equipment, devices or paper documents
IV.
Unauthorised disclosure
V.
Other
Total
1
2
0
1
0
Midwifery Service Supervisory Nursing Assessment
All midwifery services in the UK are audited annually against national supervisory
standards which measure the quality of care. A visit by the regional midwifery officer
every year provides an opportunity to examine the evidence, speak to the midwives
and also hold a focus group with the women who receive this care. We are pleased
to report that our annual assessment produced positive assurance that we are
maintaining the highest standards of service delivery.
Declarations
Same Sex Accommodation
Every patient has the right to receive high quality care that is safe, effective and
respects their privacy and dignity. Newton Community Hospital is committed to
providing every patient with same sex accommodation because it helps to safeguard
their privacy and dignity when they are often at their most vulnerable. Other than in
exceptional circumstances, patients admitted to Newton Community Hospital can
expect to find the following standards for the provision of same sex accommodation:
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The room where their bed is will only have patients of the same sex.
The toilet and bathroom will be just for one gender, and will be close to the
bed area.
Patients may share some communal space, such as day rooms or dining
rooms.
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In the occasional circumstance when it is not possible to care for patients in a same
sex environment - in the case of an emergency or specialist care situation - the
clinical (medical) need will take priority over keeping the patient apart from other
patients of the opposite sex. This is to make sure patients receive appropriate
treatment as quickly as possible and it will only happen by exception.
Newton Community Hospital took part in a peer review for delivering same sex
accommodation during 2010 and received a favourable report from the Strategic
Health Authority (SHA) with no actions required. A monthly return is now completed
to identify any breaches. During this reporting period no breaches occurred.
Equality, Diversity and Human Rights Legislation
The trust recognises and welcomes its legal duties and responsibilities under current
equality legislation to all those with a protected characteristic. The trust also
recognises the importance, value and benefits to staff, service users and the general
public to pro-actively and positively promote the principles of non-discriminatory
behaviour, advancing equality of opportunity and fostering good relations.
Leadership and Development
Key Leadership Priorities
The primary focus for organisational development during 2010/11 has been to
increase the uptake of staff accessing mandatory training and personal development
reviews (PDR). We have now introduced e-learning modules to improve access for
staff to relevant training and have seen a significant improvement in our uptake rates
as a result, although we still have work to do.
Key leadership priorities and actions for the organisation have included:
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Development and implementation of a Learning and Development Policy
Learning and Development opportunities cascaded to all staff via a weekly
Learning and Development Bulletin
Monthly Did Not Attend (DNA) reports for mandatory training
Implementation of Knowledge and Skills Framework (KSF) across the Trust
Mandatory training reports to identify staff who have and have not attended
mandatory training – updated regularly
Management Development Programmes and Leadership Development
Programme provided to develop staff within the Trust
Monthly Corporate Induction Programme for new starters
NVQ training for staff on Agenda for Change (AfC) Bands 1-4
Flexible training opportunities via a suite of e-learning packages
Monitoring personal development review uptake across the Trust – reporting on
activity and when PDRs are due
Provide an overarching innovation strategy to the organisation to enable the
promotion and adoption of innovative practice
Work to promote a culture of innovation, new ideas, new thinking and creativity
across all levels of the organisation to ensure continuous improvement
Support service improvement and redesign through the facilitation of innovations
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hubs to develop, support and promote creativity within teams, services and
individuals
To engage, within the innovation agenda, any partner or patient to enable
continuous service improvement through innovative and creative thinking
Leadership Development Programme
A Leadership Development Programme has been developed in conjunction with our
commissioners over the past twelve months. Its purpose is to equip leaders within
the organisation with the confidence, insights and practical skills to make the most of
their gifts and potential as leaders, helping them to navigate complex political and
emotional situations and challenges and to work creatively in an ever changing
environment.
The course covers the following areas:
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Leadership within the NHS
Capturing creativity and innovation in the workplace
Strength deployment inventory
Neuro Linguistic Programming (NLP)
Myers-Briggs Type Indicator (MBTI)
The leader’s role – developing capacity
The leader’s role – relationship management
Management Development Programme
A Management Development Programme has been developed to equip managers
(or those aspiring to be) with the confidence, insights and practical skills to enhance
their performance.
The programme covers the following areas:
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Change management
Social marketing
Finance
Project management and business case methodology
Diversely confident
Method of delivery
Essential Training Programme
We are fully committed to ensuring all staff attend essential training for their role
which meets legislative requirements and demonstrates good employment practice.
Essential training is defined as training deemed vital for the safe and efficient
functioning of the organisation and / or safety and well being of individual members
of staff. Making sure staff attend and participate in this training helps to ensure the
safety and well being of patients, visitors and other staff is maintained.
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Transforming Community Services Overview
The PCT Board made a decision at the end of 2009/10 to devolve all of CHS
services along care pathways into NHS, local authority and third sector
organisations. The implementation of this direction of travel commenced at the
beginning of 2010/11.
The Department of Health outlined in October 2010 that all NHS organisations
should confirm their direction of travel and divest their services by the 31 March
2011. As a result of this, the Board reconsidered its plans and agreed that for an
interim two year period provider services should transfer to Ashton, Leigh and Wigan
Community Healthcare NHS Trust (ALW), with the exception of sexual health,
diabetic retinopathy, musculo skeletal, chronic pain and community dental services.
ALW was established as a stand-alone NHS Trust with effect from 1 November
2010. The organisation will be renamed Bridgewater Community Healthcare NHS
Trust in May 2011, to reflect the wider geographical area for which it is now the main
provider of community health services: Ashton, Leigh, Wigan, Halton, St Helens,
Warrington and Trafford. Services for Halton and St Helens will continue to be
delivered by local staff within the local area, working in partnership with local
authorities and all identified commissioners.
During this transformational year we have continued with a service improvement
quality agenda and reviewed all services to make sure they are efficient and
productive. Further development of the Transforming Community Services agenda
will be explored with commissioners and external agencies during the two year
transitional period.
Quality, Innovation, Productivity and Prevention Framework
In response to the national programme of QIPP (Quality, Innovation, Productivity and
Prevention), and the economic downturn, we need to ensure that our services
continue to provide quality for our patients and local population, and deliver value for
money within the current financial envelope.
The organisation identified a staged approach to the Productive Community Services
(PCS) programme, in order to build capability, increase awareness of improvement
tools and techniques and support staff who were undergoing high levels of change
within the organisation at this time.
Three stages of work were agreed to support teams in reviewing their current service
provision, to identify and implement areas of quality improvement and the potential to
increase productivity, to reduce inefficiency and waste:
Stage One – Lean Approach
Lean methodology encourages teams to look at the value of their service through the
eyes of the patient and user, and in doing so, evaluate those elements that could be
more productive and less wasteful, with the chief aim of improving quality of care and
service delivery. A number of teams have undertaken Lean workshops and
developed improvement in quality of services. Teams have sought feedback from
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customers of the service to ensure greater quality, and removal of non-value activity
that previously existed.
Some examples are described in section 10.
Stage Two – Organising for Quality
This approach further embeds service improvement methodology amongst the CHS
workforce to ensure sustainability of good practice. Each participant identifies a
suitable small improvement project as part of their learning, which also contributes to
the overall QIPP agenda. This programme commenced at the beginning of 2011/12.
Stage Three – Productive Community Services
Introduction of the full Productive Community Services programme is due to
commence mid summer 2011, in tandem with the Organising for Quality workshops
currently being delivered.
This is the agreed plan in order to ensure quality is delivered at all levels of the
organisation.
Supporting Statements for Partnership Working
Statement from St Helens MBC
Re: St Helens Adult Social Care and Health Overview and Scrutiny Panel Quality
Account Commentary 2010/11
Thank you for submitting your Quality Accounts for 2010/11 and for your attendance
at the Adult Social Care and Health Overview and Scrutiny Panel on 13th June 2011.
Our comments are as follows:
The panel accepts the Quality Accounts as being an overview of the organisations
performance during the year. It is important to note that the panel felt that it could
not comment on issues in the report relating to Halton.
The Council notes that 2010/11 has been a difficult year for Community Health
Services in St Helens with significant demands placed on the organisation and
services by both the Efficiency Agenda across Public Services and the change in the
organisational structure relating to Community Health Services nationally.
These pressures have caused a number of difficulties during the year with some
delays to recruitment to posts and implementation of initiatives. At times, these
difficulties have been compounded by a lack of up to date and comprehensive
performance information. The Panel is pleased that Officers of the Council and
Community Health Services have worked together to address difficulties as they
arise and trust that positive relationships will continue in the future. The Panel note
that the Quality Account contains a list of performance indicators at Appendix 1, but
little in the way of performance information. The panel is aware that work is going on
across all partners to address this issue and trust that future reports will address this
deficiency.
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In summary the Panel is pleased to receive the Quality Accounts for 2010/11 and
looks forward to maintaining positive partnership working with the new Community
Health Services Provider in the Borough.
Yours sincerely
Councillor Suzanne Knight
Chairman of Adult Social Care and Health Overview and Scrutiny Panel
Statement from Halton BC
Halton and St Helens CHS Quality Accounts – comments
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There is recognition of the significant organisational change within the trust
this year. However there has been some significant improvements in service
provision, as detailed in the report.
We are please to note recent registration with CQC and a review of clinical
governance has been completed.
Improvements in the area of Information governance are required, following
the rating of “Not satisfactory”.
It is good to see the approach around productive communities being
progressed- this should result in improvements in the quality of service
provision.
There has been some good progress in relation to partnership working, for
example: Nutrition, Safeguarding and Well-Being, however further
opportunities could be progressed.
Absence rates are improving; it is good to see a proactive approach to this.
Service delivery responses to making changes from feedback from users are
really positive.
Priority areas for 2011/12 appear to be positive, but it would be beneficial to
see some targets associated with these.
Overall a positive report- however we would like to see some performance
information included in the report e.g. waiting times, incidence of pressure
ulcers and falls.
Councillor E Cargill
Chairman of the Health Policy and Performance Board
LINks
Both Halton LINk and St Helens LINk did not wish to submit a commentary on this
year’s Quality Account. St Helens LINk felt that they did not have enough evidence
to pass comment but hoped to contribute to this in future.
Patient Safety
The trust has an established incident reporting system to ensure all incidents are
reported, managed and lessons are learnt. In 2010/11, 2,066 incidents were
reported by our staff using this system. 84% of the incidents related to issues in
activities that we undertook or were responsible for. The top 3 categories reported
by staff related to the reporting of pressure ulcers, accidents/incidents involving
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children attending our Sure Start centres, e.g. minor bangs/bumps, slips, trips and
falls, and violence and abuse against our front line staff.
This year we have introduced a weekly report for our divisional managers, to
consolidate the data on incidents and complaints reported within their division into
one report, thereby allowing them to have a ‘heads up’ on key issues and incidents
that have occurred within their area.
Infection Control
It is a requirement of the Code of Practice (2006) that a quarterly report is presented
to provide assurance that there are adequate systems in place for combating Health
Care Associated Infections (HCAI). This is aligned to the HCAI Assurance framework
and incorporates targets for all provider services.
The purpose of this report is to provide an update on progress with the Hygiene
Code and to declare compliance with the standards as set within the Code of
Practice 2006. There has been considerable investment to improve premises and
make our clinical environments fit for purpose and this has been as a result of audit
and measurement against national standards in conjunction with estates and the
infection control team. Clinical audit of the environment and spot checks are made
throughout the year, for monitoring compliance with the Cleaning Strategy, Code of
Practice 2006 and Care Quality Commission standards.
We also invested in clean trace equipment to facilitate environmental swabbing, to
improve standards of cleanliness.
We have continued to reduce the number of cases of Health Care Associated
Infections, completing root cause analysis for all Clostridium difficile and MRSA
bacteraemia patients. Root cause analysis is now also being done on e coli
bacteraemia. We remain under trajectory with CDI and MRSA bacteraemia within
the community.
We have promoted the clean your hands campaign programme and have continued
to carry out random observational hand decontamination audits on clinic staff.
Newton Community Hospital has continued to minimise the effects of norovirus and
rotavirus though good practice, hand decontamination, isolation and environmental
cleaning. The hospital is currently undertaking an Aseptic Non Touch Technique
(ANTT) programme.
Regular training is provided for all clinical and non clinical staff through induction and
monthly infection control mandatory sessions and attendance is monitored in order
to target staff groups who fail to attend. Acute infection control team leads meet
quarterly with other provider leads to share good practice. Communication with the
clinical microbiologist continues.
Organisational Lessons Learnt
We have continued to develop and publicise our Lessons Learnt brief which aims to
share the learning from incidents that have occurred since the last period.
19
In addition we have run promotional campaigns in our in-house newsletter ‘In Touch’
promoting the key issues and actions that should be undertaken by staff on the
following key areas:





Winter Weather – preventing slips, trips and falls
Vehicular security
Personal safety and incident reporting
Data Security
Confidentiality
Effectiveness/Productivity
During 2010/11 we ran a highly successful Lean programme across 18 of our
services. Some of the highlights are included in the two examples below:
Primary Care Mental Health Team
This Lean event was held with two teams, the single point of access team (Open
Mind) which is the gatekeeper for all referrals into the mental health system, and the
primary care mental health team.
The Open Mind service generated a value stream map which identified an 18%
improvement opportunity and from this developed a range of ideas including the use
of an assessment template to avoid duplication of work, maximise clinic time by
reviewing the demand and capacity, and reduce the use of OTTER (5 Boroughs IT
system) for non-value added activity.
The primary care mental health team identified an improvement opportunity of 43%
and developed a number of ideas to improve the quality of their service, including the
development of motivational groups to improve access to the service, to liaise with
Open Mind to review the referrals for secondary care, to explore the use of partial
booking for appointments, to review the DNA process, and to introduce
transdiagnostic group sessions.
Both teams developed action plans to be addressed through their respective team
meetings with a view to the new group therapy service being ready to “go live” in
January 2011.
Community Matrons
The community matrons service offers chronic disease management and care
orchestration to those patients previously defined as “very high intensity users”
(VHIU). These patients are currently identified by GP practices within the PCT
boundaries of Halton and St Helens.
A total of 145 hours per week were identified as currently Not Adding Value (NVA)
and contributing to the capacity problems identified in the service overall. There
were however, other processes identified that, although not saving hours, will when
initiated reduce clinical and corporate risks, increase quality for patients and
eliminate waste from over production and re work.
20
Service Achievements
Speech and Language Therapy
The adult speech and language therapy (SLT) team recently ran a successful
volunteer recruitment programme, where volunteers with the essential skills for the
role were selected via the trust recruitment process. Additional training has enabled
them to contribute to specific therapeutic and administrative tasks.
The use of volunteers has improved the effectiveness and efficiency of SLT service
delivery. Volunteers were current SLT students or had aspirations to pursue this
career. This enabled the department to benefit from their basic level of knowledge
and training in the further development of the skills required for this role. Continuity
of volunteer staff was essential to enable the development of therapeutic
relationships with patients and for the co-ordination of the work to be completed.
Long-term plans include building up and maintaining a small bank of volunteers who
are able to contribute to SLT service delivery for discrete projects that can be
planned well in advance. Continuity of this innovative workforce plan is hoped to
continue to deliver benefits to patients, services and local students aspiring to
become SLTs in the future.
Community Nursing Team (Children’s Services)
Children on the waiting lists for immunisations have been a long standing issue for
all health provider organisations and not least in Halton and St Helens, where a
'suspended' list compounds the problem. The suspended list accumulates when
parents do not attend with their children on two occasions without offering a reason.
In 2010 in anticipation of GPs assuming full responsibility for the immunisation of
children our commissioners requested that we aim to offer immunisations to all these
children. The community nurses in St Helens have galvanised themselves and
almost 1,000 appointments have been sent out since December, with 300 additional
children immunised and therefore protected from life-threatening diseases.
The waiting list and suspended list in St Helens has been reduced by almost 50%.
Halton Paediatric Speech and Language Service
The Halton paediatric speech and language service (SLT) has been highlighted as
an example of good practice in the North West review of speech, language and
communication needs for 2010.
Speech, language and communication needs take in a wide range of difficulties
related to all aspects of communication in children and young people. These can
include difficulties with fluency, forming sounds and words, formulating sentences,
understanding what others say, and using language socially.
The team has piloted new ways of delivering paediatric speech and language
therapy within Halton for the past six years. One of the main successes has come in
the recruitment of local parents who have no child care qualifications.
21
They are offered an on-the-job training package to train them up to work as speech
and language therapy assistants. This new recruitment approach has brought with it
a number of advantages in the service’s overall delivery.
Walk in Centres/Minor Injuries Unit
During 2010/11 we saw over 109,000 patients at our Walk in Centres and Minor
Injuries Unit. 99.9% of patients were seen within the Government’s four hour waiting
target.
Halton Healthy Schools
Halton Healthy Schools Programme (based within the health improvement team)
reached its 10th birthday and has been a significant success over this period.
National targets have been surpassed and we are proud to see that all schools in the
area have now been awarded the National Healthy Schools status.
Once schools have gained this status, they complete an annual review in order to
evidence that the foundations of health and well-being are being maintained.
Schools are currently being invited to develop a mixture of school-based, local and
national priorities which will be flexibly tailored around the needs of each school
community.
This will allow schools to select appropriate interventions to bring about health
changes. Areas of need are already being identified by schools in Halton and
schools have started to work towards improving these needs.
Health Improvement Team
All our health improvement activities are subject to internal evaluations and some
programmes are also subject to more rigorous independent evaluations, involving a
wider variety of stakeholders. These involve users, staff involved in the delivery of
programmes and a selection of key partners working in related service areas.
Some of these evaluations have been designed in such a way as to collect
quantitative measures of users’ health, programme performance (DNAs, completion
rates etc), before and after the intervention outcomes, or to quantify the impact of the
intervention from a health economics perspective.
Evaluations include members of the target group, who were referred to health
improvement programmes, but also those who did not take part or who did not
attend in order to explore barriers to involvement and engagement.
This award-winning team has continued to deliver strongly against its targets, with
some highlights from 2010/11 including:
Service
Annual
target
Actual figure
achieved
Men’s Health
1,500
1,510
% variance
on annual
target
101%
Definition
No. engaged
22
Specialist
Weight
Management
1,750
2,332
133%
Brief
Interventions
Fit 4 Life (7yrs –
13yrs)
Passport to
Health
3,000
3,206
107%
300
392
131%
80
107
134%
Fit 4 Life (2yrs –
6 yrs)
30
30
100%
Get checked –
Early detection
of cancer
2,000
2,200
110%
participants.
No. referrals.
No. people
signposted.
No. participants.
No. Train the
Trainer
provision
No. families
engaged.
No. engaged
participants at
events
Halton Midwifery Service
The Halton midwifery service provides quality evidence-based midwifery care for
women and children in Halton which is underpinned by national and professional
guidance.
The midwifery service has for the past 6 years been successful in achieving all the
national standards and has been commended for its forward thinking and service
delivery. We are also assessed on key performance indicators (access to a health
care professional before 12 weeks of pregnancy and booked in for maternity care by
12 weeks) set by the Department of Health and reach 90% consistently within these
targets. We encourage women and families to take an active role in service
development and all have user representation on groups within the service.
We were the first service within the North West to develop 'Earlybird Sessions' which
enable contact with a midwife as soon as the woman knows she is pregnant. This
service won a British Journal of Midwifery and Royal College of Midwives award and
has since been replicated within other maternity services in England. We developed
'Grandparents' sessions last year which are well attended and evaluated.
Organisational Effectiveness
National Institute for Health and Clinical Excellence (NICE)
The National Institute for Health and Clinical Excellence is an independent
organisation which was set up to ensure everyone has equal access to medical
treatments and high quality care from the NHS, regardless of where they live in
England and Wales. Guidance from NICE exists to provide advice to NHS clinical
23
staff, commissioners and patients as to those treatments that are clinically and cost
effective.
The organisation has in place a NICE and National Guidance Group; it is a sub
group of the Clinical Quality and Standards Group. The remit is to ensure that
Community Health Services has a centralised structure and process to monitor the
effective and appropriate implementation of all NICE guidance and other national
guidance.
The objectives of the group are to:





provide a centralised process for the overall co-ordination, planning and
monitoring of NICE and National Guidance implementation.
determine the relevance of published NICE and National Guidance to CHS.
identify and support an appropriate designated implementation lead.
communicate information for dissemination.
provide assurance of compliance with NICE/National Guidance to the Board
via the Clinical Quality and Standards Group.
An electronic database was implemented last year to improve the monitoring of
NICE guidance within the organisation. Baseline assessments were completed in
relation to 27 pieces of guidance.
NICE published Quality Standards during this period and will continue to deliver new
ones next year. The organisation will review all Quality Standards produced and
implement those relevant to the organisation in the coming year.
New Policies and Clinical Guidelines
The clinical guidelines group has been instrumental in ensuring that there are
effective clinical guidelines and procedures in place within year, which are evidence
based and clear in what is expected of staff.
Outlined below is a sample of those clinical guidelines and policies that have been
approved this year:




Care and maintenance of IV therapy infusion pumps
Caring and feeding a client via nasogastric tube in the community
Guidelines for the removal of peripherally inserted central catheters and midlines
Guidelines for the administration of intramuscular and subcutaneous injection of
drugs
Managing Attendance, Health and Wellbeing in the Workplace
Throughout 2010/11, the Trust has continued to work with Managers and staff to
promote our attendance standards and good absence management.
Over the past year, although we have not yet reached our target of 3.3% for sickness
absence, our absence rates have been lower than the previous year and were as
follows:
24
CHS % Absence Rates
Apr
May
2009/10
4.87%
2010/11 4.66%
Oct
Nov
7.26%
2009/10 6.72%
5.65%
2010/11 5.38%
Jun
4.95%
Dec
6.40%
6.24%
Jul
7.12%
4.96%
Jan
6.87%
6.11%
Aug
6.45%
4.59%
Feb
6.21%
5.35%
Sep
6.26%
5.49%
Mar
6.07%
5.12%
To assist in achieving this reduction a performance management framework for
absence management which is known as “absence league tables” was introduced.
The absence league table is a monthly report in which departmental managers need
to check their team absence rating and complete action plans and exception reports
to explain high levels of absence and actions taken to address unacceptable levels
of absence. This information is then reported to the director of workforce strategy
and organisational development and the chief executive.
Emergency Preparedness
We are classified as a ‘Category 1’ responder under the Civil Contingencies Act
2004 and we therefore have a statutory responsibility to:

Assess the risk of emergencies occurring and use this to inform contingency
planning

Put emergency plans and business continuity management arrangements in
place

Arrange to make information available to the public about civil protection matters
and maintain arrangements to warn, inform and advise the public in the event of
an emergency
In order to perform all these duties effectively, Category 1 responders must cooperate and share information with other local responders.
The Operating Framework for the NHS in England 2010/11 lists preparing to respond
in a state of emergency, such as an outbreak of a new pandemic as one of the five
national priorities for the NHS.
During 2010/11 the organisation was part of the Cheshire command and control
arrangements and contributed to the multi-agency emergency planning framework of
Cheshire Local Resilience Forum (LRF). However, as Halton and St Helens crosses
two LRF areas, links are also in place with Merseyside.
We have a Major Incident Plan based on integrated emergency management
principles that can be adapted as necessary to respond to a wide range of
emergencies. It complies with the requirements of the NHS Emergency Planning
Guidance 2005 and associated guidance and is reviewed and updated annually, as
well as in response to any changes to national guidance and after any incidents or
exercises.
Staff took part in a number of exercises throughout the year to test our plans with
partner organisations in both Cheshire and Merseyside. Some of these have
25
involved multi-agency partners outside the NHS, such as local authorities, the
environment agency, police and fire service.
Command and control arrangements were invoked during the period of severe
weather in December 2010 and early January 2011 which also coincided with an
outbreak of influenza. We were able to use the experience gained during the H1N1
(swine flu) pandemic in 2009 when responding to the challenges which this
presented. We have reviewed our response to last winter’s pressures to build into
plans for 2011/12.
Patient Experience
Involving patients in the work of Community Health Services is an essential element
in ensuring that we provide the right services, in the right places and at the right
times to ensure a patient led health service.
We value the feedback provided by our patients and service users and use a variety
of mechanisms, outlined below, on which to review and improve the services we
offer to our patients and service users.
o Talk to Us feedback forms
o Engagement with LINK networks and lay reader groups
o Complaints and concerns received
In 2010/11 we received over 9,600 Talk to Us forms returned to us, many of which
provided useful comments and suggestions as to how we could improve the services
we deliver. In addition to providing comments and feedback, patients and service
users can use Talk to Us to grade a range of indicators from Poor through to
Excellent. Consistently throughout 2010/11, patients have returned a high approval
rating against the overall service provided by our staff.
Our last round of analysis of over 490 Talk To Us forms revealed that overall 98% of
those responding thought that our staff provided a service that was either ‘good’ or
‘excellent’
Some of the improvements that we have made in response to patient feedback
include:
Service area
St Helens Walk in
Centre
Health Improvement
Children and Young
people
Health Improvement
Weight Management
Service
Open Mind Service
Improvement
In response to feedback from patients we re-painted an
area of the centre described by patients as ‘dull’, as well
as erecting new patient information boards
We changed the range of fruit on offer as part of the
Children and Young People Health Improvement
programme
New weekend and evening sessions have been built into
this programme to accommodate the needs of those who
work full time
Group therapy sessions are now offered ‘out of the area’
where patients reside or work to mitigate any possible
social issues for residents/employees from the area
26
Primary care
Psychological Therapy
Service
Podiatry
In response to patients’ concerns about the waiting times
to access the programme, introductory appointments are
now offered to new referrals
Patients reported that they were having difficulty
accessing the service using the conventional methods; a
new generic email address has now been established to
enable another mechanism for patients to contact the
Podiatry team
Our patients and service users make an invaluable contribution to service
developments, and throughout 2010 we have engaged them in numerous
recruitment exercises including:


Appointment of a community nurse for the Halton community stroke service
Appointment of 3 speech and language therapists
Our lay reader panels have contributed to the development of the following
information leaflets that we have produced:



‘Are you aged under 18 years. Do you have issues with your bladder’
Bedtime reminder cards for parents
Leaflet on the work of our outreach team at Newton Community Hospital
In 2010/11, 117 formal complaints were handled by our complaints team. 50% of the
complaints we managed related to services we commission; and 50% to services we
directly provide. A significant number of the ‘informal concerns’ handled by our
customer contact centre can be resolved quickly before they become formal
complaints.
218 informal concerns reported to our dedicated customer contact centre were
resolved within 24 hours of being raised, to the satisfaction of the complainant.
We have made a number of changes to the way we deliver services as a result of
analysing the complaints and concerns raised by patients:
Attitude of Staff – Case Study 1
In response to a complaint regarding the attitude of staff, random sampling of
patients’ views has been implemented to determine the level of satisfaction and will
particularly ask “how did it feel for you”. This is in addition to the usual satisfaction
surveys carried out. The patient expressed his thanks and his appreciation that his
concerns had been truly heard.
Service Delivery – Case Study 2
At one of our clinics it was expected that patients would arrive, take a seat in the
waiting area and wait to be called for their appointment. In one case, a patient
arrived late and was unable to make their arrival known to staff who had assumed
they were not attending. To prevent this situation arising again we have reviewed our
procedures and all patients are now booked in via the reception team on arrival for
27
their appointment. Patient letters and service leaflets have also been amended
outlining how we manage late arrivals.
Provision of Equipment/Waiting Times – Case Study 3
When we began delivering the wheelchair service we were contacted by a patient
highlighting that she was in possession of manual wheelchair which is too heavy for
her husband to push. She was totally housebound and had not been out of the
house for six years.
On hearing of the couple’s plight the service manager arranged for an assessment
for a power-assisted chair which would expedite the process significantly.
The patient was delighted with this action and advised that both her and her husband
will be able to escape from "prison". This is how they described their life for over the
past six years. They will both finally get their lives back.
Quality Improvement Visits
This year our senior management team (SMT) introduced a programme of ‘walk
arounds’ under the banner of Quality Improvement Visits.
Planned and unplanned visits are led by a member of the SMT who visits each of the
premises where our staff are based or where we deliver services to check that a
suite of quality indicators are being met.
Clinical Audit and Research Programmes
Clinical Audits
We completed a number of clinical audits during the year to measure the
effectiveness of the services we provided to our patients. 19 clinical audits were
initiated within 2010/11, with 11 being completed by end of March 2011 including
audits of annual record keeping, Newton Community Hospital outpatient department,
Halton wheelchair service, pressure area care, community matron service, sexual
health and both child and adult speech and language therapy.
The following actions have taken place following the audits to improve the quality of
health care:





Improvement in the delivery of pressure area care across the services
Improvement in the choice of wheelchairs available in the equipment service
Improvement in the use of individual’s occupational therapy aids at Newton
Hospital
Improvement in the falls assessment undertaken on admission at Newton
Hospital
Improvement in the engagement of Speech and Language Therapy in preschool settings
Key achievements this year for clinical audit programme were:
28

Comprehensive corporate clinical audit programme created including clinical
audit activity within corporate support services, i.e. infection control and
medicines management.

Clinical governance review undertaken to examine the effectiveness of
existing structures. This enabled services to focus on appropriate standards
and agree individual service specific audit plans.

Refresh of Clinical Audit Sub Group terms of reference and membership.

Identification of a clinical audit lead within every clinical service.

Integration of clinical audit activities with other governance functions, e.g.
information governance, NICE and National Guidance Implementation Group,
complaints/incident reporting and patient and public involvement.

Reviewing the whole audit programme in readiness for 2011/12.
During 2010/11 Halton and St Helens Community Health Services participated in
one national clinical audit and no national confidential enquiries which it was eligible
to participate in. The national audit that Halton and St Helens Community Health
Services participated in was:

The Falls and Bone Health Audit
As a result of the clinical governance review the organisation is developing a full
audit programme for 2011/12 which will include the national audit and national
enquiries appropriate to the services.
Health Improvement Team Research Overview
Our health improvement team’s social marketing approach uses local people’s
expressed wishes and preferred communication channels to ensure that key health
messages get across, in a way that they find stimulating and relevant.
It is critical to ‘get under the skin’ of any issue being considered and develop a
genuine understanding of the marketing and communication need. Extensive desk
research is carried out including the use of tools such as MOSAIC software to
produce audience profiles, enabling us to conduct intelligent research with our target
audience and stakeholders. Recent projects have included public consultation into
alcohol usage in 35-55 year olds, drug polyuse 16-24 year olds, breastfeeding,
obesity and smoking.
The ‘Moment of Truth’ obesity campaign saw extensive research with the public and
medical staff across Halton and St Helens. This led to the development of a
simplified weight management referral system and a GP and nurse facing campaign
called ‘Moment of Truth’. The launch of the Moment of Truth referral boxes to
practices across Halton and St Helens in September 2010 saw a 54% year on year
increase in referrals to the team.
29
The team has also recently carried out a research project looking into smoking in
pregnancy. The project is looking at the existing pathway, partnership working,
demographic and lifestyle factors of the target audience and development of
communications and training materials. Stakeholders from across the care pathway
have been interviewed individually and focus groups have been run collectively.
Practice Development and Research Partnership
NHS Halton and St Helens and the Faculty of Health and Social Care at the
University of Chester formalised their relationship by creating a partnership through
the development of a Practice Development and Research Partnership (PDRP) in
2008. This involved Academics and NHS staff working together on a range of
research, clinical audit and service evaluation activities with all staff groups.
There has been a wide variety of projects in this PDRP led by a range of health
professionals such as school nurses, district nurses, tissue viability team, advanced
practitioners, health visitors and family health co-ordinators. The projects were
spread across the child and adult services of the Community Health Services. All
projects had a clinical lead (NHS Halton and St Helens) and an academic lead
(University of Chester).
Table 1: Projects involved in the PDRP and their status as of the 31st March 2011.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Project
Clinical Lead
Status
Nicotine replacement
therapy – School Nurse
Health Care Assistant
Evaluation
(Specialist Practitioner
Qualification
Assignment)
Maternal Mental Health
Family Health Needs
Assessment Tool
Domestic Abuse Audit
Reablement
Walk in Centre:
Programme Evaluation
Tissue Viability
Community Matrons
Alison Gibbons
Pilot - fieldwork
Gail O’Carroll
Write up
Thelma Osborn
Madeleine Ashcroft
Write up
Analysis / write up
Carol Hornby
Sean Andrews
Lynn Swift and Tony
Mayled
Keith Moore
Amanda Booth
Analysis / write up
Analysis / write up
Analysis
Data collection
Proposal development
The positive outcomes from the research are improved quality of care to patients.
The research programme also allowed the organisation to participate in national
conferences to present posters and presentations and the publication of the research
in professional journals.
Conferences
Conference Attendance
Title of paper
Service
30
INVOLVE
Annual Conference, 16th 17th November 2010
St Helens community
intermediate care service
reablement team: The
views of service users and
their carers - focus group
method.
Members of the
intermediate care service
CPHVA - Community
Practitioner and Health
Visitors' Association
Annual Professional
Conference, 20th - 22nd
October 2010
A clinical record audit to
determine to what extent
the key performance
indicators are being met
post implementation of the
policy
NHS Halton and St Helens
health visiting team
Two papers presented
An exploration of health
visitors’ perceptions of the
health needs assessment
tool and its impact on
health visiting practice.
NET - Networking for
Education in Healthcare
Annual International
Conference, 7th - 9th
September 2010
An exploration of
stakeholders views on the
Practice Development and
Research Partnership
between NHS Halton and
St Helens (Community
Health Services) and the
University of Chester
(Faculty of Health and
Social Care).
Representatives from the
PDRP Management
Committee
NET - Networking for
Education in Healthcare
Annual International
Conference, 7th - 9th
September 2010
An exploration of
stakeholders views on the
Practice Development and
Research Partnership
between NHS Halton and
St Helens (Community
Health Services) and the
University of Chester
(Faculty of Health and
Social Care).
Representatives from the
PDRP Management
Committee
NET - Networking for
Education in Healthcare
Annual International
Conference, 7th - 9th
September 2010
Work Based Learning Making it happen!
Senior clinicians from St
Helens Walk in Centre
Tissue Viability Society
Annual Conference, 13th 14th April 2010
A longitudinal cohort study
to measure wound
breakdown following
Senior clinicians from St
Helens Walk in Centre
presented (oral
31
Negative Pressure Wound
Therapy and the impact
the therapy has on
individual’s quality of life in
a community setting.
presentation
Publications
Title of Article
Developing Training
Advanced Practice
Journal
in Independent Nurse
Journal, 23rd August 2010
Service
Walk in Centre staff
Performance Framework
The organisation currently uses several mechanisms to monitor the performance of
its services. The main system, which is used universally across all clinical services,
is called the QPRF (quality and performance reporting framework). The system
which was revamped and redesigned in 2010, works to monitor a multitude of quality
indicators across key monitoring areas.
A comprehensive list of our indicators can be viewed in Appendix 2.
1. Template
Submitted
(Raw Data)
2. Data
Warehouse
(Analysis)
3. Corporate
Performance
(Review)
4. Senior
Management
(Assurance)
Feedback
The performance of our services is monitored on a monthly basis and all services
are assessed based on a core of indicators, which include counting mechanisms,
such as how many patient contacts. However, the number of indicators against
which a service is assessed is directly related to its core business, for example a
district nursing service operates in a totally different way to a school nursing service.
Furthermore, the aim of the QPRF is to capture all necessary information on one
core sheet (Box 1), so as well as general quality indicators, we collect all related
information governance indicators at the same time. This allows services to submit
all the relevant indicators in one submission, with one set deadline, which allows
them to fit the overall submission around their caseloads.
After services submit their information, it is then imported into a data warehouse (box
2), which allows the organisation to store and analyse data effectively. In addition,
all noticeable variances are questioned by directly contacting the service manager
and all further issues are directed for review by divisional management. A question
regarding submitted data from services across all divisional remits is correlated by a
standing report to the Corporate Performance Group (Box 3), which sits to review the
monthly performance of the organisation against a set list of indicators, including
patient experience, information governance, and other core areas.
32
After the overall scrutiny phase, the data are then aggregated to produce a corporate
report, which is combined with indicators such as waiting times within our urgent
care centres, and statutory returns. The report is then reviewed within the senior
management team (Box 4) and key issues papers are produced. The papers drive
improvements within the reporting of data, and the overall assurance gained from its
review across services within our organisation.
Data Quality
Data quality is an important measure of service quality and as such, data accuracy
and quality are considered to be key indicators. To achieve this Halton and St
Helens Community Health Services will be taking the following action to improve
data quality:

A framework for data quality has been developed in 2010/11 and will be
implemented in 2011/12.
CQUIN
CQUIN funding of £89k for 2010/11 was consolidated into the main contract with
Halton and St Helens PCT and enabled the continued development and
implementation of the primary quality schemes relating to the Telehealth Admissions
Avoidance project and the rollout of IT services and data capture systems to
clinically led departments.
Halton and St Helens Community Health Services income in 2010/11 was not
conditional on achieving quality improvement and innovation goals through the
commissioning for quality and innovation payment framework because of the above
consolidation.
Telehealth
The Telehealth project undertaken by the organisation has worked to enable a new
way of caring for people with a multitude of complex and chronic conditions. Its main
aim is to allow patients to monitor their own health in their own home, and have all
their results reviewed by local clinicians through a monitoring centre.
The Telehealth project is now entering its second year. Currently to date, there have
been a total of 115 installations of the Telehealth equipment. Numbers started to
decline towards the end of the year due to a variety of circumstances. However,
following recent updates and further training sessions there has been an elevation in
numbers of new installations in March 2011.

Since its commencement in July 2009 a total 104 people have used the
service.

As from March 2011 there are currently 44 Telehealth Users including 1
demonstration unit based at Newton Community Hospital.
Telehealth Equipment
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Equipment currently used covers a variety of long term Illnesses:
Long Term Condition
Chronic Obstructive Pulmonary Disease (COPD)
Chronic Heart Failure (CHF)/ Stroke
COPD / Diabetes
CHF / Diabetes
% Usage
65%
21%
9%
5%
Positive Outcomes
Recent data analysis shows significant reduction in accident and emergency (A&E)
attendances and hospital admissions from 37 patients used/using Telehealth, based
on 12 months pre and post installation data.
Areas of reduction
A&E attendances
Cost of attendance to A&E
Hospital admission
Average length of hospital stay
Cost of admissions
% Reduction
62.7%
53.5%
30%
44.9%
42.6%
Patient Benefits
Results of a patient questionnaire show benefits for patients following the use of
Telehealth equipment as part of their care.
Managing their condition
 85 % improved their understanding of the impact of the condition on daily life
 79 % agreed there had been an improved understanding of their condition.
 81% of patients learnt what to do if symptoms worsened.
 79 % answered 'yes' to having coped and managed their condition better.
Personal Benefits
 89% of patients benefited 'a lot' from using the Telehealth service
 76% of patients and 79% of their families/carers reduced their anxiety about
their condition.
Based on 28 patients who have had Telehealth system removed
 81% will continue to benefit now Telehealth has been removed and
 68% stated they would have liked to have kept the equipment longer.
Testimonials from some patients
 “Telehealth has been a great benefit to me. It helps me manage my condition
on a daily basis whereas before if I became unwell I would wait another day to
see if my condition improved. Sadly it never did, and I would end up in
hospital for long periods of time. I now know when I’m becoming unwell and
it’s acted on immediately”
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
“Telehealth has given me and my family the greatest sense of security ever, I
now feel like I’m in control of managing my health I’ll be sad when the
programme finishes”

“I go to doctors and it’s always high, and that makes me panic more”

“Allows some flexibility in your life”

“It’s the best thing since sliced bread - I have got my life back, and it’s like
having your own personal nurse with you”
Paris Implementation
In 2009 NHS Halton and St Helens opted out of the National IT Programme and
procured its own alternative patient administration system. The successful company
in the tendering process was Civica who deployed the Paris system.
This system is designed to both store and monitor patient information, including
demographics, referral information, and patient notes. The system also contains a
comprehensive appointment system, where clinicians can manage their caseload
effectively in real time. This ensures appointments are used effectively and clinical
time is maximised.
Furthermore, Paris allows clinicians to update records outside of the office, through
the use of portable notebooks. Services such as district nursing that are very mobile
within the community can both make a referral for one of their patients and update
their care record whilst in the patient’s home. This will help us ensure that patient
records are as up to date and accurate as possible, whilst saving input time for
clinicians when they return to office base.
Fundamentally, the project is about bringing care in the community into the 21st
century. It gives our clinicians the tools to allow them to have more time for their
patients, whilst removing unnecessary paper forms and duplication.
As of the end of the 2010/11 financial year the system has been rolled out across our
children’s services (for example health visiting), and is being implemented within our
community nursing division (for example district nursing).
Quality Improvements for 2011/12
As part of our commitment to maintain and improve quality of services the
organisation needs to ensure it continues to build on the quality improvements
delivered in 2010/11 and further advance the quality agenda of the organisation
Key Priorities for 2011/12
We have agreed with our commissioners that the following priority areas will be
monitored through the monthly Performance Reports and Quality Assurance Board
meetings:

Patient Reported Outcomes and Measures
35


Patient Safety
Patient Experience and Involvement
We will continue with the Quality Improvement Visits and programme, and the further
roll out of Telehealth and the implementation of Paris, a community based
information system, which is aligned to data required for the Community Data Set.
Quality Indicators 2011/12
Discussions will take place throughout 2011/12 in order to identify a specific number
of quality indicators which will be monitored through the monthly performance reports
and Quality Assurance Board meetings.
Data Security
In 2011/12 we will complete the roll out of our solution to limit access to USB ports
thereby significantly reducing the risk that information and data can be downloaded
onto portable media and subsequently lost.
Telehealth Future Planning 2011/12
We are expecting to work in partnership with a third sector organisation, developing
a service which can monitor multiple patients/clients within a residential home as
required, with one set of equipment, covering a wide variety of illnesses and
diseases, following identification and assessment by the community matron.
The multi-user could be tried as part of a step down approach from hospital to
intermediate care facility, or community focal point, i.e. pharmacy.
The potential to monitor patients within the home who may not have a physical
disease but have diagnoses of severe reduced mental capacity, and who are often
difficult to monitor, will help maintain the patient in their own environment whilst
proactively monitoring for signs of physical deterioration and unnecessary hospital
admissions.
Plans for 2011/12 also include the use of small mobile heart monitors (ECG pendant)
which will help extend the number of long and short term illnesses which can be
monitored from home environments.
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Appendix 1
Full list of Halton and St Helens Community Health Services Core Indicators
Number of Care Quality Commission (CQC) standards
Number of CQC standards achieved
Number of actions assigned
Number of assigned actions completed
Service income
Service operating costs
Number of practitioners (headcount)
Sickness/absence rate
Planned personal development reviews (PDRs)
Delivered PDRs
Staff turnover levels
Clinical outcomes set
Service user experience forms received
Number of did not attends (DNAs)
Number of could not attends (CNAs) (practitioner)
Number of CNAs (service user)
Whole time equivalent (WTE) of practitioners
Incidents received in 24hrs
Number of investigations completed within time
Incidents received
Number of investigations completed
Number of telephone contacts
Clinical outcomes achieved
Poor greeting by staff
Satisfactory greeting by staff
Good greeting by staff
Excellent greeting by staff
Poor help offered by staff
Satisfactory help offered by staff
Good help offered by staff
Excellent help offered by staff
Poor verbal information given to patients
Satisfactory verbal information given to patients
Good verbal information given to patients
Excellent verbal information given to patients
Poor written information given to patients
Satisfactory written information given to patients
Good written information given to patients
Excellent written information given to patients
Poor privacy
Satisfactory privacy
Good privacy
Excellent privacy
Poor dignity afforded to patients
Satisfactory dignity afforded to patients
Good dignity afforded to patients
Excellent dignity afforded to patients
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Poor opportunities to ask questions
Satisfactory opportunities to ask questions
Good opportunities to ask questions
Excellent opportunities to ask questions
Poor staff listening
Satisfactory staff listening
Good staff listening
Excellent staff listening
Poor overall
Satisfactory overall
Good overall
Excellent overall
Administration incidents
Admission/referral incidents
Child protection incidents
Child incidents
Collision related incidents
Contact with hazard incidents
Diagnosis related incidents
Discharge/transfer incidents
Environmental incidents
Equipment (not medical devices) incidents
Slips, trips and falls incidents
Fire related incidents
Immunisation incident
Infection control incidents
Unknown injury incidents
Lifting/handling incidents
Maternity clinical incidents
Medication incidents
Needle/sharps incidents
Out of hours incidents
Pressure care relief incidents
Vulnerable adults incidents
Records related incidents
Security breach incidents
Deliberate damage incidents
Loss/accidental loss related incidents
Staffing related incidents
Treatment related incidents
Illness related incidents
Violence/abuse/harassment incidents
Number of serious untoward incidents (SUIs)
Number of plaudits
Number of concerns
Number of complaints
Number of complaints resolved
Number of National Patient Safety Agency (NPSA) incidents
Ambulance transport incidents
Appointment related incidents
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Cold chain incidents
Human resources records incidents
Display screen equipment incidents
Ergodynamics incidents
Exposure to harmful agent incidents
Food hygiene incidents
Fraud incidents
Medical devices incidents
Occupational stress incidents
Road traffic accident incidents
Bomb threat/scare incidents
Self harm incidents
Trap incidents
Treatment problem incidents
Undefined incidents.
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