QA
Quality Accounts 2011
Contents
P04
CHIEF EXECUTIVE SUMMARY & QUALITY STATEMENT
P06
RESULTS FROM 2010/11 PRIORITIES
P18
REVIEW OF QUALITY IN 2010/11
P32
PRIORITIES FOR IMPROVEMENT FOR 2011/12
P42
ASSURANCES ON QUALITY OF NHS SERVICES PROVIDED
P50
STAKEHOLDER INPUTS
Quality Accounts 2011 3
The Quality Accounts are an annual report to the public from their NHS
organisations on the quality of services provided. This is Liverpool
Community Health NHS Trust’s second Quality Accounts.
Liverpool Community Health (LCH) is at the heart of the delivery of
healthcare within the communities of Liverpool and neighbouring areas, with
a strong history of providing valued and innovative care. Our services allow
people to be cared for in their own community and stay as independent as
possible, rather than having to go to hospital for treatment. Many of our
services are delivered out-of-hours, with 24 hour, 7 day a week access.
Liverpool Community Health NHS Trust provides a wide range of services. Core services include
District Nursing, GPs, Community Matrons, School Nurses, Health Visitors, Therapists, Dental
Services, Walk-in Centres, and Sexual Health. We also provide health services ranging from
Specialist Community Nursing Services, Prison Healthcare, Community Equipment and the
Wheelchair Service, to outreach for vulnerable groups and the Family Nurse Partnership. There
are currently 60 services now operating from over 100 locations serving communities of
Liverpool and Merseyside.
1. ChiefExecutiveSummary
&QualityStatement
LCH was formerly part of Liverpool Primary Care Trust (PCT) and became an NHS Trust on
1 November 2010. The Trust has ambitions to become one of the first Community Foundation
Trusts (CFT), a new model for NHS community services. This will provide greater flexibility for
the Trust, enabling greater investment in local health services and be fully accountable to
local people.
On 1 April 2011, the Trust acquired the contracts to deliver community health services across
most of Sefton as well as the Community Dental services in Knowsley and Public health services
for Liverpool. This has meant an additional 900 staff joining LCH and will enable greater flexibility
across Merseyside for a number of community services.
The Trust is committed to our vision to ‘improve the health and well-being of the
communities we serve by providing high quality care’. As a separate Trust we have begun
to build more links with patient groups and others to help set our priorities and to give us
feedback on how well we are achieving them.
These accounts provide an overview of quality across the organisation which I am happy to
confirm presents a balanced picture of the organisation’s quality performance. To the best of my
knowledge the information in the document is accurate.
I hope you enjoy reading the report and find the work and results reported by LCH of interest.
Should you have any comments please feel free to contact our Communications Team. (Contact
details are on the back page).
On behalf of everyone at LCH, I would like to take this opportunity to thank you for your support
over the past 12 months. We look forward to your continued support as we work towards our
overriding goal of providing outstanding care to the people of Liverpool, Sefton and Knowsley.
Bernie Cuthel
Chief Executive for Liverpool Community Health NHS Trust
Quality Accounts 2011 5
In 2010/11 Quality Accounts we identified three priorities which are highlighted in the table
below. This section describes our achievements against each priority.
Indicator
Objective(s)
PRIORITY 1
A large number of
Partially
targets across a
Achieved
range of measures
reflecting
improvements in the
standard of nursing
care.
• Your Skin Matters
• Staying Safe –
Preventing Falls
• End of Life Care
• Prevention of
Infection
• Keeping
Nourished –
Getting Better
• Fit & Well to Care
• New systems for recording and
measurement have been put in
place.
Continue to Improve Fully
responsiveness to
Achieved
personal needs of
patients
• Two year programme of
surveying has been fully
completed. Action plans are
being implemented to further
improve quality where needed.
Implementation
of High Impact
Actions for
Nursing &
Midwifery
2. Resultsfrom
2010/11Priorities
PRIORITY 2
Improved
Patient
Experience
Result
What Have We Done?
RAG
• Education and Training for
nursing staff and, where
appropriate, for patients.
• Improvements have been
achieved across all quality
indicators.
• Several of the improvements
have not reached the agreed
target levels, but other quality
benefits have been evident as
a result.
• Mystery shopping has been
successfully piloted to test the
quality of customer care.
PRIORITY 3
Productive
Community
Services
Achieve Productive
Community
Services (PCS) for
District Nursing
Service
Fully
Achieved
• Roll out of PCS to all District
Nursing teams achieved well
ahead of the June 2011 target.
Quality Accounts 2011 7
Resultsfrom2010/11Priorities(continued)
The following is more detail on the targets set and the results obtained:
In September 2010 we established that our baseline was 24 ulcers per year. In the
remaining six months (between October 2010 and March 2011) Community Care has
been a contributory factor for 20 Pressure Ulcers at Grade 3 or 4. Whilst it is
acknowledge that LCH has not met the CQUIN indicator, consideration needs to be
given to the increase in reporting due to general increase in reporting and improvements
as result of more focused training.
Quality benefits as a result of this indicator are:
PRIORITY 1: High Impact Actions for Nursing & Midwifery
High impact actions are about getting the basics right first time to prevent further injury or illness
for patients.
Your Skin Matters – Reduction in numbers of pressure ulcers
Pressure ulcers (often referred to as ‘bed sores’) can be extremely painful and cause significant
debilitation and disruption to patients reducing their quality of life. They create significant
difficulties for patients, carers and families, as well as increasing time in hospital and cost to the
NHS. The aim of the High Impact Action is expressed as “No avoidable pressure ulcers in NHS
provided care” simply this means that everything possible is done to prevent a pressure ulcer
occurring.
The key steps are:
• Fully evaluate clinical condition and pressure ulcer risk factors
• Plan and carry out interventions consistent with patient needs/goals and standards of best
practice
• Check the impact of the interventions and revise the interventions as appropriate.
Some ulcers are “unavoidable”:
• Clear confirmation as to where the harm has occurred (hospital/care home/community)
in order for improvements to be made in the appropriate place.
• Analysts of all grade 3 & 4 Pressure Ulcer incidents in order to learn and improve
(b) Pressure Ulcers in Care Homes
CQUIN Target: 40% Reduction in Grade 3 or 4 Pressure Ulcers in 3 selected Care Homes.
This work was an extension of the successful pilot reported in 2009/10 Accounts. A
programme of wound and pressure ulcer competency training (theory & practice),
originally used to reduce occurrence of pressure ulcers for patients in a single care home,
was applied to three further homes. Data collection processes have been put in place to
record pressure ulcers.
During the initial period the number of patients with grade 3 & 4 pressure ulcers was 18
(prevalence 19.1%) and at the end of the project the number has reduced to 11 (11.7%
prevalence). At present our prevalence reduction is 39% across the 3 homes. Although
the target hasn’t quite been met though a large reduction has been achieved and a huge
cost saving has been seen.
• The person receiving care develops a pressure ulcer even though the provider of the care
carried out all of the key steps
• An individual does not adhere to prevention guidance
Number of patients with Reduction
Number Number of patients with
of beds grade 3 / 4 pressure ulcers grade 3 / 4 pressure ulcers
Nov 10 – Feb 11
May – Aug 2010
(a) Pressure Ulcers in Community
CQUIN Target: 30% Reduction in Grade 3 or 4 Pressure Ulcers caused in the
Community.
At the onset of this indicator LCH did not have robust data about community acquired
pressure ulcers and therefore had to improve systems to record relevant information.
This improvement was made at a time where incident reporting as a whole was
improving due to electronic systems being put into place. In addition to this, an
extensive programme of awareness and competency training has been led by the Skin
Team at LCH to further raise the knowledge of nurses and identification of pressure
ulcers This has also lead to a considerable increase in reporting.
Our reporting system has been developed as part of the process. Each incident of the
more serious pressure ulcers (Grade 3 & 4) is now reviewed using Root Cause Analysis
to confirm where and how the ulcer has been caused. Besides confirming whether
Pressure Ulcers were Community Acquired or Non Community Acquired these reviews
are used to identify themes or trends to inform learning and best practice.
8 Liverpool Community Health NHS Trust
28
5
3
40%
30
5
4
17%
36
8
4
50%
94
18
11
39%
Care Home 1
Care Home 2
Care Home 3
Total
Quality Accounts 2011 9
Resultsfrom2010/11Priorities(continued)
The delivery of Wound and Pressure Ulcer Competency training has again been shown to deliver
real improvements in a Nursing Home setting. In addition, there has been a large (64%)
reduction in district nurse visits to the three nursing homes in two comparable periods of time of
the project. Whilst the reduction in visits cannot be definitively be attributed to the desired
outcome of improved confidence and competence of nursing home staff to manage patients
with wounds including pressure ulcers, it is reasonable to assume that the project has had a
positive impact.
Staying Safe; Preventing Falls
The aim of High Impact Action: staying safe – preventing falls is to demonstrate a year-on-year
reduction in the number of falls sustained by older people in NHS-provided care. Falls can
happen for a number of reasons for example poor footwear, living conditions or types of
medication and can often be prevented with advice following assessment, aids to improve
independence or referral onto other services.
(a) Reduced Falls in Kent Lodge
Kent Lodge is a community based intermediate care facility based in the grounds of
Broadgreen Hospital. Patients can either ‘step up’ from the community for rehabilitation
or for assessment instead of being admitted to hospital, alternatively they can be
discharged from hospital into an intermediate care or assessment bed.
A 10% reduction of falls in Kent Lodge was identified by our commissioners. The
2010/11 CQUIN target was to reduce falls to no more than 130 in a year. The final figure
for 2010/11 was 149 falls. At present LCH has not seen a reduction in falls, however
work is underway to both understand the persistence of the current level of falls and to
look for new ways to achieve a reduction. There is a belief that the level of need (acuity)
of the patients admitted to the Unit is increasing and hence there is a potential for
increased falls as patients are less mobile. This belief will be tested when a new
complexity tool is applied over the coming months. It is also possible that improvements
in the processes of reporting (the introduction of DATIX Web) may have led to some
additional falls being captured.
To support the work a training model has been established and implemented for staff.
LCH have also developed and implemented a patient education programme.
Standardised Falls-Related Care Plans have been rolled-out across the Unit from
January 2011.
(b) Falls Assessments
CQUIN Target was set to carry out the FRAT (Falls Risk Assessment Tool) assessment for
95% of patients over 65 on District Nurse & Community Matron caseloads and in Kent
Lodge. Patients were screened for history of falls, medication, balance and previous
medical history. The final results were as follows:
Indicator
Target
Q4 Result
FRAT Kent Lodge
95%
93%
FRAT Community Matron Caseload
95%
55%
FRAT District Nurse Caseload
95%
42%
In addition there was a requirement to put a Falls Care Plan in place for those found to be
at risk in Kent Lodge. An auditable Care Plan was started in Kent Lodge in January and
for Q4 was in place for 66% of relevant patients.
LCH has not met the target across the range of patients though Kent Lodge has got
close to it. LCH has moved from recording on a paper system to electronic data capture
which identifies all patients who have/have not received a FRAT. This will enable LCH to
identify where there are gaps in practice.
End Of Life Care – “Important choices where to die when the time comes”
Community nurses have expert knowledge in end of life care. End of life care is needed when for
example a person has cancer or a long term condition, such as end stage heart failure. Dignity
in dying is essential in patient care and patient choice. “Important choices where to die when the
time comes” covers the choices for patients who are on End of Life pathways. Our objective is
that patients, who have expressed a wish, are able to die in their Preferred Place of Care (PPC).
We also ensure that patients who are on End of Life pathways on our caseloads will have
discussed their choice and had it recorded.
Staff undertake training to enable them to have sensitive discussion with patients and their
families in order to support their wishes. Targets were set for Community Matrons and District
Nurses to have discussed and recorded PPC for 70% of patients with a terminal diagnosis and
for 60% of patients who die to do so in their PPC.
District Nurses and Community Matrons were not able to record either the patient’s preferred
place of care or place of death on their current clinical system. Therefore, a new retrospective
audit process (where we looked back in records to gain information) was established to look at
all deaths recorded for patients on an end of life pathway.
LCH is pleased to announce that the target for this indicator was met. Data for nurses and
matrons has been combined.
10 Liverpool Community Health NHS Trust
Quality Accounts 2011 11
Resultsfrom2010/11Priorities(continued)
Keeping Nourished; Getting Better – Nutrition Assessment
Keeping patients well nourished is important to improving their health and recovery. Figures
show that patients with poor nutrition visit their GP more often, are more likely to succumb to
infection and require longer term and more intensive care. These patients also have a higher risk
of both falls and of developing pressure ulcers. Our aim for 2010/11 was that inpatients and
eligible patients being treated by District Nurses and Community Matrons in the community
would have a Malnutrition Universal Screening Tool (MUST) assessment.
Preferred Place of Care
90%
Percentage
discussed PPC
(Target 70%)
80%
70%
Percentage who
died in PPC
(Target 60%)
60%
50%
Q1
Q2
Q3
Q4
District Nurses and Community Matrons have exceeded the targets. This information will
continue to be collected in 2011/12 with the view to further increasing the recording and
achievement. A system to make the collection of data less labour intensive is being sought.
Prevention of Infection – Urinary Tract Infections
Urinary Tract Infections (UTIs) often referred to as ‘water infections’ are the second largest single
group of healthcare associated infections in the UK. Evidence suggests that 60% of all UTIs are
related to urinary catheter insertion (a catheter is a tube inserted into the bladder to drain urine).
In working on this indicator LCH has developed an electronic data capture system which
identifies all patients who have/have not received a MUST. Previously this information could only
be attained via Record Keeping audit, and was therefore based on a sample of patients not the
total caseload.
A training programme has been developed and implemented for relevant staff. To date, 330 LCH
staff members had been trained and MUST training is included on all inductions for clinical staff.
Training sessions have been supported by E Learning developed as an additional means for staff
to complete their training.
The CQUIN target was set to carry out the MUST assessment for 95% of patients over 65 on
District Nurse & Community Matron caseload and all patients in Kent Lodge.
Indicator
Target
Q4 Result
MUST Kent Lodge
95%
92%
MUST Community Matron Caseload
95%
65%
MUST District Nurse Caseload
95%
69%
The objective of this indicator was a reduction in level of UTI’s for patients with an indwelling
catheter in Kent Lodge and in the Community (on District Nurse Caseload). The numbers of
infections have been found to be low making it quite hard to achieve a significant reduction. An
initial review found there had been no UTIs in Kent Lodge. On the District Nurse caseload there
were 16 cases out of a cohort of 140 patients which is a prevalence of 11.4%.
At present LCH has not fully achieved the target though Kent Lodge has got close to it. The
electronic data capture system which was introduced for District Nurse & Community Matron
staff has aided recording and reporting on this indicator. Teams are now aware of their own
performance against this indicator in order to improve for 2011 – 2012.
A repeat audit in Q3 found that this had dropped to a prevalence of 13 cases (equivalent to
9.3%) and a fall of 18.5%. The commissioners at Liverpool PCT had proposed a target of a 30%
reduction (2 fewer cases). LCH is now in discussion to prepare our action plan for future work in
this area and has created a standard operating procedure to embed continued improvement.
Fit & Well to Care – Reduced Staff Absence due to Sickness
This initiative has focussed on reducing sickness absence in the workforce. Our target for
2010/11 was to reduce the absence rate for all staff to 5%. In addition to the savings related to
reducing sickness absence, benefits would include increased continuity of care which will in turn
have a positive impact on both patients and their relatives.
Indicator
UTI Prevalence
Q1 Baseline
Target Reduction
Q3 Result
Actual Reduction
11.4%
30%
9.3%
18.4%
Indicator
2009/10
Target
2010/11
Q4
Staff Sickness Absence
5.39%
5%
5.06%
4.74%
LCH has achieved the target for the most recent quarter. A significant reduction has been made
from last year’s level.
12 Liverpool Community Health NHS Trust
Quality Accounts 2011 13
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2009/10
Patient Experience Surveying
Positive patient experience is important, LCH strive to ensure patients receive services that they
value. 2010/11 was the second year of a 2 year rolling programme for the CQUIN Indicator.
Each LCH Service undertakes a Patient Experience survey every other year to fulfil the
requirements of the programme. A number of services have been classified as a priority and are
to be surveyed every year. These are services that have high numbers of incidents and/or
complaints registered with the Customers Services Department. The following chart shows the
response to the question, ‘How would you rate your overall experience of the Service?’ for the
priority services:
tN
on
20%
20%
M
gt
40%
PRIORITY 2: Improved Patient Experience
ic
st
60%
2010/11
tr
Ke
80%
40%
PC
ns
er
Ev
100%
Service
Patient
Satisfaction
•Priority
Improved
electronic
system
for recording and reporting sickness/absence
• Improved system for staff to notify of sickness/absence
• Improved Occupational Health support
100% checks and lifestyle advice available to staff
• Health
80% promotion awareness sessions for staff throughout the year
• Health
• Annual
60% health checks for night staff
is
in
LCH has 10 Primary Care Medical Services (PCMS) GP Practices. Each of the 10 Practices
participates in the National GP Survey. The results of the 2010/11 survey have yet to published
(will be available via the following link from July 2011 http://www.gp-patient.co.uk/results/ )
however, the 2009/10 results and January to December 2010 can be seen in the graph below.
A more robust HR policy has been put in place which has included the following changes:
D
ar
to
C
Resultsfrom2010/11Priorities(continued)
G
n
hi
R
ld
w
oa
al
d
l
0%
To Dec 2010
100%
In 2009/10
36 surveys covering 44 services were undertaken, and reported in last year’s Quality
90%
Accounts.
For 2010/11, 25 surveys covering 27 Services have all been completed. Action Plans
80%
have
been
submitted
by services following review of the results.
70%
60%
Of the
50%25 surveys in 2010/11, 2 surveys did not contain the question on satisfaction. The
Services
40% concerned are; So 2 Speak; Sexual Health information and education service for young
people;
to
30% and the Sexual Assault Referral Centre; provides choice and confidential support 2009/10
adults
20%or young people following sexual assault or rape. It was agreed that a question on2010/11
10%
satisfaction
was not appropriate for patients visiting these services. These Services collect
0%
patient feedback using separate, more appropriate questions sets.
AHP
Health Visiting
Dental
PCMS
Planned
Care
Sexual
Health
Unplanned
Care
Overall
To provide a view of overall satisfaction year to year survey results from services have been
grouped within the former directorate structure.
Prison Healthcare
Kent Lodge & CCAU
100%
Liverpool Out Of Hospital
90%
Walk-In-Centre - City
80%
Walk-In-Centre - Garston
70%
60%
Walk-In-Centre - Old Swan
50%
Walk-In-Centre - Smithdown
40%
Walk-In-Centre - Adults
30%
20%
Walk-In-Centre - Paediatrics
10%
0%
20%
40%
2009/10
60%
80%
100%
0%
AHP
Dental
PCMS
2010/11
2009/10
It is to be noted that for the Walk-In-Centre Service in 2010/11 satisfaction rates are split by
paediatrics and adults as it is thought that this gives a more reflective view of patient’s views of
the service. In 2009/10 results were disseminated by individual Walk-In-Centre.
14 Liverpool Community Health NHS Trust
Planned
Care
Sexual
Health
Unplanned
Care
Overall
2010/11
NB The Sexual Health Directorate surveys in 2009/10 did not use the generic Patient Experience
question set. The Dental Directorate did not have to undertake any Patient Experience Surveys
in 2010/11. Full year PCMS GP National Patient Survey data will not be available until June
2011.
Quality Accounts 2011 15
Resultsfrom2010/11Priorities(continued)
Mystery Shopping
Mystery shopping is an approach widely used by commercial companies to test the quality of
their customer service to continually improve the service they provide. LCH has taken its steer
from commercial practice to develop tools and techniques to undertake Mystery Shopping. This
year the trust ran a pilot exercise using Mystery Shoppers recruited from the staff Talent Pool to
look at two services: Walk in Centres and the PCMS Practices. The exercise explored two areas:
• WOWE: (Well Organised Work Environment) – Increasing efficiencies of working environment
using no/low cost techniques
• PSAG: (Patient Status At a Glance) – Visual patient information to improve communication,
patient experience and patient flow
• KHWD: (Knowing How We are Doing) – Using facts/data to demonstrate improvements and
understanding why it is helpful to display measures visually
The team leaders have been coached and supported by the facilitators including members of
the LCH Talent Pool. The Showcase Team have reported a 10% increase in time spent with
patients as a result of the work. In addition, nurses have reported improved productivity and on
a personal level an increased sense of responsibility and pride along with reduced stress.
The principles and practical modules are being reviewed elsewhere in the organisation with the
intention of applying them in other settings.
Approach
To test
Telephone call
Greeting; responses to questions
Visit:
Access; signage; greeting; waiting area; responses to questions
Evaluation questionnaires were completed by the mystery shoppers and the results collated:
Results
WIC
PCMS
Welcome – % made to feel welcome or very welcome
90%
61%
Politeness – % of Shoppers considered receptionist polite/very polite
90%
89%
Response to Enquiry – % answered satisfactorily
100%
82%
The information gathered has been given to the services for staff to evaluate and act on the
findings to improve services where necessary and inform the customer service training
programme. A Mystery Shopping programme is to be introduced at LCH to periodically assess
services as part of our overall patient experience work. We are keen to explore other services
and issues relating to patients who do not use English or have a disability. Further work is also
planned including looking at different ways to recruit mystery shoppers.
PRIORITY 3: Productive Community Services
The Productive Community Series (PCS) is an organisation-wide change programme which was
officially launched in October 2009 by the NHS Institute for Innovation and Improvement
following a series of pilot programmes around the country. Feedback from pilot sites indicated
that community service teams can substantially increase their productivity, which in-turn
improves patient experience by releasing more time to care. Following a positive experience with
the Productive Ward, LCH took on the objective of introducing Productive Community Services
into all teams in the District Nursing service.
The programme has been successfully completed. PCS has been rolled out across the 19
District Nursing Teams of LCH ahead of the June 2011 target. A neighbourhood approach was
used for the roll out with North Neighbourhood designated as the Showcase Team. All teams
have worked through the three Foundation Modules:-
16 Liverpool Community Health NHS Trust
Quality Accounts 2011 17
This section of the Quality Accounts provides a review of other quality measures within LCH and
our activities across the various aspects of quality.
Overview
QUALITY DOMAIN/Indicator
TARGET
QUALITY DOMAIN/Indicator
MRSA screening for all relevant
admissions into intermediate care
100%
100% Screening
Assessment of patients on admission
to intermediate care bed for C diff risk
100%
100% Screening
Isolation of intermediate care patients
with known or suspected C Diff within
4 hours
100%
100% Isolation (4 cases)
RAG
SAFETY
Infection Prevention & Control:
Compliance with HCAI Framework
Never Events
3. Reviewof
Qualityin2010/11
Compliant
Zero
No Never Events
Completeness of Breastfeeding Status
at 6-8 weeks
95%
95.3% achieved
Child Measurement Programme
85%
95.67% Reception &
89.10% Year 6 achieved
Chlamydia Screening
(Part of PCT Programme)
35%
Liverpool PCT 29.3% Knowsley
PCT 29.7% LCH activity largely
completed. Rated Amber
NICE Guidance & Appraisals
N/A
Systems & Processes in place for
Clinical Guidance & Technical
Appraisals.
EFFECTIVENESS
Cellulitis Pathway – Bed Days Saved
540 days
Target exceeded; 870 bed days
saved
Quality Accounts 2011 19
ReviewofQualityin2010/11(continued)
QUALITY DOMAIN/Indicator
TARGET
QUALITY DOMAIN/Indicator
VACCINATIONS
Tetanus, Polio, Pertussis, Haemophilus
influenza type b at 1 year
(DTaP/IPV/Hib)
95%
95.0% achieved
Measles, Mumps & Rubella at 2 years
(MMR1)
95%
91.8% achieved
Haemophilus influenza type b,
Meningitis C at 2 years (Hib/Men C)
90%
92.7% achieved
Pneumococcal booster at 2 years
(PCV)
90%
92.0% achieved
Measles, Mumps & Rubella at 5 years
(MMR2)
85%
85.8% achieved
Pre School Booster (PSB)
85%
Human Papillomavirus (HPV) at 12-13
years (girls) - three doses
87.6% achieved
Achievement 2nd dose received by 84%
to April 11 3rd dose received by 71%
*see commentary below.
PATIENT EXPERIENCE
Safety
Patient safety is the most important aspect of all care provided by Liverpool Community Health.
The Trust delivers training to all staff and has a number of statutory and regulatory duties placed
upon us that we are required to meet.
RAG
LCH registration with the health regulator (CQC) is covered within the Dept of Health Required
Content in Section 2.
Infection Control
The Hygiene code sets out standards for organisations to meet. Compliance with the Hygiene
Code/HCAI Assurance Framework has been maintained, meeting the requirements of the Care
Quality Commission. Reduction in Health Care Acquired Infections (HCAI) is a target for all
organisations. Clostridium Difficile (C-Diff) is one of these infections. Screening assessments are
carried out for 100% of patients entering the intermediate care facility at Kent Lodge. In 2010/11
4 patients with C-Diff were identified and isolated within the target of four hours. Another
commonly known one is Methacillin Resistant Staphylococcus Aureus (MRSA), screening for this
is also carried out in Kent Lodge. In 2010/11 there have again been no episodes of MRSA
bacteraemia.
The incidence of C-Diff can be related to the prescribing of antibiotics. The Medicines
Management Team have been working closely with the Infection Control Team to support the
agenda around C-Diff infection by running an intensive campaign of education and audit around
the use of antibiotics, especially those implicated in increasing the incidence of this infection.
This has resulted in the rates of C-Diff infection falling to 35% below trajectory at the end of
September 2010 for patients in the Liverpool PCT catchment area. The prescribing of high-risk
antibiotics for C-Diff infection also fell by 28.9% from 2008/9 to quarter one 2010/2011.
NPSA PEAT Scores (Patient
Environment Action Team)
Environment =
Good
Food & Hydration = Good
Privacy & Dignity = Good
Never Events
LCH has not had any of the most serious “Never Events” in 2010/11. Never Events are serious,
largely preventable patient safety incidents that should not occur if the available preventative
measures have been implemented. Further detail and the original list is available on the NPSA
website: http://www.nrls.npsa.nhs.uk/resources/collections/never-events
Complaints
133 in 2010/11 (Compared to 131
in 2009/10; 89 in 2008/9).
See commentary below.
From February 2011 the listing has been expanded to contain more events relevant to Primary
Care: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH_124552
Walk In Centres Waiting Times
(4 Hour Breaches)
99.97% seen within four hours
Zero
Same Sex Accommodation Breaches
at Kent Lodge
No breaches in 2010/11
No events covered by the expanded list have occurred during 2010/11.
ALLIED HEALTH PROFESSIONAL WAITING TIMES
<18 weeks
Physiotherapy
99.1%
Dietetics
<18 weeks
84.7%
OT
<18 weeks
100%
Adult Speech & Language Therapy
<18 weeks
100%
Podiatry
<18 weeks
99%
“Achieving” in
Equality Performance Improvement
majority of
Toolkit (EPIT) – Assessment with three
goals for
performance levels: Developing;
2011
Achieving; Excellent in 12 deliverables
20 Liverpool Community Health NHS Trust
Significant Untoward Incidences (SUI):
During 2010/11 there has been two serious safety related incident in the LCH organisation. The
first related to a spillage of sharps in the boot of a nurse’s car. New procedures have been put in
place to prevent a similar incident from happening. The second related to a serious assault by a
member of the public on a member of LCH staff. This is currently being investigated.
Significant improvement from
09/10 submission. Reached
“Achieving” performance level in
eight out of twelve deliverables.
Quality Accounts 2011 21
ReviewofQualityin2010/11(continued)
Effectiveness
Clinical Effectiveness is about using evidenced based practice in the delivery of care to patients.
It was the main focus set for 2009/10 Accounts on the basis that this links to the other Quality
streams (Safety, Patient Experience & Innovation). It remains a key focus for the organisation and
many measures are included through the Quality Accounts:
• A number of measures for effectiveness of nursing care were set as CQUIN targets. The
outcomes for these are reported within the review of last year’s objectives.
• Clinical Audit is reported in detail in the Dept of Health Required Statements of Assurance.
Improving Health and Well Being
Breast Feeding: It is important to give children the best start in life, this starts with breastfeeding.
The collection of breastfeeding data is part of work with Liverpool PCT, Liverpool Children’s
Centres and Liverpool Women’s Hospital toward full accreditation under the UNICEF Baby
Friendly Initiative. Stage One accreditation was achieved in September 2010 and the submission
was highly commended for the standard of the paperwork submitted. Stage One included:
• a comprehensive training plan for all health visiting staff
• a breastfeeding policy that covers all of the best practice standards
• a written description of how the policy is communicated to pregnant women and parents in an
appropriate and effective manner
• audit processes and plans and a written description of the mechanism for audit
• an assessment of all premises to ensure compliance with UNICEF BFI guidance
Evidence for Stage Two accreditation requires submission in September 2011. We continue to
collect the data and work with partners to identify issues/gaps. We are currently developing
pathways in line with national guidance.
National Child Measurement Programme (NCMP):
The National Child Measurement Programme (NCMP) involves the collection of the height and
weight of Reception and Year Six children. Their Body Mass Index (BMI) is calculated from this
data and the children are then grouped into four categories: underweight, healthy weight,
overweight and obese. Whilst it is vital that the data is complete the focus should be on the
levels of obesity amongst children in Liverpool. Whilst the national approach to parental
feedback has been to send details to all parents, LCH are now using a targeted approach to
parental feedback. Liverpool Community Health has achieved this target with 95.7% in reception
and 89.1% in year 6 participation of eligible children for the school year ending in 2010.
22 Liverpool Community Health NHS Trust
Chlamydia Screening: Chlamydia is a sexually transmitted disease that can go unnoticed and lead
to fertility problems in later life. It is important to screen for Chlamydia as treatment is simple and
effective. Due to the importance, targets have increased year on year and LCH deliver part of
the Chlamydia screening for both Liverpool and Knowsley PCTs. Target coverage is 35% with
level of coverage being reported by PCT’s. While end of year figures are from HPA not yet
confirmed it is likely that both PCTs will miss the target. However each PCT has seen significant
year on year improvements as targets have rapidly increased.
Chlamydia Screening Coverage
35%
30%
Target
25%
Liverpool PCT
20%
Knowsley PCT
15%
10%
5%
0%
2008-09
2009-10
2010-11
NICE Guidance & Appraisals: The National Institute for Clinical Excellence (NICE) produced
evidence based guidance on best practice. In LCH Systems and processes are in place and
progress is tracked on Performance Accelerator®, a commercially produced software system
for tracking and driving compliance and improvement plans. Guidance status is shared with
service leads and any issues are escalated through the committee structure. The status and
approach has been agreed with Commissioners. 2011/12 will see an increased focus on
Quality Standards.
Quality Accounts 2011 23
ReviewofQualityin2010/11(continued)
Vaccinations and Immunisations:
Vaccination and Immunisation is important not only to protect the health of children and adults,
but also to protect the health of the population to prevent spread of disease is outbreaks occur.
In 2009/10 LCH made significant improvements citywide to the uptake and coverage of all
childhood vaccinations. LCH have, in 2010/11, built upon this success to reach most of the
challenging targets. Immunisers have continued to engage in routine and additional vaccination
activity. Flexible scheduling reaches those who have difficulty accessing services and groups
difficult to engage with. Vaccinations have been offered in a variety of settings such as schools,
clinics and the home involving early evening and weekend working, resulting in an increase of
uptake and coverage of vaccination. LCH have sought to address the challenges faced in inner
cities where transient populations impact upon vaccination uptake and coverage. As part of this
initiative a total number of 1169 home visits were made to families who wouldn’t otherwise
access the service. While no contact was made in just over half of visits and many families
needed to be visited more than once an additional 255 vaccinations were given.
More work is planned to further target children missing their Measles, Mumps and Rubella
(MMR) vaccine to ensure they have their 2 doses prior to school entry to reduce the risk of
outbreaks of measles, mumps in our schools and reduce the transmission of rubella to pregnant
women.
ons: Coverage Levels
The diagram provides a view over a longer time frame of the progress made on coverage levels.
Human Papillomavirus (HPV) infection causes cervical cancer. When vaccine uptake is good, the
HPV vaccine could prevent the majority of cases of cervical cancer. The vaccine is offered
routinely to all school aged girls aged 12 to 13 years in school year 8. In 2009/10 78.5% of Year
8 children received all 3 doses in Liverpool Schools but in 2010/11 84% of Year 8 children have
already received the first 2 doses, with the 3rd dose being administered in schools until the end
of July 2011. Update of 3rd dose will not be known until August 2011, therefore details of
performance will be published in 2011/12 Quality Accounts.
As of February 2011, Liverpool’s uptake figures exceeded the average figures for the
North-West and also for England.
It is important to understand the reasons why girls who are due their vaccine miss scheduled
school HPV immunisation sessions, LCH have established this and a remedial action plan has
been put in place to improve the uptake of HPV vaccine in these girls. The actions include
reviewing and improving information given to parents and girls and follow up processes for girls
who have missed planned immunisation sessions. In addition School Health Practitioners have
local school intelligence and have produced individual school action plans addressing potential
health inequalities and refocusing school interventions accordingly.
Patient Experience
Some of our results from Patient Experience surveying and Mystery Shopping have been
reported within the review of last year’s objectives. The following covers other elements of this
quality domain.
Through 2010/11 there have been no breaches of same sex accommodation at Kent Lodge.
Delivering same-sex accommodation is a long standing commitment in the NHS as part of the
drive to deliver the best possible experience for all patients. The recording of any breaches of
this commitment is a national indicator.
Percentage Immunisation Coverage 2007 - 2011
92.1
%
92.4
%
94.7
%
95
%
84
%
83.4
%
90.9
%
91.8
%
62.9
%
79.6
%
89.4
%
92
%
39.4
%
87.7
%
89.7
%
92.7
%
Hib Men C Booster at 2yrs
65.7
%
72.1
%
79.8
%
95.5
%
MMR2 at 5yrs
92.
7%
73.3
%
80.3
%
87.6
%
Pre School Booster
2007/08
2008/09
2009/10
2010/11
24 Liverpool Community Health NHS Trust
DTaPIPVHib at 1yr
MMR1 at 2yrs
Complaints
LCH learns from both compliments and complaints as part of improving the patient experience.
There is a reporting process for both. Complaints Reports are provided to LCH Board and the
Commissioners as part of Quality Reporting. Every complaint received is investigated to fully
understand what has happened and to actively seek the lessons that can be learned from it.
GRAPH 3
In 2010/11 there were 133 complaints to LCH. (Compared to 131 in 2009/10; 89 in 2008/9).
The complaints were divided across a range of issues:
PCV at 2yrs
Categories
Equipment & premises
Appointments
Attitude of staff
Clinical treatment
Communication/information
Privacy and Dignity
Personal records
Confidentiality
Other
2009/10
2010/11
Quality Accounts 2011 25
ReviewofQualityin2010/11(continued)
The table below shows complaints return which is sent to the Department of Health for KO41a
submission. Please note that only certain categories of complaints are reported to the
Department of Health.
Subject
08/09
09/10
10/11
A01 Admissions, discharge and transfer arrangements
1
Compliments
A total of 173 compliments were passed to Customer Services during the year 2010/11
(compared to 68 in 2009/10). The increase is at least in part due to better reporting from
services. The review of compliments is still in development but they can offer some valuable
insight for services into what is considered important by patients.
Many of the compliments received express great appreciation by patients or their families for the
work of LCH staff. A common theme of many of the compliments is the combination of
professionalism and kindness and reflects success in balancing the quality domains. The letters
also remind us that the care for an individual patient may be delivered from more than one
service.
A02 Aids and appliances, equipment, premises (including access)
8
9
4
A03 Appointments, delay/cancellation (outpatient)
4
11
15
A07 Attitude of staff
20
30
31
A08 All aspects of clinical treatment
35
51
60
A09 Communication/information to patients (written and oral)
13
17
12
Innovation
LCH encourage staff to be innovative. This includes listening to ideas staff may have to improve
services for patients through to putting these ideas into practice. Mystery Shopping and
Productive Community Services are highlighted elsewhere within the Quality Accounts. Both
were supported by the LCH Talent Pool – who are staff members who were keen to develop
their existing role by supporting organisational projects.
5
Some other examples are as follows:
A10 Consent to treatment
2
A12 Patients’ Privacy and Dignity
5
5
A17 Personal records (inc med records & complaints)
2
A18 Failure to follow agreed procedures
1
Improving Patient Experience - Communication Support Pack developed in
Speech & Language
A21 Transport (ambulances and other)
1
A24 Hospital services (including food)
1
A25 Other
3
2
4
Grand Total
89
130
133
The charts show that the three main areas of complaint are, clinical treatment, appointments
and staff attitude. One area which will be of particular priority this year will be staff attitude LCH
will invest in a programme of customer service training which will look at the following:
The pack contains resources to support communication with patients who may have difficulty
understanding information or expressing themselves at initial assessment interviews. The
materials are available on the LCH staff intranet for all to use and can be customised to meet
particular needs.
The underlying aim is to not just ‘treat’ patients, but to deliver personalised, responsive, holistic
care in the full context of how people live their lives.
Training
Content
• Patients can use the pack to understand information about their healthcare needs
• Patients can use the pack to answer questions about their health care needs
• Health Professionals can use the pack to support their assessment and ask questions about
all areas of health and social care
Programme in Customer
Service
Vocational Qualification (formally known as NVQ), Technical
Certificate in Customer Service and Certificates in Literacy &
Numeracy (focussed on customer service)
Improved Access for Patients - Transfer of community dental triage to Unplanned Care
Direct
Creating a Positive
Impression
Accredited programme focused upon face to face customer
services
Communicating
Effectively
Focused upon face to face and verbal (telephone) customer
contact
Customer Care &
Communication
A programme for clinical staff (nurses and GPs) from across
Walk in Centres, PCTMS Practices and Treatment Rooms.
Training commissioned and to be piloted. Wider roll out will be
considered if successful
26 Liverpool Community Health NHS Trust
To improve the quality of the dental triage service for patients LCH have standardised and
centralised the Dental Access Centre (DAC). Previously if a patient required an emergency dental
procedure they were required to leave a message on an answer machine and a member of the
dental service would call them back within 1 hour. By moving the triage for Community Dental
services into Unplanned Care Direct we have made a 66% reduction in the amount of time a
patient may spend waiting for someone to call them back. The new process is auditable and
performance managed, reportable electronically and allows dental nurses at the Everton Dental
Centre to concentrate solely on clinical care.
Quality Accounts 2011 27
ReviewofQualityin2010/11(continued)
Appointment Reminder Text Messaging
In an attempt to reduce the number of appointments patients did not attend (DNA) LCH have
piloted an innovative free of charge text message reminder service. Although the pilot was
relatively short and only included 2 services the DNA rate for those who received a text message
was 5% lower than those that did not and the number of patients giving notice and cancelling if
they couldn’t attend was increased. During the pilot patients were asked to complete a short
questionnaire the results of which show that 74% of people asked think that this service would
be of use to them.
Families and Children - Family Nurse Partnership
Family Nurse Partnership (FNP) is an intensive home visiting programme is delivered from the
early antenatal period and until the child is 2 years old and is offered to first time teenage
parents. A team of 4 family nurses, 1 Family Nurse Supervisor and a Project Support Officer
work with other groups to identify gaps or issues and develop pathways for teenage parents
e.g. breastfeeding, smoking. The team are based at the Yew Tree Centre and work closely with
Children’s Centres, Liverpool Women’s Hospital, Local Authority and other agencies.
Kent Lodge OT Seating Assessment
Occupational Therapists at Kent Lodge have developed a more rapid seating assessment
process to ensure patients have the correct chair from admission. This process has done away
with potentially inappropriate use of manual handling equipment due to patients being classed
as more dependent than they actually are. The work has been presented at the National
Occupational Therapy Conference in 2010 and will be published in a national journal in due
course.
Quality Management, Governance & Assurance
The LCH Quality Strategy remains in place as it was designed for a three year period. (Work will
commence on the Monitor Quality Governance Framework as part of development towards
Foundation Trust status). A new Clinical & Patient Quality Group led by the Executive Lead for
Quality has been formed to review all aspects of quality performance. Directorate and Service
Leads report and review all quality related activities including Equality. The group provides a clear
path for any quality issues to Governance Committees and to Board level.
LCH has commissioned Mersey Internal Audit Agency (MIAA) to provide an internal audit of the
2009/10 Pilot Quality Accounts. The audit has reviewed the processes used for the Quality
Accounts and within individual CQUIN work streams. The audit has reported “significant
assurance” within the pilot process indicating a good system for the reporting of quality. Some
potential weaknesses have been identified (hence not “high assurance”) but these are either of
limited impact or unlikely to occur.
Information Systems
Through the year a number of new/updated systems have been introduced. These include new
systems for Community Dental & Sexual Health services. For both there is a move toward
'paper light' working; this will mean no printed patient notes, greater data protection & quicker
retrieval of patient information. There have also been system developments for Primary Care
Medical Services (PCMS) – LCH’s general practices. While consultations take place within
general practice, care is also given in patient’s homes, clinics and secondary care settings and
information sharing has historically been poor. In 2010/11 we have implemented a system which
provides real time data sharing between LCH general practices, acute trusts and other NHS
organisations. The new system has improved communication, reduced duplication of work and
ensures up to date patient information is available to clinicians.
A number of new/improved reports and audit processes have been developed to support work
on CQUIN indicators. These include:
• Improvement of the system for reporting and analysis of pressure ulcers.
• Web based reporting of all incidents to enable speedier and more complete reporting of all
levels of incidents
• The capability to record falls and malnutrition assessments on community clinical system
• A number of new audit processes established for end of life care and for discharge processes
and documentation.
Reports providing a visual overview of quality indicators known as “dashboards” are increasingly
used. The benefit is that an effective dashboard can provide an “at-a-glance” view of how we
are doing and communicate that information for all levels of the organisation.
Liverpool Community Health also makes extensive use of Performance Accelerator ® a
commercially produced software system for tracking and driving compliance and improvement
plans. The system is currently used for a range of areas including CQC Regulations, NICE
Guidance and the Hygiene Code.
Workforce Factors
Each year a significant percentage of LCH staff are surveyed across a range of areas relating to
their work and the organisation. Findings are set into context of all organisations across the
NHS. The results are carefully reviewed to look at how well LCH are meeting its commitments to
staff. In most areas LCH scores show performance which is on a par with those of other trusts
in meeting its commitments to staff.
One of the questions asked in the survey relates to reviewing staff performance and planning
their development. Good staff performance and career development means that patients
receive quality care by staff who are enthusiastic and who continually update their skills. In 2010
the staff survey showed:
• 80% report having an appraisal or review in the last 12 months (National = 79%)
• 93% agreed a personal development plan as part of the appraisal or review (National = 89%)
LCH has made a significant investment in data quality in 2010/11. The work is reported within
the Dept of Health required assurances in Section 5.
28 Liverpool Community Health NHS Trust
Quality Accounts 2011 29
ReviewofQualityin2010/11(continued)
One area which had already been identified as a priority for improvement prior to the survey is
the completion of training. The survey confirms that LCH has poor uptake with training across a
range of areas. A key objective for 2011/12 will be improved uptake of mandatory training
through a more flexible approach to delivery (i.e. training online). There will also be better
mechanisms in place to feedback to directorates on their position.
The NHS staff survey also provides a view of how quality of care within LCH is viewed by its
workforce.
• 89% of LCH staff agree they are satisfied with the quality of care they give to patients
(National = 88%).
• 72% agree they would be happy with the standard of care if a friend or relative needed
treatment (National = 65%).
During 2010/11 staff sickness absence has been the subject of a CQUIN indicator. The details
of LCH performance have been reported in Section 2.
Delivering Equality
Liverpool Community Health NHS Trust believes that we cannot truly achieve quality without a
strong commitment to equality. We understand that it needs a highly motivated diverse
workforce that understands the unique needs of the diverse group of patients and communities
that it serves in order to respond appropriately and deliver high quality health outcomes for all.
LCH has a dedicated Equality & Diversity Team that works in partnership with managers and
front line staff across the organisation on a range of initiatives that are aimed at promoting
equality for staff and patients alike. Equality & Diversity interventions that improve access to
services include:
• Provision of telephone and face to face interpretation services
• Information available in alternative formats and languages upon request
• A Disability Access Advisor who audits the physical accessibility of buildings and provides
advice and guidance to reduce barriers.
• Equality, diversity and human rights training are mandatory for all staff including our board.
• LCH hold employment accreditations such as Positive about Disabled People, Mindful
Employer and Age Positive.
• LCH were successful in being placed 13th of the 53 NHS bodies that made submissions to
the Stonewall top 100 index 2010 for employers who promote best practice for lesbian, gay
and bisexual employees.
• All of our plans including policies, Board papers and strategies are assessed for their potential
impact on people with protected characteristics.
• Building relationships and working in partnership with patients who share protected
characteristics.
Our performance in the delivery of equality outcomes is measured by the Equality Performance
Improvement Toolkit (EPIT). Our improved performance in 2010/11 has been reported in the
quality overview above.
30 Liverpool Community Health NHS Trust
The following are the quality priorities for LCH in 2011/12. Most of these priorities are part of an
overarching programme called “Energising for Excellence”.
PRIORITY 1: HIGH IMPACT NURSING ACTIONS
High Impact Actions are a set of best practice initiatives developed in consultation with
experienced nurses and midwives. Significant improvements in patient safety, clinical
effectiveness and patient experience are believed to be available from their adoption
throughout the organisation
4. PrioritiesforImprovement
for2011/12
2010/11 Activity
2011/12 Targets
Monitoring/Measurement
Reporting
• Development of
a range of
monitors/
measures.
• Improvements
under six “High
Impact Actions”
Initiatives.
• Build upon the High
Impact Actions for
10/11.
• Promote a culture of
ownership,
engagement and
accountability for the
quality of nursing
care given.
• Demonstrate the
impact of the
programme on
patient and staff
experience as well
as health outcomes.
Clinical Incident
reporting.
Internal reporting
through Governance
routes to LCH Board.
Root cause analysis.
Clinical recording
systems.
Record keeping audits.
Sickness absence
reporting.
Incident reporting to
National Patient Safety
Agency (NPSA).
Commissioning for
Quality and Innovation
(CQUIN) Project
reporting to
Commissioners.
Report to public in
2011/12 Quality
Accounts.
Work in 2011/12 will be a continuation and development of the 2010/11 “High Impact Actions”
indicators.
• Your Skin Matters
This year’s CQUIN project will seek to further reduce community acquired Grade 3 and 4
pressure ulcers for patients managed in Kent Lodge or on a District Nurse or Community Matron
caseload. In addition, Grade 2 pressure ulcers will be monitored for reduction, along with
transfer of information from Kent Lodge to receiving the team for patients discharged with a
pressure ulcer.
• Staying Safe – Preventing Falls
This indicator will continue to look at the reduction in falls in Kent Lodge and increased use of
risk assessment for patients managed by Kent Lodge, District Nurses or Community Matrons.
There will be increased monitoring of care plans for patients who are identified at risk of having a
fall. Additional requirements may be to engage carers and patients representatives in falls
management and prevention, and a decrease in the severity of injuries as a result of a fall.
• Keeping Nourished – Getting Better
This continuation of last year’s indicator will monitor screening for malnutrition using the MUST
tool for patients on a District Nurse or Community Matron caseload and on admission to Kent
Lodge. Additional requirements may focus on re-screening and action planning for those
patients considered “at risk of malnutrition”.
Quality Accounts 2011 33
PrioritiesforImprovementfor2011/12(continued)
• End of Life Care
This continuation of last year’s indicator will see a further increase in recording of Preferred Place
of Care (PPC) and increase in patients dying in their PPC.
• Fit and Well to Care
Last year’s target for reducing sickness for LCH’s workforce is to be further reduced to bring the
level closer to the private sector rate of 4%.
• Protection from Infection
As a continuation of last year there will be a further reduction required in the number of
incidences of Urinary Tract Infections (UTI) for patients with an indwelling catheter managed
within Kent Lodge and on the District Nurse caseload.
PRIORITY 2: IMPROVED RESPONSIVENESS TO PATIENT NEEDS & CUSTOMER CARE
Measurement and improvement of the Patient Experience is a key priority for LCH. Ensuring
patients are involved in the assessment and development of services is crucial to ensure the
correct commissioning of services and patients feeling the benefit of the local health services
on offer to them.
2010/11 Activity
2011/12 Targets
• Successful
• Improved
completion of two personalisation of
year programme
care planning and
of Patient
self-management
Experience
amongst patients
surveying.
with long term
• Repeat surveys
conditions (LTC).
for Priority
• Improved
Services.
responsiveness to
• Pilot of Mystery
personal needs of
Shopping.
patients receiving
community based
hospital healthcare
services.
• Improved patient
outcomes through
the development of
quality of life tools.
• Continued
development and
improvement of
Patient Experience
and Equality &
Diversity in
collaboration with
the Clinical & Patient
Quality Group.
Monitoring/Measurement
Reporting
Responses to two
questions with patients
on LTC registers and
managed within the
community
Internal reporting
through Governance
routes to LCH Board.
Dedicated Patient
Reported Outcome
Measure (PROM) tool.
Further detail to be
agreed with
Commissioners at
Liverpool PCT.
CQUIN Project
reporting to
Commissioners.
Report to public in
2011/12 Quality
Accounts
Patient Survey results
Customer Care Training
Feedback from Mystery
Shopping
Qualitative Information
including from Focus
Groups and other
engagement
Work on patient experience in 2011/12 will be across a broad front of initiatives some of which
will be supported under the CQUIN framework.
• Personalisation of care planning and self-management amongst patients with long term
conditions.
• Improve the responsiveness to personal needs of patients receiving community based hospital
healthcare services
• Improve patient outcomes through the development of quality of life tools.
• Customer Care Strategy – Customer care training has been delivered in response to staff
surveys where issues have been identified. LCH need to develop a comprehensive strategy for
full roll out.
34 Liverpool Community Health NHS Trust
Quality Accounts 2011 35
PrioritiesforImprovementfor2011/12(continued)
• Mystery Shopping – Following on from the successful pilot project undertaken by the Talent
Pool, LCH will be rolling out Mystery Shopping across the organisation. There are two
elements to this project; the first will use staff to test manner and attitude of staff when making
initial contact with the service, including corporate. The second will require patients to do a
more detailed evaluation.
• Capturing Qualitative Information. We are looking into ways of capturing feedback from our
staff that use our healthcare services. We will be tracking patient journeys and finding
innovative ways to capture patient stories. Potentially this will include the use of video diaries.
We will build on our use of Patient Participation Groups and Focus Groups to capture patient
feedback. We will extend our involvement with local community and voluntary groups to
engage with patients.
• Patient/public engagement – Whilst this occurs in some services, there is not a consistent
approach across LCH. Within the Equality & Diversity Team we have plans to strengthen
engagement with equality groups.
The objectives for 2011/12 will be aimed at supporting the Commissioning programme of
improvement in public health (Better Lifestyles). Liverpool PCT wishes to build public health
capacity in the local workforce and increase the numbers of Front Line NHS staff who are
trained to deliver brief interventions/advice to patients at all contacts in their everyday work. This
indicator will involve having an Executive Lead for Public Health who is responsible for plans to
progress LCH as a public health organisation. More staff will be trained to deliver advice.
Current targets around smoking advice and referrals may be stretched along with the
introduction of indicators around alcohol & drugs, and weight management.
PRIORITY 4: POLICY DEVELOPMENT & IMPLEMENTATION
Completion of a process for systematic policy development in line with NHS Litigation
Authority (NHSLA) standards.
2010/11 Activity
2011/12 Targets
Monitoring/Measurement
Reporting
Policy review
• Working towards
NHSLA Level 2
• Ownership for
policies in line with
new Directorate
structure
Audits
Internal reporting
through Governance
routes to LCH Board.
Achieved NHSLA
Level 1
PRIORITY 3: PUBLIC HEALTH INITIATIVES
Community Services have a key role to play is supporting the Public Health Agenda and
helping improve public health.
2010/11 Activity
2011/12 Targets
Focus on Smoking • Continued support
Prevention, Alcohol
for Commissioning
& Drug reduction
programme of
and Weight
improvement in
Management for a
public health (‘Better
selection of
Lifestyles’)
Services.
• Recording
smoking status,
drug & alcohol
use, weight..
• Delivering Brief
Advice.
• Referral to
relevant services.
Mixed level of
achievement across
Services.
Significant impact
from IT system
issues.
36 Liverpool Community Health NHS Trust
Monitoring/Measurement
Reporting
Further development of
recording within clinical
systems.
Internal reporting
through Governance
routes to LCH Board.
Additional training for
staff.
CQUIN Project
reporting to
Commissioners.
Report to public in
2011/12 Quality
Accounts.
Assurance for Care
Quality Commission
(CQC).
Peer review
Lead directorates for
named policies
Register of policies and
owners
Report to public in
2011/12 Quality
Accounts.
A process for policy development and implementation is already in place at LCH. However at
present, due to the acquisition and integration of other NHS Services along with changes in
directorate structures, the process is being reviewed and made more robust. It is anticipated
that the review will:
• Ensure relevant clinical leads will be responsible for review, implementation and monitoring of
policies to ensure patients are treated in a safe manner
• Further align LCH policy management to that of National organisations such as NHLSA
• Enable sharing of good practice which will improve the treatment and experience of our
patients
• Train and develop staff to ensure they have up to date skills to care for patients and also
enhance staff career progression and workplace satisfaction
PRIORITY 5: MANDATORY TRAINING
Increased uptake for Mandatory Training and improvements in the way it is delivered.
2010/11 Activity
2011/12 Targets
Monitoring/Measurement
Baseline of
Mandatory Training
• Increased uptake of
Mandatory Training
• New methods for
delivery of training
based on ‘Lean’
principles
Monthly reporting
Reporting
Internal reporting
Review of current system through Governance
routes, to HR/OD
Peer review and review
Committee to LCH
of lessons learnt
Board.
Performance
Report to public in
Development Review
2011/12 Quality
(PDR) process
Accounts.
Quality Accounts 2011 37
PrioritiesforImprovementfor2011/12(continued)
Achievement of mandatory training has proved challenging, particularly for LCH as an
organisation which has so many different services delivered across a large geographical area.
The need for further improvement has been highlighted by internal review and feedback from the
NHS staff survey. Work has commenced and the objectives are:
CQUIN 2011/12.
Indicator
2011/12 Targets
Monitoring/Measurement
NHS Sefton
Community
Services VTE Ward 35 ONLY
90% of all adult
inpatients who have
had a VTE risk
assessment on
admission to hospital
using the criteria of
the national tool
Monthly return through
Internal reporting
appropriate systems with through Governance
community services
routes.
• Improved uptake of mandatory training
• Flexible approach to delivery of training
• Effective feedback to directorates on their progress
Work on the objectives above will include applying ‘Lean’ principles to delivery of training and
development. Successful completion will further improve patient safety by having all staff up to
date with relevant training.
Safe Discharge Ward 35 ONLY
Reporting
Project reporting to
Commissioners.
Report to public in
2011/12 Quality
Accounts.
a) 95% of discharge
Discharge letter audits.
summaries received in Process for reporting.
General Practice
within 24 hours
b) 95% of approved
electronic discharge
summaries (quality of
discharge information)
Internal reporting
through Governance
routes.
Project reporting to
Commissioners.
Report to public in
2011/12 Quality
Accounts.
c) 95% of patients
leaving hospital with a
completed discharge
summary, medication,
referrals, follow-up
appointments, sick
notes, transport
arrangements, followup appointments.
Development of
performance
dashboards across
all community
services
SEFTON Services:
It is to be highlighted that as of April 2011, a proportion of services from Sefton PCT will merge
with LCH to become one organisation.
All community
Implementation plan
services have in place Submission of draft
by Q4 a robust and
dashboards for approval
effective dashboard to
report performance
and allow
benchmarking across
teams and stretch
targets for
improvements in the
coming years
Internal reporting
through Governance
routes.
Project reporting to
Commissioners.
Report to public in
2011/12 Quality
Accounts.
Whilst LCH does not have a role to report on Seftons quality performance over the last 12
months (Sefton Quality Accounts can be viewed at http://www.seftonpct.nhs.uk/)
this document does outline CQUIN priorities for Sefton for the forthcoming year. It is to be noted
that these CQUIN targets are set by NHS Sefton and therefore differ from those set for Liverpool
Community Health by Liverpool PCT.
38 Liverpool Community Health NHS Trust
Quality Accounts 2011 39
PrioritiesforImprovementfor2011/12(continued)
CQUIN 2011/12 (continued)
CQUIN 2011/12 (continued)
Indicator
Improved
processes of
communication
between
Community Nursing
services and
General Practice
Improvement in
performance in
appropriate areas
of high impact
actions:
2011/12 Targets
Monitoring/Measurement
Understanding the
Plans for implementation.
options for
Options Appraisal.
communication across
community nursing
and primary care.
Explore possible
mobile technology
which enables links to
Clinical systems in
primary care, focusing
initially on the
independent
prescribing
information
a) 5% Reduction in
numbers of pressure
ulcers across all
services
b) 10% improvement
on completion of
nutritional assessment
for those patients
identified as having
complex needs to
include screening and
assessment of
support need or
referral to specialist
intervention if required.
c) Reduction in
infection levels due to
indwelling catheters
through the
implementation of
catheter care
programme (% yet to
be confirmed)
40 Liverpool Community Health NHS Trust
Implementation plans.
Audits.
Indicator
2011/12 Targets
Monitoring/Measurement
Reporting
Health Visiting and
School Nursing
Developments
Improvements to
Health visiting and
school nursing
provision through:
Implementation plans.
Internal reporting
through Governance
routes.
Reporting
Report to public in
2011/12 Quality
Accounts.
Report to public in
2011/12 Quality
Accounts.
Report to public in
2011/12 Quality
Accounts.
b) Implementation of
improved school
health records via
HSW to record height
and weight,
immunisation including
school leaving
boosters and HPV
Project reporting to
Commissioners.
Project reporting to
Commissioners.
Project reporting to
Commissioners.
a) Implementation of
HV commitment
Internal reporting
through Governance
routes.
Internal reporting
through Governance
routes.
Training schedules.
Improvement in
productivity
resulting in better
access and
experience in
relation to
community
phlebotomy
services through
review of service
logistics and
reduction of DNAs
1a) Reduction in
DNA's
1b) Increase in
'Happened'
Appointments
1c) Reduction on
duplicate
appointments.
Implementation plan.
Evidence of
implementation of
appropriate systems.
Activity data.
Internal reporting
through Governance
routes.
Project reporting to
Commissioners.
Report to public in
2011/12 Quality
Accounts.
1d) Reduction in
average waiting time.
Aiming to deliver the
proposed 48 hours for
urgent and 5 days for
non urgent from
APRIL 2012
(% yet to be
confirmed)
Seftons other quality priorities will be combined with the priorities that LCH have identified to
ensure consistent quality approach across the two geographical areas.
Quality Accounts 2011 41
LCH are proud of the services we deliver. As part of ongoing quality improvement we seek to
review and develop all of our services. The following content covers some of this work and is set
out in a standard format specified by Dept of Health regulations.
Review of Services
During 2010/11 LCH provided and/ or sub-contracted 60 NHS services.
LCH has reviewed all the data available to them on the quality of care in 56 of these NHS
services.
The income generated by the NHS services reviewed in 2010/11 represents 99.3% of the total
income generated from the provision of NHS services by LCH for 2010/11.
Participation in National Clinical Audits
During 2010/11, 5 national clinical audits covered NHS services that LCH provides.
During that period LCH participated in 100% of National Clinical Audits which it was eligible to
participate in. The national clinical audits that LCH was eligible to participate in, and for which
data collection was completed during 2010/11, are listed in the table below, alongside the
number of cases submitted to each audit as a percentage of the number of registered cases
required by the terms of that audit.
5.
AssurancesonQualityof
NHSServicesprovided
National Clinical Audit
LCH Eligible
LCH
Participated
% of Cases
Report
Reviewed
1
National Diabetes Audit
Yes
Yes
N/A
Report not
published
2
Falls & Bone Health National
Clinical Audit
Yes
Yes
N/A
Yes
3
National Audit of Continence Care
Yes
Yes
100%
Yes
4
National Audit of Depression
Detection and management of
NHS staff on long-term sickness
absence by Occupational Health
Services
Yes
Yes
N/A
Report not
published
5
National Audit of Services for
people with Multiple Sclerosis
Yes
Yes
N/A
Report not
published
(Content & Format Specified by Dept of Health)
The report of 1 National Clinical Audit has been reviewed by LCH in 2010/11. Reports have not
yet been published by the national coordinators for 4 of the 5 audits. Actions from the
Continence Care audit have been received, the main action point being to ensure that patients
are provided with more information relating to their individual management / treatment plan. This
information will also be recorded within the relevant patient records.
Quality Accounts 2011 43
AssurancesonQualityofNHSServicesprovided(continued)
21 of our clinical staff participated in research approved by a research ethics committee at LCH
during April 2010 to March 2011. These staff participated in research covering a variety of areas
including measuring the impact of CQUIN, evaluating personal health budgets, non medical
prescribers and the evaluation of the Health Research Support Service.
Participation in Local Clinical Audits
LCH have an annual clinical audit plan. 65 local clinical audits were undertaken by LCH in
2010/11. (51 of these have been completed through to final report). The reports of 51 local
clinical audits have been reviewed by LCH in 2010/11.
As well, in the last two years LCH have been actively committed to encouraging dissemination
of research and ensuring research evidence is cascaded to appropriate service leads. One
example of this is the recently developed Research Interest Group which supports and
promotes evidence based practice with staff.
Action Plans are implemented following the conclusion of all local audits to ensure that any
issues are addressed for future practice. As local clinical audits are undertaken across a variety
of Community Services, findings usually relate to the specific service. There are very few actions
which have a general applicability. The following are examples of actions from some of the audits
undertaken.
Goals Agreed with Commissioners
Use of the Commissioning for Quality and Innovation (CQUIN) Payment Framework
A proportion of LCH income in 2010/11 was conditional on achieving quality improvement and
innovation goals agreed between LCH and Liverpool Primary Care Trust (PCT) through the
Commissioning for Quality and Innovation payment framework.
Mental Capacity Act Audit:
Further details of the agreed goals for 2010/11 and for the following 12 month period are
available electronically at http://www.institute.nhs.uk/commissioning/pct_portal/cquin.html
• Ensured adequate training was available for all relevant staff requiring training on the Mental
Capacity Act. A combined training package on Record Keeping, Consent and MCA has been
implemented. One session per month booked until July 2011.
GP Cellulitis Pathway Audit:
• Improved communication between the Intravenous Therapy Team and GP’s with regards to
more efficient and effective use of the GP Cellulitis Pathway. Communication is now much
improved though some referrals are still coming from secondary care. Information is to be sent
to consortia to highlight GPs that are not using the service.
Participation in Clinical Research
The number of patients receiving NHS services provided or sub-contracted by LCH in April 2010
to March 2011 that were recruited during that period to participate in research approved by a
research ethics committee was 359.
Research and Development enables our staff to use evidence based practice and deliver
clinically effective care. Participation in clinical research demonstrates 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.
LCH was involved in conducting 39 clinical research studies in a variety of different medical
specialities including; stroke, cardiovascular disease, diabetes, teenage pregnancy and prison
based research with a focus on mental health, suicide and drug treatment systems during April
2010 to March 2011. LCH continues to take part in research studies that ask key clinical
questions that will potentially improve patient care and that align to our strategic objectives.
What Others Say About LCH
Statements from the Care Quality Commission
LCH is required to register with the Care Quality Commission (CQC) which is the independent
regulator of health and social care in England. For the first half of 20010/11 LCH was registered
with the CQC under Liverpool PCT. This changed when LCH became an NHS Trust in its own
right in November 2011 and was Unconditionally Registered with CQC as Liverpool
Community Health NHS Trust.
The Care Quality Commission has not taken enforcement action against LCH during 2010/11.
LCH has not participated in special reviews or investigations by the CQC during 2010/11. LCH
has however participated in the following visits and inspections:
• CQC unannounced visit to Kent Lodge re infection prevention and control
• CQC/Ofsted announced inspection of safeguarding and looked after children
During Aug 2010 the CQC made an unannounced visit to Kent Lodge, which is a 76 bedded
unit and provides intermediate care, community clinical assessment and rehabilitation services.
The visit concentrated on certain areas of practice to form a ‘snap shot’ of LCH’s activities
related to infection prevention and control. This allows the CQC to identify issues that are a
potential risk to patients’ safety or that could affect their experience of care.
The inspection found no cause for concern regarding the organisation’s compliance with the
regulations on cleanliness and infection control. http://caredirectory.cqc.org.uk/caredirectory/
searchthecaredirectory.cfm?FaArea1=customWidgets.content_view_1&cit_id=
5NL&element=HCAI
“Building Blocks” is one such high quality research project. This national evaluation of the Family
Nurse Partnership and Fit for Birth (to improve care for obese pregnant women in Liverpool) will
potentially lead to an improvement in patient health outcomes in LCH and demonstrate that a
commitment to clinical research leads to better treatments for patients.
44 Liverpool Community Health NHS Trust
Quality Accounts 2011 45
AssurancesonQualityofNHSServicesprovided(continued)
In Feb/Mar 2011 CQC/Ofsted carried out a full inspection of safeguarding and looked after
children arrangements. These inspections (previously Joint Area Reviews) have to take place
every three years. The purpose is to evaluate the contribution made by relevant services towards
ensuring that children and young people are properly safeguarded and to determine the quality
of service provision for looked after children and care leavers. LCH participated along with
partners across Health and Social Care in Liverpool.
The overall findings for ‘Health’ were as follows:
Safeguarding Children Arrangements – Grade 1: Outstanding
Looked After Children Health Provision – Grade 1: Outstanding
An “Outstanding” grading means a service that significantly exceeds minimum requirements.
The full report is available at:
http://www.ofsted.gov.uk/oxcare_providers/la_download/(id)/5475/(as)/lac_2011_341.pdf
Other Regulators
The NHS Litigation Authority (NHSLA) is a Special Health Authority, which was established in
1995 to administer the Clinical Negligence Scheme for Trusts (CNST) and thereby provide a
means for NHS organisations to fund the cost of clinical negligence claims.
All NHS organisations are subject to an NHSLA assessment, which is based on 3 levels of
compliance 1, 2 or 3. LCH were assessed against Level 1. A Level 1 assessment demonstrates
that an organisation has processes for managing risks that have been described and
documented through a number of policies (50). On the 31st Jan 2011 LCH were awarded Level
1 compliance.
Statement on Relevance of Data Quality and Actions to Improve Data Quality
The Data Quality Team was brought together in January 2010. Since then the team has worked
with many services:
NHS Number and General Medical Practice Code Validity
LCH submitted records during 2010 to the Secondary Uses service (SUS) for inclusion in the
Hospital Episode Statistics which are included in the latest published data. (A limited dataset is
submitted to SUS – Inpatient data for Kent Lodge and selected Outpatient data for
Homoeopathy/Dermatology).
The percentage of records in the published data:
• which included the patient’s valid NHS number was:
99.85% for admitted patient care;
99.87% for outpatient care;
• which included the patient’s valid General Medical Practice Code was:
100% for admitted patient care;
100% for outpatient care;
(LCH do not send any accident & emergency data to SUS).
PatientLCH
Satisfaction
2009/11
as a Community
Services Provider has a set of local data quality standards within its Data
Quality Policy. These include NHS Number and General Medical Practice Code. The results are
as set out in the chart.
LCH Data Quality Standards
Outcome Outpatients
Outcome of Episode of Care
Reconcilation of Outpatients
Actualised Contacts
Referral Source
• auditing, amending and closing records
• promoting the value of improved data quality and its benefits to patient care
• encouraging Services to take ownership of data quality
• implementing plans, processes and reporting procedures to support this ownership
Referral Date
LCH will be taking the following actions to improve data quality:
Ethnicity
• Completion of annual health records audit
• Continue to increase level of ethnicity coding
• Continue work with Services
• Results from an external audit on district nurse records conducted by the Cheshire and
Mersey Clinical Coding Team will be published later in 2011
• Other reports will be developed as required on completeness and accuracy of data
Postcode
GP Practice Code
NHS NumberOutpatients
0%
20%
40%
Standard
46 Liverpool Community Health NHS Trust
60%
2011
80%
100%
2010
Quality Accounts 2011 47
AssurancesonQualityofNHSServicesprovided(continued)
Standards have been improved or maintained in 2010/11 with the exception of Actualised
contacts. The small fall here is due to a significant increase (28%) in the recording of all planned
District Nurse contacts.
The increase in the recording of Ethnicity Coding for LCH patients has been achieved by
providing support, guidance and training to services that had poor records of recording. To
make further improvement towards the target the Data Quality team has identified, and referred
to team leaders, patients who have had recent contact with an LCH service but ethnicity details
have not been recorded. In addition new referrals across services where ethnicity is not
recorded will be highlighted to ascertain if any barriers remain and further support and training
will be provided.
Information Governance Toolkit Attainment Levels
LCH Information Governance Assessment Report score overall score for 2010/11 was 62% and
was graded unsatisfactory (under the new grading mechanism). Satisfactory compliance is
expected by 31st March 2012.
LCH takes the management of its information and its confidentiality and security very seriously. It
has in place a strategy and supporting plans which include:
• Ensuring all staff have the necessary knowledge about Information Governance responsibilities
(refreshed yearly)
• Ensuring there is clear ownership of information and strengthened responsibilities in how it is
managed
• Ensuring information risks are identified in relation to the management, sharing and use of
information
• A plan to improve the quality of the information collected to meet national standards
• Making sure corporate records are appropriately controlled and audited to ensure compliance
with expected standards
Clinical Coding Error Rate
LCH was not subject to the Payment by Results clinical coding audit during 2010/11 by the
Audit Commission. (This does not apply to Community Services providers at present).
48 Liverpool Community Health NHS Trust
Liverpool Local Involvement Network
The principal source of outside patient input has been from Liverpool Local Involvement Network
(LINk). The LINk have used their contacts with patient groups and individual patients along with
responses to an internet questionnaire. A link to the questionnaire was posted on the LCH
patient website.
The relationship between LCH and Liverpool LINk is still in development. A series of meetings
and events have provided valuable engagement on both the process and some key priorities for
patients from a LINk perspective. LCH have provided Liverpool LINk with outlines of our
objectives, proposals for contents of this year’s Accounts and also drafts of the document as it
has been prepared. The LINk have provided some input to the content and also a statement in
response to the draft document issued to them in May 2011.
LCH and Liverpool LINk have held discussions along with Sefton and Knowsley LINks on the
development of engagement through 2011/12. Action plans are in development and
discussions through a range of forums will continue through the year.
6.
Stakeholderinput-
whohasbeeninvolved?
Liverpool Primary Care Trust
Many of the priorities for LCH have been developed in collaboration with the Commissioners at
Liverpool Primary Care Trust (PCT). Throughout the year bimonthly quality meetings review
current performance and progress toward key objectives particularly those set under the
Commissioning for Quality and Innovation (CQUIN) Scheme. There are also detailed discussions
on the development of objectives for the coming year. This year these discussions have been
informed by input from General Practitioner groups in preparation for the transfer of PCT
commissioning responsibilities. The PCT have also provided a statement in response to the draft
document issued to them in April 2011.
Liverpool Community Health Staff
LCH staff have also been involved in the process. LCH staff have generated most of the
document content. Wider staff input to the content has been collected from responses to the
NHS Staff Survey, the LINk questionnaire (signposted on staff intranet), feedback to Lessons
Learned Review on CQUIN projects and review of the Quality Accounts document at different
levels of the organisation.
Others
Finally via its launch as a new organisation LCH has had contact with a wider range of
stakeholders. These have included local politicians and representatives of charities and other
NHS providers.
Quality Accounts 2011 51
Stakeholderinput-whohasbeeninvolved?(continued)
Statement from Liverpool PCT
2011 Commissioning PCT statement
In line with the NHS (Quality Accounts) Regulations Liverpool PCT is happy to receive the Quality
Account for 2010/11 from Liverpool Community Health NHS Trust.
As Director for Service Improvement and Executive Nurse for Liverpool PCT I have reviewed, the
information contained within the account and verified this against data sources where this is
available and can confirm that this is an accurate account of the quality of care in relation to the
services provided. I have also reviewed the content of the account and can confirm that the
Quality Account complies with the prescribed information, form and content as set out by the
Department of Health. I believe that the account represents a fair and balanced view of the
2010-2011 progress that Liverpool Community Health NHS Trust has made against the
identified quality standards. The Trust has complied with all contractual obligations and has
made progress over the last year with evidence of improvements in key quality & safety
measures.
Liverpool Community Health NHS Trust has engaged with patients, staff and stakeholders in
developing a set of quality priorities and measures for the forth-coming year 2011/12 and I
personally acknowledge their continued commitment to sustainable quality improvements.
Trish Bennett
Director of Service Improvement & Executive Nurse
Liverpool PCT
Statement from Liverpool LINk
Liverpool LINk Commentary on Liverpool Community Health Quality Account 2010/11
The comments made here pertain to a draft document that was made available to LINk prior to
Quality Account publication. This means that the published document may have already been
amended in line with some of the suggestions made here.
Liverpool Community Health has engaged with Liverpool LINk members during 2010/2011 and
Liverpool LINk is aware that Liverpool Community Health is keen to engage with a wide variety
of stakeholders. Liverpool Community Health has welcomed LINk representatives and
participated in LINk events and meetings in order to assist LINk in monitoring the quality of the
service.
As a relatively new organisation Liverpool Community Health is clearly still developing its
engagement structures around Quality Accounts but has made a good start and Liverpool LINk
will continue to work with Liverpool Community Health to develop engagement further.
This Quality Account makes good use of graphical information to illustrate the large amounts of
detailed information that it contains and generally makes good use of plain English. However,
the published document would benefit from the inclusion of information on how the obtain the
document in accessible formats and other languages.
In engaging with Liverpool Community Health regarding this Quality Account Liverpool LINk has
found that despite the great efforts made by the Trust to simplify the information given in the
document, it still requires background knowledge to understand all of the many details that it
contains. Liverpool LINk have obtained a good deal of this background knowledge via our
engagement with the Trust and will be continuing this engagement.
Liverpool LINk Quality Accounts commentaries are restricted in scope to commenting on quality
issues pertaining to individual Quality Accounts. Liverpool LINk will continue to work with
Liverpool Community Health to ensure that we monitor the implementation of the measures
contained in the Quality Account and to ensure ongoing progress on improving the quality at the
Trust more generally.
Endorsed by Liverpool LINk Core Group May 2011
52 Liverpool Community Health NHS Trust
Quality Accounts 2011 53
© Liverpool Community Health NHS Trust 2011
translations are available upon request by e-mailing equality@liverpoolch.nhs.uk
or telephone 0151 295 3243