Quality Account
The Quality of Care Our
Patients Receive
2010 - 2011
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Quality Account
GLOSSARY
CAMHS
COPD
CQC
CQUIN
DoH
E4E
HCAI
IPC
LINk
MKCHS
MKSCB
MMSE
MRSA
NHSLA
NICE
NPSA
PCT
PEAT
QA
QC
QIPP
QRP
RCA
R&D
RiO
TOPAS
UTI
WICU
Children’s and Adolescents Mental Health Service
Chronic Obstructive Pulmonary Disease
Care Quality Commission
Commissioning for Quality and Innovation
Department of Health
Energising for Excellence
Health Care Acquired Infections
Infection Prevention and Control
Local Involvement Network
Milton Keynes Community Health Services
Milton Keynes Safeguarding Children’s Board
Mini Mental State Examination
Meticillin-resistant Staphylococcus aureus
National Health Service Litigation Authority
National Institute of Clinical Excellence
National Patients Safety Agency
Primary Care Trust
Patient Environment Assessment Team
Quality Account
Quality Control
Quality Innovation Productivity and Performance
Quality Risk Profile
Root Cause Analysis
Research and Development
Clinical records data collection system (Rivers of
Information)
The Older People’s Assessment Service
Urinary Tract Infection
Windsor Intermediate Care Unit
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Quality Account
Contents
Section 1
1.
Introduction
Page No.
4
Section 2
2.
2.1
2.2
2.3
2.4
2.5
2.6
2.7
2.8
2.9
2.10
2.11
2.12
Priorities for 2011/12
Priorities for Improvement
Statements of Assurance from the Board
Statements to Review Services
Participation in Clinical Audit
Measuring Participation
Measuring Coverage/Recruitment
Reviewing Reports of National Clinical Audits
Reviewing Reports of Local Clinical Audits
Research
Goals agreed with Commissioners
What others say about the Provider
Data Quality
7
12
13
14
15
16
17
18
23
28
32
33
SECTION
Section 3
3
Review of 2010/11
3.1 Review of Quality Performance
3.1.1 Patient Safety
3.1.2 Clinical Effectiveness
3.1.3 Patient Experience
3.2 Statements from Local Involvement Networks,
Health and Community Wellbeing Select
Committee and NHS Milton Keynes
3.3 How to Provide Feedback
36
36
47
53
63
66
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Quality Account
SECTION ONE
Introduction
High quality care is what we all want to receive. Here at Milton Keynes
Community Health Services (MKCHS) maintaining high quality services is our
top priority underpinned by good patient safety, clinical effectiveness and
patient experience. We aspire to excellence in all of our services which
include: Adult Services, Older People’s Services, Children’s Health Services
and Mental Health and Learning Disability Services.
The quality agenda is a key component of our Quality Innovation Productivity
and Performance (QIPP) programme and is threaded through the work that
has been undertaken during the last year to transform community services.
We understand that the community we serve must have confidence in the
services we provide. From first contact through to discharge, the patient
journey must be a positive experience. We strive to work with patients, users
and their carers in identifying where patient experience has not been as good
as it should have been and we will ensure that learning and changes to
services occur as a result.
We will make sure that quality includes equality and inclusion. Ensuring high
quality care always takes into account a person’s age, disability, gender
reassignment, marriage and civil partnership, race, religion or belief, sex and
sexual orientation. This will help us to meet and go beyond the Care Quality
Commissions standards of care and comply with today’s equality rules.
The patient experience strategy we have produced is “a partnership between
the people who use our services, the Milton Keynes community, clinical staff
and service managers. The strategy comprises a series of ‘Campaigns’
designed to make real and lasting improvements in areas which matter to our
service users”.
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Quality Account
We have used our Patient Experience Working Group and our Clinical Council
to give initial feedback on this quality account and established a working
group which members including senior clinicians, managers and Local
Involvement Network (LINk) representatives, to pull the report together. This
input, along with feedback from the National Staff Survey and the Care
Quality Commission’s Quality Risk Profile, helped us to determine where
we’ve done well and areas that need improvement. In using this approach we
are assured that this report gives a true and accurate picture of Milton Keynes
Community Health Services and the issues that are important to the local
community and our staff.
We are confident that the data and information contained within this report
gives a true and accurate picture of our achievements in 20010/11 and areas
for development in 2011/12.
Our Quality Account, in its draft format, was discussed and approved by the
Leadership Management Team, the Patient Experience Working Group, the
Joint Negotiation & Consultative Committee and our Clinical Council. The
draft document was also circulated to NHS Milton Keynes, the Health and
Community Wellbeing Select Committee and Milton Keynes Local
Involvement Network (LINk).
Once feedback was received the report was finalised and then formally
presented to our organisation’s Board (Provider Committee) before final
publication.
Within this Quality Account we have highlighted areas of importance to people
who use our services; under Patient Safety we have included, falls, pressure
ulcers, infection control, and safeguarding vulnerable people. The Clinical
Effectiveness section gives assurance that we have a high quality workforce,
we are taking forward the national ‘Productives ’ initiative ,improving safety,
quality and reliability of services. Finally that we actively participate in audit at
a local and national level, and use this to demonstrate how we make
improvements and sustain them. Under Patient Experience we have included
making improvements to communications with service users and their carers,
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Quality Account
transfer of care, nutrition and hydration as well as work to improve Patient
Environment (PEAT), looking at patients’ access and patient safety and
standards, as well as privacy and dignity.
We hope you find the report interesting and that it gives you an understanding
of how seriously we take quality – it’s at the heart of everything we do.
Milton Keynes Community Health Services Leadership Team
Left to right; Sheila Begley (Deputy Director of Nursing), Jenny Williams (Head of Business
Development), Cathy Walker ( Managing Director and Operational Director of Adult and Older
People’s Services), Ruth Weetman (Operational Director of Patient Safety and Standards and
DIPC), Matthew Webb (Associate Director of Finance, Performance and Business
Development), Jane McVey (Director of Human Resources), Dr. Nanda DeSilva (Medical
Director), Anna Selby (Operational Director of Joint Mental Health Services) and Jill Wilkinson
(Operational Director of Children’s Health and Secure Settings and Lead Nurse).
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Quality Account
SECTION TWO
Priorities for 2011/12
2.1 Priorities for Improvement
Our 2010 /11 quality account identified three areas as priorities for
development within the coming year; these were Transfer of Care, Nutrition
and Hydration, and Communication with the focus on improved information to
service users and their cares. We will demonstrate how these were taken
forward and achieved within section three of this document.
We have identified the following areas as priorities for improvement in
2011/12:
•
Patient Safety – Pressure Ulcers
•
Clinical Effectiveness – Energizing for Excellence in Care (E4E) high
impact actions for Nurses.
•
Patient Experience; which includes Medicines Management as one of
the areas for focused work
Patient Safety – Pressure Ulcers
Pressure ulcers, also known as pressure sores, affect some of our most
vulnerable service-users and are often preventable; they are of concern for
everyone who provides care in Milton Keynes; in the community, in hospital
and in residential and nursing homes. It is essential therefore, that we work
with our partner organisations to achieve progress. Pressure Ulcers featured
in our 2009/10 Quality Account (please see section 3), we plan to progress
the initiatives in the coming year in partnership with the hospital and Local
Authority.
How do we achieve progress?
We have developed a set of standards jointly with the hospital and the nursing
team which provides support and training on this subject in nursing homes.
The standards relate to;
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Quality Account
•
Numbers of avoidable pressure ulcers measured against the baseline
established this year.
•
Staff training on pressure ulcers
•
Peer review, by partner organisations, of each others pressure-ulcer
investigations.
How are we monitoring and measuring?
These standards have been included in this year’s CQUIN (Commissioning
for Quality and Innovation) scheme and we will be expected to present reports
on a bi-monthly basis to our Commissioner, and to undertake peer review of
investigations at the Serious Incident Review Group. We will also be carrying
out regular audits of pressure-ulcer incidents.
How will progress with this be reported?
Reports will be presented
•
internally, to the Clinical Governance Committee and Patient
Experience Strategy Group,
•
to the Commissioner at the Serious Incident Review Group and the
quality monitoring forum.
•
to people who use our services via the Patient Experience Strategy
Group and through the Quality Account.
Clinical Effectiveness – Energize for Excellence
Energise for Excellence in Care (E4E) provides a national framework for
promoting quality in nursing and midwifery. The framework is structured under
5 key domains:
1. Get staffing right
2. Deliver care
3. Measure impact
4. Patient experience
5. Staff experience
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Quality Account
Energise for excellence aims to draw together many of the initiatives which
have been designed to improve safety, quality and involvement in care under
these 5 domains such as:
•
High impact actions
•
Productive care
•
Safety Express
•
Essence of care.
Few of these initiatives are new to Milton Keynes Community Services,
however energize for excellence draws together and provides a clear
structure to understand the range of work aiming to deliver clinical service
improvement, as shown in the diagram below.
Energise for Excellence Work in Community Health Services
How will we achieve progress?
•
Get staffing right - correct staffing levels and mix is critical to providing
safe and effective care
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Quality Account
•
Delivery of care - via re launched Essence of Care work so we can be
accurately benchmarked nationally
•
Measure impact - The Department of Health has identified eight high
impact actions to monitor the effective of nursing and clinical care
practice. These will be adopted and monitored.
How will we monitor and measure this?
Milton Keynes Community Health Services has an active essence of care
steering group which works to maintain momentum across clinical services in
the use of essence of care benchmarking. This group will be used to monitor
and measure progress.
How will progress be reported?
A range of tools and systems as shown in the diagram page 9 are used to
measure the impact of clinical care across the organisation. However many of
these tools are Acute Hospital based so we have adapted them for use within
the community setting. e.g. Royal Collage of Nursing staffing level tool used
rather than Acute based HURST tool. Most of this information is reported
through performance reports to each service through the directorate meetings
and through leadership team and board meetings.
Patient Experience - Communication and Transforming
Services
Our priority during
challenging financial times is
to communicate well with our
service users particularly
where services are being
transformed or reduced. This
will ensure that service users
have the information they need to enable them to understand the decisions
made about their care and treatment.
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Quality Account
Our aim is to gain real insight into how it feels for our service users, to move
away from traditional paper based surveys and to listen to our patients.
How do we achieve progress?
•
Conducting interviews with service users where service’s are being
transformed
•
Using ‘real time’ patient feedback systems allowing us to make any
improvements much faster
•
Reviewing our complaints to look for trends
•
Creating an email address for service users to contact us on
•
Developing a Community Health Service Patient Panel who will offer
advise on all aspects of patient care
How are we monitoring and measuring?
We will be using the information from both our ‘real time’ feedback and our
interviews to give us a full picture of how well we are communicating. This
information will be monitored by our Patient Panel and our Clinical
Governance Committee, which consists of both staff and patients.
How will progress be reported?
Progress will be reported formally through our Patient Panel and our Clinical
Governance Committee and also fed back to our patients using a variety of
medias including our website.
Patient Experience – Patient Experience Strategy
Community Health Services has an active Patient Experience Strategy which
includes five campaigns chosen annually to make measurable improvements
to services and care experience. The campaigns are chosen based on both
national initiatives and local information including patient feedback, incidents
and complaints. Medicines Management will be one of the campaigns for
2011 and will include work with the Mental Health Pharmacy Team and the
patients who attend the Clozapine Clinic. They will be focusing on what they
do well and what can be improved. (Other campaigns are noted page 53 -59)
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Quality Account
How do we achieve progress?
•
Each of the campaigns will have a working group including patients
who will assess current baseline information and set objectives for the
coming year
•
Regular reporting will ensure that campaigns are progressing well and
that any issues are dealt with promptly
How are we monitoring and measuring?
The Patient Experience Strategy will be monitored through the Patient Panel
and the Patient Experience Strategy Steering group. Individual campaigns
including Medicines Management will have their own working groups.
How will progress be reported?
The campaign groups will report quarterly to the Patient Panel and the Patient
Experience Steering group. Progress made will also be reported back to the
patients
2.2 Statements of assurance from the Board
One of the aims of the Quality Account is to give information to the public
which will be common across all Quality Accounts in the country. In order to
do this our Quality Account has a number of statements that must be
included. To quickly identify these compulsory sections we have printed them
in a different coloured text (yellow) to the main body of the report.
Performing to essential standards.
Milton Keynes Community Health Services achieved ‘unconditional’
registration with our regulatory body, the Care Quality Commission (CQC).
Our priority now is to make sure that we comply with the new CQC Essential
Standards.
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Quality Account
To provide extra assurance, we have opted in to an assessment by the NHS
Litigation Authority which will test all the policies we have in place to manage
risk.
Measuring clinical processes and performance
MKCHS is a research-active organisation; we are able to participate in
research and to support our clinicians in providing excellent, research
evidence-based care (details can be found pages 24 – 27) We measure our
delivery of high-quality care through a program of Clinical Audit; the audit
plan includes audit linked to NICE and topics identified from national reports
as well as local clinical concerns.
Involvement in national projects and initiatives aimed at improving
quality
MKCHS participates in research projects arising from the Comprehensive
Research Network (a national portfolio of projects) and the national clinical
audits which apply locally. MKCHS takes account of any concerns arising
from National Confidential Inquiries and reports (such as the Francis Report),
to address any issues which might apply locally and to provide assurance that
these are addressed.
2.3 Review services
During 2010 /11 Milton Keynes Community Health Services provided and/or
sub-contracted 36 NHS services.
Milton Keynes Community Health Services has reviewed all the data available
to them on the quality of care in 36 of these NHS services.
The income generated by the NHS services reviewed in 2010 /11 represents
100% percent of the total income generated from the provision of NHS
services by Milton Keynes Community Health Services for 2010 /11.
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Quality Account
2.4 Participation in clinical audits
During April 2010 to March 2011, 11 national audits and 1 confidential enquiry
covered NHS services that Milton Keynes Community Health Services
provides.
During that period Milton Keynes Community Health Services participated in 4
(40%) national clinical audits and 100% national confidential enquiries of the
national clinical audits and national confidential enquiries which it was eligible
to participate in.
The national clinical audits and national confidential enquiries that Milton
Keynes Community Health Services was eligible to participate in during April
2010 to March 2011 are as follows:
National Clinical Audits
•
Childhood Epilepsy
•
Chronic Pain
•
Parkinson’s Disease
•
Chronic Obstructive Pulmonary Disease
•
Stroke Care
•
Falls and Non-hip fractures
•
Depression and Anxiety Psychological Therapies)
•
Prescribing in Mental Health Services
•
Schizophrenia
•
National Patient Survey for Mental Health Services
National Confidential Enquiries
•
Suicide and Homicide by People with Mental Illness
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Quality Account
2.5 Measuring participation
The national clinical audits and national confidential enquiries that Milton
Keynes Community Health Services participated in, and for which data
collection was completed during 2010/11, are listed below alongside the
number of cases submitted to each audit or enquiry as a percentage of the
number of registered cases required by the terms of that audit or enquiry.
During the period April 2010 to March 2011, 10 (18.5%) of 54 national clinical
audits were relevant to Milton Keynes Community Health Services. The table
below details audits the organisation did or did not participation in and
reasons for non-participation where applicable.
National Clinic Audit
MKCHS
Reason for non-participation
Participation
Yes
No
Childhood Epilepsy
×
Chronic Pain
×
No reason given
Parkinson’s Disease
×
A new post was created at the
beginning of 2010 for a Specialist
Parkinson’s Nurse so it was
considered unsuitable to audit the
service at such an embryonic
stage.
COPD
×
No reason given
Stroke Care
×
A new Stroke Care service was
established in 2010 so it was not
considered suitable to audit
performance until it was properly
embedded.
Falls and Non-hip
×
N/A
×
N/A
fractures
Depression and Anxiety
(Psychological
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Therapies)
Prescribing in Mental
×
N/A
Health Services
Schizophrenia
×
Unable to capture diagnosis info as
implementation of new patient
management system.
National Patient Survey
×
N/A
for Mental Health
In the same period, Milton Keynes Community Health Services participated in
all national confidential enquiries that were relevant to the services they
provide. The table below details participation.
National Confidential
MKCHS
Enquiry
Participation
Yes
Suicide and Homicide
Reason for Non-participation
No
×
N/A
by People with Mental
Illness
2.6 Measuring Coverage/Recruitment
National Clinical Audit
Participation
Yes
% Cases Submitted
No
Childhood Epilepsy
×
N/A
Chronic Pain
×
N/A
Parkinson’s Disease
×
N/A
COPD
×
N/A
Stroke Care
×
N/A
Falls and Non-hip fractures
×
40 hip fracture
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Quality Account
20 other fragility fractures
(100% of requested sample)
Depression and Anxiety
×
38 service user surveys and
(Psychological Therapies)
5 therapists survey were
returned (unsure of
numbers distributed or
eligible cases) and 123
patients were submitted for
a retrospective analysis of
patients who ended their
care between September
and November 2010
Prescribing in Mental Health
×
5 patients (unsure of
Services
number of eligible cases)
Schizophrenia
National Patient Survey for Mental
×
×
Health
856 patients submitted
(52% of eligible patients)
2.7 Reviewing Reports of National Clinical Audits
The reports of the four national clinical audits relevant to our services were
reviewed by the organisation in 2010/11 and MKCHS intends to take the
actions described in the table below to improve the quality of healthcare
provided.
AUDIT
Summary of Actions
Falls and Non-hip fractures
Results not yet available – no confirmed
date for publication
Depression and Anxiety
Results due for publication October 2011
(Psychological Therapies)
Prescribing in Mental Health Services
Although results for Milton Keynes
Community Health Services were good
overall, it was considered suitable to
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Quality Account
design a pro-forma as a front sheet to
records to act as a reminder to carry out
required physical health checks for
patients prescribed antipsychotic
medication. This is currently underway
and should be in place by Autumn 2011.
National Patient Survey for Mental
Overall the results of the 2010 patient
Health
survey were disappointing in several
areas, and a comprehensive action plan
has been applied to all areas identified as
performing less well
2.8 Reviewing Reports of Local Clinical Audits
The annual clinical audit plan reflects local and national priorities for service
improvement and there is an expectation for all services to engage fully in the
audit process to ensure continual review of current practice against specific
objectives.
All services are expected to complete an audit of their record keeping practice
each year to demonstrate that adequate information is recorded for each
patient to ensure safe and effective treatment and care. Health and Safety
audits, Hand Hygiene and Infection Prevention audits are also carried out in
all services annually and are of great value in terms of ensuring safety of
patients and staff and minimising spread of infection.
Consent audits are conducted for all services on a three year cycle and the
purpose of these is to demonstrate that patients are suitably engaged in the
consent process. Although some services include an assessment of whether
consent has been sought in the care records audit, it was considered that
qualitative audits should be conducted in order to assess the extent to which
patients are involved in discussions and decisions about their care and
whether the content of these discussions can demonstrate clear patient
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Quality Account
agreement to and understanding of their treatment and care prior to consent.
In general, results have demonstrated good practice and continual
improvement year on year.
In addition to mandatory audit requirements, the annual audit plan is an
integral part of the service improvement process for all services and topics
relate clearly to service objectives against local and national priorities.
Included in the plan are projects to identify level of compliance with national
quality and best practice indicators such as the NICE guidelines and the Care
Quality Commission’s Standards for Equality and Safety as well as locally
applicable patient satisfaction surveys or audits pertaining to emergent
themes in incidents or complaints.
The reports of 163 local clinical audits were reviewed by the provider in
2010/11 and MKCHS intends to take the recommended actions to improve
the quality of healthcare provided. Four case studies are given below as an
illustration and details of the audits are available on request.
The case studies below are examples of audits conducted within Milton
Keynes Community Health Services during the past 12 months.
Transfer of Care.
Concerns had been raised about the quality of processes for transfer of care
between clinical settings and for discharging people from healthcare settings
into the community. A review of incidents relating to transfer of care was
conducted to provide information to support improvements in processes and
communication throughout the health and social care economy in Milton
Keynes.
The aim of the audit was to enable people who use our services to have a
seamless experience, however many times they are transferred between
clinical and/or social care settings.
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Quality Account
The study demonstrated that problems relating to transfer of care are wide
ranging and impact upon services in all areas and in general relate to poor
communication between services. These communication issues result in lack
of public confidence in health and social care services.
As a result of this audit, the following recommendations were made:
•
Staff are aware to report all incidents relating to transfer of care,
however minor and copies of these should be provided to both
MKCHS and MKFTH.
•
That all services have a designated Senior Manager with
responsibility for leading transfer of care discussions relating to their
service.
•
To establish a Senior Manager’s forum for Milton Keynes Hospital
and Community Health Services to consider strategic issues such as
care pathways, protocols and training.
•
The issue of transfer of care should be a standard agenda item at
MKCHS Directorate meetings and the Commissioning Clinical
Concerns Group.
NICE.
In November 2006, NICE published guidance on supporting people with
Dementia and their carers in health and social care. Part of this guideline
pertained to pharmacological interventions for the cognitive symptoms of
Dementia, with three drugs recommended as suitable options in the
management of patients with the disease.
The guideline made the following recommendations:
•
That only specialists in the care of people with Dementia
(psychologists, neurologists, physicians) should initiate treatment
•
That patients prescribed drugs for Dementia should be reviewed every
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Quality Account
six months.
•
That drug treatment should only continue while the patients ‘mini
mental state examination’ (the MMSE is a test use to determine level of
cognitive ability) remained above 10 points unless it is judged by
significant impairments in functional ability and personal/social function
that the patient likely has Dementia.
•
The drug treatment should only continue for as long as the patient’s
global, functional and behavioural condition demonstrates the drug is
effective.
An audit was conducted to identify level of compliance with this guideline with
good results and last year, a re-audit was carried out to ensure continued best
practice.
25 patient cases were reviewed for this audit. Of these, 24% of patients had a
mini mental state score of between 10 and 20 on commencement of treatment
but 76% of those with a score above 20 displayed significant functional
impairments to justify a clinical diagnosis of Dementia.
100% of patients receiving pharmacological intervention were reviewed six
monthly.
22 of 25 patients’ MMSE score remained between 10 and 20 throughout the
review period. 100% of patients whose score fell below 10 had medication
discontinued.
19 patients with drug intervention displayed that the drug continued to be
effective. Of those for whom it seemed ineffective, 2 patients had drug
treatment discontinued and 3 continued with the same prescription. It is
unclear from audit data whether their prescription was continued due to
evidence of functional impairment.
Overall this audit demonstrates good practice although further review of those
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Quality Account
patients prescribed medication with a MMSE score of below 10, not displaying
significant functional impairment may be required to justify pharmacological
intervention.
Patient Satisfaction.
Gaining information regarding patient experience of and satisfaction with
treatment and care has been a high priority across all services provided by
Milton Keynes Community Health Services over the past 12 months.
Numerous projects have been conducted to attempt to adequately collect
information to help us improve services and a Patient Experience Strategy
Group has been established to ensure continued commitment to inclusion of
patient and public perspective in planning and delivery of services.
Many services have distributed service user questionnaires to assist in
establishing a baseline of patient perception of services. One such
questionnaire was distributed by Children and Adolescents Mental Health
Services and collected feedback from children under the care of the service
but also from the parents of those children.
Parents and children were asked the same questions, ranging from whether
or not they felt their therapist had listened to and had understood their
problems and whether they felt confident that the therapist could help to
whether the treatment was adequately explained, if their appointments times
were suitable and if waiting room facilities were comfortable and inviting.
Overall results were very positive with
parents reporting overwhelming
satisfaction with the service. They felt
that the support offered by therapists
extended to their own needs as well as
their children’s, that issues were
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Quality Account
discussed sensitively and professionally and many felt that their children had
enjoyed therapy sessions, despite them being difficult at times.
Children felt that they were able to speak very openly and honestly with their
therapists and many reported an increase in confidence and ability to express
themselves positively. Most children felt that appointment times were
suitable, not interfering with school or extra curricular commitments. One
commented it was helpful to have appointments outside of school hours as
the nature of appointments could create issues with peers.
Some valuable points were made that could help to improve the service:
•
Parents and children commented that referral to the service was often
slow and that children were possibly discharged too soon.
•
A few were concerned by lack of information provided regarding
withdrawal of medication. Some felt medication was stopped too soon
and others felt they were ready to stop medication long before their
prescriptions were withdrawn.
•
Some mentioned that toys and reading materials provided in the
waiting area were unsuitable for older children and were designed for
very small children or adults only.
Although overall, results demonstrate that parents and children are satisfied
with the service, appointment referral times and communication regarding
medication are both important issues to be addressed.
2.9 Research
In order to ensure compliance with the Department of Health’s Research
Governance Framework, all research active NHS organisations are expected
to have a forum for monitoring all aspects of research governance and for
promoting evidence based practice. Milton Keynes Primary Care Trust’s
Research & Development Committee meets quarterly to fulfill this dual
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Quality Account
function and is made up of designated research leads from each service with
relevant expertise to consider the impact of participation in research studies in
terms of clinical, financial and resource Implications. Additional members
include the organisation’s R&D Facilitator, Chief Knowledge Officer and key
contacts from Milton Keynes Hospital Foundation Trust and Academia.
Committee meetings consist of progress updates from all service members
regarding studies being conducted by service staff or external studies the
service are currently participating in; a summary of new or pending studies
that have recently received or are awaiting organisational approval for
participation and discussion of potential risks; presentations of research
results by internal or external researchers and general research news and
legislative updates.
Over the past 12 months Milton Keynes Primary Care Trust has hosted
approximately 55 local and national research projects, working in partnership
with Trust staff, academia and commercial industry. Patient participation in
local and national research provides a valuable contribution towards the
advancement of medical knowledge overall but can also be of significant
benefit in terms of identifying areas for improvement and refining service
provision locally.
Study Reference
Details
Number of
Patients
Recruited
ASCEND
Aspirin vs placebo and omega-3 vs
34
placebo for primary prevention of
cardiovascular events in people with
Diabetes.
REAL
Rehabilitation Effectiveness and
3
Activities for Life. Study of rehab
services and efficacy of promoting
activities for people with severe mental
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Quality Account
health problems.
SNIFS Study
A primary care trial of steam inhalation
5
and nasal irrigation for recurrent sinusitis
SSEW
Study of Suicide in England and Wales
3
BDR Donor
Brains for Dementia: Recruitment of
1
Recruitment
potential brain donors for longitudinal
cognitive and memory assessment prior
to donation
6605
Studies of psychiatric in-patients who
1
commit suicide in first week of admission
and suicides within 2 weeks of discharge
from psychiatric in-patient care
PET1
Comparison of acute mental health in-
2
patient wards which use protected
engagement time with other wards
delivering standard care alone
7462
Cardiovascular outcomes in patients with
Unknown
Type 2 diabetes
9906
Nasopharangeal pneumococcal carriage
2
in pre-school children
9845
Nasopharangeal pneumococcal carriage
32
in older people
9422
Swine flu vaccine study
17
8976
Meningitidis vaccine study
33
8556
Canaglifozin vs placebo for treatment of
Unknown
older people with Type 2 Diabetes
8092
Pneumococcal vaccine study
11
7297
Meningoccal B vaccine study
15
7296
Meningoccal B vaccine study
16
6953
Meningoccal B vaccine study
5
5173
Staying well after depression
Unknown
4609
Effects of meningococcal opa proteins on Unknown
the immune system
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Quality Account
9456
Work related illness survey
1
7844
Evidence in management decisions:
1
advancing knowledge utilisation in
healthcare management
3C
Cough complications study
160
7410 PRISM
Primary care streptococcal management
5
study
TOPIC
Study of effectiveness of inter-
1
professional working for community
dwelling older people
7467
Cough complications cohort study
104
The number of patients receiving NHS services provided or sub-contracted by
Milton Keynes Community Health Services during April 2010 to March 2011
that were recruited into research approved by a research ethics committee
was approximately 452.
We are committed to supporting research in all areas of healthcare and to
ensuring continued organisational and staff development. The table below
gives an overview of research studies we have been involved with in the last
12 months in various categories.
SPECIALITY
NUMBER OF STUDIES
Cardiovascular Disease
1
Neurodegenerative Disease
9
Stroke
3
Diabetes
5
Paediatrics/Child Development
10
Mental Health
21
Chronic Obstructive Pulmonary Disease
5
Cancer
6
Urgent Care
3
Pregnancy
1
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Quality Account
Organisational Development
4
Ear, Nose and Throat
9
Obesity
1
Epilepsy
1
Pharmacology
1
Vaccinations
14
Older People
3
Staff Development
3
Dentistry
1
Musculoskeletal Conditions
2
Miscellaneous
5
Additional Research and Development priorities over the last 12 months were
to arrange a research shared learning event and to include service user
perspective in identifying priorities for research by establishing the Service
Improvement Patient Panel.
Although slightly delayed, a shared learning event is planned for July 2011
and has been organised collaboratively with Milton Keynes Foundation Trust
Hospital and the faculty of Health and Social Care at the Open University.
This event will provide an opportunity for staff and students to present their
research findings and to discuss applicability to local services and care,
therefore potentially influencing changes in practice. We hope this event will
prove a great success and will provide a platform for development of future
collaborative events to promote research locally.
The Service Improvement Patient Panel, a committee of public and patient
representatives now meets quarterly to discuss improvement priorities and
these are reflected in the organisations annual audit plan that includes studies
conducted by staff as part of academic study. Panel members are actively
involved throughout the project process and recruitment of members is an ongoing process and a priority for the year ahead.
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Quality Account
2.10 Goals agreed with commissioners
A proportion of Milton Keynes Community Health Services income in 2010
/11 was conditional on achieving quality improvement and innovation goals
agreed between Milton Keynes Community Health Services and any person
or body they entered into a contract, agreement or arrangement with for the
provision of NHS services, through the Commissioning for Quality and
Innovation payment framework.
Further details of the agreed goals for 2010 /11 are summarised below. Full
details and the CQUIN scheme for the following 12 month period are available
electronically at [http://www.miltonkeynes.nhs.uk/default-ContentID-6202.htm]
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Quality Account
Outlined below are the 2010/11 CQUIN standards and a summary of our
achievement against them:
2010/11 CQUIN STANDARDS
COMMUNITY SERVICES (CS) & MENTAL HEALTH SERVICES (MH)
Clinical Quality Indicator (CQUIN)
2009/10 Performance
We have achieved our interim target for
CS1
To achieve recommended levels of
this CQIN which is 443 people aged 0-5
health visiting
per health visitor.
.
The experience of patients using MK
Community Health Services will be
sought and analysed on a regular basis
by service providers and the outcome
CS2
shared with commissioners.
All five ‘campaigns’ have resulted in
In-year, there will be 5 patient
service improvements. Details available
experience strategy ‘campaigns’. (as
from the Clinical Governance Team
outlined in MKCHS Patient Experience
Strategy 2010-13) These are designed
to make measurable improvements to
CQC priority topics and cover all service
areas
Pressure Ulcers. A year on year
reduction across the MK health
economy in newly acquired preventable
CS3
pressure ulcers of no less than 25%
against the baseline.
(n.b. the CQUIN was revised mid-year
Achieved; there have been significant
improvements in patient assessment,
training and management of people at risk
of developing pressure ulcers this year.
to reflect changes in requirements)
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Quality Account
End of Life Care.
Use of the Liverpool Care Pathway to
support people in the last stages of life.
•
CS4
anticipatory prescribing for key
symptoms that may develop in
the last days and hours of life.
•
compliance with completion of
Achieved; the work has included the
development of pathways used in acute
trust, care homes and CHS.
There has been an emphasis on training
of staff this year.
the LCP.
Re – admission to hospital during the 90
CS5
days following discharge from
Intermediate Care Services.
Achieved; all readmissions were for
conditions unconnected with the original
admission
Community Stroke Services.
Access to stroke specialist supported
On track for achievement by year-end.
discharge
Development of pathway is awaiting final
Development of early improvement plan sign off.
CS6
for whole of community stroke service
At the last audit, 100% of patients had a
All Stroke Patients being transferred
comprehensive care plan and access to
from hospital to community and/or social specialist staff
services will have a comprehensive
stroke care plan and access to specialist
staff.
(n.b. HONOS is a Health of the Nation
indicator)
The commissioner will expect quarterly
MH1
audit reports that detail HONOS
compliance, aggregate outcomes and
Achieved
The audit showed 97.5% compliance
for HoNoS
recommendations for improvement
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Quality Account
Achieved.
The focus has been on
1. Medication and health review
Using Care Program Approach to
MH2
clinics
improve engagement, health and well-
2. use of Advance directives
being: MKCHS Mental Health providers
3. 7 day CPA follow-up
will adhere fully to the new CPA
4. Number of adults in contact with
guidance issued by the DH.
secondary mental health services
in settled accommodation and
employment
5. Patient surveys
.
Achieved; highlights include
1. Service user involvement in the
development of recovery pack,
CPA and risk training for staff.
User Involvement: Providers will work
with service users and carers to develop
MH4
a method that promotes full engagement
2. Service user involvement in
training.
3. Development of local focus groups
across the service.
with service users and carer from
.
Minority Ethnic
4. Employment of service user/expert
by Involvement of SU forum in
service design
Recovery Planning Tool: Providers will
implement the Recovery Star as a
recognised tool for recovery planning;
Action plan in place leading to full roll out
in March 2011.
who have signed recovery plans
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Quality Account
2.11 What others say about the Milton Keynes
Community Health Services
The Care Quality Commission
Milton Keynes Community Health Services is required to register with the
Care Quality Commission and its current registration status is ‘Unconditional
Registration’
Milton Keynes Community Health Services has not participated in any special
reviews or investigations by the CQC during the reporting period.
During 2010 /11 the Care Quality Commission introduced a monthly Quality
Risk Profile for all NHS Organisations. The Quality Risk Profiles (QRP) are
used by the CQC to support monitoring of compliance with essential
standards of quality and safety.
The monitoring is carried out by using external data that is relevant to MKCHS
e.g. National Staff Survey, Patient Environmental Action Team Assessments,
National Mental Health Patient Survey. This data is then put together in a
report and depending on what the data is indicating e.g. good / poor
performance is given a risk rating.
The QRP’s were introduced in September 2010 and since this time MKCHS
have shown month on month that 88% of the data collected relevant to our
organisation is ‘similar to’ or ‘much better than expected’ This is a good
indicator that on the whole we are performing well. However there are a
number of areas that we are already aware of where performance could be
improved.
These exceptions (areas for improvement) are monitored via monthly
performance reports that go to our Provider Committee on a bi monthly basis.
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Quality Account
In 2011, we have continued to build upon our successes with the introduction
of provider compliance assessments. These assessments relate specifically
to the outcomes that service users should experience when receiving care
and treatment and so are highly relevant tools for understanding our services
and service user experiences. Services are demonstrating innovative
approaches to embed CQC standards in practice and to complete the
compliance assessments including full team involvement. This will help
MKCHS be able to demonstrate compliance with CQC standards and also
provide high quality care for all our service users.
2.12 Data Quality
Relevance of Data Quality and actions to improve Data Quality:
Milton Keynes Community Health Services will be taking the following actions
to improve data quality.
The quality and accuracy of data is a key factor in monitoring and improving
performance across all services. MKCHS has made significant strides forward
in improving both the completeness and validity of the data that is captured.
Opportunities to further improve data quality are routinely identified and the
Information Team & the Performance Team sets clear priorities every month
for development and improvement.
MKCHS has a comprehensive and systematic approach to the management
of data quality held on its patient information systems, mainly RiO (River of
Information) that is then used for reporting. The Information Team liaises with
the end users and the RiO team on a regular basis to fix system issues & the
data quality issues; the aim is to ensure substantial assurance ratings to our
systems and processes. This should give everyone confidence that data
reported in these accounts and routinely in our information and performance
reports is reliable and of high quality.
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Quality Account
Our performance on data completeness is good but with room for
improvement and the measures taken to rectify RiO during 2011/12 will
enable us to make great strides towards the achievement of the target for the
all the community services.
During 2010/11, we made considerable progress to enable the internal and
external reporting of performance data required as a result of increased
contractual requirements. We achieved this through the implementation of
RiO in Mental Health & Children and Young Peoples Directorates, various
data collection tools in a number of services, the enhancement of established
information databases and increasing the capacity and capability of staff
within services with regard to data recording, reporting and analysis.
For 2011/12 Milton Keynes Community Health Services are taking the
following actions to improve data quality.
We have set a key business objective of making sure that all services are in a
position to record, report and analyse their activity and performance data to
enable them to manage capacity and demand, ensure delivery of contractual
requirements, increase quality of services and measure the outcomes from
service improvement initiatives.
We will build on the foundations established in 2010/2011 and develop the
following areas to act as a tool for measuring our quality, efficiency, cost
effectiveness and in some areas accessibility:
Work has started to ensure good data correction processes are in place for
the RiO national IT system that will continue to be implemented throughout
the organisation along side regular weekly monitoring of quality at both initial
data entry stage and post corrections.
NHS number and general medical practice code validity:
Milton Keynes Community Health Services submitted records during April
2010 to March 2011 to the Secondary Uses service for inclusion in the
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Quality Account
Hospital Episode Statistics which are included in the latest published data.
Based on published data in the SUS data quality dashboard from the
Information Centre for coverage between April 2010 to January 2011 (latest
release at time of writing); the percentage of records which included the
patient’s valid NHS number was: 99.7% for admitted care and 99.6% for out
patient care. The percentage of records in the published data which included
the patient’s valid General Medical Practice Code was 97.8% for admitted
care and 99.6% for out patient care.
On Information Governance Toolkit attainment levels:
Milton Keynes Primary Care Trust (MKCHS & NHSMK) Information
Governance Assessment Report score overall score for 2010/11was 60% and
was graded ‘red’
This national tool kit is compulsory for all NHS organisations to complete. The
data from this ‘tool kit’ gives a benchmark concerning how the organisation
looks after information regarding our service users as well as information
about services and the organisation it self. For the purpose of this submission
MKCHS data is joined with that of NHS Milton Keynes which gives feed back
as a Primary Care Trust (PCT) The above information in the compulsory
section is combined for both organisations.
Across the South Central Strategic Health Authority 1 out of the 9 Primary
Care Trusts (PCT’s) was graded ‘green’ The average score was 60%, with 3
scoring above and 5 scoring below.
We are aware of the key areas that will need improvement over the coming
year and have in place a director led action plan to ensure a compliance by
the time of the next annual review.
On Clinical Coding Error Rate:
Milton Keynes Community Health Services was not subject to the Payment by
Results clinical coding audit during 2010/2011 by the Audit Commission.
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Quality Account
SECTION THREE
Review of 2010/11
3.1 Review of Quality Performance
3.1.1Patient Safety
Falls
Why is this a priority?
We are concerned about the number of
falls in one of our in-patient units, which
provides care for older people, many of whom have conditions which make
falls more likely. It is recognised that if someone falls a subsequent fall is
more likely, and that health and wellbeing can deteriorate very quickly after
someone has fallen.
In one quarter of this year there were 36 falls and in order to understand the
causes we carried out an audit of the falls incident reports. For some of the
falls, physical factors contributed to the incident; physical frailty was an
underlying theme for all patients and it is included separately in this diagram
only where it was the primary cause of the fall.
Key;
Slippers; ill-fitting or not worn
Toilet; patient fell in the toilet or
because of an urgent need to go
Walking aid; two incidents related to
patients not using walking aids
correctly and the others related to
patients not using equipment which
had been provided.
Did not ask; The patient did not call
for assistance in walking
Task; patient fell while doing
something else (getting dressed,
cleaning a sink)
Not clear; the incident report
included only brief information and
contributory factors were not
explained.
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Quality Account
The audit also looked at assessment of people’s risk of falling, the care
environment, staffing levels, training and the transfer of care between one
clinical setting and another, and made recommendations about all of these
factors.
What are the outcomes from the work developed?
We have made a number of changes which aim to reduce the number of
people who sustain falls;
•
The Community Health Service Inpatient Slips, Trips and Falls policy
has been reviewed to ensure that it reflects the latest guidance from
National Patient Safety Agency.
•
In-patient units have local procedures that reflect the organisations
recommendations.
•
This particular in-patient unit has purchased stand-alone telecare
devices which will alert when those at risk are moving from safe areas.
•
Training around falls awareness is available for all units and in May
2010 Windsor Intermediate Care Unit which has the most vulnerable
services users in relation to falls arranged enhanced training for its
staff.
•
We are working with our partner organisations to improve the quality
and timeliness of information given when a patient moves from one
service to another. This must include the person’s risk of falling
Pressure Ulcers
Why is this a priority?
This was a priority in 2010/11 and the topic will be included in this year’s
quality initiatives to ensure that improvements are sustained.
Pressure ulcer prevention is a priority because there has been an increase in
patients with pressure ulcers across the NHS; it is also understood that the
majority of pressure ulcers are avoidable.
n.b. Pressure ulcers are categorised according to severity; Grades one and
two are superficial and grades three and four involve greater damage to
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Quality Account
tissues. Grade two ulcers are reported as ‘incidents’ and grades three and
four are reported as Serious Incidents and are subject to a full investigation.

The topic was included in the CQUIN scheme for the year; it included a
measure of the number of avoidable pressure ulcers above category 2
against the baseline. The CQUIN also required at least 90% compliance
with national guidance.

Audit of MKCH staff undertaking pressure ulcer prevention training is
also part of the CQUIN.

The threshold for reporting pressure ulcers as Serious Incidents was
reduced in 2010 so that now, all category 3 and 4 pressure ulcers must
be reported. This resulted in an initial increase in reports, mainly
because of increased awareness of the need to report, but is of benefit
as it enables pressure ulcer incidents to be investigated thoroughly.
What are the outcomes from the work developed?
There has been considerable work progressed within the last year including:

All category 3 and 4 ulcers now have Serious Incident Investigations
carried out.

Rolling programme of training in place across the health economy giving
an integrated approach to prevention and treatment.

Dedicated Pressure Ulcer Nurse working with community nursing staff
and nursing homes to improve reporting and documentation

Accurate reporting in place to measure prevalence

Development of patient education

Monitor documentation to ensure that nutritional and pressure risk
assessments are in place- training to take place in risk assessments

Register of pressure ulcer and risk assessment guide in place for staff
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Quality Account
Pressure ulcer figures for 2009/10 and 2010/11.
This shows that there has been an increase in pressure ulcer reporting since
last year; an investigation demonstrated that the increase relates to a greater
awareness of the need to report ulcers. It is very positive to see that the
number of grade three and four ulcers has fallen since 2009/10; we will
continue to monitor these trends as one way of determining the effectiveness
of improved training and management of pressure ulcers.
Infection Prevention and Control
Why is this a priority?
Effective infection prevention and control standards and
avoidance of healthcare associated infections (HCAI’s)
are essential to ensuring the safety of patients in our
care, wherever their care is provided. We know form
speaking with patients and the public during the last year
that good infection control and the cleanliness of all of
our facilities is really important to them. We are proud of
our infection control achievements, some of which are set
out below.
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Quality Account
What are the outcomes from the work developed?
Hand Hygiene:
Studies show that infection rates can be reduced by 10-50% when healthcare
staff regularly clean their hands. The introduction of alcohol hand rub has
been instrumental in improving hand hygiene compliance in healthcare and is
recommended for routine use where hands are not visibly soiled. Hand rubs
at the point of care are critical to increasing the likelihood that staff will clean
their hands at the appropriate times. Our hand hygiene strategy has included
the availability of alcohol hand rub for all of our staff regardless of whether
care is being provided in our in-patient settings, health centres or within the
patients own home. We continue to embrace ‘bare below elbows’ for all our
staff undertaking clinical duties. This requirement has been included in our
uniform and dress code policy and all relevant infection prevention and control
policies and procedures.
Meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia
We have made a significant contribution to the reduction in the number of
patients admitted to hospital with MRSA bacteraemia. South Central Strategic
Health Authority set a standard of no more than 2 cases of MRSA
bacteraemias across all community care within Milton Keynes.(MKCHS is one
of many providers of health care outside the hospital) We met this target with
only two patients diagnosed with an MRSA bacteraemia for 2010/11. Of these
two cases, none were attributed to Milton Keynes Community Healthcare
Services.
Clostridium difficile
Incidence of Clostridium difficile is also monitored very closely and reported
as a key performance indicator on a monthly basis. A target of no more than
59 cases across community care was set. In total, 29 cases were reported
and of these only 3 cases were attributed to Milton Keynes Community
Healthcare in-patient services. There is clearly more work to be done to
reduce this further, and the work undertaken this year is anticipated to form a
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Quality Account
solid foundation upon which to drive the incidence of Clostridium difficile
infection down.
Clean environments
Improvement of infection prevention and control standards requires a multifaceted approach. It is widely recognised that environmental cleanliness is a
key component in the provision of safe, clean care. To this end, in July 2010
the Domestic services integrated fully with the infection prevention and control
team.
This re-organisation of services has meant much closer working and shared
goals, with patient safety and satisfaction at the heart of everything we do.
Since July 2010, a key initiative that we have fully developed, is monthly
Quality Control (QC) audits of standards of cleanliness in all of our in-patient
facilities.
Areas are audited against nationally recognised NHS standards and targets.
A scoring system is used which gives a clear indication of compliance with the
national targets. Whenever standards are found to be below this target, a
report with recommendations is issued to the unit manager identifying where
improvements are required.
The Domestic team, together with the infection control team, the unit manager
and clinical staff, work together to ensure that standards improve to an
acceptable level by the following month. Integration of the Domestic team with
the infection prevention and control team has made this process streamlined
and efficient, ensuring that we are all working to one standard that is
compliant with the Health and Social Care Act (2008).
The graphs below show compliance with the national targets for standards of
cleanliness for all of our in-patient areas from July 2010.
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Quality Account
Outcomes of all audits undertaken are formally reported to the Provider
Committee on a bi-monthly basis.
We are currently engaging with patients and visitors in all of our clinical areas
to find out their perceptions of standards of cleanliness. We will use our
findings to continually improve the way that we work and enhance and sustain
levels of satisfaction for all of our service users.
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Quality Account
Prudent Antibiotic Prescribing
One of the innovative pieces of work carried out by the antibiotic pharmacist
and IPC team this year, has been the introduction of Guidelines on
Diagnosing a Urinary Tract Infection (UTI) in an Older Person. This guideline
was developed as it has been shown that older people, particularly within
healthcare environments receive antibiotics for a suspected UTI when they do
not need them.
Older people often have bacteria in their urine with no accompanying
infection, this is called asymptomatic bacteriuria, treatment of asymptomatic
bacteriuria in older people is not good practice and can cause harm in one out
of three people treated with antibiotics for it.
In order to improve antibiotic prescribing within the care home environment
and to reduce the risk of unnecessary harm, (including Clostridium difficile
infection) associated with antibiotic overuse in older people, a guide was
compiled from nationally recognised guidelines and translated into easy to
understand English for use in the care home environment. This guideline was
then adopted and rolled out across primary care including district nursing and
MKCHS inpatient settings that look after older people.
Comparison of antibiotic audit prescribing in these units Nov 09 to Nov 10 has
shown a decrease in antibiotic prescribing of 28%. The antibiotic prescribing
related to UTI symptoms has also fallen from 71 to 50%. Improvements were
also seen in appropriateness of urine dipstick tests and compliance with PCT
guidance on choice of antibiotic prescribed, dose and course length for
urinary tract infections.
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Quality Account
This work has been presented verbally at the national Infection Prevention
Society Conference September 2010 and as a poster at the North West
Antibiotic Pharmacist Group Inaugural Conference in November 2010. At both
conferences the work received first prize for best free paper and poster
presentation respectively.
Safeguarding Children
Why is this a priority?
Safeguarding Children has been in the national media over the last few years,
flagging up devastating outcomes that can happen when systems to protect
vulnerable children fail. Working Together to Safeguard Children (2010) is
statutory guidance which sets out how organisations and individuals should
work together to safeguard and promote the welfare of children and young
people in accordance with the Children’s Act 1989 and Children Act 2004.
What are the outcomes from the work developed?
Milton Keynes Community Health Services has a small team of nurses and a
doctor who are specially trained to offer advice, support and training to staff
about safeguarding children.
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Quality Account
In the past year the Safeguarding Children Team has:
•
continued to increase the number of training sessions for staff to make
sure they are all up-to-date with what they need to know about
safeguarding children.
•
updated the policy for our staff to follow in line with national guidance
•
undertaken audits of practice and developed a better process for
reviewing safeguarding children cases so we can learn lessons for
improving practice.
•
developed a more robust governance structure within the organisation
to monitor safeguarding activity
•
continued as an active partner in supporting the work of the Milton
Keynes Safeguarding Children Board (MKSCB): a multi-agency Board
set up as part of the Every Child Matters reforms, which requires all
organisations that work with children to co-operate to keep children
safe from harm.
We continue to increase the number of training sessions for staff to make sure
they are all up-to-date with what they need to know about safeguarding
children including what to do if they have concerns about a child.
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Quality Account
We are confident that because of this ongoing work ensuring staff have the
required skills and competencies it will enable them to identify and take
appropriate action when there are safeguarding concerns. This therefore
ensures staff are better able to safeguard and promote the welfare of
vulnerable children within Milton Keynes.
Safeguarding Adults.
Why is this a priority?
Safeguarding Adults has again been in the
news over the last year. The Francis
Report into Mid Staffordshire Hospital will
now be reopened as a public enquiry, and
the NHS Ombudsman reported in February
on the care of older people, using ten case
studies to highlight concerns. Again, these developments have lead to
MKCHS using recommendations contained in these reviews to check and
measure our own service provision, even though the cases cited took place in
hospital surroundings.
What are the outcomes from the work developed?
The work of the Safeguarding Adults Board continues after its re launch last
year, and MKCHS continues to play a leading part in the running of this and
the four sub-groups which report on progress to the main Board. The four
sub-groups are:
•
Policy and Procedure
•
Training
•
Quality Assurance and Serious Case Review
•
Communication and Stakeholder Engagement
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Quality Account
These continue to ensure high level involvement in developments which aim
to protect people from abuse or to respond effectively to abuse which is
suspected or reported. Last year’s Safeguarding Adults annual report showed
a further increase in such cases. This increase is felt to be an indicator that
more staff members are now aware of the policy through training and are
responding appropriately to concerns.
Training provision continues to increase, with the hospital declaring
Safeguarding Adults to be a mandatory session for its staff. Three sessions a
month are now running, including an induction session for all new staff.
MKCHS attendance on these multi-agency half day courses continues to rise,
and there have been several requests for targeted sessions where staff
cannot be released otherwise. The Clinical Effectiveness Manager for
Vulnerable Adults has also addressed volunteer and charity groups both
locally and nationally, and has presented a paper on joint Safeguarding Adults
work in Milton Keynes at a national conference.
What do service users say?
LINk MK has representation on the Safeguarding Adults Board and all of its
sub-groups to ensure that service users are considered at all points. These
developments are continuing to raise awareness of Safeguarding Adults both
internally and externally, with the aim of improving the experience of service
users.
3.1.2 Clinical Effectiveness
High Quality Workforce
Milton Keynes Community Health Services employs around 1000 staff,
around two thirds of whom hold professional qualifications, either as doctors,
nurses, therapists or other technical staff.
Why is this area a priority?
The key to providing excellent care to those who use our services is to ensure
that we recruit and retain a skilled and competent workforce. Most of the
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Quality Account
healthcare budget is spent on staff. Therefore the quality of our staff, how
motivated and committed they are to their jobs, can really affect the standard
of care provided to patients and service users. It is important to ensure that
staff are effectively trained, given opportunities for development and feel
engaged in the work they are doing.
What are the outcomes from the work developed?
We have placed a great deal of emphasis this year on ensuring that our staff
receive all the training defined as mandatory – this covers issues such as
infection control, load and patient handling and safeguarding children.
Currently over 75% of staff have undertaken the training and we continue to
work towards increasing this. Our aim is for 87% of all staff to have completed
their mandatory training.
We have put in place robust monthly monitoring of mandatory training via the
Leadership Management Team meeting and performance reports which go
formally to the Provider Committee. High levels of Mandatory training is also a
key objective for our Risk Committee and therefore this is also monitored on a
directorate basis as we know this does impact on the overall ‘risk status’ of
the organisation. Further steps being implemented is to hold managers and
directors more robustly to account if areas fail to reach the targets set.
The table below highlights some results from the national Staff Survey 2010,
which benchmarks us to similar organisations. We are pleased to see that
staff generally enjoy their work, are well trained and are able to contribute to
making improvements at work.
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Quality Account
Issue
% 2010
% 2009
% average
Similar
organisations
Staff received health and
93%
86%
83%
75%
32%
47%
Staff receiving appraisal
93%
71%
78%
Quality of appraisal
46%
33%
38%
Number of staff with
84%
62%
68%
Staff job satisfaction
93%
86%
83%
Able to contribute to
93%
71%
78%
safety training
Staff received equality and
diversity training
development plan
improvements at work
Although there are a few occasions when it s difficult to recruit staff, we have
had no major recruitment issues this year, and our turnover rate is reducing.
Due to improved planning and management of our services, we have been
able to reduce the use of agency staff this year, which saves us money as
well as ensuring a good quality service for patients. The rate of sickness
absence amongst staff is also reducing overall, although there have been the
normal winter ‘flu pressures.
We have also reviewed our recruitment processes to ensure that staff are
recruited safely and that all the underpinning checks are in place. All
qualifications, registration details and permits to work are checked before an
individual is allowed to start work. An online process for giving CRB clearance
has also enabled us to speed up the process by several weeks, reducing the
gap between one person leaving and another taking up post.
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Quality Account
The Productives
Why is this a priority?
The Productive Ward is a national initiative by the NHS Institute for Innovation
and Improvement to remove waste from clinical area and release time to
spend on direct patient care.
The Program aims to:
•
Ensure every patient has a good experience
•
Improve patient safety and clinical outcomes
•
Offer a systematic way of measuring quality and patient outcomes
•
Equip frontline staff with known improvement methods
•
Develop staff capability for improvement and productivity
•
Address the NHS reforms and wellbeing agenda
•
Reduce variations in practice in core procedures
What are the outcomes from the work developed?
Milton Keynes Community Health services has been rolling out the productive
ward program across four key in-patient areas over the past two years
•
Windsor Intermediate Care Unit.
•
The Older Peoples Mental Health Unit and
•
Hazel and Willow Wards of the Campbell Centre
All units have made good progress with rolling out the modules of the
program. The most obviously successful has been the well organized ward
which produced demonstrable improvements in:
•
Clearing out sorting and organizing a range of working areas
•
Developing standardized procedures for tasks such as administration
of medicines, cleaning patient equipment,
•
Producing minimum stock levels lists reducing time spent ordering and
reducing the costs of over stocking.
•
Improving the working environment for staff reducing potential for
stress.
In addition the meals module for example has been completed by all wards
supporting the work across the organisation on nutrition and hydration, the
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Quality Account
medicines module also has been completed by all wards improving medicines
administration processes to improve patient safety and reduce errors and
improve effectiveness of medication therapy.
More recently the organisation has commenced roll out of ‘productive
community ‘ which will use the same systematic approach to improvements.
How patient feed back makes a difference
During one of the regular weekly community meetings at The Older Peoples
Assessment Service (TOPAS) which involves patients relatives and staff,
there was a guest presentation and discussion about the nutritional needs of
older people who are restless and agitated.
One patient involved in this praised the unit for introducing a range of snacks
and fruit which gave free access to the increased calories these patients
needed, but the patient felt that this could be further improved. They
suggested a greater range of health snacks such as fruit smoothies, cheese
and biscuits and drinking yogurts.
Following some discussion on how these foods could be stored it was agreed
the unit would buy a small glass fronted fridge which would be kept in the
dinning area. This would allow patients to see what was in the fridge and help
them selves. The fridge is now a permanent fixture, is check and stocked on a
daily basis and is well used by patients. By acting on patient feed back the
unit has been able to further support good nutrition for patients.
Clinical Audits
Why is this a priority?
Clinical Audit is considered by the CQC to be the ‘gold standard’ for
determining whether clinical treatment and care is in-line with best practice
and policies. People who use our services have been very keen to see the
results of audits which have been discussed at our Clinical Audit Patient
Panel and have helped to determine what should be in our Patient Experience
Strategy Campaigns. MKCHS has a robust program of audits for all clinical
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Quality Account
services; audits of care records, safety and consent are mandatory and we
also conduct audits where we know, from external reports and incidents or
complaints, that there might be a risk.
What are the outcomes from this work?
Some of our audits were described in section two of this document and all are
available on request. An example is given here to illustrate the link between
patient safety incidents, clinical audit and the patient experience strategy.
The audit reviewed all medication incidents during quarter 1 of 2010 from all clinical
service areas; the study was conducted to provide information to support
organisational learning and to facilitate improvements in processes and
communication.
The audit showed that Incidents were less frequent in areas with:
•
•
•
•
•
•
Good support from pharmacy advisers (technicians and pharmacists). There
was evidence of very good support in many settings, particularly mental
health.
An effective approach to the management of incidents; for example WICU
reviews all incidents on a regular basis and develops action plans where
necessary. This is effective in preventing recurrence.
Prompt reporting and reflection; there were some excellent examples where
this had minimised the impact of incidents e.g. in District Nursing and Oakhill
where it had supported a staff-member’s learning.
Training; there was evidence of good practice across many service-areas
together with evidence which suggests lower numbers of incidents where
training is in place.
Clinical supervision of staff particularly when there has been an error. This
needs to strike the right balance between supporting the staff member and
performance management if necessary.
Effective communication between prescribers and administrators of
medication; this has been shown to reduce the likelihood of incidents.
Communication breakdown was a feature in some incidents in the community
where DNs and Local Authority staff have different working practices; it was
also an issue at a service where roles and responsibilities of staff from
different organisations are not always
clear.
There were several recommendations, one of
which was to carry out further work on
medicines, to understand the issues from the
service-user perspective.
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Quality Account
3.1.3 Patient Experience
Patient Experience - Patient Information
Why is this a priority?
As an organisation it is vital that we ensure
that service users, or those acting on their
behalf, have sufficient information to enable
them to make informed choices and
decisions about the services they access
and any treatment they receive. In order to
ensure that this happens, and that MKCHS is compliant with CQC Essential
Standards of Quality and Safety and the DH Information Standard, patient
information was agreed as a priority campaign of work.
A work group was established to develop a patient information strategy and
guidelines for development of patient information that would result in:
• The provision of good quality, timely information about services, care
and support, in appropriate language and format.
• A consistent approach to developing, distributing and reviewing
service-user information
• Partnership working with service users as well as other agencies in
the development of service user information
• Service users being engaged with and given timely, appropriate
information before, during & after care
What are the outcomes from the work developed?
1. A Patient Information strategy and action plan enabling work to commence
on developing new guidelines for creating patient information.
2. Service users’ views influenced the direction of the strategy and action
plan from the outset through:
• active participation in the workgroup through 2 LINks MK
representatives
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Quality Account
• feedback from public consultations
• Workgroup representatives giving accounts of their service user
views and needs (e.g. RNIB, Deaf Community, young people &
children, older people).
3. New leaflet templates have been produced for services that are more
‘author-friendly’, addresses local issues such as alternative formats and
also satisfies Equality & NHS Brand standards.
4. An audit and database of patient information leaflets in use by MKCHS
Next Steps
A New guideline for producing patient information is currently being
developed. This guideline includes an agreement on the information that must
be made available to service users and the requirement to proactively consult
with service users and other stakeholders. An audit encompassing service
user views will be conducted following implementation of the guidelines and
the production of new patient information,
Patient feed back from listening events
For the deaf community, a large number will be unable to read letters or
leaflets, either because they have limited literacy or because the way in which
the deaf community structures sentences and use BSL (information obtained
from consultation with deaf and visually impaired community re: council and
health services)
Many of the people at the event had perceived that they had received a poor
service as a result of their blindness or partial sight. None had felt able to
complain and questioned whether we produce our complaint information in
different formats? (Information obtained from a LINk event which was held in
conjunction with the RNIB)
Need to involve other LINks members in evaluating forms and leaflets and
have more communication with carers (focus group held with representatives
including patient, Age Concern, MK Carers, and LINks re: End of Life Care)
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Quality Account
National NHS Community Mental Health Service Users Survey 2011
Detail from the 2011 results of the above survey has shown a marked
improvement in the care and treatment of peoples with mental health
problems locally.
Our results compare more favourably than the national average for some
aspects of our interventions, for example:
•
70% of those surveyed had been seen in the last month in comparison
to 60% of people surveyed nationally.
•
More people know who their care co-ordinator is.
•
More people report being able to express their views at care planning
meetings and find their review helpful.
The survey supports the need to focus further on medication and talking
therapies. These are areas of development that we have already started work
on by investing in staff training and development and the creation of more non
medical prescribers.
With this investment we should see more staff who can advise service users
on all aspects of their medication, as well as give greater emphasis on the use
of psychological interventions and talking treatments which will result in a
better patient experience.
This Year’s Patient Experience Strategy aimed to produce real,
measurable improvements in topics which we know (from incident
reports, complaints and reports from other organisations) can be a
cause for concern. As described earlier, some of these topics will need
further work in 2011 to ensure that improvements are sustained.
Examples from the Patient Experience Strategy are given below.
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Quality Account
Patient Experience - Medicines Management
The Mental Health Pharmacy Team has seen a number of developments this
year targeted at improving medication safety and ensuring the best use of
medicines.
Why is this area a priority?
The priority for our patients is to ensure that they have their medicines when
they need them, in a safe way and that wherever possible they have
information about the medicine being prescribed made available to them or
those acting on their behalf.
What are the outcomes from the work developed?
In line with the national Medicines Reconciliation Initiative we strive to ensure
that our patients are prescribed the right medication on admission to hospital.
A six month study was conducted to assess our compliance with this and the
results showed that in the majority of cases this took place. Over half of the
patients were involved in this process, an example of excellent practice
working with a challenging cohort of patients.
Some excellent work has been conducted in response to the National Patient
Safety Alerts related to the safe use of medicines. A new policy on Lithium
and Mood Stabilisers have been developed and a booklet for patients newly
prescribed lithium will shortly be made available.
Patient Experience: Transfer of Care
Why is this a priority?
The Patient Experience Strategy identified Transfer of Care as one of its first
priorities last year after an audit of transfers from the hospital to MKCHS. The
audit was triggered by a rise in reported incidents which identified problems in
transferring patients.
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Quality Account
What are the outcomes from the work developed?
Part of the response to this audit within MKCHS was the commissioning of a
new policy to underline a commitment to multi-agency working in transfers of
care. This now nears completion in agreement with health and social care
statutory agencies, and MKCHS is also developing its own internal policy to
reflect the provisions of the wider document. Together, these policies will
make clear the agreed components of any transfer of care, wherever it occurs
and whichever services are involved. Key areas at this stage are felt to be
improved inter-agency communication and forward planning, which have been
the subjects of previous audits.
Training sessions have been developed to share information to support joint
planning and understanding of transfers of care. These will be open to all
health and social care staff who are engaged in such transfers. It is hoped
that these will be widely attended to share knowledge and good practice.
What do service users say?
Work carried out for the Patient Experience Strategy has underpinned these
developments. Here, work is on-going to develop a format that will allow
service users in all clinical areas to report on their experiences of transfers of
care. Within MKCHS, these transfers will fall into one of three categories:
•
From MKCHS clinical services to another agency or vice versa (for
example, from the Older Peoples Assessment Service (TOPAS) to a
private nursing home);
•
Between MKCHS clinical services (for example, from the Windsor
Intermediate Care Unit (WICU) to community nursing services); or
•
Between sections of one MKCHS clinical service (for example, from
adult mental health services to older peoples mental health services).
It is hoped that the interviews will be representative of all three of these
categories and that enough respondents can be found amongst service users
to provide important feedback on how transfers of care are experienced
currently.
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Quality Account
Service user feedback and involvement is key, and a representative from LINk
MK is being sought to act as a conduit for policy and other developments in
this area. Without such involvement, work would not be able to be responsive
to those who experience them.
Nutrition & Hydration – better patient care better patient
outcomes.
Why is this a priority?
Nutritional care is fundamental to patient dignity and human rights. The
nutritional care of in patients is a top priority for us as it ensures our service
users have better treatment outcomes if they have appropriate and sufficient
food and drink when in our in patient units.
What are the outcomes from this work?
There has been considerable work undertaken over the last year in MKCHS.
The nationally recognised Malnutrition Universal Screening Tool (MUST) has
been rolled out across MKCHS across inpatient areas and for those patients,
identified as at risk, in their own homes.
Four community wards have been participating for the past 2 years in the
Productive Ward program and all areas have completed the Meals Module.
This has resulted in some innovative developments in the delivery of good
nutritional support for patients. There is a protected mealtime’s policy in place
across all inpatient units and implementation of this is audited on an annual
basis.
An annual nutrition audit is undertaken to ensure that the trust nutrition policy
is being implemented consistently across in patient units, these are:
•
Windsor Intermediate Care Unit (WICU 20 beds)
•
The Older Peoples Assessment Service (TOPAS 20 beds)
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Quality Account
•
The Campbell Centre (36 beds).
•
Oakwood (6 beds)
The audit (completed February 2011) demonstrates significant improvement
across all areas with 100% of patients having their nutritional status assessed
following admission to the unit across the first three areas and 80% in
Oakwood which is a Learning Disability Unit. This is the first year that
Oakwood has been assessed and given the size of the unit (6 beds) the 20%
relates to one patient who refused to be weighed on admission.
While these audits are useful in demonstrating that specific aspects of the
policy and good practice is being implemented, they do not reflect if patients
are actually experiencing the care and support they want and need. As a
consequence, a survey has been completed by in-patients to capture their
actual experiences of nutritional care.
What did patients users say?
Patient’s responses showed that there was a high level of satisfaction with
access to and quality of the food and beverages provided on all units. While
all of the units provided 24/7 access to food and beverages one or two
patients expressed that they were not aware of this or how to access it. A
recommendation from the survey generally was that units need to make this
clear to patients on admission and throughout their stay.
Patient Environment Action Team (PEAT) Audits
Why is this a priority?
Every year all NHS Trusts in the UK are required to undertake an in-depth
audit of all in-patient settings which have 10 beds or more. The PEAT audit
programme is managed by the National Patient Safety Agency (NPSA) and as
from 2011 the data submitted from these audits will be released to the public
as an official statistic. PEAT data is also used as a highly valued performance
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Quality Account
tool by the Care Quality Commission, contributing to five outcomes on a
Trusts ‘Quality Risk Profile’.
Within Milton Keynes Community Health Services (MKCHS) three premises
qualify for PEAT audit, the Campbell Centre, Windsor Intermediate Care Unit
and TOPAS (The Older People’s Assessment Service).
As PEAT is an audit focusing on the ‘patient perspective’ therefore MKCHS
ensures patient representation on all audits. In addition the PEAT Lead has
undertaken a training session on PEAT with the LINk MK and plans to make
this an annual event.
What are the outcomes from this work?
Following a PEAT audit an action plan is developed, issued and followed up
by the PEAT Lead. Any serious concerns that are flagged are dealt with as a
matter of urgency on the day of the audit. Meetings are held with the relevant
service managers to progress the action plans and updates are also supplied
to the Infection Prevention & Control Committee (IPCC).
As the PEAT audit programme takes place between January and March of
each year, with scores being released in early spring, the 2011 data is not yet
available to publish. Below is a table showing the data from 2006 to 2010.
Table 1 – PEAT scores 2006-2010
2010
PEAT Section
Campbell Centre
TOPAS
Windsor ICU
Environment
Good
Good
Good
Food
Good
Good
Good
Excellent
Good
Excellent
Campbell Centre
TOPAS
Windsor ICU
Environment
Excellent
Excellent
Good
Food
Excellent
Good
Good
Privacy &
Excellent
Excellent
Excellent
Privacy &
Dignity
2009
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Quality Account
Dignity
2008
2007
2006
Campbell Centre
Ward 14
Windsor ICU
Environment
Good
Acceptable
Good
Food
Excellent
Excellent
Acceptable
Campbell Centre
Ward 14
BCH
Environment
Good
Acceptable
Acceptable
Food
Excellent
Excellent
Excellent
Campbell Centre
Ward 14
BCH
Environment
Poor
Acceptable
Acceptable
Food
Good
Excellent
Good
Note: Prior to 2009-10 audit programme Privacy & Dignity score was incorporated into
Environment section
The new patient weighing and nutritional assessment sections which caused
the ‘Food’ scores to drop in 2010 have significantly improved in 2011, with two
of the three sites likely to return to ‘Excellent’.
In addition the element which kept TOPAS from getting an ‘Excellent’ in
‘Privacy & Dignity’ in 2010 has been rectified. Overall ‘Environment’ scores
are likely to remain the same despite improved section scores in two of the
premises.
As PEAT is a national tool it is useful to compare the 2010 data with the
national averages for NHS trusts:
Table 2 – PEAT 2010 data national comparison
PEAT
Campbell
Section
National Average
Centre
TOPAS
Windsor ICU
Environment
Good (62%)
Good
Good
Good
Food
Excellent (57%)
Good
Good
Good
Good (48%)
Excellent
Good
Excellent
Privacy &
Dignity
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Quality Account
For more information on PEAT please contact: Lee.Peddle@mkpct.nhs.uk
Or visit: http://www.npsa.nhs.uk/nrls/improvingpatientsafety/cleaning-andnutrition/peat/about-peat/?locale=en
PEAT 2011
Although MKCHS has now had formal notification of the 2011 PEAT
results we are unable to publish them within this Quality Account as
they have not been formally released for general publication. However
we can indicate that our position from the 2010 results has improved.
What patient said during the PEAT Assessments for 2011:
Windsor Intermediate Care Unit
‘The staff are very friendly, accommodating and take time to talk to you’
‘You are made to feel at home’
‘The food is good and drinks are available on request’
The Older Peoples Assessment Service (TOPAS)
‘I’ve no complaints the food is good’
‘Very nice food!’
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Quality Account
3.2 Statements from Local Involvement Networks
(LINks), Health and Community Wellbeing Select
Committee and NHS Milton Keynes.
NHS Milton Keynes ( Local commissioners of NHS care)
NHS Milton Keynes has reviewed the MKCHS’ Quality Account. All of the
nationally mandated elements of a Quality Account are covered and there is
evidence that MKCHS has used both internal and external assurance
mechanisms.
NHS Milton Keynes is satisfied as to the accuracy of the data contained in the
Account.
The account identifies significant progress in relation to:
1. Low rates of MRSA and C Difficile / PEAT
2. Safeguarding Vulnerable Adults & Children
3. Antibiotic prescribing
MKCHS have identified in their quality account a number of improvements
linked to the experience of patients:
1. Use of clinical audits
2. Implementation of a Patient Experience Strategy
3. Implementation of the Productive Ward Initiative
4. Learning from falls and pressure ulcer incidents
NHS Milton Keynes was pleased to note the achievement of all CQUIN schemes
in 2010/11 and the impact that this will have on patient care.
NHS Milton Keynes will continue to work closely with MK CHS and support
their ambition to achieve excellence in the quality of care provided to patients,
through quality monitoring, incentivising (through CQUIN Schemes), and
performance management.
We believe that this coming year will be even more challenging both clinically
and financially but I am sure with the commitment the trust has built that we
will see further improvements in quality.
Health and Community Wellbeing Select Committee ( Milton Keynes Council)
The Panel welcomed the document, which it believed was readable and easy to
access by members of the public and as well as giving a fair and frank
assessment of performance, included examples of the patient experience.
The Panel noted that the Service had conducted / been part of a number of
detailed audits and recognised where improvements needed to be made,
although in places the document failed to detail the actual areas to be
improved. Specific examples identified by the Panel of where improvements
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Quality Account
were being made were in communications, both between prescribers and
administrators of medication and between different service providers.
The Panel also welcomed the attention being given to the issues around
prescribing antipsychotic medication and that a checklist was being
introduced to ensure that physical checks were undertaken to quickly detect
any harmful side-effects.
The Panel recognised the apparent success in implementing the Productive
Ward initiative and the success in achieving all of the CQUIN Standards.
However, the Panel suggested that the 5 patient Experience Strategy
Campaigns (CS2) could have been named for clarity and information.
The Panel particularly welcomed the work being done to reduce the number of
injuries caused by falls.
The Panel would have liked to have seen greater emphasis being given to how
engagement between different services was being taken forward to ensure that
the transfer of care was handled smoothly. It was noted that the role of the GP
in the transfer of care was not mentioned.
With regard to the outsourcing of services the Panel would expected to see
details of how service quality was monitored and maintained at a required
standard.
Also the Panel noted the concerns of users at apparent reductions in the
podiatry service, which had seen not only a reduction in services available, but
also longer waiting times. It was also believed that the changes to the service
had been poorly communicated.
The Panel believed that the document would be even more useful and
informative if further contextual details were provide such as patient numbers,
together with benchmarking information and trend data.
On a more minor note the Panel found the use of the abbreviation N/A and
thought that vas a general rule abbreviations should be avoided.
Generally the Panel believed that, to help the public to understand and use
Quality Accounts, it would be helpful if there was a standard template / format
used by all health providers.
Milton Keynes Local Involvement Network (LINks)
We would like to acknowledge the efforts of Milton Keynes Community Health
Service in producing a comprehensive, open and wide ranging report on
Quality Accounts as well as take this opportunity to thank them for involving
LINk:MK and its members in its work in the past year.
LINk:MK enables the voice of the patients and the public to be heard and taken
into account in the design and delivery of health and social care services. We
are pleased to note that Patient Experience has been taken on as a priority and
efforts are being ploughed into seeking feedback from service users to help
make service improvements as well as maximise patient satisfaction. We are
also pleased to note that access to health care services by the hearing
impaired and the visually impaired have been classified as priorities to achieve
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Quality Account
real, measurable improvements in the coming year and we look forward to
working together to achieve this.
We would also like to acknowledge MKCHS achievements in Patients Safety in
the areas of preventing Pressure Ulcers, Infection Prevention and Control as
well as Prudent Antibiotic Prescribing. We also sincerely hope that the new
commissioning policy on Transfer of Care that underlines a commitment to
multi-agency working is completed successfully and the internal policy within
MKCHS is developed at the earliest so as to provide clarity to the components
of transfer of care encompassing all services.
LINk:MK would also like to congratulate the commitment of MKCHS in
successfully conducting the PEAT (Patient Environment Action Team) Audits
that focuses on the ‘patient perspective’ on the quality of inpatient settings in
premises and would also like to place our sincere thanks in involving LINk:MK
members every year.
LINk:MK is pleased to note the priorities for 2011/12 and would urge MKCHS to
continue to focus and aim to make significant improvements in involving
service users as well as in the communications with regard to services that are
being transformed or reduced. It is in this context that LINk:MK is looking
forward to work
LINk:MK Responsewith MKCHS in the coming year and in particular with
regard to the provision of Podiatry Services, which is an area of great concern
to LINk:MK.
MKCHS Quality Accounts shows dedication in involving patients and the
public in the design, development and delivery of health and social care
services including continuous efforts in making service improvements. We are
equally committed in extending our help and support to MKCHS in the future to
enable the citizens of Milton Keynes to participate and influence the
commissioning and delivery pathways across all of their services.
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Quality Account
3.3 How to Provide Feedback on the Account
Your comments and feedback are always welcome and will help us to shape
the future healthcare provision in Milton Keynes.
If you wish to comment or provide feedback on any aspect of this document
please contact the Communications and Engagement Team on Tel: 01908
278801 or email communications@mkpct.nhs.uk
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