NHS North Somerset Community Services
Quality Accounts
2010/11
Page 1
Contents
Part 1
Statement of Quality from the Chief Executive
North Somerset Explained
Statement from Stephen Harrison
Statement from Penny Brown
Page
3
5
5
Part 2
Priorities for Improvement
Priority 1 – Improve Patient Experience
Priority 2 – Improve Patient Safety
Priority 3 – Provide Clinically Effective Services
Statements of Assurance
Page
7
8
10
14
Part 3
Review of our Quality Performance in 2010/2011
Review of our Quality Performance in 2010/2011
Patient Experience
Patient Safety
Clinical Effectiveness
Additional Quality Improvements in North Somerset
Statements from third parties
Page 2
Page
25
26
31
37
42
42
Part One
North Somerset Community Services Explained
North Somerset covers an area over 145 square miles. It serves a very diverse
population ranging from communities in the wealthy suburbs on the outskirts of Bristol, to
rural villages and the communities of popular seaside towns. The PCT area shares its
boundaries with North Somerset Council and works with a diversity of health care
providers, ranging from small, local hospitals to the large, high profile acute and teaching
Trusts of Bristol. Community Services are delivered from a range of localities, including
Clevedon Community Hospital, Weston General Hospital, and a number of community
bases including GP practices. The healthcare locations throughout the area are
highlighted on the map below;
We provide a total of 25 services in our core area, including community nursing and
therapies, children’s services and learning disabilities. We deliver a number of specialist
services including diabetes nurses and a service that works across Bristol and South
Gloucestershire supporting patients with Lymphoedema (swelling caused by impairment
to the lymph system). We also have a community hospital in Clevedon where we have 18
beds and are able to provide rehabilitation and respite. A range of outpatient services are
also delivered on that site including a community endoscopy service.
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Statement by our Trust Chair - Stephen Harrison
This report describes the quality account for services provided by North Somerset
Community Services. Members of the public, patients and others will be able to use the
report to understand new clinical developments and plans for further enhancement of
services in the future.
Some exciting clinical innovations have been introduced this year in North Somerset; the
introduction of community wards has meant more patients can be cared for outside of
hospital by an integrated team of nurses and therapist with strong links with social
services. Community staff have also fully engaged in the Quality Improvement Patient
Safety Programme co-ordinated by the Strategic Health Authority. This is a programme
that helps the health community work together to enhance clinical care for patients. Areas
of focus are those patients who are at risk of falling, vulnerable to pressure ulcers or
infection. These are just two examples of the excellent work being achieved.
In 2011/12 NHS North Somerset Community Services are separating from the Primary
Care Trust and becoming a social enterprise, with focus on integrated working. This
attention to ‘seamless working’ across North Somerset is perhaps the most important way
in which we can improve the clinical quality, where there is a culture of continuous
improvement based on partnership with staff, patients and other stakeholders.
In closing I would like to extend my appreciation to all staff within North Somerset
Community Services for their hard work last year and their commitment to innovation and
improvement in services for the population of North Somerset.
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Statement by our Chief Executive designate
I am pleased to present the Quality Accounts for NHS North Somerset Community
Services and take the opportunity to describe to a wide local audience the story of how we
have provided the best possible care and treatment for all our
service users and carers in 2010/11.
This account aims to give an honest picture of Quality in the
organisation in the past year.
Part 1 contains the brief statements required to introduce the
account and confirm the accuracy of the information contain within.
Part 2 explains the priorities for Quality in the coming year and covers the information
prescribed by law.
Part 3 describes how the North Somerset Community Services performed in 2010/11,
combining the hard data, wider descriptions of Quality through the year, and what some
service users have said.
This is the first North Somerset Community Services Quality Account which marks an
important step in demonstrating our commitment to delivering safe, high quality care and
services to the population of North Somerset. We recognise the importance of this in the
light of our full separation from NHS North Somerset to becoming a social enterprise, and
will continue to strive to improve the quality of our services year on year. This will take
effect from 1st October 2011.
Our strategy to date has mirrored that of NHS North Somerset, with four principal
objectives:
•
•
•
•
Identifying the health needs of their local populations and responding to diversity;
Developing plans for health improvement
Working as part of Local Strategic Partnerships to ensure co-ordination of planning
and community engagement, integration of service delivery and input to the wider
government agenda including Modernising Social Services, Sure Start, Community
Safety, Quality Protects, Youth Offending Teams and Regeneration Initiatives;
Leading in the development of the local health strategy to implement national
priorities and to meet local health needs and to deliver this strategy by both
providing and commissioning services from primary care practitioners and NHS
Trusts.
We have aimed to ensure all our services “Make it right for you” – this embraces making it
right for our patient, our staff and our stakeholders.
We have a firm commitment to work towards seamless services with our partner agencies,
integrating them wherever possible, and over the year have further built on the integration
of services between ourselves and North Somerset Council for both Adults and Children.
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We have embarked on a huge organisational change programme, developing community
teams, which started in November 2010. We have brought together our community
nursing and therapy services into community teams, to deliver joined up care to the
patient. Within the team there is a community ward element where patients with the
highest need are supported more intensively. We believe this will further aid seamless,
integrated services and will improve the quality of services we can offer to our patients.
This has necessitated further education and training for front line staff to maximise the
capabilities and competency of the workforce, and we have built a robust education and
training strategy to support this.
We have introduced a new Community Information system, RIO, which enables clinicians
to have a full understanding of the other practitioners involved in the care of our patients.
As this rolls out fully, it will further enhance the quality of the service we provide.
We are committed to working as efficiently as possible, and have adhered strongly to the
principles of high quality, safety, and value when redesigning services. We have started a
whole system service improvement programme, based on productive techniques and lean
methodology, and have full clinical involvement through training key staff in service
redesign techniques.
With the financial challenges that are facing all organisations, it is vital that we continue to
find better and improved ways to deliver our services more effectively. Quality will remain
our absolute priority, and we will continue to improve our services at the same time as
improving value for money.
Statement by Chief Executive designate
In accordance with the NHS (Quality Accounts) regulations 2010 No. 279, I hereby state
that to the best of my knowledge the information in this document is accurate.
Signed
Chief Executive designate
Date: 30th June 2011
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North Somerset Community Services Team at the NHS Leadership Challenge
Part Two
Priorities for Improvement and statements of assurance from the Board
2.1 Priorities for Improvement for 2011/2012
As we move towards a social enterprise, we are committed to further improving the quality
of the services we provide for the population of North Somerset. Our three main priorities
are;
Priority 1: Maintain and improve the experience of our patients
Priority 2: To improve patient safety
Priority 3: To provide clinically effective services, that we are able to demonstrate deliver
the outcomes our service users expect
Priority 1: Maintain and improve the experience of our patients
Gathering patient experience feedback on the services we provide is the first step in our
journey to provide effective care. The information we gather and then analyse, will
contribute to the day to day management of our services and our strategic intentions. As
a social enterprise our governance structures will inform all stakeholders of our patients’
feedback. The Board of Directors will ensure that this information is gathered and acted
upon and they will be held to account for this by the Council of Governors.
We are currently part of the NHS North Somerset patient experience strategy; however we
will create our own strategy as part of the successful development of a social enterprise.
This strategy will place quality at the heart of everything we do and have a significant
impact the services we provide. It will achieve this by setting out how we will listen and
respond to patient and carers feedback.
To enable this to happen we will provide a range of functions that will inform and enable
service improvement.
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•
•
•
•
Complaints Management
Patient Advice and Liaison Service (PALS)
Dedicated feedback channels through a range of measures such as Patient
surveys, patient experience audits, stakeholder group feedback
Dedicated incident reporting system
We recognise and value liaising closely with the community in which we work to ensure
the services we develop are based on local needs. Therefore, as part of our new structure
as a separate organisation we will develop a Community forum. This forum will be open to
service users, carers and volunteers and will meet on a regular basis, with an open
meeting held at least annually to assist us in understanding the perspective of Service
Users. As part of this commitment, we will ensure that the Community Forum will elect a
member to serve on the Council of Governors.
This will give them the opportunity to influence the organisation as the Council of
Governors will have the authority to;
•
•
•
•
•
•
Promote and encourage participation in the Company’s affairs;
Strive to ensure that the relevant interests of the community ( including service users,
carers, staff, the voluntary sector organisations and the local authorities) served by
the CIC are appropriately represented;
Appoint the Chair and Non Executive Directors;
Delegate powers to identified lead within the organisation where decisions need to be
made;
Approve major transactions, for example major financial decisions;
Change the constitution.
Priority 2: To improve patient safety
In North Somerset we continue to strive to deliver services that are safe and effective. We
recognise that in order to deliver improvements for our patients we need to review the
model of care and develop information to support the requirement for service design and
highlight the intended benefits. We are developing ways of instigating a systematic
approach to reviewing what we do.
One of the systems we have used and will continue to apply is highlighted below;
As providers of community services, we are closely engaged with the Quality and Patient
Safety Improvement Programme in the South West. Using the PDSA (Plan, Do, Study,
Act) model, we have targeted areas where service re-design and the development of
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reliable data will improve the safety for patients. During 2011/2012 identified workstreams
will be further developed with key outcome measures and data requirements agreed and
captured. We will pilot the programmes within 2 care homes in the region.
The programmes we will be implementing throughout 2011/2012 are;
Infection Prevention and Control
Aim: To reduce the amount of catheter infections
• Number of urinary Catheters in situ
• Number of patients with a urinary catheter being treated for a Urinary Tract
Infection (UTI) arising from a current inpatient stay
• Percent compliance with a urinary catheter insertion bundle
• Percent compliance with urinary catheter ongoing care management bundle
Venous ThromboEmbolism (VTE)
Aim: All patients to be assessed for VTE on admission and after 24 hours.
If needed, VTE prophylaxis prescribed and administered
• Number of patients who have developed a Venous Thromboembolism (Deep Vein
Thrombosis or Pulmonary Embolism) in hospital only
Falls
Aim: To reduce or eliminate patient falls
• Number of falls resulting in harm
• Days between falls resulting in harm-only to be used when falls become a rare
event
• Percent compliance with falls risk assessment and identification
• Percent compliance with comfort/rounds
Pressure Ulcers
Aim: To reduce or eliminate the risk of patients developing pressure ulcers
• Number of pressure ulcers newly acquired on your unit
• Days between pressure ulcers newly acquired on your unit
• Percent compliance with SKIN bundle
Rescue and recognition of the deteriorating patient Aim: To recognise and act upon deterioration in health of patients within the
community.
• Percent compliance using the Daily Safety Briefing
• Patients with observations complete
• Trigger patients receiving appropriate response
Leadership
• Number of walk arounds completed
• Actionable items identified during walk arounds completed
Medicines Management
• Patients with medication reconciliation performed and documented within 24 hours
of admission
• Patients with medicines reconciliation performed and documented on discharge
• Selected drug adverse event rate
We have involved clinicians from all professions and services to support this programme,
along with the audit and performance teams to ensure we are able to collate data and
evidence the outcomes and benefits for the patients.
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We are aiming to achieve the following outcomes by 2014 by implementing the
programme in our services;
Pressure ulcers (grade III,IV)
Pressure ulcers (grade III,IV)
Manage deteriorating patient
Manage deteriorating patient
VTE
Catheter Associated Urinary tract infection
Falls
Medicines Management
80% reduction in hospital setting
30% reduction in community setting
95% of patients to have observations and
early warning score to highlight potential
issues
95% of patients assessed as deteriorating
receive an appropriate response
95% of patients assessed to be at risk of
venous thromboembolism receive
appropriate prophylaxis
Reduce by 50%
Serious injury from falls reduced by 50%
95% of patients have a medication
reconciliation within 24 hours of admission
Priority 3: To provide clinically effective services, which we are able to
demonstrate and will deliver the outcomes our service users expect
Community Teams
In 2010/2011 Community Services were commissioned to develop a structure to deliver
seamless services for patients, reducing unnecessary admission to acute trusts and
providing care in patients homes.
In 2011/2012 we will be completing the implementation of the community team model
throughout our region, bringing together nursing and therapy services. Each of these
teams will be based around 3 GP practices, to ensure closer communication about the
patients we will be caring for. Within the community team there will be a community ward
element that steps up the intensity of service if the patient becomes unwell and
commission social care on a short term basis when it is required to support the patient at
home. We recognise to provide effective services that support patients in the community
we need to ensure we are able to deliver the right service with the right person, in the right
place, at the right time. We believe that the Community Teams will give us the ability to
meet this challenge.
The purpose of this service re-design is to improve the outcomes we expect by;
•
•
•
Reducing emergency hospital admissions and bed days
Reducing NHS costs
Improving patient experience
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The model of care is represented:
Social Care
LInks
Community
Ward
Community
Ward
Community
Ward
Urgent Care
Community
Ward
Acute
Care
Community
Ward
GWAS
Clinical specialities
Community
Ward
Community
Ward
Clevedon
Hosptial
GPs
Strategic
Partners
Multidisciplinary Community Wards meeting patients health & social care needs
We have linked with the Nuffield Trust to support us in gathering of evidence we require to
validate the outcomes. We will be evaluating these in a number of ways, for example;
• Prevention of Admission;
To establish the effectiveness of this intervention, patients admitted to a virtual ward will
have to be compared with a control group containing patients of similar characteristics
living in areas without a community ward. Both quantitative and qualitative information will
be needed to provide a complete picture. This would include quantitative data such as;
•
•
•
•
•
•
•
•
•
•
Number of patients referred
Route of referral
Admission decision (including referral/access to other services if not admitted to
the ward)
Location of admission (e.g. own home, nursing home)
Patient demographics (age, sex, postcode, living arrangements)
Patient conditions (primary and secondary diagnosis using ICD10 codes)
Care provided (staff, procedures, medication, equipment)
Average length of stay
Discharge location
Ward occupancy
We will collate this data using information gathered from within our Electronic Patient
Record (RiO) and also from the intelligence accessed through sources such as Dr. Foster
or the Primary care data Resource (PCDR) tool, which identifies patients who are at risk of
hospital admission.
We will be collecting qualitative data such as;
•
•
•
•
Patient acceptability and perceived benefits
Professional acceptability and perceived benefits
Opportunity costs
Communication and team working
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•
•
•
•
•
Management & IT issues
Level of awareness
Effectiveness of referral processes
Perceived under / overprovision of services
Issues of equity
We will gather this information from a range of sources such as patients experience
questionnaires, complaints and compliments, feedback from the Community Forum and
by the development of focus groups as we implement evaluation.
Our data will be used to provide monthly performance figures for the Commissioners and
will be reported using our balanced scorecard.
During 2011/2012 we will fully implement a capacity management tool which has been
benchmarked on a snapshot audit in February 2011. We have used this information to
further develop the model to take into account how unwell the patients are, and reflect this
in the capacity of the community team to safely and effectively manage the care of the
person in their own home. By implementing an organisational wide management system
to our service delivery, we will ensure that patients will be seen when they need to be, by
developing an organisation wide approach to service delivery, with professionals in the
community teams providing support to other areas when that is required.
By implementing this model across our community teams we will improve care for the
patient, communication with the GP and Hospital and build on our links with our social
care partners. Our vision is a health system working in partnership for the benefit of the
patient and their community, as illustrated below;
Vision of the Care System
Community
Urgent
care
Elective
care
System
management
•Organising care around
care packages including
social care
•Clear entry to the system
•Clinical leadership and
operational management
built around patient journey
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Clevedon Community Hospital
We will be working throughout the next year on the development of a new community
hospital. The illustrations above indicate the possibilities for the new build. The site
chosen is where a supermarket was previously trading, and is ideally sited with excellent
transport links for the community to be able to access the facility. The new hospital is
planned to be completed in 2012 with 24 beds and access to a range of outpatient
services and diagnostics as indicated below;
• Inpatients (24 single en-suite bedrooms)
• Minor Injuries Unit (MIU) open from 7am to 9pm,
• Outpatient (OP) Clinics
• Diagnostics (including x-ray and ultrasound scanning)
• Rehabilitation Therapies
• Resource Centre
• Out of Hours (OOH) GP service
Some areas that will not be available in the new Community Hospital and these are
highlighted below;
• No admissions will be accepted from emergency/blue light ambulances;
• No walk-in services users will be accepted apart from in the Minor Injuries Unit
and Out of Hours
The Community Hospital will support an overall population of approximately 120,000
people covering the northern part of North Somerset. This includes the three main
settlements of Portishead, Nailsea and Clevedon. The remainder are rural parishes and
villages scattered within the area. There will be the opportunity to review the figures based
on the potential change predicted in the population in North Somerset.
The benefits of building a new hospital are highlighted in the table below.
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2.2 Statements of Assurance relating to the quality of services provided
Review of Services
During 2010/11 North Somerset community services provided 25 NHS services. North
Somerset Community Services has reviewed all the data available to them on the quality
of care for all of these services.
The income generated by the NHS services reviewed in 2010/11 represents 100% of the
total income generated from the provision of NHS services by North Somerset Community
Services for 2010/11.
Data relating to performance for all services is collated and is used to populate a
scorecard. The scorecard is presented on a regular basis to commissioners, the
Community Services Committee and the Community Services Governance and Risk
Committee.
Using the scorecard approach managers and clinicians regularly review service related
data and action plans can be proactively developed and implemented where areas of
concern become apparent.
Incident data is reviewed on a monthly basis by the Governance, Quality and Risk Group
and the Community Services Committee any trends highlighted are investigated further.
A total of 831 incidents were reported during 2010/11. 53% of these were patient related
incidents. 42% of incidents reported were completed by the District Nursing Teams.
An illustration of the reports we prepare for the board and staff is shown below;
Total Incidents received 2010/11 01.04.10 to 31.03.11
Staff related
Incident, 191
Trust related
Incident, 26
Incident related to
the Public, 3
Patient related
Incident, 442
Non Patient related
Incident, 169
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Total Incidents received 2010/11 ( 01.04.10 to 31.03.11)
Treatment or
Procedure, 3
Other, 84
Access, Admission,
Transfer, Discharge,
88
Abusive, Violent,
Disruptive or Self
Harming Behaviour, 37
Security, 41
Accident that may
result in personal
injury, 109
Assessment, 5
Implementation of Care
or Ongoing Monitoring
or Review, 218
Medication, 36
Medical Device, 33
Infrastructure or
Resources, 122
Consent,
Confidentiality or
Communication, 24
Patient Information, 31
We can further interpret the data to highlight where there are trends, areas of high
reporting and produce reports tailored to specific services. This gives us the opportunity to
further scrutinise areas and take all appropriate action.
Quality Improvement Plan for 2011/2012 for Incidents
We will continue to build on the learning from the use of a comprehensive reporting
process. Our plans for 2011/2012 are;
• To introduce the online reporting, improving access for staff to further encourage
ease of reporting incidents and provision of prompt feedback.
• To further develop the comprehensive training package for all staff, ensuring all are
aware of the importance and value of incident reporting.
• To produce an integrated scorecard showing performance and incident data.
As we move into a Social Enterprise we will ensure data is reviewed by the Board of the
new organisation. We are also planning to introduce quality reviews to support senior
staff shadowing front line clinicians to gain knowledge and understanding of clinical
concerns as issues.
Participation in Clinical Audits
During 2010/11 we have not participated in any national audits but have been involved in
strategic audits such as:
-
Pressure Ulcer
Stroke
We have been engaged with partners in a range of audits within our clinical teams. The
information we have been collating and analysing link to a range of different areas, both in
the direct delivery of services, but also highlighting the range of support for staff.
These are highlighted in the section below.
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Palliative Care Audit
11/11/10
This audit was carried out in response to the Marie Curie Delivering Choice initiative which
is currently being undertaken in North Somerset and Somerset. The aim of this initiative is
to enable the provision of the support, expertise and information to allow the individual to
die peacefully in the place of their choice. In order to achieve the most effective way to
deliver care, a coordination centre was planned to be developed in the autumn of 2010.
An initial audit was required to benchmark the time spent in direct patient care for those on
the palliative pathway.
A snapshot audit was carried out on any one day during the week commencing 26th April
2010, and completed by all 13 community nurse teams (including the Community
Matrons) in North Somerset PCT. The aim of the snapshot was to have a feel for the
amount of time and the proportion of the working day community nurses currently spend
responding to the needs of palliative patients and the impact of end of life care on the
teams.
CLINICAL EFFECTIVENESS AUDIT
747
800
725
700
MINUTES
600
500
480
225
315
415
400
300
200
70
335
432
480
95 90
460
0
265
0
300
0
0
100
80
EN
TI
R
EN
E
7
TI
R
E
EN
6
TI
R
SO E 5
U
T
SO H 7
U
T
SO H 6
U
TH
N
5
O
R
TH
N
7
O
RT
H
N
6
O
R
TH
5
0
TIME DIRECT CARE
0
CO-ORDINATION OF CARE ENTIRE PCT
0
0
0
0
0
0
TRAVEL ENTIRE PCT
TIME DIRECT CARE
TRAVEL ENTIRE PCT
CO-ORDINATION OF CARE ENTIRE PCT
This has been further broken down into the different nurse roles to evidence who would be
more involved in the delivery of palliative care in the community;
Time spent on direct care by nursing teams
In total, 1620 minutes were spent in End of life care
Band 7 – Community Matrons spent a total of 415 minutes on direct care – 25% of the
total
Band 6 – District Nursing Sisters spent a total of 480 minutes – 30% of the total
Band 5 – Community Nurses spent a total of 725 minutes – 45% of the total
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Quality Improvement Plan for 2011/2012
The Marie Curie delivering choice programme will be evaluated in 2011/2012. As part of
the evaluation, this audit will be completed using the same methodology. We will then be
able to evidence the effect on the clinical services from the development of the end of life
coordination centre.
There have been no national confidential enquiries relevant to North Somerset Community
Services during this period.
Our plan for 2011/12 is to identify and arrange participation in relevant national clinical
audits to benchmark the quality of our clinical services and we will also ensure
participation in National Confidential Enquiries. Over the next twelve months we will be
reviewing how we will be able to participate in national audits for conditions our staff
manage. For example;
•
•
•
•
•
Childhood epilepsy
Diabetes in children and adults
Chronic Obstructive Pulmonary Disease
Falls and non-hip fractures
Hip fracture.
Reviewing reports of Local Clinical Audits
Local clinical audits relating to records and documentation and patient experience are
completed as mandatory each year. During 2010/11 all services completed these audits
and they were reviewed by Commissioners at contract meetings on a quarterly basis.
The service managers and clinicians review the audit results to ensure action plans are
fed into their annual work plan.
In 2011/12 we will implement additional local service specific audits to further evidence the
quality of the services provided.
Clinicians and Services Leads have highlighted the following topics as preferred audit
subjects:
1. Decontamination Audit for Clevedon Community Hospital
2. Single Sex Accommodation
3. Audit of Complaints and Compliments
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Research
Participation in clinical research
Getting Out of the House National Research Project
The number of patients receiving NHS Services provided by North Somerset Community
Services in 2010/11 that were recruited during that period to participate in research
approved by a research ethics committee was 19. The Occupational therapy service is
participating in a Multi-Centre Randomised Control Trial of rehabilitation aimed at
improving outdoor mobility for people after stroke. The Getting Out of the House Study is
being led by the University of Nottingham and funded by a research grant provided by The
National Institute of Health Research.
BACKGROUND TO THE STUDY
Getting out of the house after a stroke is important for various reasons but many people
cannot get out of the house as much as they would like. It is not just about improving
physical mobility but improving confidence, motivation and self-belief. A pilot study was
carried out in Nottingham in 2005 where 176 stroke survivors were recruited and provided
with verbal and written information about local transport and mobility issues. Half the
people then received the targeted outdoor mobility therapy. The study showed that the
therapy had a positive effect on getting out of the house. However for the therapy to
become routine clinical care across the country the study has to be scaled up using
several different areas and several different therapists. There are now 15 sites across the
country and will include 506 people who want to get out of the house more often.
Priorities agreed with Commissioners
In 2010/2011 North Somerset Community Services met all the quality priorities required by
NHS North Somerset.
A proportion of our income in 2010/11 was conditional on achieving quality improvement
and innovation goals (CQUIN) agreed between North Somerset Community Services and
NHS North Somerset. This was included in the contract for the provision of NHS services
through their Commissioning for Quality and Innovation Framework.
CQUIN
Performance
RAG Rating
100% of patients are VTE risk assessment
using the national tool
100%
Green
100% of patients who are identified as requiring
appropriate VTE prophylaxis receive it
100%
Green
Improve responsiveness to the personal needs
of patients – five set questions were asked on
the survey and the responses will set a baseline
for comparison measurement during 2001/12
Clevedon Hospital – measure number of
pressure ulcers – grade 2 and above acquired
whilst on caseload and report via incident
reporting
Page 18
100% of services asked
patients these questions
Green
100% of services
completed a patient survey
Achieved
Green
CQUIN
District Nursing – measure number of pressure
ulcers – grade 2 and above acquired whilst on
caseload and report via incident reporting
‘Recruit’ and train an agreed number of
designated service champions to improve the
care for people with dementia
Undertaking of agreed championing activities to
agreed specifications and timescales
Performance
RAG Rating
Achieved
Green
Achieved
Green
Achieved
Green
In 2011/2012, we will continue to work with our staff to ensure that the targets we have
agreed within our contract will be achieved.
Performance against national requirements
Within our contract for 2010/2011, we were required to deliver safe and effective services
that also met national requirements for the community services. We have achieved an
excellent level meeting these targets and will continue to ensure we remain focused on
the provision of services that continue to meet these requirements.
1.1.1 Methicillin-resistant Staphylococcus Aureus (MRSA) - Number of
acquired Infections (Bacteraemia)
Target
Performance
RAG Rating
Number of MRSA Bacteraemia Acquired
Green
0
Infections
1.1.2 Rates of Clostridium Difficile (Cdiff)
Target
Performance
Number of Cdiff Acquired Infections
2
RAG Rating
Green
1.1.3 Breaches of Mixed Sex Accommodation in line with Delivering
Single Sex Accommodation
Target
Performance
RAG Rating
No single sex accommodation breaches
0
Green
1.1.4 Referral to Treatment – Patients seen within 18 weeks for nonadmitted pathways
Target
Performance
RAG Rating
For patient referred for specialist physiotherapy
- 95% in 8 weeks (except where assessment
cannot be completed during this time due to
Green
99%
patient choice or where patients require
investigations e.g. MRI, Nerve Conduction
study)
For patients referred for non-specialist
Green
physiotherapy – 95% of percentage of patients
100%
seen within 13 weeks
1.1.5 Supporting Measures – Number of Diagnostic Waits >6 weeks
Target
Performance
RAG Rating
100% of patients seen within 6 weeks
100%
Green
1.1.6 < 4 hour wait in A&E (Minor Injury Unit)
Target
Performance
98% of patients seen within 4 hours
100%
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RAG Rating
Green
Performance against our contract
The Community Contract contained 106 Key Performance Indicators (KPI’s) with targets
set against them and 104 Key Performance Indicators which were benchmarked to
provide information for target setting for 2011/12.
Number of Targeted
KPI’s
Number of Targeted
KPI’s Achieved
Number of
Targeted KPI’s Not
Achieved
106
82*
23*
*awaiting confirmation of the final outturn for expenditure on wound care
% of KPI’s
Achieved
Overall
77%
Only two KPIs were not fully completed:
•
•
Community Occupational Therapy 95% urgent patients seen within10 days of
referral target ( relating to staffing shortages in the team – this is now resolved and
in Quarter 4 the service is now achieving the KPI)
Community Physiotherapy non face to face contact target (see below).
For 2011/2012, we have worked closely with our commissioners to review the
performance and the indicators that were used last year. We have developed our learning
to ensure we are able to agree targets that are achievable, and focus on the delivery of
effective clinical care for patients.
An example of the application of this is that the non face to face contact target has been
removed from the performance framework for community physiotherapy, as it was
recognised that the service is most effective when seeing patients face to face.
Patient environment action team (PEAT)
As required by the Community Contract we completed an assessment led by PEAT.
The result this year shows an improved outcome following action plans instigated after the
review in 2009/2010.
This year our scores were:
Site Name
Clevedon Hospital
Environment
Score
Good
Food
Score
Good
Privacy
& Dignity
Score
Good
Last year our scores were:
Site Name
Clevedon Hospital
Environment
Score
Good
Food
Score
Excellent
Privacy &
Dignity
Score
Acceptable
We are delighted with the improved score on privacy and dignity. The food score has
between ‘good’ and ‘excellent’ in the last few years and will be reviewed again based on
the information from last year to see where we may improve. The hospital manager will
continue to monitor quality to maintain high standards and ensure further improvement.
Page 20
What others say
Regulation with the Care Quality Commission
The provider arm of NHS North Somerset has “full registration status without conditions”
with the Care Quality Commission. It is registered to provide three regulated activities –
Treatment of disease, disorder or injury Diagnostic and screening procedures. Nursing
care. These are in two registered locations – Clevedon Hospital and East End Court
(provider services HQ).
There have been no enforcement measures carried out by the CQC in the last year.
NHS North Somerset Community Services has not participated in any special reviews or
investigations by the Care Quality Commission during this reporting period.
Quality and Risk profile
“The
quality and risk profile tool produced by the Care Quality Commission gathers
together key information about the organisation. It enables the CQC compliance
inspector to assess where any risks may lie in relation to the regulated activities the Trust
carries out”.
CQC staff survey
Staff Survey 2010 - Community Services Highlights
The findings of the NHS Staff Survey 2010 have been structured around the four pledges
in the NHS Staff Constitution which was published in January 2009 plus two additional
themes. The response rate was 60% and the findings were structured around 38 key
findings.
Staff Pledge 1 – To provide all staff with clear roles, responsibilities and rewarding
jobs
33% of community services staff reporting that they were dissatisfied with the quality of
work and patient care they are able to deliver and was a theme that was reported in the
previous two years’ surveys. Health visitors, in particular were a group who reported
negatively to this finding with 76% reporting dissatisfaction in this area and was
significantly above the Trust average of 65%. It is anticipated that staff’s perception
around the quality of work and patient care will improve with the introduction of
community wards and the increased funding for the SPHN service. 92% of Health
Visitors, 89% of Community Nurses and 76% AHPs are still reporting that they are
working additional hours compared with the Trust average of 65% and managers need to
be proactive about monitoring this situation via day to day supervision and 1:1s and
being alert to situations where working additional hours could lead to sickness absence.
Page 21
Staff Pledge 2 – to provide all staff with personal development, access to
appropriate jobs and line management support to succeed.
There is a marked improvement in the number of completed staff appraisals with 82% of
community services staff reporting that they had received an appraisal in the last 12
months. 71% of staff reporting that they had already received job relevant training
identified in the appraisal with 29% saying it was too early to say.
Staff Pledge 3 – To provide support and opportunities for staff to maintain their
health, well-being and safety.
The areas of work related injury and work related stress were highlighted as areas for
improvement and the results remain unchanged from last year. 24% of staff working at
Clevedon Hospital, 25% of District Nurses and 24% of Specialist Public Health Nursing
reported that they are suffered work related injury compared with a Trust average of
13%. The reported incidents of injury accidents do not support the findings of the survey
and indicate an under-reporting of injury incidents/accidents.
The Community Groups reporting that they had suffered from work related stress above
the Trust average of 32% were District Nursing (35%), Specialist Public Health Nursing
(39%) and Specialist Services (38%). The Health and Safety Manager has offered further
stress management training and the Associate Director of Organisational Change is
running two “Happiness” workshops. The Improving Working Lives Group has financially
sponsored Mindfulness Sessions and more recently a number of Pilates sessions, both
of which have been well supported. A new policy reference document entitled Health
and Well-being has been introduced signposting staff to relevant policies and help. In
October 2010, an Employee Assistance Scheme was launched to offer timely, quality
counselling sessions as well as an interactive website to help staff manage life’s planned
and unplanned events. It is anticipated that staff will benefit from the scheme during the
forthcoming organisational changes.
Staff Pledge 4 – To engage staff in decisions that affect them, the services they
provide and empower them to put forward ways to deliver better and safer services
This area was not so strongly reported on in community services as it was in
Commissioning.
53% of Community staff agreed that they were consulted about
changes that affect them. 20% neither agreed nor disagreed and 27% disagreed or
strongly disagreed. 50% of staff agreed that senior managers encourage staff to suggest
new ideas for improving services with 30% neither agreed nor disagreed and 20%
disagreed or strongly disagreed. This result probably reflects the organisational changes
that community services staff are experiencing.
Additional Theme – Staff Satisfaction
19% of Community staff reported an intention to look for a new job in a different
organisation in the next 12 months although, in this period of national and organisation
change, this result is not unexpected. This result was better than Commissioning (27%).
Additional Theme – Equality and Diversity
58% of Community staff reporting receiving Equality and Diversity Training (Trust
average 63% and National average 48%) although 11% of Community staff reported
experiencing bullying, harassment or abuse from a manager or colleague which is an
average result across PCTs nationally.
Page 22
Data quality
Secondary Uses Service
Due to the historical organisational relationship, North Bristol Trust submits records on
behalf of North Somerset Community Services to the Secondary Uses Service. The data
is included in the hospital episode statistics in the latest published data. The percentage of
records in the published data which included the patient’s valid NHS number was:
100% for admitted patient
100% for out patient care
89% for the Minor Injuries Unit (MIU) - for the 11% where this was not recorded the
identifier on the electronic record was.
The percentage of records in the published data which included the patient’s valid General
Medical Practice Code was:
100% for admitted patient care
100% for out patient care
100% for Minor Injuries Unit
Information Governance Toolkit attainment levels
North Somerset Community Services Information Governance Assessment Report score
overall score for 2010/11 was 77%. The following statement was submitted for Community
services by the Information Governance team in North Somerset.
In 2010, NHS North Somerset undertook and completed its annual assessment that
enabled it to assure Connecting for Health that it was meeting the requirements as set out
in the following workstreams, that allowed it to safeguard information:
•
•
•
•
•
•
Information Governance Management
Confidentiality and Data Protection Assurance
Information Security Assurance
Clinical Information Assurance
Secondary Use Assurance
Corporate Information Assurance
The organisation submitted a score of 77% in the above standards, which enabled it to
fully comply with the required levels.
The scoring process was between 0 and 3, with Connecting for Health stating that the
minimum required standard is a level 2. NHS North Somerset achieved this across the
board.
Due to the expansive review to the requirements undertaken by Connecting for Health,
comparison with last year’s score would not reflect the improvements made by NHS North
Somerset during the assessment timeframe.
Page 23
Clinical coding error rate
North Somerset Community Services was not subject to the payment by results clinical
coding audit during 2010/11 by the Audit Commission.
Page 24
Part Three
Review of our Quality Performance in 2010/2011
This is a review of North Somerset Community Services performance over the past year.
The information relates to community nursing and therapies, Learning Disabilities,
Children and Young People’s Services, and Clevedon Community Hospital. We have
worked with staff and users to agree our Mission and Values;
Mission Statement
We aim to provide first class health care services within the community,
delivering effective outcomes with people through collaboration education and
innovation.
Values
We value and respect people
We act honestly and fairly
We listen and learn
We support and develop our staff
We work hard to continually deliver quality and value for money
In 2010/2011 our key objectives were;
To improve quality and the patients experience
To ensure our workforce are the best they can be to deliver effective community
services
To meet our contractual obligations
To highlight the quality of service provided within that framework, we have linked them to
the key headings of patient experience, patient safety and clinical effectiveness.
“
I have my confidence again. (Home Oxygen Patient)
Page 25
3.1 Patient Experience
3.1.1 Dignity in Care
As a result of a national audit, a Dignity in Care Group was established by Community
Services. They have developed some key principles to ensure that all professionals
delivering care are aware of their role and commitment to ensure that all service users are
treated with the dignity that they would expect. Our policy states that it is our intention to
ensure dignity in care is extended to all adults receiving health and social care services
irrespective of the setting and service provided, thereby including all vulnerable and hard
to reach groups.
The ten point dignity challenge we have adopted is a clear statement of what people can
expect from a service that respects dignity. In North Somerset we aspire to all those
providing care to adopt that challenge as individual organisations and as partners in the
local health and social care community.
Ten point dignity challenge
Zero tolerance of all forms of abuse
Treat each person as an individual by
offering a personalised service
Listen and support people to express their
needs and wants
Ensure people feel able to complain without
fear of retribution
Assist people to maintain confidence and a
positive self esteem
Support people with the same respect you
would want for yourself or a member of your
family
Enable people to maintain the maximum
possible level of independence, choice and
control
Respect people’s right to privacy
Engage with family members and care
givers as care partners
Act to alleviate people’s loneliness and
isolation
Each service has nominated a champion within the team, and it is their responsibility to
ensure information is effectively cascaded. Service managers will review the data
presented from complaints and patient experience audits to monitor any areas that may
require action, or investigation.
Quality Improvement Plan for 2011/2012
We will further develop the initial work the group has completed. For example;
• We will be developing a People Strategy within the organisation ensuring that
services are able to access data reflecting patient experience.
• We will build on the learning from the existing clinical champions
• We will work closely with the Community Forum to learn more about the views of
the local community.
Over the last year we have introduced the End of Life Coordination
Centre in partnership with Marie Curie. For people who are coming to the
end of their lives, the team ensures there is a care plan in place,
equipment is ordered as soon as required and arranges overnight care to
support the carers and patient. We have been able to more effectively
manage services to support people to die in the place of their choice.
To date there has been a 10% reduction in deaths in hospital
Page 26
3.2.2 Recording patient experience
During 2010/11 all 25 Community Services teams completed a Patient Satisfaction Audit.
Following the development of the audit programme, each service was allocated a 3 month
period in which to ask their patients/services users what they thought of the service
provided by our staff.
This audit formed part of the mandatory audit programme and contained 4 questions
relevant to all services which relate directly to the delivery of the Contract held with NHS
North Somerset and service leads were asked to select additional service related
questions from a pre written list.
Questionnaires were sent to a minimum of 25% of the case load at the time of the audit
and the results were to be displayed as a report. A total of 3059 questionnaires were
sent out to patients who had been seen in our services. Of those, 1143 were returned,
giving a response rate of 37%.
These reports were reviewed by the Lead Commissioners for each service and feedback
given. The results for all services have been collated below, with the totals reflecting the
percentage number of ‘yes’ replies we recorded.
Q1
Q2
Q3
Q4
Did you feel involved in decisions about your treatment
or care?
If you had worries or fears, was a member of staff
available to you to discuss them?
Was there sufficient privacy when you were being
examined or treated?
Were you or your family given information about who to
contact if you were worried about your condition or
treatment?
Page 27
Quality improvement plan for 2011/2012
The mandatory patient experience audit programme will run in the same way as 2010/11,
with the addition of 4 new services:
Community Wards –Tyntesfield, Weston North
End of Life Care
Continuing Health Care
Single Point of Access
The number of questions to be asked has reduced to a maximum of 15, to include 8
mandatory questions. The reason for this change is because last year it was felt the
questionnaires were too long, some included up to 30 questions. It is anticipated that this
change will also improve the return rate.
Some changes to the wording of the questions will take place in order to include our
learning disabilities clients.
“
Thank you for the help you have given me and my family. (DARRT
Patient)
3.2.3 Customer services
Information on complaints and compliments received about Community Services has been
collated by the Patient Advice and Liaison Service (PALS) provided by NHS North
Somerset, and within the internal audit structure.
Complaints
We receive information on a complaint with a timeline in which we will have to respond to
the complainant, and whether we are the lead or have provided part of the service related
to the complaint. For example, a service user or their carer may have concerns about all
services that have been involved in the care, not just Community Services.
Page 28
Once concerns about the quality of treatment provided are received, the service involved
is required to make a response made to the complainant within an agreed timeframe.
There is an internal review looking at the issues that are raised and any potential services
changes that are highlighted as a result. The service managers are required to produce an
action plan with a timeline for implementation, and an agreed date for a further reflection
and learning from any new practices that have been developed.
The information on complaints is reported on a monthly basis by service and is presented
on a Community Services dashboard to the contract and performance meeting and the
Community Services Committee.
We received a total of 15 complaints across all the services we provide.
Compliments
We collate the compliments we receive within the organisation. The information on
compliments is reported on a monthly basis by service and is also included on the
dashboard. The compliments we received by category are illustrated below.
We received a total of 184 compliments for our services in 2010/2011.
Page 29
Quality Improvement Plan 2011/2012
In 2011/2012 we will be developing and implementing a People’s Strategy which will;
•
•
•
Develop and implement a complaints and compliments process within our own
organisation, with a clear performance framework
Ensure complaints and compliments are collated and shared across the operational
services
Share action plans developed as a result of a complaint across all services,
ensuring learning is cascaded and captured.
A patient information leaflet was required by the Community
Matrons to tell patients what they could expect from the service.
In order to make the information accessible, they asked for
support from their patients. The resulting document was
developed and written by one of those patients, and read many
more. The feedback from use in the community has been
extremely positive. Below is an extract;
“Matrons will make sure you understand how your medicines
help you and can prescribe or arrange new medicines if
needed.
In addition, they will make sure your views are listened to and
that your care is designed around your needs. That way you can
be confident that you are in control of your health and care”
3.2.4 Eliminating mixed sex accommodation.
We have successfully maintained single sex accommodation throughout the last year.
We have also completed the necessary compliance to ensure that we have confirmed our
continuing commitment to this target. This is available on the NHS North Somerset
website (www.northsomerset.nhs.uk) but is also reproduced below;
North Somerset Provider Services is pleased to confirm that we are
compliant with the Government’s requirement to eliminate mixed-sex
accommodation, except when it is in the patient’s overall best
interest, or reflects their personal choice.
We have the necessary facilities, resources and culture to ensure
that patients who are admitted to our hospital will only share the
room where they sleep with members of the same sex, and same-sex
toilets and bathrooms will be close to their bed area.
Sharing with members of the opposite sex will only happen when
• Clinically necessary; for example where patients need a safe
haven bed to prevent admission to an acute hospital; whilst
this is highly improbable we would not turn away patients in
need of our services but make special arrangements for
interim provision.
Page for
30 instance a mixed sex
• Patients actively choose to share;
couple wishing to share a double room.
Quality Improvement Plan 2011/2012
We will continue to deliver the service as we have committed to do so in the above
compliance. Any failure to meet these requirements will be reported immediately to the
commissioners and Board.
3.2 Patient safety
NHS South West has agreed the need to triangulate several of its existing
safety and quality governance processes (including performance, finance,
patient safety and workforce) to strengthen the assurance of providers
operating plans in relation to workforce change and patient safety
NHS North Somerset Community Services has been selected to test the 10
self-evaluation questions in order to determine whether or not they provide a
useful basis to undertake a self evaluation and resultant action plan to
compliment the Trust’s existing governance arrangements.
This approach will be rolled out to other Trusts once feedback has been
received.
Throughout the year we have focused on key work streams where we recognise there is a
need to develop our understanding in order to improve the quality of the services that we
provide. We have involved key clinicians, working together to share knowledge and
experience in these different areas.
3.2.1 Management of Pressure Ulcers
The management of pressure ulcers is an area we have concentrated on in the last year.
The purpose of this scrutiny is to promote the safe management of patients in the
community.
Definition:
a) Number of pressure ulcers inherited from acute care and seen at
Clevedon Community Hospital and by community nursing services
b) Number of pressure ulcers acquired whilst being seen by community
nursing services
Data Source:
A Point prevalence snapshot audit of pressure ulcers managed by the
District Nursing Service (DNS) which took place on May 24th 2010. This
audit has highlighted that within the District Nursing Service 91 patients
were being treated with pressure ulcers on that day resulting in a
prevalence of 5% of the total caseload numbers.
Before admission to DNS caseload - 60 – 66% (24% from Acute Care)
After admission to DN caseload - 31 – 34%
Rationale:
National prevalence is unclear as methods of collecting data vary greatly,
however Narzarko (2005) suggest that prevalence ranges between 5%
and 32% across different settings.
Page 31
Progress:
The number of pressure ulcers inherited from acute care showed a 10%
reduction from the prevalence audit carried out previously in Jan 2010.
There was a 2% increase in the number acquired on the caseload. This
led to a more qualitative audit being undertaken in October 10 looking at
the assessment process and care planned. An action plan has been
formulated using the information obtained from both these audits.
During 2011/2012, we will be implementing the learning from the action
plan to reduce the incident of pressure ulcers acquired on our caseloads.
Following the engagement with this workstream, a group of
clinicians entered the NHS South West Leadership Challenge.
Their entry was presenting a tool to ensure community staff are
able to fully assess for any of the risk factors leading to
development of a pressure sore;
This is shown below;
Pressure needs PROMPT action
R – Red? Report / Refer it
O – Oral Intake – adequate?
M – Moisture Levels P – Posture – manage it
T – TAKE THE PRESSURE OFF
Page 32
Managing the Deteriorating Patient
It is important to be able to identify early those patients who may be at risk of becoming
more unwell and therefore require extra support. Over the last year, we have implemented
a number of different systems within our community hospital to change the care of
patients as soon as it is required.
Definition:
Number of patients who are assessed using the early warnings
system in Clevedon Community Hospital.
Data Source: As from Monday 11th April 2011, all patients are now assessed using the
Community Services Early Warning System (EWS). This has been developed from the
experience of local hospitals and forms part of the observation chart. To date 15 patients
have been managed using the system.
Rationale: The EWS has been implemented as part of the safer patient initiative; the aim
of this programme is to detect any changes in the patient’s vital signs and to act upon the
changes.
Progress: Although still in the early stages of the programme, initial signs are positive,
Staff have engaged fully with the new charts and are encouraged and empowered by the
support offered by using EWS.
Infection Control
As part of our performance targets we monitor closely the infection rates at our community
hospital. This information is highlighted below.
Definition:
Number of recorded cases of MRSA and C.diff inherited from or
acquired in Clevedon Community Hospital.
Data Source: This data is collected on a monthly basis as part of our agreed data capture
for the commissioners. All patients admitted to CCH are routinely screened for MRSA.
There have been no incidences of acquired or imported bacteraemias throughout the
year. However, Clevedon Community Hospital had one case of acquired C-Diff and no
cases of acquired MRSA. There were 13 confirmed cases of imported MRSA.
Rationale: The reason for such low rates of acquired infections is down to the diligence of
the staff and the leadership of the senior team. Regular auditing of IC compliance is
performed routinely.
Progress: Infection prevention and control is taken very seriously at CCH, as the low
rates of infections prove. We are not complacent and are always striving to improve. We
have CQUINS targets to reach which we are confident we can achieve.
Page 33
Safeguarding our patients
In order to support fully the patients and service users, we maintain a process of training
and development in the key areas of safeguarding adults and children
Safe guarding Adults
Definition:
Ensure that effective systems are in place and that staff are appropriately
trained and supported to safe guard and promote the welfare of vulnerable
adults.
Data Source: Training needs analysis using MLE and CPD in line. The local authority
provides the training and collects the data which is reported on quarterly.
Rationale: To ensure that staff are competent and capable to assess and deliver services
and to raise awareness and minimise the risk of abuse taking place.
Progress: The new training contract commissioned form the local authority has recently
been redesigned.
E Learning is available to all new starters and as a refresher course.
Level 1 For all non clinical and clinical staff every 3 years. Clinical staff have to do a
refresher E learning course annually.
Level 2 is for staff that undertakes investigations.
Train the Trainer course is for staff that will be delivering training.
Update sessions to inform staff of lessons learnt at serious case reviews.
Team supervision sessions to discuss cases and any new developments.
Safeguarding Children
Definition:
Ensure that effective systems are in place and that staff are appropriately
trained and supported to satisfy their statutory requirement relating to
Section 11 (Children Act 2004) to safeguard and promote the welfare of
children.
Data Source: Training needs analysis across organisation using MLE and CPD online
(Local Authority training tracking system).
Rationale: To ensure that staff were commensurate and compliant with safeguarding
children competencies in line with Working Together to Safeguard Children (2010) and the
Intercollegiate Document (2010).
Progress:
Level One: the requirement for compliance with this level is that all staff will complete the
e-learning package within 6 weeks of employment. This needs to be refreshed every 3
years. Current levels indicate that 80% of staff have completed this training within the
required time frame. Data is tracked via MLE (Managed Learning Environment).
Page 34
Level Two: This was highlighted as an area for review. An intensive package of training
has been put in place. Those staff at Band 6 and above within clinical adult led services
have been targeted for this level of training. Currently 61% of this group have attended.
Training will now be available on a rolling programme. Data is logged onto MLE with an
expectation that the training will be refreshed every three years.
Level Three: this applies to all staff who work directly with children and families. Data
obtained indicates that 100% of staff have accessed this level of training or specialist
training e.g. domestic abuse, substance misuse within the past three years.
Work is ongoing to maintain and improve these levels. Additional work is planned to
ensure that staff working with children are kept updated at least yearly via professional
forums.
Falls at Clevedon Community Hospital
It is important that we understand fully what may be the causes of falls in our community
hospital. We have instigated a full process reviewing where and when a fall happens, and
how we introduce changes to improve safety of the patient in our care.
Definition:
Number of falls reported within Clevedon Community Hospital.
Thematic analysis of falls incident forms from April 2010 to March 2011.
Thirty five incident reports were collected during they year, all the incident reports are
directly related to patients falls.
The break down of geographical areas are as follows (Chart 1).
Geographical areas - falls (chart 1)
30
27
25
20
15
Area
10
6
5
1
1
Corridor
Dayroom
0
Ward
Bathroom
The year’s falls have been analysed including, what day of the week the falls occurred
(Chart 2). Thursdays, Fridays and Saturdays were the days when most falls occurred,
totalling 8 per day.
Page 35
Falls per day of the week (chart 2)
10
8
6
4
Saturday
Friday
Thursday
Wednesday
Tuesday
Sunday
0
Monday
2
The analysis of falls per month is detailed below (Chart 3).
Mar-11
Feb-11
Jan-11
Dec-10
Nov-10
Oct-10
Sep-10
Aug-10
Jul-10
Jun-10
May-10
7
6
5
4
3
2
1
0
Apr-10
Falls per month (chart 3)
Clevedon Community Hospital (CCH) admitted 224 patients (GP, Rehabilitation, Safe
Haven and day cases) last year, a total of 35 incidents were recorded, which equates to
15.6% of the patients had one or more incident forms submitted. It is notable, that last
year we had at least one patient, who fell on a number of occasions, this patient’s falls
contributes significantly to the 15.6%.
Staff at CCH work hard to reduce the number of patients falling, however, as we provide a
rehabilitation service there will invertible be a small number of patients who fall.
Page 36
Our aim next year is to reduce the number of falls and we intend to do this by:•
•
•
•
•
Introducing a multidisciplinary falls assessment
Identifying and managing patient who are deemed at risk of falling (via falls
assessment)
Continuing to ensure environmental falls hazards are minimized, i.e. de-cluttering
wards and generally keeping the hospital tidy
Working in partnership with experts, i.e. Consultant, GP’s, therapists and nurses
Quality Improvement and Service Plan, this is a regional plan working in
conjunction with the Institute Of Health and Innovation (IHI) to formulate a specific
work stream to assess and manage falls with in CCH. The plan is to use PDSA
cycles to trial a full falls assessment as against a PACT falls assessment to
determine the most appropriate for CCH. Consider the colour coding of walking
aids with a RAG/Name tag to determine level of support required to mobilise. Also
considering use of Intentional Rounding for patients most at risk, this is a checklist
carried out by staff at timed intervals to reduce key risks to falling. Also maintain
links with QPSIP Falls team to share knowledge and progress via conference calls.
South West Hospitals Standards in Dementia Care audit implementing work. This audit
will help assess and eliminate falls risks for dementia patients, i.e. shadows, poor lighting,
good visible signage etc.
3.3 Clinical effectiveness
Within our organisation we have a service improvement team, working with clinicians to
improve the services they provide for the benefits of patients. We are committed to the
provision of services with quality as its organising principle through a period of expected
significant financial challenge. A number of initiatives have taken place during 2010/2011
which will be built on and further developed during 2011/2012.
3.3.1 Productive Community Services
“
Thank you for the wonderful service I have received since leaving
hospital (Clevedon Community Team Patient)
Productive Community Services (PCS) is part of the NHS Institute productive programme.
It puts staff at the forefront of redesigning services with the aims of:
•
•
•
•
Increasing patient facing time
Reducing waste
Reduce inefficient work practices
Improve the quality and safety of care
Page 37
PCS was launched in March 2010 with the following services:
•
•
•
•
•
•
•
Rapid Response & Rehabilitation
Bladder & Bowel Service
Occupational Therapy
District Nursing Portishead
District Nursing Weston
District Nursing Worle
The Musculo-skeletal Interface and physiotherapy service
Initially services concentrated on the working environment to ensure it contributes
positively to the care delivered, as opposed to hindering it, making things easy to find,
understand, use and manage consistently.
As a result of PCS a number of improvements were realised including:
•
•
•
•
•
Reduction in expenditure on stock & equipment - using a systematic approach to
reorganise store cupboards, nursing bags and stock carried in staff cars
Standardised “grab bags” introduced in Rapid Response & Rehab team ensuring
that staff are able to quickly access all the equipment required when seeing a
patient in their own home
Using lean problem solving approach the Bladder & Bowel service implemented a
number of actions to reduce the Did Not Attend rates in the service from 30% in
April 2010 to below 10% by March 2011
Administration processes were streamlined across the musculoskeletal
physiotherapy and triage service, improving cross cover and reducing admin costs.
Standardised bags introduced within District Nursing team to ensure all staff are
able to access what they will need when caring for a patient in their own home.
Plan for 2011/2012
Due to the introduction of Community Wards the PCS programme has been relaunched
with the focus on Community Wards to ensure that effective and efficient working
practices are in place.
3.3.2 Education & Training
Training in Lean Principles
During 2009/10 fourteen staff within NHS North Somerset Community Services attended
Lean Practitioner training. A further 10 staff attended Lean Awareness training. The aim
of the training is to equip staff with the knowledge and skills to carry out quality and
service improvements within their own services and for staff to recognise the importance
of making every intervention and action count, to get the best for patients and the best for
the cost of each intervention. This encourages staff to really consider how to get value
from their time and the systems they use to improve patient outcomes. A number of
service improvements were made following the Lean Practitioner training including
streamlining the Essence of Care processes, streamlining performance reporting process.
The knowledge and skills gained during 2010/11 will be built on and developed this year
through our Productivity & Efficiency programme.
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Project Management
A total of fourteen staff attended Essentials of Project Management training in 2010/11to
equip with the knowledge and skills to apply project management principles to service
improvement and change management within their own services.
Organising for Quality
During 2010/11 6 staff are participating in the NHS Institute Organising for Quality
programme. The emphasis of the programme is to develop knowledge and skills around
quality and service improvements and will enable staff to demonstrate the outcome of our
interventions and services. We will do this by measurement for improvement, linked with
other measures such as clinical audit, clinical governance to improve services and
demonstrate our outcomes.
As part of the course staff are carrying out small projects within their area which have
included;
•
•
•
•
Use of Safe Haven beds
Reviewing caseloads
Response times
Single point of access
Plan for 2011/2012
• We will continuing to embed the Productive Community services programme across
all teams, ensuring we are able to evidence the efficiency of our services and
improved quality.
• We will be assessing the outputs of the quality programme and cascading the
learning.
3.3.3 Service Improvements
A number of service improvements have taken place during 2010/11. Examples of these
are shown below.
•
Introduction of centralised system for ordering on-line wound care products
During 2009/10 a centralised on-line system for ordering wound care products was rolled
out across community services. Alongside this a wound care formulary was introduced to
ensure wound care was standardised across community services and products used were
evidence based and cost-effective. A wound care formulary was also introduced across
nursing and residential homes. During 2011/12 we are planning to roll the centralised
system for ordering on-line wound care products.
3.3.4 Care Homes Training Programme
In conjunction with the University of the West of England a number of our staff and
services have been involved in an on-going training programme for care home and
residential staff. Our staff have delivered sessions on a variety of topics including wound
care, managing long term conditions and services available within the community to
support care and residential home staff managing residents.
Our staff have also visited care homes with a large number of hospital admissions to offer
the home support, advice and signposting to services to prevent hospital admission.
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Quality Improvement Plans for 2011/2012
Productivity & Efficiency Programme
We are introducing a Productivity & Efficiency programme to pull together a number of
quality and service improvement workstreams. Examples of these include:
•
•
•
•
System redesign & flexible working
Information quality & mobile working solutions
Training & development
Capacity management
Each workstream will have a project lead and clinical lead and a project plan detailing key
workstreams and milestones. We are planning to work with services to achieve the aims
of each workstream and to develop staff skills in service and quality improvements. By
doing so will help to achieve a culture of continuous quality and service improvement
across the organisation.
“
This has been an excellent service and a great help to my comfort.
(Lymphoedema Service user)
3.3.5 Improving outcomes for patients with lower limb pressure ulcers
The close working relationship between the podiatry service and the tissue viability
specialist has led to the introduction of a new service, and an enhancement to the existing
podiatry service. We are now offering a treatment option called Versajet, a non-invasive
process that will remove infected material from the ulcer, promoting healing and repair.
This is available for patients for whom the standard conservative treatment options have
not been effective.
The podiatry team have also developed skills in providing soft casts for patients with heel
ulcers. This will reduce the pressure on the area, by applying a cast that is made to
measure for the patients and is adaptable to their needs.
“
I have been in excruciating pain for over a year….now I can walk a
little way with no pain” (Podiatry Patient)
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Improved Access to clinical services
Definition: Improved access to all services via Single Point of Access (SPA).
Data Source: Numbers of Professionals referring to Community Nursing & Community
Occupational Therapy through the Single Point of Access (an integrated service with Local
Authority).
Rationale: The purpose of the Single Point of Access (SPA) is to provide improved
access to adult health and social care community services. The establishment of a Single
Point of Access including the co-location of multi-disciplinary health and social care teams
enables it to play a key role in providing an integrated community care model. The
objectives of the SPA are as follows:
• To improve access to services for both professionals and the public
• To promote early recognition and resolution of service needs
• To maximise the % of skilled Professional resource available for complex cases
• To enable information to be collected once, in line with the agenda for single
assessment
• To minimise unnecessary administration by community services professional staff
• To maximise use of technology and electronic referral and case management
systems, rather than paper
Progress: All referrals for Community Nursing and Occupational Therapy in the South of
the region are coming via SPA. This allows for a number of cases to be closed within
SPA, without having to be referred on to the Community Teams. We are introducing
physiotherapists to the team following the success of the occupational therapists so
referrals for this service can come via SPA.
“
I have been feeling very much on my own with my problem, it’s nice
to know of someone I can contact and talk. (Home Oxygen Patient)
Healthcare for All
A very successful stakeholder event was arranged by the
Learning Disability team that was used as a forum for reviewing
our progress against the standards required for Healthcare for
All. This was the third self assessment and involved service
users, carers, stakeholders and staff. This showed what a
significant improvement has been made to supporting people’s
health since the first self assessment two years ago, with most
measures now being scored green (compared with the majority
being red two years ago)
This includes better identification of people with learning
disabilities by GP’s with the majority of practices now providing
an annual health check. There is better access to healthcare
which is more responsive to meet people’s individual needs.
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3.4 Additional Quality Improvements in North Somerset
3.4.1 North Somerset Community Partnership
As a result of the Government NHS White Paper ‘Equity and Excellence; Liberating the
NHS’, that sets out the commitment that there will be a change in the structure for
provider services to ensure that they are truly separate from the Commissioner functions.
Therefore we have been developing a new organisational form. We took into account the
views of our staff and stakeholders who told us that they wanted to have a community
service that represented our population.
Over the last year we have been working towards becoming a social enterprise, a
business that is set up for the benefit of the community and will reinvest any surplus into
the service or for the benefit of the local population. This will become fully operational as
North Community Partnership on October 1st 2011.
This will be an opportunity to build on our learning and develop services based around the
needs of the community. We feel this will benefit patients, staff and all our stakeholders to
improve health and well being.
3.5 Statements from third parties
3.5.1 Statement from NHS North Somerset Board
The Board discussed the North Somerset Community Services Quality Account in May
2011 and with some minor amendments, they agreed to ratify the report and confirmed
they were satisfied the areas below had been followed:•
•
•
•
The Quality Accounts presents a balanced picture of the Trust’s performance
over the period covered;
The performance information reported in the Quality Account is reliable and
accurate;
There are proper internal controls over the collection and reporting of the
measures of performance included in the Quality Account, and these controls
are subject to review to confirm that they are working effectively in practice;
The data underpinning the measures of performance reported in the Quality
Account is robust and reliable, conforms to specified data quality standards
and prescribed definitions, is subject to appropriate scrutiny and review; and
the Quality Account has been prepared in accordance with Department of
Health guidance
3.5.2 Response from North Somerset Local Involvement Network
North Somerset LINk appreciates the opportunity to comment on this Quality Account.
The LINk supports and has been activity involved with contributing to the process for
North Somerset Community Services to move to a Social Enterprise.
We believe this move will provide a framework that will be beneficial both to patients and
staff. Community Services will be playing an increasingly important role as more care is
moved closer to and delivered in a patient’s home. There are and will be challenges and
this will demand more staff, patient and public involvement. We believe there is a
determination within Community Services to promote and pursue these issues in the
interests of a quality service for patients.
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We note ‘the driver’ for the change to ‘Community Wards’ is described in the priority order
as:
•
•
•
reducing emergency hospital admissions and bed days
reducing NHS costs
improving patient experience
and that Community Services 2010/11 objectives are:
•
•
•
to improve quality and the patients experience
to ensure our workforce are the best they can be to deliver effective community
services
to meet our contractual obligations
We understand the current economic situation and agree that changes must include value
for money but would highlight the importance of prioritising ‘improving patient experience’
(as shown in Community Services objectives) as the long-term beneficial way forward.
The LINk supports Community Wards and would like to see the objectives for these
service changes reflecting the objectives for Community Services giving priority to
improving quality and patient’s experience.
This report shows good levels of care for patients and we are pleased to note that
identified concerns in relation to staff well-being are being addressed with appropriate
training and support.
The LINk would welcome the opportunity for continued dialogue and involvement with
Community Services in the future.
3.5.3 Response from North Somerset Health and Overview Scrutiny Panel
We would like to thank these parties for taking the time to comment on our first Quality
Account. We will use the comments made to help us develop the structure and content of
our Quality Account in future years.
3.5.4 Response from Commissioner
Thank you for inviting us to comment upon your Quality Accounts for 2010 - 11.
We welcome the identification of your key priority areas to include:
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Maintain and improve the experience of patients
Improve patient safety
Provide clinically effective services which deliver outcomes patients expect
The above are all key areas of work identified in the last year to improve quality and
patient safety provision in North Somerset Community Services and reflect the
discussions and areas of involvement the commissioners have been engaged in over the
last year.
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In 2010 - 11 North Somerset Community Services has demonstrated strong performance
in a number of areas including implementation of VTE assessments for all patients in line
with the national target, maintaining requirements under ‘Elimination of Mixed Sex
Accommodation’ and in achieving zero incidence of hospital acquired MRSA
bacteraemias. The service has also improved patient experience in a number of ways to
include adoption of the Ten point Dignity Challenge, patient surveys in all 25 service
teams and in responding to patient feedback.
Throughout 2010 -11 Community Services have embarked on a longer improvement
journey, taking part in national initiatives such as Productive Community Services,
regional initiatives such as the Quality and Patient Safety Programme and more local
initiatives such as setting up and delivery of training to local care homes to improve care
they can provide to patients with long term conditions.
These are clear indicators of improving quality and a further programme for quality
improvement for 2011 -12 is set out. We note the need to provide a greater emphasis on
both clinical effectiveness measures such as NICE and best practice guidance, and in the
use of clinical audit. We will continue to work together with Community Services to both
support and monitor this.
The PCT and Community Services have worked closely together during 2010/11 to
resolve any performance issues that arose and Commissioners did not issue any
performance notices. Detailed contract monitoring processes are in place for 2011/12
which will benefit from increased electronic data collection and improved presentation of
data. Individual service specifications include an improved focus on service continuity
during staff absence and service staff will complete their work to understand and manage
their service capacity to maximum effect.
Community Services achieved all of their CQUIN goals, except one which the
commissioners withdrew due to unavoidable recruitment delays. Learning emerging from
the CQUIN schemes has been useful in setting both realistic measures and in ensuring
data systems are sufficiently developed to deliver baselines early in the year where this
has been agreed. CQUIN schemes for 2011 – 12 will further reflect this learning.
Throughout the year Community Services has engaged with commissioners both within
the formal contract and quality monitoring processes, but also in delivery of the wider
health and social care agenda to include safeguarding arrangements for adults and
children.
There are a number of key themes underpinning the priority areas for the forthcoming year
and we look forward to an increased programme of patients, carers and families’
involvement in the delivery of these areas, particularly in planning care and providing more
acute care for patients within Community Wards.
The document itself was clear in presenting the content, however it would be helpful next
year to clearly articulate data collection which is retrospective or is planned for the
forthcoming contract year. We feel that this could be further developed in 2011 -12 with
the engagement of the planned patient involvement group ‘Community Forum’ in exploring
particular areas of interest for the local population, and in further developing an easy to
read format.
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