Plymouth
Quality Account 2010/11
Healthy People Leading Healthy Lives in Healthy Communities
Contents
Part
Page
One
3
1. Introduction
3
1.2 Services provided by NHS Plymouth
3
1.3 Chief Operating Officer’s Statement
Part
4-5
Two
6
2. Our priorities for quality improvement in 2011/12
2.1 Statements of assurance relating to the quality of services provided
Part
Three
6-10
10-16
17
3. Review of our quality performance in 2010/11
17
3.1 Patient Experience
17-21
3.2 Patient Safety
22-26
3.3 Clinical Effectiveness
27-30
3.4 Additional quality improvements
31-32
3.5 Statements from third parties
32-33
3.6 Conclusion
33
3.7 How to provide feedback 33
Glossary
35
Addendum 1 36
2
Part One
1. Introduction
Quality Accounts are annual reports to the public from providers of NHS healthcare services which outline
the quality of services they provide. You (the public) can use this Quality Account by NHS Plymouth
Provider services to understand:
• What we are doing well.
• Where we need to make improvements.
• What our priorities for improvement are for the coming year.
• How we have involved staff, service users, carers and others to decide those priorities.
Quality Accounts aim to improve our accountability to the public. We do this by providing open,
honest and meaningful information on the quality of NHS healthcare services that we provide for the
communities of Plymouth.
The Quality Account submitted by NHS Plymouth in June 2010, focused on the quality of Mental Health
services for 2009/10. It also identified three priorities for Mental Health to achieve. All of these priorities
were achieved and progress can be viewed in Part Three of this account. For this year, the priorities
identified and agreed for 2011/12 apply to all services we provide.
1.2 Services provided by NHS Plymouth
NHS Plymouth directly manages a number of units providing inpatient services. These include Mount
Gould Hospital (Stroke Unit, Plym Neurological Rehabilitation Unit), Edgcumbe Unit, Cotehele Unit,
Local Care Centre, Plympton Hospital, the Gables, Glenbourne Unit, Syrena and Lee Mill Unit. The main
services provided by NHS Plymouth are:
• Mental Health and Learning Disability.
• Inpatient Rehabilitation.
• Community Service.
• Community Healthcare Services for Children and Families.
To learn more about us, please visit our website:
www.plymouthpct.nhs.uk
Lee Mill, inpatient facility providing
Mental Health Rehabilitation
3
1.3 Chief Operating Officer’s Statement
Welcome to the second Quality Account for NHS Plymouth which covers the financial year
from 1 April 2010 to 31 March 2011.
This account looks back on the previous year’s information regarding quality of services, explaining both
what we are doing well and where improvement is needed. It is also forward looking and identifies areas
that we will improve for the coming year, and how we will achieve and measure progress.
Improving quality for our patients and for the public we serve
is fundamental to us and at the heart of everything we do.
NHS Plymouth is committed to improving the quality of our
services, and we welcome this opportunity to demonstrate
our commitment.
The Trust’s vision is to see ‘Healthy people leading healthy
lives in healthy communities’. It supported by a set of values
which strengthen quality improvement in all that we do.
Steve Waite
Our Values
• To treat you with respect, dignity and fairness, addressing equality and diversity issues.
• To involve you in decision-making.
• To demand high quality and effective personalised care.
• To be sensitive to your needs.
• To be honest and act with integrity.
• To take personal responsibility.
• To spend NHS money wisely and achieve better value for all.
To help us evidence high quality patient care, we have developed a Quality Strategy which will be
published later in the year. Our quality programme is fully aligned with our broader business strategies
to ensure that the right issues are prioritised at the right time. We recognise that quality is central to the
provision of the services we deliver and have worked hard to improve our quality performance against
national targets and indicators. However, we still need to do more and have identified a range of areas
where we want to improve the quality of our services further.
4
NHS Plymouth staff play an important role in improving the experience of our patients and service users.
Through their hard work, dedication and commitment we have continued to make real improvements
and have introduced significant programmes to build our culture and capabilities around quality. We
have a number of examples of activities taking place throughout the Trust and just a few of these have
been highlighted in Part Three of this account. Our key achievements over the last year have focused on
maintaining privacy and dignity by providing same sex environments for people who use our services,
Releasing time to care: The Productive Series and Transforming Community Services.
The involvement of our stakeholders is crucial to improving quality, and I would like to take this
opportunity to thank all our staff, service users, carers, statutory partners and members of the public
who have helped us to focus on the areas that are important and make a difference. By far, the two areas
considered most important by participants in the consultation were treating patients fairly with respect
and dignity and reducing the number of medication incidents, such as drugs incorrectly prescribed and
drugs given in error. As a result, the Trust has made these priorities for 2011/12. Our third priority for
2011/12 is providing the right level of information to patients.
We view quality improvement as an ongoing cycle and will continue to update and adapt our plans and
priorities to reflect the needs and experiences of service users, staff and others with an interest.
This account sets out a true and accurate narrative of our achievements during the reporting period and
I hope you find the information useful and meaningful.
Steve Waite
Chief Operating Officer
5
Part Two
Stakeholder engagement event
2. Our priorities for quality improvement in 2011/12
The three key areas for improvement in 2011/12, and the content of this Quality Account have been
identified through feedback from staff, service users, carers, commissioners, partner organisations and
members of the public. A variety of methods have been used to gain feedback, such as patient groups,
committees, social media, on line quality questionnaires, newsletters, visiting groups and various events.
NHS Plymouth worked in partnership with Plymouth Local Involvement Network (LINk) to help identify
what issues were important. We developed a ‘long list’ of potential priorities grouped into patient
experience, patient safety and clinical effectiveness. In collaboration with LINk we then asked service
users, staff and others to help us identify three key priorities.
Based on what people told us, and taking on board ease of implementation, national priorities,
existing initiatives and benchmarking, the following three priorities were identified as quality
improvement indicators for 2011/12:
6
Patient Experience:
Priority 1
To treat patients with respect and dignity
Patient Safety:
Priority 2
To reduce the number of medication incidents, such as
drugs incorrectly prescribed, drugs incorrectly prepared
and drugs given in error
Clinical Effectiveness:
Priority 3
Providing the right level of information to patients
The priorities identified for the coming year are new areas for improvement and have been signed off
and agreed by NHS Plymouth’s Provider Board. Priorities set for 2010/11 have been achieved, and we will
continue to measure and develop these through our Provider Governance Committee. Progress to date
can be viewed in Part Three of this account.
Priority 1
To treat patients with respect and dignity
Whilst the vast majority of patients
are happy with our services a few
patients have told us through
feedback that we could improve
our ‘customer care’ as they have felt
unwelcomed and occasionally staff
have been rude or off hand with
them.
The aim will be to ensure that
all patients receive the very best
‘customer care services’ from all of
our staff and services.
Staff nurse at a clinic treating a local patient
We have commenced a rolling programme of ‘Customer Care’ training for staff and will undertake
a survey of patients who have experienced our services in June 2011, to ensure that there has been
an improvement in this area. We will also make available simple questionnaires available for patients
when attending outpatient appointments asking how they feel and how they have been welcomed and
treated.
The areas for improvement will be all services and Trust staff, in particular reception and
administration staff.
7
Patient Safety:
Priority 2
To reduce the number of medication incidents, such as
drugs incorrectly prescribed, drugs incorrectly prepared
and drugs given in error
Ensuring patients receive their medication at the right
time is a very important part of their treatment and
care. Failure to give medication or missed doses may
result in patient harm or deterioration. This is a national
priority and the aim is to improve the medication incident
reporting.
All staff who are involved in the giving of patient
medication are trained and have clear policies and
procedures to follow. Our policy states that any errors
when dealing with drugs should be reported and recorded
as an incident. These are investigated by the ward / unit
manager and actions taken to prevent a similar error
occurring. The number, type and severity of errors are
monitored on a monthly basis across the Trust. Trends of
a particular type of error or a sudden change in reporting
from a ward / unit are investigated and discussed with the
ward / unit manager.
It is important to appreciate that human error can never be completely eliminated but systems should
be in place to minimise errors and their impact on patients. The incidents reported by us and other
Trusts are collated at a national level and we receive reports of our reporting frequency compared to
other Trusts. We have an average rate of reporting of ‘no harm’ incidents and this is regarded as good
as that demonstrates an active reporting culture within the organisation (it is recognised nationally that
many medication errors are never reported). However our low rates for low, moderate and severe harm
incidents demonstrates that we have good processes in place to minimise the impact of the errors.
To improve the reporting of medications incidents in 2011/12, the following will be implemented:
• Continue to adopt an open culture within the organisation where it is normal practice for staff to
report medication incidents, without fear of being criticised or reprimanded. This includes learning
from incidents, sharing good practice and examining how incidents have been dealt with.
• To improve follow up actions after a medication incident has been highlighted, for example
recommending further training for staff.
• The Provider Medicines Governance Group (PMGG) will include medication incidents as a standing item
on the monthly agenda to ensure that learning from incidents is embedded into policy development
and clinical practice. We will measure progress by assessing the number of each category of medication incident
reports (no harm, low, moderate, severe harm and death) that have been submitted for 2011/12 and
comparing these to 2010/11 by ward / unit and for the Trust as a whole. Actions taken as a direct
result of reported incidents will be collated and publicised. 8
Clinical Effectiveness:
Priority 3
Providing the right level of information to patients
Information plays a crucial role in supporting people with long-term conditions to take care of themselves
and improve their quality of life. Previously, there has been no way to ensure that a person will have
access to or receive the right information when they need it most – at diagnosis and as their needs
continue. Information Prescriptions will give everyone access to the information they need, at the right
time.
Information Prescriptions can contribute to the commitments of the NHS Constitution and represent good
practice for supporting patient rights. They provide a route for helping individual’s access information to
feel empowered and more able to participate fully in decisions about their care.
The aim is to introduce Information Prescriptions
across a range of relevant services for people
with long-term conditions (including Mental
Health). We are already in the process of
developing Information Prescriptions and will
be introducing them within a number of key
services during 2011/12.
Progress will be measured by recording of the number of Information Prescriptions provided and
monitoring the implementation. Regular progress reports will be submitted to NHS Plymouth’s Provider
Governance Committee and Plymouth LINk.
How will we review and monitor these priorities?
Our Quality Account will be monitored through the Trust’s Governance and Performance processes.
This will include regular reports to our Provider Governance Committee. These priorities will also be an
integral part of the Trust’s Quality Improvement Plan for the coming year.
We have also developed a Quality Report which incorporates quality measures into a balanced scorecard
with key performance indicators. The scorecard reflects a list of National Indicators for Quality and is
reviewed monthly by our Provider Governance Committee. It is broken down into different directorates
which focus on specific performance areas, and quality indicators are reviewed monthly to ensure regular
scrutiny of quality.
A simple traffic light system helps identify areas that are underperforming and are reviewed by the
Provider Board, Provider Governance Committee and directorate business meetings. By reviewing
data at all levels, the Quality reporting framework allows individual services and directorates to
take action to improve quality in their areas as part of a rolling programme.
9
In order to provide additional assurance and top level ownership of this Quality Account, NHS Plymouth
Provider Board will receive quarterly reports on performance. We will also provide Plymouth LINk and
other third parties with regular performance reports to ensure we maintain our open and honest approach
to Quality Accounts.
How are we developing quality improvements capacity and capability to deliver these priorities?
As part of assessing and strengthening our approach to quality, the Trust has developed a Quality Strategy
which includes a number of quality outcome measures. These measures are based on a combination of
patient and staff reported experiences, and measures of patient safety and clinical effectiveness. This will
ensure that quality remains central to everything that we do, at all levels within the organisation, rather
then something ‘separate’ or seen as an ‘add on’
To view our ongoing progress for the coming year, comments from this year’s consultation and a list of
stakeholders contacted and involved in the development of this review, please visit our Quality Account
web page: www.plymouthpct.nhs.uk/CorporateInformation/reportsandinquiries/Pages/
qualityaccounts.aspx
2.1 Statements of assurance relating to the quality of services provided
2.1.1 Review of Services
During 1 April 2010 to 31 March 2011, NHS Plymouth provided 53 NHS services.
NHS Plymouth has reviewed all the data available to them on the quality of care in all of these NHS
services.
The income generated by the NHS services reviewed in 2010/11 represents 100% of the total income
generated from the provision of NHS services by NHS Plymouth for 2010/11.
2.1.2 Participation in National Clinical Audits and National Confidential Enquiries
By being involved in clinical audits nationally, regionally and locally within our own Trust we can learn
from what other leaders in the field are doing and from our own practice. We can also discover where
we are providing excellence in our services and where we can improve.
During 2010/11, two national clinical audits and no national confidential enquiries covered NHS services
that NHS Plymouth provides.
During that period NHS Plymouth participated in 100% of national clinical audits of the national clinical
audits for which it was eligible to participate in. NHS Plymouth was not eligible to participate in any
national confidential enquiries.
10
The national clinical audits and national confidential enquiries that NHS Plymouth was eligible to
participate in during 2010/11 are listed in Table 1. The national clinical audits and national confidential
enquiries that NHS Plymouth actually participated in during 2010/11 are also listed in Table 1.
The national clinical audits and national confidential enquiries that NHS Plymouth participated in, and
for which data collection was completed during 2010/11, are listed 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.
Table 1
Audit or Enquiry
Eligible to
participate
in
Actually
participated
in
Data
collection
completed
No. of
cases
submitted
Actions
identified
N/A
N/A
N/A
N/A
National Confidential Enquiry
National Confidential Enquiry into
No
N/A
N/A
Patient Outcome and Death
(NCEPOD)
Confidential Enquiry into Maternal No
N/A
N/A
and Child Health (CMACH)
N/A
N/A
National Confidential Inquiry (NCI) No
into Suicide and Homicide by People
with Mental
Illness (NCI/NCISH)
National Clinical Audits
Falls and non-hip fractures ( National Falls & Bone Health Audit )
Organisational Audit
Yes
Yes
Yes
N/A
N/A
N/A
Reviewing
report
C linic al Audit
N/A
N/A
Yes
No –
insufficient
sample size
N/A
Stroke care ( National Sentinel Stroke Audit)
Organisational Audit
Yes
Yes
Yes
N/A
Clinical Audit
Yes
Yes
N/A
Yes
In the
process of
reviewing
the
reports.
The reports of two national clinical audits are in the process of being reviewed by the provider for
2010/11, and NHS Plymouth intends to develop action plans as appropriate to improve the quality of
healthcare provided.
The reports of 36 local clinical audits were reviewed by the provider in 2010/11, and NHS Plymouth
has a robust system in place to improve the quality of healthcare provided. For each local clinical audit
undertaken, an action plan is created for each individual team involved in the audit if appropriate, or an
overarching action plan is developed. Each audit has an identified lead and the action plans are
monitored through NHS Plymouth’s Provider Governance Committee.
11
2.1.3Participation in clinical research
We recognise the importance of involving service users
in clinical research. Being able to use their direct
experience helps us to provide better services and
improve quality.
The number of patients receiving NHS services
provided or sub-contracted by NHS Plymouth
for the period April 2010 to March 2011 that
were recruited during that period to participate
in National Institute for Health Research
(NIHR) research approved by a research ethics
committee was 202.
2.1.4Research and development
NHS Plymouth has a successful programme of research projects, which ensures Plymouth people benefit
from new innovations, leading edge thinking and a sharing of academic and healthcare partnerships. In
return, Plymouth people also help answer some of the difficult questions which interest both local and
national researchers. In the financial year 2010/2011, there were 37 research projects approved across
the organisation. These ranged from drug trials to observational studies across almost every discipline.
The projects not only benefit our patients, they encourage health professionals to take part in research,
therefore keeping our employees aware of new developments. The money generated through participating
in large projects is put back into both research and clinical services, not only further improving patient
care but also allowing additional support to get local projects “off the ground”.
Last year we offered small grants, in collaboration with Plymouth University, which resulted in a speech
and language therapist and a clinical psychologist get funding to start up a local enquiry into improving
how care is delivered.
2.1.5Goals agreed with Commissioners
A proportion of NHS Plymouth’s income in 2010/11 was conditional on achieving quality improvement
and innovation goals agreed between NHS Plymouth Provider and NHS Plymouth Primary Care Trust
through the Commissioning for Quality and Innovation (CQUIN) payment framework.
A significant area of improvement for the Trust has been the reduction in falls in inpatient areas. This
can be seen in the graph on the next page.
A reduction of falls has been achieved by introducing a range of initiatives within the service, including
the Productive Ward Series and intentional rounding (ensuring that patients who have a high risk of
falling have the right support around them). In addition, we have taken part in the South West Safety
Improvement Initiative and have focused on the reduction of falls as part of this programme. This work
will be presented to the Strategic Health Authority in May 2011. 12
No. of Falls - Mental Health & Learning Disabilities
No. of Falls - Mental Health & Learning Disabilities
35
No. of
No.falls
of falls
30
35
25
30
20
25
No. of falls
15
20
Trend
No. of falls
10
15
Trend
5
10
0
5
0
Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar10
10
10
10
10
10
10
10
10
11
11
11
Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- MarMonth
10
10
10
10
10
10
10
10
10
11
11
11
Month
In addition, we have consistently met, and exceeded the Accident and Emergency
In addition, we have consistently met, and exceeded the Accident and Emergency four hour waits in the
four
hour waits
in theconsistently
Minor Injuries
as shown
in the graph
below.
In
addition,
we have
met,Unit
and(MIU)
exceeded
the Accident
and Emergency
Minor Injuries Unit (MIU) as shown in the graph below.
four hour waits in the Minor Injuries Unit (MIU) as shown in the graph below.
% total
% total
patients
patients
attending
attending
MIUMIU
% of patients seen within 4 hours
101%
100%
101%
100%
100%
99%
100%
99%
99%
98%
99%
98%
98%
97%
98%
97%
% of patients seen within 4 hours
Target
Actual
Target
Actual
Apr10
Apr10
May10
May10
Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar10
10
10
10 10
10 10 11
11 11
Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- MarMonth
10
10
10
10
10
10 10 11
11 11
Month
Further details of the agreed goals for
2010/11 and for the following 12 month
period are available on request from:
Liz Cooney
Director of Professional Practice
& Patient Safety
Local Care Centre
200 Mount Gould Road
Plymouth PL4 7PY
Liz.Cooney@plymouth.nhs.uk
13
2.1.6How our regulator the Care Quality Commission views our services
NHS Plymouth is required to register with the Care Quality Commission (CQC) and its current registration
status is ‘full registration status without conditions’.
The CQC has not taken enforcement action against NHS Plymouth during the reported period (1 April
2010 to 31 March 2011), and NHS Plymouth has not participated in any special reviews or investigations by
the CQC during this time. This means that we have not received any untoward concerns about the services
we delivered during this period, and it recognises the adequacy of the systems we have in place to oversee
patient safety and quality.
NHS Plymouth declared compliant with all but two regulations for the whole Trust plus an additional
regulation for one specific unit. We declared non-compliance against Regulation 13: Management of
Medicines for one unit, Regulation 20: Records, and Regulation 23: Supporting Workers for the whole Trust. Action plans for these Regulations were instigated and monitored by NHS Plymouth’s Provider Governance
Committee. Compliance against Regulations 13 and 23 were achieved earlier in the year. Regarding Regulation 20: Records, the following have been implemented and planned to improve the
essential standards and quality of safety:
• An action plan for compliance work is underway to ensure that further storage is identified for records.
• Training and awareness sessions are scheduled to ensure all staff have up to date knowledge on all aspects of Record Management.
• References to current retention times for all records will be included in the Trust’s Record Keeping Policy.
2.1.7Care Quality Commission national staff survey
The CQC published findings of the national NHS staff survey for 2010, in March 2011. As in
previous years, NHS Plymouth chose to survey its entire staff with questionnaires sent to 2376
eligible employees of which 1449 staff completed and returned a usable survey questionnaire.
14
There were a number of areas where staff showed their satisfaction in the way they are managed,
trained and valued. The graph below provides a comparison against 2009 results in these areas, and
the results show an improvement in the way that staff are managed, trained and valued. The focus on
appraisal and personal development continues to be a high priority.
Areas where staff showed
satisfaction
National Staff Survey Results 2010
Their role makes a difference to patients
Felt valued by colleagues
Have a personal development plan
2009
2010
Received an appraisal
Received diversity and equality training
Received job related training
0
20
40
60
80
100
% of staff
It has been acknowledged that more work is required to build on this progress and a staff survey action
plan is being developed to address any outstanding issues.
2.1.8. Data Quality
Good quality information underpins the effective delivery of patient care and is essential if improvements
in quality of care are to be made. We understand the importance of ensuring that information held
within the Trust is of the highest quality possible so that it enables us to make informed, accurate and
timely decisions about our patient care and our community involvement.
Over the past year our Clinical System team have identified areas within the Patient Demographic
information held in patient’s records where Data Quality was a concern to the Trust. We have now
developed an automated warning and reporting system where errors, omissions and duplications are
automatically flagged up on a daily basis allowing the team to investigate and remedy any problems as
soon as they have become identified.
Work has been on going to improve the numbers of patients on caseload with an Ethnic Category
completed, particularly within Mental Health where it is a reported requirement of the Mental Health
Minimum Data Set. This has improved from a submitted figure of 85% completed ethnic codes for
2007/08 to a current figure of 99.9% in 2010/11.
15
NHS Plymouth submitted records during 1 April 2010 to 31 March 2011 to the Secondary User Service
for inclusion in the Hospital Episode Statistics which are included in the latest published data. The
percentage of records in the published data which included the patient’s valid NHS number was:
• 99.7 % for admitted patient care (national average 98.4%).
• 99.6 % for out patient care (national average 98.8%).
The percentage of records in the published data which included the patient’s valid General Medical
Practice Code was:
• 100 % for admitted patient care (national average 99.8%).
• 100 % for out patient care (national average 99.8%).
NHS
Plymouth’s
Information
Governance
Assessment Report score for 1 April 2010 to 31
March 2011 was 66% (overall score) and was
graded ‘red’ from the Information Governance
Toolkit Grading Scheme. Red indicates that the
organisation needs to improve its performance
in this area. We acknowledge that further work
is required to improve Information Quality
and Records management for 2011/12, and a
remedial action plan is in place to ensure that
improvements are made. The action plan is
monitored by the Trust’s Information Strategy
and Governance Committee.
NHS Plymouth was not subject to the Payment by Results clinical coding audit during
1 April 2010 to 31 March 2011 by the Audit Commission.
16
Part Three
3. Review of our quality performance in 2010/11
This is a review of NHS Plymouth’s quality performance over the past year. The information relates to the
Trust’s Mental Health and Learning Disabilities, Community and Rehabilitation, and Children and Families
services. Progress regarding the priorities set for 2010/11, which only focused on Mental Health Services,
are also reported below.
The priorities for 2010/11 were:
• Improve our patient’s experience by involving patients and carers and drawing on their experiences to inform every aspect of care.
• Managing and reducing Meticillin Resistant Staphylococcus Aureus (MRSA) rates and other Healthcare Associated Infections - specifically focusing on reducing our MRSA rates by 2%
in the next year.
• To provide Privacy, Dignity and same sex environments for people who use our services.
Performance and progress is grouped under three themes; patient experience, patient safety and clinical
effectiveness.
3.1 Patient Experience
3.1.1 Privacy, dignity and respect
We are committed to making sure that all patients receive high quality care that is safe, effective and
focused on our patients needs. The NHS Constitution states that all patients have the right to privacy and
to be treated with dignity and respect and we support this.
The graph on the next page shows what our patients told us about privacy, dignity and respect (Source:
Mental Health Inpatient Survey 2010).
17
Safety, Dignity & Respect - Inpatient User Survey 2010
& res
pect by the
Always treated with dignity
Safety,
Dignity
& Respect
nurs es
- Inpatient User Survey 2010
Always
had
confidence
trus t in the
The
nurs es
always
lis tenedand
carefully
nurs es
Always treated with res pect and dignity by
The nurs es always lis tened carefully
the Ps ychiatris t
Responses
Responses
Always treated
had confidence
and trus
t in
theby the
& res
pect
Always
with dignity
nurs
es es
nurs
Other Trusts
Always treated with res pect and dignity by
The Psychiatris t always lis tened carefully
the Ps ychiatris t
NHS Plymouth
Other Trusts
Always
felt s afe
in hos pital
The Psychiatris
t always
lis tened
carefully
NHS Plymouth
Did not share sleeping area with oppos ite
Always felt s afe in hos pital
gender
Diddefinitely
not shareknew
sleeping
area
with oppos
Staff
about
previous
care ite
gender
received
Staff definitely knew about previous care
Made to feel welcome
on arrival by s taff
received
Made to feel welcome on arrival by s taff
0%
20%
40%
60%
80% 100%
of re spondents
0% % 20%
40% 60%
‘‘
80% 100%
% of re spondents
The staff treated us with respect and dignity at all
times….they
handleduseach
with dignity
the
The staff treated
withsituation
respect and
at all
The
staff
treated
us
with
respect
and
dignity
at
all
times
…. they handled
upmost
respect
and
professionalism
times….they handled each situation with the
each
situation
with the
upmost
respect and professionalism
upmost
respect
and
professionalism
Our Trust will continue to build on this as onethe
of three priorities identified in Part Two of
thisTrust
report.
Our
Trust
will continue
build
onofthis
one
the
of three
priorities
Part Two
Our
will
continue
to build ontothis
as one
the as
three
priorities
identified
in Partidentified
Two of this in
report.
this report.
Achieved
Priorit y for 2010/11 – Mental Health Services
Achieved
Priorit y for 2010/11 – Mental Health Services
To provide Privacy, Dignity and same sex environments for people
who
our services.
Touse
provide
Privacy, Dignity and same sex environments for people
who use our services.
Providing same sex environments for people who use our services is a National and Trust wide target in
order to improve the privacy and dignity of patients. For the purposes of this report we have focused on
improvements in Mental Health Services as this was identified as a priority for 2010/11.
• Mental Health services are compliant with
Department of Health guidance. From
December 2010, the service is obliged to report
monthly to the South West Strategic Health
Authority (SWSHA), identifying any breaches; all
returns have shown that there are no breaches.
• The structural work on Syrena House (Mental Health
Rehabilitation Unit) is now complete and provides a
total male/female split.
Providing privacy, dignity and
same sex environments for
people who use our services
• The Glenbourne Unit now has a large shower area
in both male and female areas. With the planned
reduction of beds at Glenbourne over the next two
years we intend to reduce the existing four bedded
areas to two single en-suite rooms.
18
• Our Oakdale Unit at Plympton Hospital has created a female only lounge.
Plympton Hospital improvements
NHS Plymouth is compliant with providing same sex environments in all areas across the organisation.
3.1.2National in-patient and community service user surveys
During 2011 the Trust received results from its National In-patient Survey, which took place in 2010.
Whilst the Trust has performed well against the national picture, there are still areas where we need to
improve performance. Although the National Community Service User Survey had been optional, we
also chose to participate in this survey to ensure information about service users’ experiences of using
our services was collated and acted upon.
‘‘
‘‘
Even though I was very distressed when I arrived on the ward the staff went
to great lengths to try to reassure me and to make me feel better and safe
More exercise for clients…more activities at weekends
We regularly review the progress of goals set out in the improvement plan, and assess whether actions
taken have improved service user experience.
The Trust is also keen to develop local real time feedback for all our services. Some of our services
have regularly scheduled user forums, with a clear focus on listening and demonstrating that
action has been taken based on the feedback received. In addition, we are using the Recovery
Star (a user rated tool which focuses on a number of domains) in Mental Health to aid in
care planning and developing user focussed outcome measures. We adopted this following
feedback from users.
19
We are committed to improving the satisfaction levels of patients and ensuring that lessons learnt from
patient comments are embedded across the Trust. Ensuring that that all aspects of service experience is
captured within a central area of the Trust is important, and work is ongoing to bring together a number
of components to ensure that there is robust and effective monitoring in this area.
3.1.3 How we involve our patients to deliver improvements
NHS Plymouth wants to continue to hear from those who have used our services; individuals, carers,
collective views or groups, our staff and the wider public. This vital information is essential to us and we
can use it to inform the way we develop our services.
Patients have been involved in events organised by the Trust. We have run a series of events about the
range of services, and patients have been asked to speak at these about their own personal experiences.
‘‘
I have applied for voluntary work as a result of my quick recovery so thanks
to the staff at the hospital for helping with this
Within the Trust we have an Acute Care Forum consisting of inpatients, carers, previous service users
and staff. The group plays a significant role in developing practices designed for improving the patient
experience.
We also have several patient survey action groups which meet on a regular basis. The groups examine
areas of concern arising from results of patient surveys conducted by the Care Quality Commission.
Priorit y for 2010/11 – Mental Health Services
Achieved
Improve our patient’s experience by involving patients and carers
and drawing on their experiences to inform every aspect of care.
• Plymouth Mental Health services will continue to voluntarily commission Quality Health, an
independent service user survey organisation, mandated by the Department of Health to
provide service user feedback about their experience of both acute in-patient and Community
Mental Health services. Quality Health’s formal feedback from the surveys undertaken for the
period 2009/10 was both very positive and demonstrated Plymouth had improved since last
year, and rate well against a number of other Mental Health organisations.
• Internally, a corporate patient survey has been implemented within both ‘in-patient ‘ and
Community Mental Health services, providing a rich source of patient experiences which has
enabled core issues to be identified and resolved across both parts of the service.
• There has been a significant increase in the number of carers assessments undertaken across all
Mental Health services with the provision of optional one to one support sessions for carers and
the ‘Carers Information Sharing Guidance’ from the Royal College of Psychiatrists put in place.
20
3.1.4 Customer services
NHS Plymouth’s Provider Governance Committee receives monthly reports regarding complaints, comments,
concerns and compliments (known as the four C’s). The Trust recognises the need to accurately capture
comments, concerns, complaints, and compliments data to ensure that lessons learnt from service users
experiences can be embedded, and positive comments can be promoted within service teams. In 2010
‘Learning from Complaints’ groups were created across Directorates. The groups meet monthly to review
all complaints responded to and this ensures that identified learning is implemented and shared across the
Trust to improve the quality of the services we provide.
Also under the umbrella of the Customer Services Department is the Patient Advice & Liaison Service
(PALS). This service provides another mechanism for those patients, relatives and carers who prefer to
proceed through the more informal route when raising concerns or accessing information. The PALS
provides support, advice and information, helps service users find their way around NHS Plymouth and will
put patients in touch with other organisations that can help.
The number of comments, concerns, complaints and compliments can be seen in the graph below.
Comment
Complaint
Compliment
Concern
110
100
90
80
70
670
50
40
30
20
10
0
Apr 2010
May 2010
Jun 2010
Jul 2010
Aug 2010
Sep 2010
Oct 2010
Month and Year
21
Nov 2010
Dec 2010
Jan 2011
Feb 2011
Mar 2011
3.2 Patient Safety
3.2.1 Incident reporting Based on the Seven Steps to Patient Safety put forward by the guidance from the National Patient Safety
Agency (NPSA), the Trust has been building a safety culture that promotes the reporting of incidents.
Staff are actively encouraged to report incidents and to help with this a new web based reporting system
has been introduced. This has been well received by staff and has led to improved quality in the reported
incident information. This system allows for better monitoring of incidents across the organisation.
The graph below shows the number and trend for reported Patient Safety Incidents over the last 12
months.
Reported Patient Safety Incidents
Trend
350
300
250
200
150
100
50
0
Apr 2010
May 2010
Jun 2010
Jul 2010
Aug 2010
Sep 2010
Oct 2010
Month and Year
22
Nov 2010
Dec 2010
Jan 2011
Feb 2011
Mar 2011
The graph below shows the number and trend for reported incidents of violence over the last 12 months.
last 12 months.
3.2.2 Promoting a responsive learning culture The Trust recognises the value and importance of ensuring all lessons from incidents are embedded
within the organisation. To this end, the Trust created a Serious Untoward Incident Panel, which aims to
implement and embed lessons learnt from serious untoward incident investigations. The group is led by
the Director of Professional Practice and Patient Safety and provides assurance that quality improvements
are being made as a result of incident learning.
Each month Assistant Directors receive a report detailing every incident reported in their services
along with the actions that their managers have taken in response to the incidents. These reports and
subsequent actions are currently monitored through NHS Plymouth’s Provider Governance Committee.
23
3.2.3 Infection control and prevention
As part of the infection prevention and control work
programme, NHS Plymouth Infection Prevention
and Control team has demonstrated a best practice
approach to the development and implementation of
Infection of Control Link Practitioners (ICLP) within all
areas that provide care to the communities of Plymouth.
The ICLP roles are taken on by existing staff within
the Trust in partnership with the infection prevention
and control Nurse Consultants, Modern Matrons and
Managers. This facilitates a best practice approach to
infection prevention and control which is being followed
by all areas to ensure consistency and effective working.
The ICLP role also includes undertaking monthly infection prevention and control hand hygiene audits.
All the audit outcomes and the associated learning is now being taken forward with a continuing steer
from the Infection Prevention and Control Sub-Committee, which reports to NHS Plymouth’s Provider
Governance Committee. Progress of the work programme is monitored throughout the year, and an
annual report is produced which shows improvements and where further work is required. The work
programme demonstrates effective leadership, partnership working and a clear ownership of best
practice in prevention and control of infection at local service level.
The term healthcare acquired infections (HCAI), refers to any infection caught as a result of a person’s
treatment by the NHS or any infection caught by a healthcare worker in the course of their NHS duties.
HCAI’s include Clostridium Difficile (C.diff) and MRSA.
In 2010/11 in Community and Rehabilitation there were no cases of MRSA Bacteraemia and four cases
of C. Diff with a year end tolerance of four. In 2010/11 in Adult Mental Health and Learning Disability
there were no cases of MRSA Bacteraemia or C. Diff. Health services managed to halve the number of
C.diff cases in 2010/11 compared with the previous year. This is a significant sustained improvement.
Primary School Children design
new hand washing posters for
NHS Plymouth
Children from Leigham Primary School designed
more than 60 posters for NHS Plymouth to help us in
our hand washing campaign.
The colourful posters were drawn as part of a
homework project for the young students. They
are now being used as a display around community
wards and facilities to raise awareness about the
importance of good hand hygiene.
24
Priorit y for 2010/11 – Mental Health Services
Managing and reducing MRSA rates and other Healthcare Associated
Infections - specifically focusing on reducing our MRSA rates by
2% in the next year.
Achieved
• Mental Health services continue to embrace Infection Control and other Healthcare
Associated Infections with the incidence of MRSA and other Healthcare Associated Infections remaining minimal and well below the national average.
• The introduction of Infection control ‘Link Workers’ is proving to be effective and the service is working towards creating protective time for this role to continue and they are supported by three matrons.
• Patient Environmental Action Team (PEAT) assessments have recently been carried out and the early indications point to extremely good results.
3.2.4 High quality environments and facilities services
We know how important it is to our patients that accommodation and food they receive whilst in our
care are of the very highest standards. The National Patient Safety Agency (NPSA) oversees the Patient
Environmental Action Team (PEAT) initiative that involves the annual assessment of all in patient hospitals/
sites with 10 beds or more. In NHS Plymouth the team is made up of patient representatives, matrons,
infection prevention and control nurses, Directors or Assistant Directors, facilities managers, Estates staff
and Hotel services representatives. Results of the assessments are published nationally every year.
PEAT teams inspect standards across a range of services including food, cleanliness, infection control,
patient environment, and privacy and dignity and highlight areas for improvement. The PEAT assessments
for 2010/11 were carried out in January and February 2011, and we are awaiting the results from the
NPSA. We have shown the results for 2009/10 in the table below. The high scores achieved in 2009/10
reflect the commitment of the Facilities, Estates and Infection and Prevention teams to deliver continued
improvement in the patient experience.
2009/10
2010/11
Site Name
Environment
Score
Food
Score
Privacy &
Dignity
Score
Mount Gould
Hospital
Plympton
Hospital
Lee Mill
Excellent
Excellent
Excellent
Excellent
Excellent
Excellent
Excellent
Good
Glenbourne
Excellent
Excellent
Environment
Score
Food
Score
Privacy &
Dignity
Score
Excellent
Excellent
Excellent
Excellent
Excellent
Excellent
Excellent
Excellent
Excellent
Excellent
Excellent
Good
Excellent
25
Excellent
3.2.5 Medicines Management
The correct use of medicines plays a significant part in achieving successful outcomes for patients and
we recognise how important it is for patients to receive the right medication at the right time in support
of their recovery. We therefore strive to ensure that the systems associated with medicines are of high
quality and staff involved are trained to a high standard with regard to their role in the medicines
processes.
The Trust has robust systems to reduce the number of medication incidents, such as drugs incorrectly
prescribed, drugs incorrectly prepared and drugs given in error. Examples are the introduction of a
web based reporting system which enables staff to report incidents more quickly, and establishing a
Provider Medicines Governance Group (PMGG), a sub-group of the Provider Governance Committee.
The role of the PMGG is to provide a multidisciplinary forum for the development, review and approval of
policies, guidance, directives and safety alerts relating to medicines. The membership includes doctors,
pharmacists and nurses from all directorates of the trust. It meets on a monthly basis. Improvement measures are listed in Part Two of this review.
26
3.3 Clinical Effectiveness
An effective service can be defined as one that provides the right service, to the right person at the
right time. This section sets out some measurable indicators to demonstrate how we are doing on key
measures of effectiveness.
3.3.1 Waiting times
The national target set by the DH, which seeks to ensure that patients who want it, and for whom it is
clinically appropriate, can expect to start their treatment within a maximum of 18 weeks from referral.
There has been a general trend towards consistently lowered waiting times and we are working towards
a maximum of 18 weeks from referral to treatment, including community services.
Speech and Language Therapy:
Waiting times and improving access
Our Speech and Language Service has
continued to improve access to the services
they offer for children. During 2010/11, the
18 week RTT target has been achieved and
sustained.
27
3.3.2 National Institute for Health and Clinical Excellence Audits 2010/11
The National Institute of Health and Clinical Excellence (NICE) is the independent organisation responsible
for providing national guidance on the promotion of good health and the prevention and treatment of
ill health. During 2010/11, the Trust conducted 12 NICE audits in respect of published NICE Guidelines
relevant to its services. Conducting NICE audits is seen as ‘good practice’ and helps us improve our
compliance with NICE Guidelines.
Issues regarding assessment, implementation and monitoring of NICE guidance within the Trust are fed
back to individual directorates and our Provider Governance Committee. This ensures:
• Compliance with national standards in respect to the delivery and monitoring of NICE guidance.
• Effective audit and monitoring arrangements are in place for NICE guidance.
• Results and findings of clinical audit and clinical effectiveness projects are reviewed.
• Progress of action plans arising as a result of clinical audit, clinical effectiveness projects and NICE guidance implementation/workshops.
Collaborative interagency working
In the Early Years Service (for children aged 0-5
years), two therapists have been seconded for
six years to be part of the ‘Every Child a Talker’
(ECaT) national initiative. This initiative aims to
raise children’s achievement in early language
and to increase parental understanding and
involvement in children’s language development.
Targeted Mental Health in Schools (TaMHS)
In 2009, the Local Authority put in a joint bid with Plymouth Child & Adolescent Mental Health Services
(CAMHS) to the Department of Health to become a pilot site for the TaMHS national project. This bid was
successful and the TaMHS project was established in Plymouth. TaMHS supports enhanced mental health
promotion and intervention in schools, building on the already well established principal of Primary
Mental Health Work and the provision of consultation to professionals working in universal services.
Over 1,740 children and young people have been involved in mental health promotion sessions and over
300 staff working in schools have received additional training to help them support pupils with mental
health and emotional wellbeing needs.
Although a time-limited pilot, the success of the TaMHS project in improving emotional health
and wellbeing in a school setting has meant it has secured additional funding to continue
provision through 2011/12.
28
Tackling Stigma Project
Plymouth Comprehensive CAMHS
was chosen as one of the pilot sites
for a national initiative, developed by
the National CAMHS Support Service,
aimed at tackling the stigma for children
and young people associated with
mental health and accessing CAMHS.
The plans for Plymouth to tackle stigma
were set out in the Plymouth Children
and Young People’s Plan 2008-11 and a
project was established, with input from
children and young people, to determine
how to approach tackling stigma. This
has led to the development of a ‘mental
health five a day’, voted upon by
children and young people in the city.
Releasing time to care: The Productive Series
The Productive Community Hospital, the Productive Mental Health Ward and the Productive Community
Services Programmes provide effective ways of empowering and involving patients and staff in the
delivery of high quality, patient focussed care. The programmes, and the modules contained within
them aim to enable frontline staff, supporting them to make and sustain evidence based improvements
in relation to the clinical issues that effect them and their patients on a day to day basis.
A fundamental principal of the Productive Series work is that frontline staff are the ones
who, because they know what the problems are, are well placed to bring about the solutions.
As well as ‘releasing more time to care’, evidence nationally has highlighted, improved patient safety
and satisfaction, lowered staff sickness rates, increased morale and the potential to make financial
savings by eliminating waste and making processes more effective. These benefits are beginning to be
realised within the Trust, with staff in many areas reporting significant savings in time; improvement in
quality and morale in relation to the Productive work they have undertaken.
Currently 12 inpatient areas and 12 community based teams and services are involved in the
programme, and remaining areas are scheduled to join over the coming months.
29
Productive Series Work in Practice
Staff reviewing clinical measures
on a ward “Knowing How
We are Doing”, board. Use of
clinical information empowers
staff and helps drive, sustain and
evidence further improvements
A clinic that has undergone 5 S
(basic technique used in the Well
Organised Working environment
module). Note the PCT wide
colour coded visual management
system
A Patient Status at a Glance
(PSAG) board in use in clinical
area. The PSAG board aims to
make important information clear
and easy to understand for all
disciplines
Memory Services National Accreditation Programme (MSNAP)
The MSNAP programme is a good practice framework which helps services to improve the quality
of their service provision and provides a nationally accredited standard of practice. The programme
specifically aims to assess standards of practice in memory services for people with dementia,
and provide those services that meet the standards with accreditation from the Royal College of
Psychiatrists. There are 24 MSNAP accredited services in the UK and 18 currently undergoing the
MSNAP process. The process involves a self review and a peer review visit by an external team. NHS
Plymouth was one of the first in the South West region and one of 8 to be accredited first time round.
Oakdale and Pinewood Wards receive accreditation
Mandy Rolfe, NHS Plymouth modern matron, said: “Staff across the two wards should be very proud
of receiving the accreditation. It is a testament to the high quality of care our patients receive. It was
hard work to pull together all the information needed to get the accreditation but we have learnt a
lot during the process.
“Many of our patients come to us after a crisis and it is very important that the care they receive is of
the highest standard. We pride ourselves on only giving the best possible care and it is very gratifying
to be assessed by the Royal College of Psychiatrists as meeting their accreditation standards.”
The assessment process included an initial self assessment across all the areas, information from
patients and carers, followed by a review visit before they were finally assessed as being of high
enough quality to receive accreditation. Assessors examine admissions, safety, facilities, and
therapeutic interventions. They described the wards as having an “abundance of good practice
with a cohesive team where patients and carers are involved”.
30
3.4 Additional quality improvements
3.4.1 Accreditation for Inpatient Mental Health Services (AIMS)
AIMs Accreditation is a voluntary national improvement and development programme published by the
Royal College of Psychiatrists to raise standards of acute inpatient mental health wards. Accreditation is
awarded in recognition of high standards based around the wards’ ability to demonstrate compliance
against the published standards. All of our in-patient areas eligible for AIMS have achieved accreditation
(Glenbourne, Oakdale and Pinewood units). Accreditation has just become available for recovery services
and they will be working toward accreditation by the end of March 2012.
3.4.3 Commissioning for Quality and Innovation
Work has commenced and will focus on clearly defining Care pathways as part of the Commissioning for
Quality and Innovation (CQUIN) and Quality, Innovation, Productivity and Prevention (QIPP) programmes.
Care Pathway development work is currently underway in the following services: Personality disorder,
Eating disorder, Psychosis, Depression and anxiety and Forensics.
3.4.4 Tier 4 CAMHS new build
The development of a purpose built inpatient unit for adolescents has been taking place through
2009/10, with completion of the project and operationalisation of the new unit set for summer 2011.
Young people have been actively involved in the design and development of the new building, inputting
their ideas through a user group on everything from colour to room adjacencies and lay-out. This has
allowed the service to ensure that it is getting a user perspective to guide improvements to the quality
of the environment and the service provided within the new unit.
3.4.5 Transforming Community Services
TCS stands for transforming community services. This is a large piece of work designed to improve how
the public receive services. It has two parts:
The first is transforming how we deliver services by working more closely with social care services to
give service users the care that is provided in or close to they live and which takes account of both their
health and social care needs.
The second is to transfer NHS Plymouth Primary Care Trust (PCT) services out of the PCT and into their
own organisation. This will mean that NHS Plymouth no longer commission (buy) and provide services,
but only commission’s healthcare services.
We are making these improvements because you said...
Over the years, people across the country and here in Plymouth have repeatedly said that they want
health and social care services to be seamless. In the most recent feedback that we had from Plymouth
people (over the last 18 months) you have told us again that what is important to you is that health and
social care work together and communicate better.
31
Our plans are supported and influenced by the Government’s NHS White Paper, ‘Equity and excellence:
Liberating the NHS’ that sets out the Government’s long-term vision for the future of the NHS. The vision
builds on the core values and principles of the NHS - a comprehensive service, available to all, free at the
point of use, based on need, not ability to pay. For further information regarding TCS, please see Addendum 1 and visit our website: www.plymouthpct.nhs.uk.
3.5 Statements from third parties
As part of the process for developing this document, we have shared the initial draft with our statutory
stakeholders; our lead Commissioner, LINk and the Health Overview and Scrutiny Committee. They
were offered an opportunity to comment ahead of publication, and below are the statements that we
received.
3.5.1NHS Plymouth Primary Care Trust Commissioning
‘The provider has strived to make improvements in relation to the public perceptions and the quality of
care. They have also strengthened their Governance arrangements which have enabled a more robust
reporting of quality standards. The account highlights where improvements have been made, and also
where further improvements are needed. Overall the account provides a good interpretation of the
available data.’
3.5.2Plymouth Local Involvement Network (LINk)
‘As a key partner in improving health services, LINk has worked closely with NHS Plymouth over the last
few years to ensure that services reflect the views and needs of local people. Having patients at the centre
of a service, being treated with respect and dignity and getting the right information at the right time in
a way that patients can understand, reflect the issues that Plymouth LINk hear frequently. Through our
meetings and work with NHS Plymouth these are issues that have been shared and which have formed
the priority for the coming year. Plymouth LINk has experienced a positive working relationship with
NHS Plymouth who have worked openly with us to improve services and consult local people on their
priorities. We look forward to continuing to work with them as health services change over the next year
to ensure patients’ voices are heard and influence services.’
Statement by a member of Plymouth LINk Stewardship Group:
‘My main concern is whether Health Watch will have the capacity and resilience to handle multiple quality
audits in the time frame being proposed. I believe this should be a rolling / constant on-going process,
rather than an annual mad scramble to get all the paperwork done. Perhaps a system of quarterly reports
combined into an annual report might be more achievable.’
NHS Plymouth’s response to LINk
Based on these comments we will be putting in place a coherent framework regarding the development
of future Quality Accounts. Engagement will be ongoing and we are developing a communication
and engagement plan for 2011/12. The rolling programme will help service users, staff and others
see how their comments have influenced our Quality Account now and in the future. It will also
help us continue with our commitment to improve the quality of our services.
32
3.5.3 Plymouth City Council Health and Adult Social Care Overview and
Scrutiny Panel
Plymouth City Council’s Health and Adult Social Care Overview and Scrutiny Panel held a special meeting
on the 30 March 2011 to consider the draft Quality Accounts of NHS Plymouth. The final draft of the
accounts was further reviewed by members of the panel on the 8 June 2011.
The panel acknowledged that the accounts provided a comprehensive coverage of services provided by
NHS Plymouth in 2010-11 but highlighted that much of the information presented was complex and
difficult to understand.
Despite recommendations made last year to NHS Plymouth, there was again little reflection within the
Quality Accounts to the organisations’ role within the City; there was a notable absence of any reference
to shared targets, the Local Strategic Partnership or any reference to the shared city wide priorities of
reducing inequalities, raising aspirations, delivering growth and providing value for communities. The
panel believe that given the importance of partnership working in the City, particularly in terms of
reducing health inequalities, the trust’s contribution to city wide partnership working should form part
of their Quality Accounts.
The panel has over the past year reviewed the development of Plymouth Provider Services as a part
of the Transforming Community Services programme. The panel is aware that the social enterprise
has now been established with a Chair and Chief Executive appointed. This major change to service
delivery and the creation of a £90m a year organisation in Plymouth has not been referred to within the
document. This is clearly a significant change and should be referred to under “Our priorities for quality
improvement 2011/12”. The panel have made the following recommendations at the meeting of the 30
March and 8 June 2011.
the quality accounts should be Plymouth focused and should reflect the four city priorities
throughout;
the quality accounts should illustrate where NHS Plymouth aligns its priorities with other service
providers in the city;
the quality accounts should be written in plain English to ensure they are accessible for the
public;
a plain English guide explaining proposed changes to service delivery in Plymouth as a result of
the Transforming Community Services programme should be made available as an addendum to
the Quality Accounts when published.
NHS Plymouth’s response to PCC Health and Adult Social Care Overview and Scrutiny Panel
We completely acknowledge and support these comments to the final version of our Quality Account,
and have included an addendum explaining the strategy and vision for the Social Enterprise: Transforming
Community Services (TCS) Programme. Over the coming months we will be developing information
regarding the changes to service delivery in Plymouth as a result of the TCS programme. It has
also been acknowledged that further work is required to establish a format that is accessible for
all members of the population. Other comments made will form part of our evaluation process
and help inform the content for next year’s Quality Account (2011/12).
33
3.6 Conclusion
The purpose of our Quality Account is to improve our accountability to you (the public) by providing
open, honest and meaningful information on the quality of our services.
This publication details the progress which we have made in a number of areas and the priorities which we
have highlighted for the coming year. The Trust believes that by driving forward the Safety, Effectiveness
and Patient Experience agendas that real quality and value can be added to the care and support we
offer to our service users and carers.
The Trust is wholly and completely committed to improving the quality of all its services for the population
it serves in Plymouth. We have listened to the feedback from our stakeholders and will take action to
ensure that the comments we have received will be reflected in the action we take to improve the quality
of our services.
3.7 How to provide feedback on this Quality Account
We welcome feedback from staff, service users, carers,
visitors, commissioners, partner organisations and
members of the public to help improve the quality of
services delivered.
If you would like to make any comments you can do so
via the contact details below.
Email: pals.pct@plymouth.nhs.uk
Telephone: 01752 435201
Or write to: Customer Services Department
NHS Plymouth
Room AF3
Local Care Centre
Mount Gould Road
Plymouth PL4 7PY
34
Glossary
Care Quality Commission (CQC)
The Care Quality Commission (CQC) replaced the Healthcare Commission, Mental Health Act Commission and
the Commission for Social Care Inspection in April 2009. The CQC is the independent regulator of health and
social care in England.
Clinical audit
Clinical audit measures the quality of care and services against agreed standards and suggests or makes
improvements where necessary.
Clinical Coding
Clinical coding translates the medical terminology written by clinicians to describe a patient’s diagnosis and
treatment into standard, recognised codes.
Commissioning for Quality and Innovation Schemes (CQUIN)
A payment framework which encourages further improvements in quality and innovation.
General Medical Practice Code
The General Medical Practice Code (Patient Registration) is an organisation code. All NHS organisations have a
unique code which indentifies the organisation. It is essential to enable the transfer of clinical information about
the patient from the patient’s GP
Hospital Episode Statistics
Hospital Episode Statistics is the national statistical data warehouse for England of the care provided by NHS
hospitals and for NHS hospital patients treated elsewhere.
Health Watch
Health Watch will be established as a new independent consumer champion for health and social care as described
in the Government’s NHS white paper where.
Indicators for Quality Improvement
The Indicators for Quality Improvement (IQI) are a resource for local clinical teams providing a set of robust
indicators which could be used for local quality improvement and as a source of indicators for local benchmarking.
Information Governance Tool-kit (IGT)
The Information Governance Toolkit is a set of Department of Health standards by which Trusts are assessed to
ensure that information is held, obtained, recorded, used and shared lawfully and ethically.
Local Involvement Networks
Local Involvement Networks (LINks) are made up of individuals and community groups which work together to
improve local services. Their job is to find out what the public like and dislike about local health and social care.
They will then work with the people who plan and run these services to improve them. LINks also have powers to
help with the tasks and to make sure changes happen.
NHS Number
Everyone registered with the NHS in England and Wales has their own NHS Number. It is the only national unique
patient identifier, used to help healthcare staff and service providers match people to their health record. It is an
important step towards providing safer patient care and improving the quality of NHS number data has a direct
impact on improving clinical safety.
Overview and scrutiny committees
Since January 2003, every local authority with responsibilities for social services (150 in all) has had the power to
scrutinise local health services. Overview and scrutiny committees take on the role of scrutiny of the NHS – not just
major changes but the ongoing operation and planning of services.
Patient Environment Assessment Team (PEAT) Scores
An annual assessment of inpatient healthcare sites in England that have more than 10 beds. It is a benchmarking
tool to ensure improvements are made in the non-clinical aspects of patient care, such as cleanliness, food and
infection control.
Secondary Uses Service
The Secondary Uses Service is designed to provide anonymous patient-based data for purposes other than
direct clinical care such as healthcare planning, commissioning, public health, clinical audit and governance,
benchmarking, performance improvement, medical research and national policy development.
35
Addendum 1: Strategy and vision for the Social Enterprise: Transforming
Community Services
Strategy
The new organisation has developed a clear vision for the social enterprise,
along with a definite message about its values. These statements reflect the fact
that the new organisation will provide services across the age range.
Vision
To work together with others to help the local population to stay physically and
mentally well, to get better when they are ill, and to remain as independent as they
can until the end of their lives.
Values
Involvement
We:
Th i s mean s :
Always involve the adults,
children, and young
people we care for in
deciding how we can
provide our services to
best meet their needs.
We want the people we
care for to actively
participate by helping us to
develop our services and
telling us when we don’t
get things right for them.
Values
Involvement
Delivery
Empowerment
Think Family
We:
Th i s mean s :
Are committed to working
collaboratively with other
organisations to achieve
improved health outcomes
for the local population.
Make sure that the people
we care for are able to
access the right help, at a
time that they need it and
in a place that is close to
their home.
Recognise the contribution
our staff make and believe
in making sure that our
staff receive the right
training and support to
help them do their job to
the best of their ability
every day that they come
to work.
Understand that offering
services across the age
range offers opportunities
to develop a ‘Think Family’
approach to the care that
we deliver.
We will work to make sure
that everyone in the
community has the same
chance of staying healthy,
independent, and safe.
We will organise our
services so that they make
sense for the people who
use them and not in a way
that best suits us.
We will empower our
workforce and invite them
to help the organisation to
find creative and
innovative solutions to any
challenges we may face in
the future.
We will arrange ourselves
around the family and not
according to perceived
boundaries between
services for adults,
children, and young
people.
The vision and values of the new organisation have been integral to defining the
approach that the social enterprise will take towards engaging staff and service
users in the transformation of services to ensure their needs are met.
36
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formátu. Volejte 01752 314172 ply-pct.qualityaccounts@nhs.net
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.‫ ﺗﻤﺎس ﺣﺎﺻﻞ ﻧﻤﺎﺋﻴﺪ‬ply-pct.qualityaccounts@nhs.net French / Français
Veuillez signaler si vous désirez ce document ou ces renseignements dans une autre langue
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Kurdish / ‫ﮐﻮردﯼ‬
‫ ﺗﮑﺎﻳﻪ ﭘﻪ‬.‫ﺗﮑﺎﻳﻪ ﺑﭙﺮﺳﻪ ﺋﻪ ﮔﻪ ر دﻩ ﺧﻮا زﻳﺖ ﺋﻪ م ﺑﻪ ڵﮕﻪ ﻧﺎﻣﻪ و زاﻧﻴﺎرﻳﺎﻧﻪ ت هﻪ ﺑێﺖ ﺑﻪ زﻣﺎﻧێﮑﯽ ﺗﺮ ﻳﺎن ﺷێﻮازێﮑﯽ ﺗﺮﯼ ﮔﻮﻧﺠﺎو‬
ply-pct.qualityaccounts@nhs.net 01752 314172‫ﻳﻮﻩ ﻧﺪﯼ ﺑﮑﻪ ﺑﻪ ژﻣﺎرﻩ ﺗﻪ ﻟﻪ ﻓﻮوﻧﯽ‬
Polish / Polski
Proszę pytać, jesli życzy sobie Pan/Pani ten dokument lub informacje w innym języku lub w
innym formacie dostępu. Prosze telefonować pod nr: 01752 314172 plypct.qualityaccounts@nhs.net
Portuguese / Português
Por favor peça se desejar este documento ou informação noutra língua ou em formato
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Russian / Русский
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доступном формате, пожалуйста свяжитесь по тел: 01752 314172
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Turkish / Türkçe
Eğer bu belge veya bilgiyi başka bir dilde ya da erişilmesi mümkün bir şekilde arzu ediyorsanz,
lütfen isteyiniz. Lütfen bu numaray arayn: 01752 314172 plypct.qualityaccounts@nhs.net
Draft Document V1.8
40
Published June 2011.
37