NHS South East Essex
Community Healthcare
Quality Account
2010/2011
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Community Healthcare, NHS South East Essex Quality Account 2010/2011
Part 1
STATEMENT OF ASSURANCE FROM THE ARMS LENGTH MANAGEMENT BOARD
The Arms Length Management Board of Community Healthcare has taken steps to ensure that this Quality Account
presents a balanced view of quality and that there are appropriate controls in place to ensure the accuracy of the data that
it contains.
STATEMENT ON QUALITY FROM THE CHIEF OPERATING OFFICER
Community Healthcare remained the provider Arm of NHS South East Essex Primary Care Trust (PCT) during 2010/11 and we
continued to deliver Integrated Community Services to local people in Castle Point, Rochford, Southend and some specialist and
nursing services in South West Essex and Hammersmith and Fulham with NHS and Local Authority colleagues.
We are currently in a period of transition, as we seek to transfer Community Services Provision to our preferred acquirer – South
Essex Partnership University NHS Foundation Trust (SEPT) by the summer of 2011.
We have for many years been developing ways in which to seek your views as patients’ and other stakeholders’ and to use your
feed-back to improve the quality of the services we offer. The quality of our services is of the utmost importance to us as it directly
affects the outcomes of care you receive from us and affects your continued health and well being.
In setting the overall vision and direction for our organisation, our Arms Length Management Board has established key value
statements that we explore with our stakeholders at every opportunity. In the increasingly commercial environment for healthcare,
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it is our stated aim to be your choice of provider for community health and care services, supporting and enabling you to live the
best life possible.
In order that we can meet this aim we need to ensure that every single day of the year:
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We design services to meet your needs.
We put you at the centre of what we do.
We deliver the best quality of care possible.
We are approachable and safe.
We do what we say we will.
We listen and involve you.
We treat everyone with dignity and respect.
This quality account is designed to share with you our progress towards this aim. By the very nature of our wide range of service
provision (across 47 services employing more than 800 staff) we cannot be sure that we are making substantial and sustained
progress unless we continue to explore the ways by which we check your experiences as patients, carers and stakeholders within
our services.
During 2010/11, we reviewed each of our 47 services to assess how they have delivered against the national watchdog’s Care
Quality Commission (CQC) requirements to be Safe, Effective and Responsive. In addition, we have further developed ways of
seeking service user feed-back to provide us with greater insight into your experiences of our services.
Some of the questions may seem quite simple such as “would you recommend this service to members of your family?” or “did we
respect your privacy & dignity?” However, such “grass roots” feedback gives us enormous insight into what we need to do to
improve our services and your experience of them.
Many of our service users are themselves frail and vulnerable and we strive to approach everyone using our services with respect
and while maintaining their privacy and dignity.
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I am confident that the governance and monitoring arrangements we have in place are fit for purpose; that they will continue to
develop and, as we integrate hopefully with SEPT later this year, that the quality and performance monitoring systems will continue
to be fully embedded in the organisation’s day to day activities.
Howard Perry, Chief Operating Officer (Interim)
During 2010/11 Community Healthcare provided and / or subcontracted 47 NHS Services. Community Healthcare has reviewed all
the data available to them on the quality of care in these NHS services through the Performance and Integrated Governance
Committees.
The income generated by the NHS services reviewed during 2010/11 represents 100 per cent of the total income generated from
the provision of NHS Services by Community Healthcare for 2010/11.
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Part 2
PRIORITIES FOR IMPROVEMENT
During next year (2011/12), the key priorities for Community Healthcare are:
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To deliver the services we are contracted to provide to the levels and standards required by the contract specification,
and/or Service Level Agreement with our commissioners.
To meet our statutory financial duties and efficiency targets as set out in the NHS Operating Framework and South
East Essex System Quality Innovation Productivity and Prevention (QIPP) plan and (post Legal Transfer to SEPT) the
MONITOR Foundation Trust Performance Regime
To develop Integrated Locality Care (aligned with Practice- Based Commissioning (PBC) clusters) in partnership with
NHS colleagues, Southend Borough Council, Essex County Council, and our partners organisations in the private and
third sectors.
To operate as an Arms Length Trading Organisation until such time as we are legally acquired by SEPT.
To support the smooth transition of our staff and services to our preferred acquirer, embedding with SEPT, ensuring
good clinical governance and aligning all policies and procedures.
To support the development of South East Essex Practice Based Commissioning Clusters.
To support the reduction in unnecessary hospital admissions in South East Essex through the community-based
Urgent/Intermediate Care Programme.
To explore opportunities for service and income growth through appropriate bidding and tendering for new and
additional services, supported by improvements in our efficiency, productivity and effectiveness across the
organisation
To provide all ambulatory foot surgery via our Podiatric Surgery service in South East and South West Essex.
To continue to integrate services and care pathways that provide high quality care, closer to or in people’s homes in
order to avoid unnecessary hospital admissions, as well as providing value for money
To remain the provider of choice for local commissioners and people for our services.
To ensure that patients and service users are actively involved in decisions relating to the design of local services.
To ensure the safety of patients and staff by ensuring that staff undertake mandatory training and receive annual
performance appraisals.
To achieve accreditation at level one of the NHS Litigation Authority Risk Management Standards.
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To increase the number of women who are supported to breastfeed their babies.
To increase the number of children and young people who have access to services provided at home, to avoid
unnecessary admissions to hospital.
To build on existing good practice in relation to Safeguarding the needs of Vulnerable Adults.
To provide services with a greater emphasis on recovery for people with mental health problems
To improve the physical health of people with mental health problems.
To improve the range of support provided to informal carers in the community.
Performance against the above priorities will be monitored through the governance structures in place, including our formal
Performance Committee and our Integrated Governance Committee. Both these committees have Non Executive Directors of
Community Healthcare as members and have clear terms of reference. Minutes of their meetings are presented to the public part of
Arms Length Management Board. In addition, progress against our stated priorities is reported at the monthly Clinical Quality
review meetings with our Commissioners from NHS South East Essex Primary Care Trust.
During 2010/ 11, Community Healthcare subcontracted with national charity Whizz Kidz to support the provision of wheelchairs to
local children with disabilities. By working together with Whizz Kidz, we both gain by having access to each organisation’s best
practice and also increase our leverage with private companies to improve the delivery time and cost of wheelchairs. In addition, we
continue to work with Commissioners to ensure that the level of service commissioned is appropriate for the number of local people
of all ages who require wheelchairs.
Other services we subcontracted include:
Southend Equipment Service
Essex Equipment Service
Wheelchair repairs
Pressure Area Care Equipment
Physiotherapy and Occupational Therapists from Southend University Hospitals NHS Foundation Trust.
Ontex Healthcare for provision of continence products
The quality of services provided by these subcontractors is monitored through formal reports to our Performance Committee,
review of complaints at the Integrated Governance Committee and by the sub-contracting providers undertaking annual patient
satisfactory surveys which are shared with our Heads of Services. An example of this quality control in action is that, as a result of
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lessons learned from an adverse incident, all referrals for equipment are now reviewed against information regarding the equipment
installed each day to ensure that no patients are waiting longer than necessary.
NATIONAL CLINICAL AUDITS
During 2010, 3 national clinical audits covered NHS services that Community Healthcare provides. During that period, Community
Healthcare participated in all three (100%) of the national clinical audits which it was eligible to participate in. The national clinical
audits that Community Healthcare was eligible to participate in during 2010 are as follows:
National Continence Audit
National Falls Audit
National Diabetes Audit
The national clinical audits that Community Healthcare participated in, and for which data collection was completed during 2010,
are listed below alongside the number of cases submitted to each audit as a percentage of the number of registered cases required
by the terms of the audit.
National Continence Category
Audit
Responses
required
Responses
submitted
< 65 urinary
incontinence
25
25 (100%)
> 65 urinary
continence
25
15 (60%)
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< 65 faecal
incontinence
15
14 (93%)
> 65 faecal
incontinence
15
9 (60%)
National Falls Audit
Organisational
response only
NA
NA
National Diabetes
Audit
Organisational
response only
NA
NA
The reports of two national clinical audits were reviewed by the provider in 2010 and Community Healthcare intends to take the
following actions to improve the quality of healthcare provided:
Continence
Our Continence Advisory Service took part in the National Continence Audit in 2009/10, the results of which have recently been
published. This audit looked at the provision of continence care across acute care, primary care, care home and community
settings. The clinical aspect of the audit focused on bladder and bowel care in each of these settings.
The results for Community Healthcare indicate that based on previous years’ audits there has been a small improvement in the
proportion of people who receive bladder care according to recognised national guidelines and, similarly, a small improvement in
compliance for bowel care according to national guidance.
The continence service recently started doing patient satisfaction surveys on initial contact and on discharge from the service.
Results so far indicate significant improvements in patients’ quality of life, in particular with regard to management of symptoms and
control following discharge from the service. Patients have indicated through the surveys that they would be willing to participate in
service developments and/ or redesign. This fits well with one of our key priorities for next year - to increase our Service User
Engagement.
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The continence service, working with the Dementia Strategy Working Group, now has direct links with local dementia cafes and the
voluntary sector, providing support and advice to clients and their Carers. Two members of the service are undertaking accredited
dementia training that will allow them to support care homes and community patients.
Diabetes
The Diabetes Team took part in the National Diabetes E Audit, the results of which will form an action plan for 2011/12, with a view
to improving diabetes services for patients across all sectors of healthcare. This audit focused on specialist diabetes services
across commissioning and provider services for hospital and community care. The areas of care audited were:
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Clinical leadership
Staff development
Patient experience
Children and young people
Adults with diabetes
Inpatients
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Prevention and management of diabetic foot disease
Inpatient management of active diabetic foot disease
Kidney screening and management
Pre-pregnancy
Diabetes in pregnancy
Results of this audit will be presented to the South East Essex Diabetes network in May 2011. Following publication, the results will
be presented to our Arms Length Management Board and an action plan will be monitored by our Integrated Governance
Committee.
Information is awaited with regard to the outcome of the third national clinical audit (Falls).
The reports of 202 local clinical audits (126 of which related to hand hygiene) were reviewed by the provider in 2010 and
Community Healthcare intends to take the following actions to improve the quality of healthcare provided:
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Ongoing monthly/quarterly monitoring of compliance with hand hygiene and bare below the elbows standards to ensure
continued reported compliance of the current level of 98% across all clinical areas and to strive to achieve 100%.
Monthly review of incidence, referral sources and healing rates of all pressure ulcers on the Community Healthcare
caseload; actioned alongside the development of a care bundle for pressure ulcers based on guidance issued from NHS
East of England.
Completion of the Central Sterilisation Services Department project plan for dental services.
Ongoing review of the environmental audits for clinical areas to ensure the continued appropriateness of the clinical
environments for patient care (in 2010, audit results supported the refurbishment of the Globe Surgery to improve patient
facilities).
Review of the feedback mechanisms of audit results to our service users; in 2010, the district nursing service started
reporting the quarterly hand hygiene audit results back to patients.
Patient experience questionnaires will be reviewed to ensure they capture information on the outcomes for patients.
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CONFIDENTIAL ENQUIRIES IN TO MATERNAL AND CHILD HEALTH (CMACH)
Community Healthcare has not reported any Child or Maternal Deaths for the period of 2010/11.
RESEARCH
The number of patients receiving NHS services provided or sub-contracted by Community Healthcare in 2010/11 that were
recruited during that period to participate in research approved by a research ethics committee was - NIL
COMMISSIONING FOR QUALITY AND INNOVATION (CQUIN) INCENTIVE SCHEME
2009/10
A proportion of Community Healthcare’s income in 2010/11 was conditional on achieving quality improvement and innovation goals
agreed between Community Healthcare and our Commissioners from NHS South East Essex Primary Care Trust, through a
contract, agreement or arrangement with them for the provision of NHS services, through the Commissioning for Quality and
Innovation payment framework. Further details of the agreed goals for 2010/11 and for the following 12 month period are available
electronically at http:www.institute.nhs.uk/world_class_commissioning/pct_portal/cquin.html.
The CQUIN schemes we agreed are set out below:
Breastfeeding
The Birth Vital signs target VSB 11 aims to improve breastfeeding coverage and the prevalence of breastfeeding at 6-8 weeks after
birth. It has been a joint CQUIN initiative with Southend University NHS Foundation Trust in 2010/11and continues into 2011/12, in
recognition that to improve levels and continuance of breastfeeding, sustained change needs to take place. Community Healthcare
has made significant progress throughout the year in the reporting of breastfeeding. This started the year as a manual recording
system and is now fully reported on our electronic SystmOne. Results show that the coverage reports now consistently meet the
95% target.
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However, NHS South Essex Primary Care Trust is not achieving the target to achieve continuance of partial and or full
breastfeeding at 6-8 weeks after birth. Performance was 69% against a target of 75%. The overall target for 2011/2012 has been
reviewed and from April 2011 is set at 75% of mothers continuing breastfeeding at their 6-8 week visit, who were breastfeeding a
minimum of 3 times per day at their New Birth visit.. Community Healthcare has a steering group to oversee progress which has
developed a robust action plan to improve rates of breastfeeding. A training curriculum has now been developed to train all staff
coming into contact with mothers, including administration and clerical staff, and the training programme for volunteers providing
peer support has been reviewed and refreshed. An audit is to be undertaken during 2011/12 and a questionnaire will be sent to
mothers whose babies are six months old to understand why some mothers continue successfully to breast feed and what enabled
them to do so and where mothers’ choice of feeding was to breastfeed and they were unable to continue, what might have helped
them.
It is expected that valuable information and feedback will be gained from this to inform practice and improvements needed going
forward. Mapping has been completed to identify areas of low initiation of breastfeeding and further work will be developed to
improve these levels with partners in local Children’s Centres.
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Brief Interventions
This CQUIN scheme required Community Healthcare to train a cross section of clinical staff to provide health promotion advice in
particular in relation to smoking, exercise, and weight loss and alcohol consumption, with aim of supporting local people to make
healthier choices. Although committed to improving the health of the population and confident that such information is provided by
front line clinical staff, Community Healthcare was not able to release staff in sufficient number to achieve this target. In addition,
there are challenges with regard to the accurate recording of such activity.
Supporting people to manage their own health and make informed choices -Personal Health Plans
(PHPs)
The aim of this CQUIN initiative is to support all GP practices to identify people with long term conditions to within 10% of their
expected population prevalence for Chronic Obstructive Pulmonary Disease, diabetes, stroke and coronary heart disease, then to
support and promote GP practices to offer personal health plans for those people they have identified.
Improving the health and wellbeing of people with long term conditions is one of the biggest challenges and opportunities facing the
health service. Personal Health Plans (PHPs) are a key tool to support the personalisation of health care and promote
independence for people with a long term condition.
Community Healthcare has made considerable progress towards ensuring that all our patients with Long Term Conditions,
including heart failure, stroke; both in primary and secondary care, diabetes, Lymphoedema and those people approaching the end
of their lives are offered a Personal Health Plan to support them in making the best possible choices in relation to their health and
well being, as well as deciding on their preferred place of care during the last year of their life. Services continue to adapt PHPs to
incorporate the most up to date information for patients and these documents continue to meet NHS East of England Strategic
Health Authority’s criteria for personalised health planning.
CQUIN funding has enabled development of these documents and the promotion of PHPs across primary care. This includes
training and education for patients and staff working in GP practices to ensure that more people are offered the opportunity of
having a PHP.
To maximise the uptake of PHPs a website has been developed signposting health care practitioners, patients and carers to a
useful resource for information and support. This website gives information about PHPs, and enables the patient, carer or health
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care professional to access a resource and link for information to registered charities and support groups for many long term
conditions. An event is being held on 26 May to launch the website and a wide range of health professional including GPs and
patients have been invited to this launch. This will also provide an opportunity to distribute posters to practices and information to
incentivise patients and carers to download and complete a PHP.
Chronic Obstructive Pulmonary Disease (COPD)
There were a number of desired outcomes in relation to this CQUIN scheme. One was to establish disease-specific care plans for
patients with Chronic Obstructive Pulmonary Disease (COPD). This has now been implemented and all patients who have services
/ care provided by Community Healthcare to support the management of their COPD are provided with a disease-specific care and
management plan.
It was also a requirement that a pathway specification for an integrated COPD service be developed, in partnership with Southend
University NHS Foundation Trust (the local acute hospital). This has been achieved and a sample specification for implementation
and to showcase as part of pathfinder was developed in September 2010.
A further aim was to reduce the number of unnecessary attendance at Accident and Emergency and emergency admissions to
hospital – monthly data is received regarding admissions for patients with COPD. Our Rapid Response Team review data to
determine whether admission was COPD related, whether these patients are known to Community Healthcare and have a Personal
Health Plan and whether admissions could have been avoided.
In order to improve the patient experience, ‘Exit Questionnaires’ have been introduced by the Rapid Response Service and are
sent to all COPD patients who are discharged by the service. The information gathered is reported quarterly to our Commissioners.
In addition, the national Dr Foster patient tracker is used by Rapid Response service and overall feedback is positive.
Currency and pricing
During 2010/11, our children’s services, finance and business teams have been working on piloting the Department of Health’s
guidance on currencies and pricing for the Healthy Child Programme. The Healthy Child Programme is the service provided by our
health visiting service to all local mothers and their children from birth to five years old. It includes new birth visits, developmental
checks and attendance at baby clinics. In the past, the performance of this service has been measured in terms of the number of
contacts with mothers and babies in a year. The aim of the project was to identify a new way of measuring health visiting services
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that include measures of quality and outcomes, and ultimately for Community Healthcare to be paid by commissioners on this
basis. By the end of the year, we had undertaken all the background work required to develop a proposal for commissioners,
which we hope will be trialled within the contract in 2011/12.
Work on developing new outcome-focussed measures and charges for other services will continue, with four additional services to
be considered under the CQUIN initiatives for 2011/12.
Data Quality
Community Healthcare was asked to produce detailed monthly and quarterly reports in a more user friendly format to enable our
Arms Length Management Board to identify areas of significant progress and also areas of concern at a glance. A dashboard of
key indicators was developed and has been well evaluated by both Community Healthcare and our Commissioners.
Community Healthcare did not submit records during 2010/11 to the Secondary Uses Service for inclusion in the Hospital Episode
Statistics which are included in the latest published data.
Community Healthcare was not subject to the Payment by Results clinical coding audit during 2010/11 by the Audit Commission.
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2B STATEMENTS RELATING TO QUALITY OF NHS SERVICES PROVIDED (in regulations)
Care Quality Commission Essential Standards for Quality and Safety
Community Healthcare is required to register with the Care Quality Commission and its current registration status is Registered.
Community Healthcare has no conditions on registration. The Care Quality Commission has not taken enforcement action against
Community Healthcare during 2010/11. This registration described above includes all clinical activities and locations where care or
treatment is provided. Community Healthcare has not participated in any special reviews or investigations by the Care Quality
Commission during the reporting period.
We are currently registered to provide five regulated activities:
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Accommodation for people requiring nursing or personal care
Treatment of disease, disorder or injury
Family planning services
Surgical procedures
Nursing care
In 2010/11 we were registered to deliver these activities from 11 locations including:
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Harcourt House (the headquarters of NHS South East Essex Primary Care Trust).
The Globe and Victoria GP Surgeries.
The Cumberlege Intermediate Care Centre.
Warrior House and Knightswick Dental Clinics
Community Healthcare also registered to deliver some of the regulated activities at premises belonging to other providers, namely:
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BMI Southend Private Hospital
Orsett Hospital
Chelmsford Medical Centre
Southend University Hospital NHS Foundation Trust
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Although Community Healthcare has not been subject to any special reviews or investigations by the CQC during 2010/11,
evidence has been collated by all clinical services in order to benchmark our compliance against the identified outcomes and action
plans have been developed in order to ensure year on year improvements.
In addition Community Healthcare regularly reviews the Quality & Risk Profile published by the CQC to understand how Community
Healthcare performs in relation to other organisations (top and bottom 20%) with regard to Patient Safety, Patient Experience and
Clinical Effectiveness.
During 2011/12, we are working closely with our colleagues at South Essex Partnership University NHS Foundation Trust (SEPT)
to ensure that the appropriate registration of our services is maintained and that the processes used to monitor the quality of the
care we provide are integrated to support us in continuing to meet the Care Quality Commission’s Essential Standards of Quality
and Safety.
DATA QUALITY
During 2010/11 Community Healthcare has continually improved data quality across all services. This includes the development of
a dashboard to assist in monitoring performance and understanding anomalies, both in the quality of service provision and data
quality. The majority of services now use SystmOne for data capture, which facilitates the monthly retrieval and cleansing of both
quality and performance information.
An internal audit of data quality has been conducted and identified only two recommendations, which have now been addressed.
The report recommended the inclusion of information from the data quality improvement plan in our Performance Committee
agenda and the Storage of an intermediate file from SystmOne to for future reference.
Each patient’s unique NHS number is now included in approximately 90% of clinical records.
Information Governance Toolkit
Community Healthcare NHS South East Essex Information Governance Assessment Report overall score for 2010/11 was (75%)
and was graded (GREEN, Satisfactory) from the IGT Grading Scheme. See Appendix 1
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PART 3 - QUALITY REPORTING
Priorities for 2010/11 – Look back, what did we achieve?
NHS South East Essex Primary Care Trust (PCT) serves a population of approximately 361,000. Community Healthcare has
provided community services for local people within this PCT’s boundaries and also provides some services including Macmillan
Nursing & Welfare Benefits services, Podiatric Surgery and Continence Services to a wider population on behalf of South West
Essex PCT. In addition, the Family Nurse Partnership Service is hosted by Community Healthcare on behalf of Hammersmith and
Fulham PCT.
Information set out below provides information with regard to key performance targets agreed with NHS South Essex PCT and
other quality initiatives that have been implemented.
Summary of Performance against Key Performance Indicators for 2010/11
Throughout 2010/2011, Community Healthcare monitored performance against 29 high level Key Performance Indicators (broken
down into sub-categories) and 162 Performance Indicators; to ensure improved patient safety, patient experience and long term
health.
The most significant Key Performance Indicators (KPIs) were:
Goal
Target
2010/2011 Performance
Improving
long term
health
Increase 6-8 week breastfeeding
prevalence
75%
69%
Improving
long term
Increase HPV immunisation rate
for girls aged around 12 to 13
90%
85%
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health
Improving
long term
health
Increase immunisation rate for
children - School Leaving Booster
90%
63%
Improving
long term
health
Increase the uptake of Long
Acting Reversible Contraceptive
methods
615
973
Goal
Target
2010/2011 Performance
Improving
long term
health
Childhood Obesity –increase the % children
in Reception Year with height and weight
recorded in past year
85%
92%
Improving
long term
health
Childhood Obesity - % children in Year 6
with height and weight recorded in past year
85%
86%
Safeguarding Children – 96.67%
Improving
patient
experience
Increase the percentage of Mandatory
Training uptake within staff
85% for each area
Adult Protection – 54.87% (target
to be met in Sep11)
Fire Safety –74.97%
Manual Handling – 84.59
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Infection Prevention –84.09%
Equality & Diversity –82.61%
Improving
patient
experience
Reduce the number of patients waiting for
18 Weeks of more in Community Services –
Podiatry
100% seen
100%
Improving
patient
experience
Reduce the number of patients waiting 18
Weeks or more in Community Services –
Wheelchair Services
100% seen
89%
Goal
Target
2010/2011 Performance
Improving
patient
experience
Increase the %age of Community equipment
delivered within 7 days - Southend
95%
99%
Improving
patient
experience
Increase the %age of Community equipment
delivered within 7 days - Castle
Point/Rochford
95%
100%
Improving
patient
experience
Improve Patient Satisfaction - Positive
responses to Dignity and Respect
None
97%
Improving
long term
health
Chlamydia Screening – increase the number
of NCSP screens returned in the period for
15-24 year olds
11800
7679
20
Improving
long term
health
100%
TBD – issues with data collection
will be resolved by end April
2011
75%
87%
Reduce the number of Grade 2 pressure
sores developing in community setting.
None
101
Goal
Target
2010/2011 Performance
Improving
long term
health
Increase the uptake of the MEND
programme – healthy eating and exercise for
7 to 13 year olds
100
86
Improving
long term
health
Increase the uptake of the mini-MEND
programme – healthy eating and exercise for
2 to 4 year olds
190
174
Improving
patient
experience
Increase the percentage of secondary
schools with a named school nurse
100%
100%
5.00%
4.24%
Improving
patient safety
Improving
patient safety
Improving
patient
experience
Increase the %age of patients with a Long
term condition offered a Personal Health
Plan
Podiatry – Increase the number of patients
who are Assessed for the diabetic foot
Reduce staff sickness absence
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Improving
patient safety
Reduce staff turnover
14.00%
12.96%
As can be seen from the table above Community Healthcare achieved the majority of the key performance indicators during
2010/11. However, for those targets not achieved a summary of performance is set out below:
Breast Feeding
Although the target for numbers of women continuing to breast feed at 6 – 8 weeks after birth was not achieved, substantial
progress has been made toward achieving this target. One of the reasons that this target is particularly challenging for Community
Healthcare is that in order to support women to continue to breast feed, we are reliant on the hospital and community Midwives
promoting and supporting women to breastfeed so that it is fully established prior to hand over to our health visiting service at 10 14 days after birth. In order to achieve this, we are working in partnership with Southend Hospital University NHS Foundation
Trust’s midwives and the voluntary sector on a variety of initiatives that will have a medium to long term impact including:
designated breastfeeding co-ordinators and volunteers and a dedicated breastfeeding website schedule to go live in May 2011.
This website will be a resource to women prior to and following the birth of their babies.
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Human Papilloma Virus Vaccine (HPVV)
Although Community Healthcare has not achieved the target for 90% of girls aged 12 to 13 years receiving the HPV vaccine, 85%
of those eligible have been vaccinated. The target is extremely challenging and we have identified all those girls who are not fully
immunised and are offering them appointments in order to improve uptake.
School Leaving Booster
In March 2011 an error was identified in relation to the performance against this target in that the target had previously been
measured against the contracted year instead of the academic school year. This error has highlighted an under performance which
is currently being investigated and discussed with Commissioners.
Chlamydia
The target for 2010/2011 was to test 35% of the eligible population and this was recognised to be an ambitious target. Of this,
Community Healthcare were commissioned to deliver 11,800 screens. We have worked tirelessly to ensure that not only are
screens offered within the Contraceptive and Sexual health services (CASH) but also that this opportunity is embedded into core
service provision through school nursing, education based health services, through outreach working with partners engaged in the
fields of sexual health, youth and Connexions work and education, postal mail out of kits and letters, the RU clear website has also
been updated and refreshed. The approach to embed screening within core provision was recognised by NHS East of England’s
lead team for Chlamydia as the preferred model in delivering a long term sustainable programme when the team visited South East
Essex early in 2010. The service has also worked on special events with a media company commissioned by the PCT and
constantly reviews activity and new and innovative ways of engaging with young people to encourage them to undertake screening
in an ethical manner.
Although Community Healthcare is unlikely to achieve this challenging target this year, it is important to recognise that overall the
service has performed well and is the second best performing CaSH service in the East of England region, in relation to the number
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of positive patients being treated and second best performing PCT in the East of England region in relation to the numbers of these
people’s partners being treated.
Mind, Exercise Nutrition Do it (MEND) and MINI MEND
MEND and Mini MEND are fun courses for families with children aged 2 to 4 years and 7 to 13 years, whose weight is above the
healthy range for their age and height. It runs twice a week after school in two-hour sessions over 10 weeks. The aim of the
programme is to help children and families manage their weights better and lead healthier lives. This target was not achieved
because it proved difficult to ensure that families continued on the programme for the full 10 weeks of the course. Next year, it has
been agreed that the target will be different and will be based on number of families recruited on to the course. It is also anticipated
that the age range will be widened, in order to provide opportunities for 5 to 7 year olds and children of secondary school age.
Monitoring wait times from referral to first treatment
For the first time in 2010/11, Community Healthcare reported on average and maximum wait times for patients from referral to the
service until the first treatment. Due to the limitations of the IT system mandated by the Department of Health, this has been a very
24
manually intensive programme. However, Community Healthcare has reported information across 25 services, commencing April
2010:
Provider
Name
Specialty/Service
Description
Target
%
Patients
Treated
within 18
Weeks
SEE PCT
Oxygen Service
100.00%
100.00%
SEE PCT
Spirometry Service
100.00%
100.00%
SEE PCT
Diabetes Service
100.00%
100.00%
SEE PCT
Jigsaw Service
100.00%
100.00%
SEE PCT
Long Term Condition Service
100.00%
100.00%
SEE PCT
District Nursing Service
100.00%
100.00%
SEE PCT
Paediatric Community Nursing
Service
100.00%
100.00%
SEE PCT
TB Nursing SEE Patients
100.00%
100.00%
SEE PCT
TB Nursing SWE Patients
100.00%
100.00%
SEE PCT
TB Nursing MID Patients
100.00%
100.00%
SEE PCT
Continence Service
100.00%
100.00%
25
SEE PCT
Podiatric Surgery
100.00%
100.00%
SEE PCT
Community Macmillan
100.00%
100.00%
SEE PCT
Community Dentistry
100.00%
100.00%
SEE PCT
Occupational Therapy
100.00%
100.00%
SEE PCT
Speech & Language Therapy
100.00%
100.00%
SEE PCT
Tissue Viability
100.00%
100.00%
SEE PCT
Podiatry
100.00%
100.00%
SEE PCT
Wheelchair Service
100.00%
71.2% *
GRAND TOTAL
98.68%
As can be seen from the above table, all services achieved the 18 week target in relation to referral to treatment time, with the
exception of the wheelchair service. However, Whizz Kidz, who work with Community Healthcare to provide the children’s
wheelchair service, have helped us to transform the service and now 65% of children leave their first appointment with a
wheelchair. “A child in a chair in a day” is a key objective of the service and is achieved wherever practically possible.
26
Local Audits
Your Skin Matters - Pressure Relieving Equipment:
Pressure ulcers are quite common and are estimated to occur in between 4% and 10% of patients admitted to hospital. Figures for
their occurrence in the community are more difficult to obtain, but it has been estimated that 20% of people in nursing and
residential homes may be affected and up to 30% of the population in general.
Pressure ulcers can occur in any patient, but are more likely in high risk groups, such as the elderly, people who are obese,
malnourished or have continence problems, people with certain skin types and those with particular underlying conditions. The
presence of pressure ulcers has been associated with an increased risk of secondary infection and a two to four-fold increase in the
risk of death in older people in intensive care units (Bo M, Massaia M et al, 2003).
In order to understand the extent of the problem for Community Healthcare, an audit of pressure ulcers was undertaken by our
Modern Matrons in the district nursing service. This audit sought to identify the number, type (grade) and source of ulcer. In
addition, we were seeking to understand whether patients were receiving optimal care, through robust care planning, regular
clinical reviews and provision of appropriate pressure relieving equipment.
The results demonstrated 147 ulcers in total - 79% of which were community-acquired. The majority were grade 2 ulcers.
Other findings were as follows:
96% of patients had received a nutritional assessment
98% of patients had a Waterlow Assessment of the likelihood of them developing a pressure ulcer
27
96% of patients had a formal wound assessment and photograph documented
99% of patients had received appropriate pressure relieving equipment (1 patient refused equipment)
95% of patients had a nursing care plan appropriate to their needs
74% of pressure ulcers of grade 2 or above had been reported on the Datix Risk Event Reporting System.
It was noted however that in some areas, patients with complex ulcers had received their care predominantly from Health Care
Assistants rather than registered nurses and this matter has been addressed.
Although the findings of this audit were positive overall, action plans have been developed to ensure ongoing improvement in the
management of patients with pressure ulcers and the care pathway has been adapted to ensure monthly reviews of nutritional and
Waterlow assessments. A ‘Your Skin Matters’ awareness event is planned for May 2011 and this will raise awareness of the care
pathway, reporting requirements and of pressure relieving equipment available.
In addition, the equipment service has made significant changes in the management of pressure relieving equipment in order to
enhance patient safety. Training and education across community care and residential care homes have enabled equipment to be
utilised more efficiently, and prescribed appropriately. Procedural guidelines have been adapted to ensure equipment is issued
appropriate to individual clinical need, through earlier intervention to those with frail skin integrity. These changes have not only
resulted in improvements to patient care, but also have resulted in significant savings through improved use of equipment.
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Information Management &Technology
In December 2009, Community Healthcare approved an Information Management and Technology Strategy for the following 18
months to support clinical practice; improve patient safety, patient experience; reduce costs and support Community Healthcare’s
Corporate Citizenship Agenda.
Achievements for 2010/11 are noted below:
Link to drivers
Project
Patient Safety
Mobile Working – 50% of district nurses are able to access the clinical
system and electronic patient record in patients’ homes. This means
that less time is spent travelling, more time is available for patient care
and travel costs are reduced. This is being rolled out to all district
nurses in South East Essex.
Corporate
Citizenship
Cost Reduction
Patient Safety
Patient
Experience
Patient Safety
Cost reduction
Improved patient communication – Community Healthcare has
developed four external websites to improve patients’ access to
clinical information and promote our services – Sexual Health;
Personal Health Plans; Peri-natal Emotional Wellbeing; and
Breastfeeding
Intranet – a new intranet was launched in November 2010. This is
exclusive to Community Healthcare staff and includes all policies
(clinical and corporate); organisational information; clinical care
pathways; forms. This has significantly reduced staff time and use of
out-dated information, as well as engendering a corporate identity,
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Corporate
Citizenship
Cost Reduction
Patient Safety
Patient
Experience
Corporate
Citizenship
Video and Audio conferencing – in 2010 Community Healthcare
introduced new procedures to introduce a variety of options for video
and audio conferencing thereby reducing travel time and cost.
Scanning – We completed a successful pilot to scan patient notes in
the Podiatry service. We found that this reduced time spent looking
for lost notes and improved patient safety as notes were available and
accessible. It eliminated the need to transport patient notes and freed
up office space currently used for storage. This is now being extended
within the podiatry service and will be widened to other services in
2011/12.
Cost Reduction
Corporate
Citizenship
Cost Reduction
Patient Safety
Cost reduction
Cost reduction
Electronic Ordering – In 2010/11 Community Healthcare migrated to
electronic ordering for al stationery and progressed toward electronic
ordering for clinical supplies, negating the need for staff to travel to
sign-off orders and reducing the lead time for orders and thereby
stock levels.
Speech Recognition - in March 2011, Community Healthcare
instigated a pilot implementation of Speech recognition software in
Health Visiting and Podiatric Surgery, to enable clinicians to record
speech directly into the IT-based clinical record. The pilot will be
completed in May 2011 and depending on the findings, may be rolled
out to clinical staff who have challenges in using IT systems.
Wireless technology – this has been introduced in the Head Office
and in clinical bases where mobile working is established. Wireless
technology means that clinical staff are now able to spend the majority
30
of their time in the community and can have ‘virtual’ space within the
office base, thereby reducing accommodation needs and costs.
Listening to Service Users
The Directorate of Specialist Services made User Engagement a directorate objective during 2010/11. Each service has identified
service users who have, along with staff, participated in events which enable the directorate to gain information and feedback when
planning and designing new ways of providing services. A number of events have been held for patients, staff and members of the
public in order to seek their views regarding service redesign, particularly in relation to relation to intermediate care and care of the
elderly; these included the Southend Association of Voluntary Services and Hullbridge Local Strategic Partnership at Hullbridge
Community centre.
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Patient Environment Action Team award Clean Bill of Health
Our bed-based unit, the Cumberlege Intermediate Care Centre, had its first annual assessment of by the national Patient
Environment Action Team [PEAT]. This assessment uses a benchmarking tool to assess quality and ensure improvements are
made in the non-clinical aspects of patient care including the environment, food, and the ability to care for people with privacy and
dignity. The assessment results are reported to the National Patient Safety Agency and help to highlight areas for improvement
and share best practice across healthcare organisations in England. Although the results are not published until later in 2011,
Community Healthcare scored highly in most categories and we are very proud of the environment and non-clinical services
provided - all of which are key to assisting patients re-gain their independence and helping them return to their own homes.
In addition to the above, there was also an unannounced food hygiene inspection by the Local Authority on behalf of the Food
Standards Agency. This inspection rated the service as very good, which is the highest rating available.
Infection Prevention and Control - No MRSA Bacteraemia, No Clostridium difficile
The infection control team is responsible for the surveillance, monitoring and control of infection throughout Community Healthcare
services. This includes the control and management of outbreaks of infection and challenging inappropriate clinical hygiene
practice or antibiotic prescribing. The team serves as a resource to all staff for advice on infection control matters. Their purpose is
to limit the acquisition and spread of pathogenic microorganisms by promoting the use of scientifically based knowledge and skills,
planning, surveillance and education as part of the overall policy of achieving good quality health care. The team consists of a
Director of Infection Prevention and Control (DIPC), a deputy DIPC, an Infection Control Nurse Specialist (ICNS) and an Infection
32
Control Doctor (ICD). The DIPC is the Director of Clinical Services and Executive Nurse, who is accountable directly to the Arms
Length Management Board, which is accountable to the PCT Board. The deputy DIPC is the clinical lead for all matters relating to
infection prevention and control throughout Community Healthcare. For the year 2010-2011, there were no cases of Clostridium
difficile or blood stream infections due to Meticillin resistant staphylococcus aureus (MRSA) reported that were attributed to care
provided by our services. Work to reduce healthcare-associated infection is ongoing to ensure continued patient safety and
compliance to the Heath and Social Care Act (2008) Code of Practice for health and adult social care on the prevention and control
of infection and related guidance.
Improved Care for People with Chronic Obstructive Pulmonary Disease (COPD)
Community Healthcare continues to improve the way we provide care to patients with COPD. The clinical pathway for COPD
patients has been further adapted to take in to account patient feedback and has resulted in improvements in the care and
rehabilitation outcomes. The development of the pathway that integrates aspects of care provided by a number of different
agencies fits in with the Quality Improvement Scheme and is in line with the National Clinical COPD Strategy, bringing significant
benefits through:
Improved medical leadership closer to patients’ homes
Improved communication between all health and social care professionals supporting people at home
Improved use of IT systems enabling prompt and timely sharing of relevant information across providers
The COPD Integrated Initiative is led by one of the Consultant Respiratory Physicians and was submitted to the 2010 Health and
Social Care Awards, where it was one of only two initiatives that were highly commended. Congratulations are due to all of the
following teams who contributed: Rapid Response Team, Community Matrons, Smoking Cessation, Home Oxygen Service, Breath
Easy, Southend University Hospitals NHS Foundation Trust Respiratory Team and the GP Lead.
Caring for People following Stroke
The Essex Cardiac and Stroke Network [ECSN] in May 2010 undertook a review of the stroke pathway which has been developed
in South East Essex as part of the Local Stroke Implementation (LIT) Group. This work is in partnership with Community
33
Healthcare, PCT Commissioners and stroke team from Southend University Hospitals NHS Foundation Trust. The review was very
positive and reported that the teams were:
experienced, responsive and committed to providing a single point of access and continued support to people during their
rehabilitation following stroke
provide good continuity of service and knowledge for stroke patients following discharge from hospital through proactive
communication at the weekly multi-disciplinary team meetings and regular access to the Stroke Consultants.
Well-structured, with clarity of focus and appropriate specialist stroke expertise throughout the patient journey and
Staff had higher level professional training, thus raising stroke standards across community rehabilitation teams.
It also acknowledged that team members provide stroke awareness training to a large number of staff in intermediate care and
expert support and mentoring to other therapy staff. The team has excellent links with care homes through the lead nurse for
stroke, keeping in touch with people following stroke and undertaking yearly reviews, which ensures high standards of stroke care
and potentially offers people improved lifestyle options.
Avoiding unnecessary admissions to hospital for chemotherapy patients
The National Cancer Action Team supported the Essex Cancer Network (ECN) to take forward a project aiming to reduce the
number of unnecessary emergency admissions to hospital for people with cancer undergoing chemotherapy in South Essex. The
project was hosted by NHS South West Essex, supported by Community Healthcare, and ran from October 2009 to December
2010. Although South West Essex withdrew from the pilot, Community Healthcare continued to provide rapid access to patients to
provide assessment and symptom management for patients at home through our Rapid Response Team.
The evaluation of the pilot proved to be both clinical and cost effective. It has been recommended that all Primary Care Trusts
(PCTs) across Essex look at implementing an initiative that provides a similar service to cancer patients, by either using current
Rapid Response Teams or incorporating with existing Intermediate Care Services. The nature of this pilot brought together a more
co-ordinated and cohesive service with the Oncology Department in the Southend University Hospital NHS Foundation Trust and
meant that patients had care delivered at home, giving an alternative choice to hospital admission.
34
Patient Satisfaction
The specialist services directorate has actively sought feedback for each of the services provided at varying stages of the ‘patient
journey’. The aim of seeking feedback is to understand the patient experience and assess potential or actual benefits for people
using the service, examples include:
Pre and post pulmonary maintenance group sessions for people with lung disease
Annual stroke review
Pre and post urinary continence assessments
Patient Tracker - an electronic survey device has been used in the Cumberlege Intermediate Centre and Parklands Care
Home and the most recent report demonstrated that:
100% of patients felt they were treated with respect and dignity
100% of patients said they would recommend the service to others
90% reported that they were involved in planning their care and rehabilitation. The remaining 10% stated that
they felt they were involved most of the time
100% reported that staff were professional, approachable and sensitive to their needs
90% of patients rated the way they were kept informed about their care as excellent and the remaining 10%
rated this as good.
Speech and Language Therapist receives Travers Reid Award
In December 2010 Jenny Packer, one of our senior Speech and Language Therapists, was presented with the 2010 Travers Reid
award for her Masters Dissertation, entitled “Consulting Parents about Speech and Language Therapy and Stuttering: Are We
Telling Them What They Want To Know?”. The awarding organisation is the Michael Palin Centre for Stammering Children. From
this research, parent information leaflets were developed and these are now sent out with every initial appointment letter, informing
parents what they might expect during the session and beyond.
35
You’re Welcome – Making service more accessible to young people
Children’s speech and language service undertook completion of the “your welcome” self assessment tool kit [Department of Health
2009]. The toolkit sets out principles to help health services become more young people friendly. This initiative covers a number of
areas to be considered by health care commissioners and health services providers, including questions regarding accessibility of
the service, the environment, staff training, skills, attitudes and values, health issues for adolescents and confidentiality. The initial
findings reflected the service had an overall good attitude to working with children and young people.
Innovations through New IT Systems
Mobile Working for District Nurses
Community Healthcare district nurses are leading the way in terms of introducing new IT systems to improve patient safety and
achieve greater efficiencies. A pilot study undertaken on Canvey Island provided nursing staff with portable computers capable of
making a secure remote connection to SystmOne (Patient information systems used in the Trust and by a number of GPs) via the
N3 network. This enabled staff while in patients’ homes to have real time access to clinical information, the required demographic
data to enable referral to other services, access to the ICE system for blood and microbiology results, hospital discharge
summaries, including prescribed medications in a typewritten format removing the risk of misinterpretation of hand written
instructions.
In addition, nurses were able to plan their visits, priorities and time more effectively, and obviate the need to attend the staff base to
access their work on a daily basis. Time identified for team meetings and clinical duties is maximised and focused on the clinical
issues which require discussion and guidance. The clinical and technical requirements were developed jointly between the local
district nursing service and the IT Deployment Team at NHS South East Essex Primary Care Trust.
The pilot study evidenced a 15% saving on travel time and cost, which will contribute to the overall Community Healthcare cost
improvement plan for 2011/12. It is anticipated that mobile working will be implemented throughout the district nursing service by
December 2011.
36
Admission Avoidance
Supporting Older People at Home -Community Geriatrician Pilot
In July 2010, Community Healthcare commenced a brief project in partnership with colleagues from Southend University Hospital
NHS Foundation Trust and South Essex Partnership University NHS Foundation Trust. This project lasted until October 2010 and
the purpose was to design an alternative model of care to improve the quality of care for vulnerable older people living at home and
those living in care homes, with the aim of reducing unnecessary Accident & Emergency attendances and hospital admissions.
Referrals were sought from community nurses and General Practitioners (GP’s) within the Fortis Practice-Based Commissioning
(PBC) group and care was co-ordinated by Community Matrons led by a Consultant Physician, supported by a Community
Psychiatric Nurse. Although brief, the evaluation of the project demonstrated a number of successes including:
•
•
•
•
•
•
•
•
•
276 patient contacts were made (potential avoided admissions), however only 20% of referrals were direct from GPs
100% of patient care plans were completed within 24 hours
60% of assessments were completed within 24 hours following referral, average wait 48 hours.
Longest wait for assessment 19 days (dementia patient)
21 care homes visited routinely
36 home visits undertaken
40% of patients had changes made to their medication following review, resulting in around £100K savings
59% of patients required an Mental Capacity Act (MCA)assessment
9% of patients required onward referral - the majority of whom required support from Community Psychiatric Nurses
(CPN’s)
Of the patients who were reviewed throughout the pilot, the most significant diagnoses were as follows:
•
•
•
•
Recurrent Urinary Tract Infections
Chest infections
Falls
Dehydration
37
•
•
•
•
•
Respiratory conditions
Hypoglycaemia
Problems with appropriate diet
Dementia
Palliative care
NHS South East Essex PCT was so impressed with the quality of care provided to patients that this project has now been
commissioned as part of the mainstream services for older people. The strategic vision is that services that work collaboratively and
provide care closer to home can anticipate “crisis” through effective case management, regular review to ensure that patients with
long term conditions and vulnerable older people are treated in a more responsive and timely manner in the optimal care
environment to meet their needs. Thereby minimising the need for acute hospital care and reducing unnecessary expenditure.
The model being developed within the long term conditions Community Matron’s team, as a continuation of the community
geriatrician pilot, involves the application and delivery of skills and knowledge dedicated to treatment and/or physical rehabilitation
to reduce hospital admission. The pilot continues to focus on people who are anticipated as being in or entering crisis, by reviewing
and triaging frequent attendees to hospital, as well as managing acute exacerbation of long term conditions.
Since February 2011, all referrals to the long term conditions [LTC] team have been logged centrally at Suffolk House. All
referrals are now triaged by a designated Community Matron on the day received. One matron is rostered for triage daily; this
provides a unified approach to the selection of patients and enables the triage Community Matron to undertake a brief
assessment of the patient within 48 hours. If the patient fits the service criteria, they are referred to the Community Matron in the
patient’s locality for ongoing care. This process also provides the triage Community Matron with dedicated time daily to analyse
data supplied by the hospital of frequent attendees to hospital. This process allows the LTC team to focus on referrals of high
risk, frequent attendees to hospital.
A Community Matron also attends the multidisciplinary team meeting on the intermediate care ward on a weekly basis to discuss
patients under their care and to discuss patients on the ward who may be appropriate to refer into the LTC service.
38
End of Life Care
In August 2010, an 18 month pilot project was commenced in Thundersley and Leigh-on-Sea. One of the purposes of the pilot is to
test whether an end of life care register facilitates improved patient care enabling the early identification of patients and ensures a
more proactive approach to care. Case managers provide a single point of contact for the service and act as a resource to facilitate
effective care. This aims to avoid unnecessary admissions to hospital and to ensure patients die in their preferred place of care,
with appropriate support and equipment in place as needed. The team is now at full recruitment with the successful appointment of
a second case manager, who commenced in post in March 2011.
Patients and staff can now access specialist palliative care assessment, advice and support over seven days 9-5pm and, critically,
at weekends when crises involving often inappropriate admission to hospital are at greater risk of occurring. Already there is
evidence to show that admissions have been avoided at weekends by the Clinical Nurse Specialist being available. The new
service will complement a broad range of health and social care staff including General Practitioners, district nursing teams,
Community Matrons, long term condition team, Hospice at Home, out of hours and many other specialists in helping to support
patients at home and ensure they are cared for in their preferred place of care.
The End of Life Care Team aims to support staff and help them develop the necessary skills and expertise to care for patients
approaching the end of their lives. We have developed a three day district nurse programme which commenced in January 2011,
with the aim of improving joint working between specialist palliative care providers and primary care nursing teams and to influence
service provision to support 24hour palliative and End of Life care - this certainly seems to have had the desired effect with great
feedback from the district nurses that have attended.
39
Results so far appear to be optimistic and so a detailed audit to establish reasons for admission to hospital of all patents in the pilot
areas and an audit of place death of patients on the end of life register will be carried out during April / May 2011, in order to identify
whether admissions could have been avoided and whether patients are achieving their preferred place of death.
A final report is to be prepared for NHS South East Essex PCT Commissioners in November 2011, in order to inform
commissioning of services for 2012 onwards.
Children and Young People’s Services
Aiming high for disabled children -Short Breaks Service for Children
In February 2011, Community Healthcare launched a new service for children with health needs and disabilities. The service aims
to enable children and young people to access existing after school activities and holiday clubs with one-to-one support from a
healthcare assistant for short periods of around of 6-8 weeks. Some home-based activities are also possible.
The service philosophy is that:
Every child with additional needs will be enabled and supported to achieve their potential through delivery of a high quality
service. The services will be shaped and developed in partnership with children and their families; they will be responsive to
need, timely and inclusive. All children and families will have fair and equitable access to services according to need.
The short break service will take a flexible approach to planning the breaks, aspiring to provide a positive experience for the
children and their families, which they will enjoy and look forward to, whilst providing as wide a choice as possible. The ethos
of the team will be the inclusion of children in to mainstream services where ever possible.
The service is here to provide opportunities to access universal existing services, activities and clubs. These could include:
40
Cooking
Sensory rooms
sports
drama
Horse riding
Music
Youth Groups
Arts and crafts
...and many more!
The Asthma Outreach service and the Health service Journal awards
Our innovative Out of Hospital Children’s Asthma Service was successfully shortlisted against national competition from health
service, Local Authorities and private sector companies in this year’s prestigious Health Service Journal’s awards. The service was
one of just eight projects shortlisted in the Enhancing Quality and Efficiency in Services for children and young people category.
41
The team and a parent of a child cared for by them attended the evening at the Grosvenor Hotel in London to hear presenter
Jeremy Vine announce the winner. Sadly, they did not win. However, the service received high profile coverage in the Health
Service Journal’s special awards supplement.
The team provides 24 hour a day access to support, advice and specialist home nursing for children with asthma and their families.
Using telephone triage and home visiting by registered nurses, the service empowers children, young people and their families to
manage asthma at home, in turn preventing unnecessary attendance at A&E or admission to hospital and thus improving their
attendance at school and social activities. This service has been very well evaluated by children and their parents.
As yet, information regarding the numbers of admissions actually avoided during 2010/11 is anticipated by May 2011.
42
New Service for Women with Post Natal Depression (Perinatal Emotional Wellbeing Service)
‘More than 70% of all new mums feel down at some point and it’s not just something that happens once your baby is born. These
feelings can start at any time during your pregnancy and can affect different people in different ways’
In October 2010, a new service was launched for women with post natal depression, in line with NICE (2007) Guidance. This
service is provided by a team of experienced mental health professionals including: three mental health nurses, a person-centred
counsellor, an emotional wellbeing assistant practitioner, occupational therapist and a midwife. The service is provided within
community clinics or at home.
The perinatal emotional wellbeing service has been developed as the pathway to support positive emotional wellbeing for all
women during their pregnancy and the after the birth of their baby (postnatal period), assisting them to maintain their mental health
to a degree where they are able to continue to provide care for their babies, either independently or with the support of carers.
The service provides a single point of access for two groups of women:
For those with no history of mental illness, there will be improved monitoring and assessment antenatally to improve identification of
women who are most at risk of developing depression according to established risk indicators including social status, age, domestic
abuse, financial status, substance misuse, number of children and increased antenatal anxiety. It is anticipated that improved
assessment and screening will result in early detection and intervention in order to reduce the impact of a mental health problem on
the woman, her partner and the infant.
In addition, the service can also provide support to women who have a personal or family history of emotional and mental health
problems. These women will be offered pre-conception advice or immediate advice following confirmation of pregnancy. As it is
known that this group of women are much more likely to develop mental health problems during pregnancy or following the birth of
their baby, these women will be monitored throughout their pregnancy and up to the first year following the birth of their baby.
Further information can be obtained by accessing the ‘baby blues’ website: www.babyblues.nhs.uk
43
The Workforce
Developing the Workforce to enhance Patient Care
Community Healthcare employs approximately 900 staff, which is made up of nursing, allied health professionals, medical, dental,
administrative and management staff. Our workforce strategy is to contribute to achieving the Community Healthcare vision and
objectives by working with our staff, volunteers, contractors and partners to ensure we recruit, train, develop and retain a workforce
with the capability and capacity to provide excellent healthcare to our patients and deliver service reforms and improvements.
Key areas of achievement from the Workforce Strategy in 2010/11 are:
44
•
•
•
•
•
significant improvements in communication and staff engagement, including a full communications programme to support
the formal consultation with staff regarding the proposed transfer of Community Healthcare services and staff to SEPT;
improvements in the health and wellbeing of staff, including the development of a Wellbeing Policy, and a significant
reduction in staff sickness absence;
improving the take up and accessibility of statutory/mandatory training through the successful implementation of E-Learning;
improving operational management capability through the development of an internal Leadership Programme which
incorporated the attributes of a successful leader, project management, LEAN methodologies, changing behaviours and
workforce planning. In total 33 employees attended the course which took place over 4 cohorts, delegates were asked to
work on a project focussing on a real life service challenge with the potential for it to be taken forward by the Trust.
Attendees were nominated as they are seen as leaders of the future by their line managers;
Four senior managers accessed the Aspiring Directors and Senior Clinical Leaders Programme, which covered personal
impact and agility, strategic understanding, leading change and influencing and results orientation.
45
Review of Quality Performance 2010/11
Statements from Third Parties
1.
Primary Care Trust Commissioners
NHS South East Essex (NHS SEE) welcomes the opportunity to comment on the Quality Account prepared by South East Essex
Community Healthcare (CHC). NHS SEE remains responsible for the CHC until its planned transfer to the preferred acquirer,
South Essex Partnership NHS Foundation Trust (SEPT). As the commissioner of services NHS SEE also has the following
statement to make for inclusion in the CHC Quality Account.
To NHS SEE knowledge, the information contained in the Account is accurate and reflects a true and balanced account of the
quality of the provision of services.
NHS SEE meets monthly with the CHC service to review all areas of patient safety, experience and clinical effectiveness and is
working with the service to provide evidence at these meetings of the ongoing improvements in quality to assure NHS SEE in its
role of the commissioner and its accountability for the monitoring of quality in the services it is commissioning.
CHC has noted that they provide forty seven NHS services and NHS SEE can confirm that they regularly report on their progress
and improvement against goals and targets within these services.
The Quality Account clearly demonstrates the achievements made in 2010/11 in relation to CHC’s performance against priorities
and recognises that more work is required to improve the experience of patients receiving care in the trust. Consideration to
providing direct feedback quotes from patients, staff and stakeholders would be welcomed.
NHS SEE acknowledges and supports the efforts of CHC in achieving no cases of Clostridium difficile or blood steam infections
due to Methicillin Resistant Staphylococcus (MRSA) as part of their infection prevention and control compliance for this reporting
period. NHS SEE will also seek assurance of CHC’s compliance against all the elements of the Code of Practice for Infection
Prevention and Control within the Health and Social Care Act 2008.
46
CHC has indicated where the undertaking of national clinical audit in respect of continence, diabetes and pressure ulcers has led to
recognition that services can be improved and NHS SEE will take the opportunity to monitor progress on these areas in the contract
quality monitoring meetings through 2011/12. The service has agreed to work with NHS SEE in looking at the incidence of pressure
ulcers across the care pathway, working with the acute hospitals and care homes.
NHS SEE recognises that there is little opportunity in community healthcare for recruiting patients to participate in portfolio research
and will seek assurance from CHC that they are managing to make a contribution in this area.
NHS SEE welcomes the detailed explanation as to why some of the key performance indicators were not met in 2010/2011 and will
work with the service to support achievement of the required standards for 2011/2012, especially in relation to the work on breast
feeding.
NHS SEE notes the reference to the ‘Community Geriatrician Pilot’ and acknowledges how this project has led to a more
collaborative approach to the care of vulnerable older people in the community.
The service notes the Safeguarding needs of Vulnerable Adults as a key priority and NHS SEE will be seeking reassurance that
national and local Safeguarding procedures are in place, subject to audit and that the service is fully represented on local
safeguarding boards and committees.
NHS SEE will also wish to support the service in monitoring its compliance with the statutory requirements of the Mental Capacity
Act and Deprivation of Liberty Safeguards to ensure that vulnerable adults are supported in making decisions related to their care
and treatment.
NHS SEE notes the detailed description of the services for children and again will seek assurances of the services continued
compliance with the statutory requirements for safeguarding children.
NHS SEE will work with the service to ensure the areas noted in the patient satisfaction feedback are fed into service
improvements. It would be useful to understand how the service is intending to gain feedback on the experience of the harder to
reach groups who receive services in the community.
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CHC was part of the Care Quality Commission (CQC) registration for NHS SEE and will be formally de-registered from NHS SEE
on completion of their transfer and registration with SEPT.
CHC staff continue to demonstrate a collaborative approach to producing evidence and assurance for the quality of services
provided at the monthly quality monitoring meetings undertaken with NHS SEE.
The Quality Account gives a good reflection of the services’ achievements for 2010/2011 and the service has been clear where
they believe there is room for improvement.
NHS SEE is fully supportive of all the priorities identified by the service in taking forward the patient safety and experience and
clinical effectiveness agenda and looks forward to working in partnership with the service whilst it remains a part of NHS SEE and
when it moves to the new arrangements under SEPT.
2.
LINks
The SE Essex locality of the Essex and Southend LINk has considered the SE Essex Community Services Quality Account 2010/2011. Our
response follows:
Members have attempted to judge the performance of Community Healthcare services in SE Essex from the experiences and outcomes of
patients and their carers. As we do not have the resources to perform a formal survey, members have performed informal surveys of the users
of these services using a variety of contacts across south east Essex. We estimate we have talked with approximately 30 people during the
course of 2010/2011 about their experiences of community healthcare services.
Members had performed a formal patient experience of discharge from general hospitals survey of south east Essex residents in 2009/2010.
The report was published in April 2010. The report is available at:
http://www.essexandsouthendlink.org.uk/wp-content/uploads/2010/05/Hospital-discharge-south-east-Essex-28-04-10-_final-report_.pdf
Our informal surveys in 2010/2011 confirmed the patient experiences of community healthcare services to be similar to those reported in
2009/2010.
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Members note that residents provided with on-going care were generally comfortable with their access to, and the quality of their healthcare.
The principal concerns noted were about the time of arrival of the care provider. We are pleased to comment that most residents who have
used Community Healthcare services have praised the quality of these services and their resulting positive outcomes. Many residents
commented that the individual healthcare provider was very pleasant and caring. The public has expressed particular satisfaction with the
outcomes from their experiences of the community health care podiatry service.
Members report that the consistent criticism of residents has been the availability of community healthcare services when these services were
promised by other NHS service providers, usually secondary care services. It appeared that the communication from the general hospitals to
community health services (and other services) was weak. Comments made have included the hospital care was fine. “Pity about what
happened afterwards”. “When I got home care ceased until I made a fuss”. These comments related to the promised provision of community
healthcare.
Members have received similar comments from patients and carers after patients had been discharged from the recently introduced “step-up”
facilities in south east Essex. We understand that the step up facility is being managed by the Southend hospital under contract from the
Primary Care Trust.
Members had expected to see more joined up care across health services and between community health services and social services. Some
members of the public we have met have expressed concerned that community health services and social care services are delivered in “silos”,
and their experiences of care services delivery does not appear to consider the whole patient experience.
We are concerned that there are 20 priorities for the Community Healthcare, and we are aware that the NHS South East Essex five year plan is
to transfer appropriate care from secondary care to primary care. We are concerned that the Community Healthcare team will find it
increasingly difficult to deliver improvements to existing care, concentrating on eliminating health inequalities, and at the same time supporting
the transfer of care to primary healthcare services from secondary care. We note that the priorities include: “To provide services with a greater
emphasis on recovery for people with mental health problems”, and “To improve the physical health of people with mental health problems”.
We would like to see a specific priority to help improve the physical health of people suffering from dementia and their carers, in the light of the
likely increase in Community Healthcare workload associated with the projected increase in dementia in south east Essex.
3. Over View & Scrutiny Committees
No response received.
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