Quality Account
2010 – 2011
Contents
Page
Part 1
1.1 Statement from Joint Director of Service Delivery
1.2 Statement of Accuracy
1.3 Glossary
Part 2
2.1 Care & Support Swindon
2.2 Quality & safety priorities
2.3 Vision & Values
2.4 Improving quality through partnership
2.5 Looking forward
2.6 Quality Improvement plan for 2011 - 2012
2.6.1improving recording of incidents
2.6.2 Quality & patient safety improvement programme
2.6.3 Privacy & dignity
2.7 Statutory Statement of Compliance
2.7.1 Participation in national audits
2.7.2 Local audit
2.8 Information Governance
2.9 Statutory visits
2.10 Care Quality Commission Registration
2.11 Research
Part 3
3.1 Demographics
3.2 Looking back – achievements in 2010 – 2011
3.3 Patient safety
3.3.1 Clinical incidents
3.3.2 Incident reporting
3.3.3 Patient falls
3.3.4 Serious incidents
3.3.5 National Patient Safety Agency
3.3.6 Risk recognition
3.3.7 Reduction in venous thromboembolism
3.3.8 Health & safety
3.3.9 Supporting the workforce
3.4 Infection prevention & control
3.4.1 MRSA statistics
3.4.2 MRSA screening
3.4.3 CDiff statistics
3.4.4 Infection Control Audit
3.4.5 Outbreak management
3.5 Patient experience – PALS and complaints
3.5.1 PALS & Complaints statistics
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3.5.2 Parliamentary & Health Service Ombudsman
3.5.3 Compliments
3.5.4 Service user comments
3.6 Clinical Effectiveness
3.6.1 Stroke
3.6.2 Patient environment action team
3.6.3 Eliminating mixed sex accommodation
3.6.4 Patient experience
3.6.5 Learning disability review
3.7 Commissioning for Quality and Innovation
3.8 Compliance with NICE Guidance
3.9 Care Quality Commission continuous monitoring
3.10 Policy development
4.0 What others say about us
4.1 NHS Swindon Commissioners
4.2 Health Overview & Scrutiny Committee
4.3 Links
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5. Appendices
5.1 National Audit requirements – Department of Health
45 - 47
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PART 1
1.1 Joint Director of Service Delivery’s Statement
NHS Swindon and Swindon Borough Council have a strong history of
successful integration and partnership working which is based on the
fundamental principle of putting our residents at the heart of all we do.
Throughout the care we deliver and our work programmes we have
sought to keep this at the forefront of our delivery plans and remain
strongly committed to ensuring the best possible service to the people of
Swindon in the future.
Through 2010 - 2011, The Board, Senior Managers and Integrated
services within the front line teams have been working to deliver safe,
quality care for the people of Swindon, and this is reflected in our first
Quality Account.
Care and Support Swindon is an integrated model of health and social
care delivery and we are proud of the progress we have made against
our core objectives, whilst acknowledging that we have a challenging
agenda and there is no room for complacency. We know that there is a
lot of work to do and we shall need to continue to push ahead in the next
year to bring these to fruition.
We trust that this report helps demonstrate that we are listening to what
patients and carers are telling us; we have continued to deliver the
excellent infection control performance and we are committed to
monitoring and improving patient safety. We are also committed to
making patients, their families and the wider public, partners in the
delivery of health and social care in Swindon.
Our Quality Account establishes a baseline of safety and quality targets
against which we will monitor our progress in 2011-2012 and sets out our
vision for the future.
Ted Wilson
Joint Director of Service Delivery
25th May 2011
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1.2 Statement of Accuracy
STATEMENT OF DIRECTORS' RESPONSIBILITIES IN
RESPECT OF THE QUALITY ACCOUNT
The Directors are required under the Health Act 2009, National Health Service (Quality
Accounts) Regulations 2010 and National Health Service (Quality Account) Amendment
Regulation 2011 to prepare Quality Accounts for each financial year. The Department of
Health has issued guidance on the form and content of annual Quality Accounts (which
incorporate the above legal requirements).
In preparing the Quality Account, Directors are required to take steps to satisfy
themselves that:
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the Quality Accounts presents a balanced picture of the Trust’s performance
over the period covered;
the performance information reported in the Quality Account is reliable and
accurate;
there are proper internal controls over the collection and reporting of the
measures of performance included in the Quality Account, and these controls
are subject to review to confirm that they are working effectively in practice;
the data underpinning the measures of performance reported in the Quality
Account is robust and reliable, conforms to specified data quality standards
and prescribed definitions, is subject to appropriate scrutiny and review; and
the Quality Account has been prepared in accordance with Department of
Health guidance.
The Directors confirm to the best of their knowledge and belief they have complied with
the above requirements in preparing the Quality Account. By order of the Board
Michelle Howard
Board Chair NHS Swindon
Heather Mitchell
Interim Chief Executive
25th May 2011
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Glossary of terms
MRSA - Methicillin-resistant Staphylococcus Aureus, which is a common skin
bacterium that is resistant to a range of antibiotics.
Clostridium difficile – C diff. Is a bacteria naturally present in the gut
IP&C – Infection Prevention and Control
NPSA – National Patient Safety Agency - leads and contributes to improved, safe
patient care by informing, supporting and influencing organisations and people
working in the health sector.
VTE – Venous Thromboembolism – refers to a blood clot
NHSLA - National Health Service Litigation Authority – Handles negligence claims
and works to improve risk management
DoH – Department of Health
SHA – Strategic Health Authority – Manages the NHS locally and provides important
link between the DoH and the NHS
CQC – Care Quality Commission – Independent regulator of health and social care in
England
RCA – Root cause analysis – problem solving methods
CQUIN - The Commissioning for Quality and Innovation payment framework makes a
proportion of providers’ income conditional on demonstrating improvements in quality
and innovation in specified areas of care.
RIDDOR - The Reporting of Injuries, Diseases and Dangerous Occurrences
Urgent care is the delivery of ambulatory care in a facility dedicated to the delivery of
medical care outside of a hospital emergency department
Health Ambassadors help local people become healthier and more confident
Community matrons are highly experienced, senior nurses who work closely with
patients
Productive Community programme is an organisation-wide change programme
which helps front line teams in improving quality and productivity.
The Productive Ward focuses on improving ward processes and environments to
help nurses and therapists spend more time on patient care thereby improving safety
and efficiency
Integrated care pathways also known as clinical pathways, care pathways, critical
pathways, or care maps, are one of the main tools used to manage the quality in
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healthcare. Pathways promote organized and efficient patient care based on the
evidence based practice.
Care Bundles are an example of one tool to help ‘measure’ the application of good
evidence based practice. It is a tool that demonstrates that agreed standards are
equitable and applied to all patients. The theory behind care bundles is that when
several evidence-based interventions are grouped together in a single protocol, it will
improve patient outcome
Data Protection People handling personal information about individuals, have a
number of legal obligations to protect that information
STEIS is the Strategic Executive Information System. STEIS is a national database
which allows NHS users to report and view Serious Untoward Incidents
Control of Substances Hazardous to Health Regulations (COSHH) is intended to
protect people from ill health caused by exposure to hazardous substances.
PART 2
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2.1 Care & Support Swindon
Care and Support Swindon is the integrated Health and Social Care service provider
from NHS Swindon Community Services (for adults) and Swindon Borough Council
Social Care Provider Services.
During the last twelve months Care and Support Swindon has been working with
local partners to deliver care in an integrated manner which more closely considers
the delivery of care closer to home.
We provide a full range of home based community care services that deliver the best
possible care tailored to meet the needs of the individual. Demand for these services
is expected to rise with the increase in the number of people with multiple long term
conditions and the shifting of settings of care from hospital to community including
end of life care.
We have a proven record of delivering the highest quality service supporting people
to remain living independently in the community for longer. We are committed to
continue to build strong community teams that move care down the spectrum as far
as possible to reduce reliance on the highest cost health and social care services.
2.2 Quality and Safety Priorities
For this reason the priorities which are outlined in this report are broad and will
continue to be shaped by the formation of new organisational boundaries.
2.3 Vision and Values of our Service
The vision, ‘To provide the best Health and Social Care, when and where needed, to
live life well’ was developed after extensive engagement with staff. This then led to
the development of our values that underpin both individual expectations and the
organisational culture.
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We are passionate about delivering integrated, quality services
We take pride in what we do
We believe that teams add value
We believe in delivering value for our public’s money
We believe in valuing and supporting each other
We believe that skilled and motivated staff deliver quality services
The combined health and social care in-house services, employ more than 1,000
staff, from a variety of professional backgrounds, including District Nurses, Social
Workers, Learning Disabilities Staff, therapists including Occupational,
Physiotherapy, Speech and Language, Podiatry, Doctors, Care Workers and
Specialist Nurses plus all the staff who deliver care in Day Care and Supported
Employment settings.
The services are currently organised into three areas that broadly reflect the
responsibilities associated with each service e.g. urgent care, intermediate care and
community care. Promoting independence and self management through
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personalisation underpins all of our services and our aim is to help individuals to be
the best that they can be and live life well.
The services are mainly community-based, providing services close to or in people’s
own homes or in local community premises. We currently operate from nineteen
community sites and our inpatient intermediate care unit across our core catchment
area of Swindon
2.4 Improving Quality through Local Service Partnerships
Over the past three years NHS Swindon and Swindon Borough Council have steadily
improved the quality and range of the services being provided in Swindon. As a result
there are more opportunities for people to live independently. NHS Swindon and the
Council are planning more changes to the delivery of services over the next three
years which will enable people to have more choice.
The Care Quality Commission inspection of older people services in 2009 found that
older people living in Swindon had good support from their adult care services.
People benefit from health and social care services which are joined up which means
decisions are made quickly and services are holistic, meeting the complete needs of
people who need support.
Building on this work NHS Swindon and the Council have put in place a number of
initiatives to promote healthy and active lifestyles. One example has been the use of
health ambassadors in communities where health needs are more pronounced.
Support services in the community have helped to keep people who are ill at home,
rather then being admitted to hospital. Community matrons have been successfully
supporting families and providing access to services.
The inspection of older people’s services found that NHS Swindon and the Council
were making good progress with end of life care.
NHS Swindon and the Council are working collaboratively to increase support for
carers through their shared strategy. There is also a plan for greater investment in
telecare and telehealth technologies to enable people to live at home safely and call
for help if they need to.
Care and Support Swindon as part of NHS Swindon has core services based on
three areas of delivery, Urgent Care, Intermediate Care and Community Care.
Through this model of service they offer high quality, fully integrated health and social
care services resourced internally and through strong partnerships with other
providers, the 3rd sector and local communities.
The service is based on a coordinated pooled resource with generic and specialist
skills coordinating all community care. While the benefits of mobile working have not
yet been fully realised, productivity increases have been achieved through the
implementation of the Productive Community programme releasing more time to
care.
Care and Support Swindon provide a comprehensive range of intermediate care
services from specialist inpatient rehabilitation for stroke and neurological conditions
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to home based reablement service. The Swindon Intermediate Care Centre is the
largest bed based rehabilitation unit in the South West. Through the implementation
of the Productive Ward programme we have significantly reduced the length of stay
to 21 days. This has resulted in increased business from other commissioners
outside Swindon.
The community rehabilitation service ensures that people who do not need to be in
an inpatient setting can access rehabilitation in the community. We have recently
integrated the community rehabilitation team with the Crisis support team to better
support people requiring rapid access to intermediate care services and to streamline
leaner processes to reduce delays. Quicker access to services improves people’s
outcomes and reduces dependency on long term support.
The benefits of the service model are achieved by service design along as much of
the integrated pathway as possible:
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using one set of common processes,
using a more generic and multi-skilled workforce managed and coordinated as
a resource pool that is flexible, located closer to peoples homes and ‘wraps
around’ the person,
using one set of agreed outcomes for the person, that is linked to one budget
and set of financial incentives, and that maximizes the opportunities of fast
access to resources for preventative interventions,
promoting a culture of service delivery that is consistently personalised,
focussed on prevention and motivated to engage communities in their own
care, and
Working with our Commissioners we are currently exploring working as partners, and
this new way of working should allow for a broader service to be delivered to people
who require support.
2.5 Looking Forward – The Next 12 Months in Swindon
The next 12 months promise to be no less challenging and interesting than the last.
We and our partners in local health and social care delivery are currently consulting
with the people of Swindon on the way services shall be provided in the future.
We are also consulting on a new organisational format which will potentially be in
place by 1st October 2011, and some services will have begun to change towards
that new organisational structure during the latter part of 2010.
Whatever the outcome, the closer working relationships which have been developed
during the last 12 months to improve patient care will become even stronger. Safe,
quality cost-effective services can only be delivered in a co-ordinated and cooperative way and this is well recognised by the organisation and our partners.
In an economic climate which dictates even closer scrutiny of every penny spent, it is
vital that the patient remains at the centre of any care delivered, and this remains our
focus. We intend to do this whilst continuing to focus our attention on the services
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around that person, and to reduce duplication and unnecessary steps which can lead
to poorer care and increased cost.
The organisational form which evolves from the consultations and the economic
climate will create a need to more clearly define the key priorities within the next 12
months.
2.6 Quality Improvement Plan 2011 - 2012
Within its plans, Care and Support Swindon sets out that the provision of safe, high
quality patient care is a high priority.
The quality and safety plan explains the key measures against which the
organisation will assess that its objectives are being met. Delivery of these plans will
provide both internal and external assurances that robust clinical governance
structures and systems are in place, monitored and appropriately managed and that
there is a continuous drive to improve the quality of care provided for our patients.
Care and Support Swindon’s aim is to set out a clear quality improvement plan
building on current local and national quality improvement initiatives to meet the it’s
quality and safety objectives and provide the safest and most effective care to
enhance the patient experience.
Care and Support Swindon proposes the following priorities for quality improvement:
1.
2.
3.
4.
To improve patient safety and reduce harm
To deliver effective, evidence based care
To improve the patient experience
To comply with governance and regulatory obligations
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The following areas for reporting on quality performance and improvement within the
four priorities have been identified:
Priority Area for Quality
Proposed quality measures
Primary Drivers
Improvement
To improve patient safety
and reduce harm
To deliver effective,
evidence based care
Reduce acquired infection
 MRSA bacteraemia
 Clostridium difficile infection
 Catheter associated urinary
tract infections
Reduce harm associated with
incidents
 Reduce Grade 3 and Grade 4
pressure ulcers
NPSA – reducing avoidable harm to
patients
 Medication errors
 Recognition and rescue of the
deteriorating patient
Compliance with VTE guidance and
action plan
Compliance CQC registration
Improve the Quality and Risk profile
CQC regulations and registration
NHSLA acute standards – work
toward Level 1
Staff survey
CQC regulations
Commissioning contract
CQC regulations
Commissioning contract
CQC regulations
Commissioning contract
CQC regulations
Commissioning contract
Compliance with Central Alert System
Patients treated with dignity and
respect
PEAT Assessment
To comply with governance
and regulatory obligations
SW Quality and Patient Safety
Improvement Programme
CQC
Commissioning Contract
Local priority
NPSA – never events
Commissioning contract
Local priority
CQC regulations
CQC regulations
Regional and commissioning
contract
National priority
National and local priority
CQC regulations
Commissioning contract
National and local priority
CQC regulations
Commissioning contract
CQC regulations
Regional and commissioning
contract
National priority
Picker survey
NPSA
CQC regulations
Health Act
Commissioning contract
Local priority
CQC regulations and registration
Compliance with NICE guidance
To improve the patient
experience
DH
CQC regulations
Commissioning contract
Local priority
Mental Health/Capacity
Vulnerable adults
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2.6.1 Improving patient safety
The Quality and Risk Teams are supporting the continued development of the team
leaders in Care and Support Swindon to enable them to better support staff in all
aspects of safety including the reporting and management of incidents and using the
learning outcomes to improve services.
With the introduction of an online reporting system for incidents they will be improving
the way that information is made available to teams so that teams are able to see
trends that need to be addressed. They will also be training staff and supporting the
investigation of incidents and complaints using the Root Cause Analysis methods,
which help to clearly identify system failures and support the improvement of these
systems.
Training sessions will be delivered to staff and team leaders and support will be
offered when required. Monthly reports will be delivered to each of our service leads,
trends and issues will be highlighted and actions identified.
The Quality and Risk Teams will continue to produce newsletters and local
information sheets to highlight areas of good practice and lessons learned, to other
services. All such lessons will also be shared through the clinical governance
meetings across the services. In liaison with the Infection Control Team and our
service partners we will ensure we learn lessons from incidents which occur and use
our learning to further improve the safety of patients, their families, the general public
and our own staff.
A new Clinical Governance Forum has been established led by the Medical Director
of Care and Support Swindon which meets monthly to discuss all patient focussed
issues such as incidents, risks and complaints. Through this forum action plans are
monitored and key areas of concern discussed by clinicians and other members of
staff.
2.6.2 Quality and Patient Safety Improvement Programme
In 2010 – 2011 Care and Support Swindon teams have joined the South West
Strategic Health Authority, Quality and Patient Safety Improvement Programme. The
local teams will start to examine ways of enhancing current safety methods and
introducing new safety initiatives:
The programme is wide covering both acute hospital and community focus, which is
to improve the health and well being of the Swindon population.
Aims of the programme:
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Reduce mortality rates – by 15%
Reduce adverse events – by 30%
Develop and build a culture of patient safety and quality improvement
Build long term sustainability through increased capacity and capability for
improvement in all levels
Build on existing work and integrate other national and local initiatives into a
coherent whole
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Achieve 95% reliability in all care processes indentified in the programme
For Care & Support Swindon the clinical areas to be focused on are:
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Falls
Pressure Ulcers
Catheter associated urinary tract infections (CAUTI)
Venous Thromboembolism (VTE)
Medicines management
Recognition and rescue of the deteriorating patient
The team from Care & Support Swindon including clinicians, support staff, managers
and clinical governance representatives has attended improvement programme
sessions in Bristol. The team are now working on taking forward the programme
within Swindon, sharing the learning across services to improve the quality and
safety of the care we are providing. This programme is aimed at trusts across the
South West Strategic Health Authority working supportively and learning from each
other to improve care for people. As an organisation we have been able to share with
other trusts the developments around competencies which we have made whilst
implementing the national Venous Thromboembolism guidance.
An important part of this programme is to link with existing groups working on the
above topics, to build on local expertise and further develop areas of good work. The
programme uses the simple methodology of Plan Do Study Act (PDSA) to try out
ideas to improve practice and work towards meeting the specific targets below.
Specific targets:
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Reduce serious injury from Falls - by 50%
Reduce grade 3 and 4 pressure ulcers – by 30% in the community
Reduce catheter associated urinary tract infections – by 50%
95% of in patients to have a documented risk assessment for VTE
95% of patients assessed to be at risk of VTE to receive appropriate
prophylaxis
95% of patients have medication reconciliation within 24hours of admission
95% of patients to have observations and early warning score completed
Swindon will be required to report back to the South West Strategic Health Authority
on progress with the programme, using examples of PDSA cycles that have been
undertaken.
Locally teams will report into the Clinical Governance and Patient Safety Forum, and
the Joint Professional Forum on progress.
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2.6.3 Privacy and Dignity
NHS Swindon has updated the Privacy and Dignity Policy. This policy reflects the
way in which we would like to care for the people who use our services so that they
receive a positive experience. Privacy and dignity is complex and covers many areas
of quality.
To assure that care is being provided in a way that respects users as individuals, a
Privacy and Dignity audit is being undertaken across services. There are a number of
benefits of undertaking an audit:
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To demonstrate that we respect the privacy and dignity of the people we
provide care for
To demonstrate that we adhere to our policy for privacy and dignity
To identify any changes that we may need to be make in response to the
results of the audit
To have the opportunity to improve our services in any subsequent action
plans resulting form the audit
There will be evidence available to external monitoring bodies such as the
Care Quality Commission
A peer review observational audit allows the observers to share learning.
It is proposed that this audit will be across as many services as possible and will
include both health and social care. The audit commenced early 2011 and so far
Swindon Intermediate Care Centre and two care homes have been visited.
2.7 Statutory Statements of Compliance
2.7.1 Participation in National Clinical Audits
During 2010 - 2011 the Department of Health listed 54 national clinical audits in
which provider organisations were invited to participate. This list can be seen at
Appendix 1. Care and Support Swindon participated in two audits that related to
services provided. These were the National Falls & Bone Health Audit and the
National Sentinel Stroke Audit. The latter was in collaboration with the Great Western
Hospitals NHS Foundation Trust. Data collection was completed during the year and
the number of cases submitted as a percentage of the number cases required by the
terms of the audit is stated in the table below:
Audit Name
National Falls & Bone Health audit
National Sentinel Stroke audit
% of cases submitted
100
100
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2.7.2 Local Clinical Audits
In 2010 -2011 50 audits were planned to be undertaken. The following graph shows
the number of audits actually undertaken or in progress:
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18
Completed
In Progress
4
4
Continuing
Stalled
A number of the audits undertaken were re-audits and these are shown below
together with the improvements in outcomes in the table below:
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Audit Title
Clinical and Cost
Effective
Prescribing of
Oral Nutritional
Supplements
Date of
initial
audit
Dec 2009
Medication chart
Jul 2009
audit in Swindon
Intermediate Care
Centre
Clinical Records
audit
Jan 2010
Wheelchair
service survey
Oct 2009
Audit of
management of
VTE within
SwICC
Sep 2010
Audit Findings
Recommendations
Date
of reaudit
Dec
2010
Improvement in Outcomes
1. Standards were not being met
2. Nutritional screening tool was
not being used
3. Cost of prescribing could be
reduced by following NICE
guidelines
Prescribing practice poor, new
drug chart implemented
All health professionals
within GP Practice to have
education package by
Community Dieticians
New audit tool updated to
meet the requirements of the
new drug chart
Nov
2010
Amended records policy,
NHS Number Project
including electronic records.
Records Management
training. Monthly auditing.
Updating documents to
include NHS Number on both
sides of document
Length of waiting lists and
Reduce waiting lists.
information given.
Circulation of information
booklet
Patient information regarding
Patient leaflets to be
VTE information was not
designed. Staff training to be
available. Anti-embolic stockings implemented and audit tool
should be fitted and monitored by to reflect NICE Guidance
trained health professional
with explicit standards
Oct
2010
Prescriptions such as:
anticoagulation/ antibiotics/
intravenous fluids and regular
medications are all consistently
prescribed with the date, dose,
route, and frequency.
50% of services audited to
date. Actions implemented on
monthly basis and
improvements made for NHS
Number.
Many areas below standard
required in particular NHS
Number
1. More than 50% improvement
when meeting standards.
2. Cost savings of up to 39% of
six monthly budgets.
Feb
2011
Both areas have improved.
Jan
2011
Compliance rose to 100% for
nearly all areas expect for
patient information on
admission which was 84%.
The following two audits were undertaken but re-audit was not possible as the service was transferred to The Great Western Hospitals
NHS Foundation Trust. These produced some good recommendations and re-audit would occur at The Great Western Hospitals NHS
Foundation Trust.
Audit Title
Audit of consent
policy
Bladder
Assessment in
Patients with MS
Date of
initial audit
Jan 2010
Sep 2010
Audit Findings
Recommendations
Documentation was not standardised, identifiers
not on both sides of document. Staff signatures
are required
Lack of documentation as to Bladder Assessment
or even discussion with patient. Patient
information
Improve documentation and
undertake staff training.
Ensure that any Bladder and Bowel
issues identified in Multiple Sclerosis
patients are documented. Patient
information leaflet specifically for
Neurology patients. To include all
recommendations in induction
training to new staff.
Date of reaudit
Jan 2011
Nov 2010
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2.8 Information Governance
Information Governance is to do with the way organisations ‘process’ or handle
information. It covers personal information, i.e. that relating to patients/service users
and employees, and corporate information, e.g. financial and accounting records.
Information Governance provides a way for employees to deal consistently with the
many different rules about how information is handled, including those set out in
various Acts, the Data Protection Act 1998 for example, and other Codes of Practice
such as the Confidentiality NHS Code of Practice.
The Information Governance Toolkit is a performance tool produced by the
Department of Health. It draws together the legal rules and central guidance and
presents them in one place as a set of information governance requirements.
Organisations are required to carry out self-assessments of their compliance against
the Information Governance requirements according to services provided.
The assessment enables an organisation to measure their compliance against the
law and central guidance and to see whether information is handled correctly and
protected from unauthorised access, loss, damage and destruction.
The Information Governance Toolkit version 8 was released in July 2010. Although
the number of requirements reduced to 41, criteria and evidence expectations have
been raised considerably and this combined with new scoring methodology has
made it difficult to achieve compliance.
The predicted year end submission indicates four key areas of weakness that
contribute towards not achieving Level 2 scores in all of the requirements. The
themes are:
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Lack of Service responsibility and Engagement
Staff training
Inconsistent Records Management practice
Information Security
Final Information Governance Toolkit submission assessment scores reported by
the organisation are used by the Care Quality Commission to risk assess outcome
21 - records (and other standards as appropriate) of Essential standards of quality
and safety therefore it is most relevant that Care and Support Swindon ensures all
services can demonstrate compliance with Information Governance requirements in
order to be compliant with outcome 21.
The predicted overall end of year score for the whole organisation is 62% which is
deemed to be ‘unsatisfactory’.
To address the areas of weakness a proposed set of actions have been established
that require service engagement that will contribute towards strengthening practices
across all relevant services and enable Care and Support Swindon to be assured it
has appropriate measures in place to protect identifiable and business information.
This will be monitored through the sub-board Audit and Assurance Committee
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2.9 Statutory Visits
Care and Support Swindon has received no formal inspection visits by the Care
Quality Commission in 2010 -2011.
2.10 Care Quality Commission Registration
Care and Support Swindon is required to register with the Care Quality Commission
and its current registration status is: ‘Registered without conditions’. The Care
Quality Commission has not taken enforcement action against Care and Support
Swindon during the period between April 2010 and March 2011.
2.11 Research
The number of patients receiving NHS services provided by Care and Support
Swindon April 2010 to March 2011 that were recruited during that period to
participate in research approved by a Research Ethics Committee was nil.
20
PART 3
3.1 Demographic Profile
Swindon sits in the very north east of Wiltshire, surrounded by a largely rural area.
NHS Swindon serves a population estimated at around 198,300 people, which
includes the town of Shrivenham which
lies outside of the Swindon Borough
Resident Population of Swindon Borough by Sex and Age in
mid-2009
Council Boundary and the surrounding
M
ale
population
=
99.4
thousand,
female population = 99.4 thousand
villages
No of People by Sex in Thousands
9.0
8.0
It has a long industrial history and
7.0
remains a centre for businesses such as
6.0
the motor industry and financial
5.0
services.
4.0
Over the last 20 years Swindon has had
3.0
a track record of growth, at one stage
2.0
being the fastest growing town in
1.0
Europe. This has resulted in a large
0.0
number of people age between 50 and
65 (in 2010), many of whom who are
Age-Group in Years
likely to start needing support over the
Males Females
Source: ONS
next 10 to 14 years. Despite the recent
recession and removal of specific regional housing requirements, Swindon’s
population is still expected to grow further by potentially 1% a year for the next few
years.
'0
'1-4 '5-9 '10- '15- '20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80- 85- 90+
14 19 24 29 34 39 44 49 54 59 64 69 74 79 84 89
The last reliable figures for BME (Black, Minority and Ethnic) populations were in the
2001 census. It is apparent from school records and the numbers of people
interacting with public services, that the 4.8% figure in the census no longer
represents the true picture of diversity in Swindon and current estimates place the
true BME population at around 11%.
Swindon is often cited as ‘the average town’ and many health statistic and
prevalence rates reflect this description. However, one area where Swindon is
showing one of the highest growth rates in the country is in the number of older
people.
The primary care trust has indicated that the take-up of private health insurance is
on the decline in Swindon and this may lead to an increase in demand for NHS
services such as dentistry and opticians, as well as other services when people age.
This means that not only is demand growing, but the complexity of cases faced by
both Health and Social Care is rising rapidly. This combination of increased demand,
greater levels of need and the drive to support people to be more independent,
means that conventional settings for, and approaches to, care are no longer viable
or sustainable.
21
3.2 Looking Back - Our Achievements 2010 - 2011
People living in Swindon benefit from the integrated services across health and
social care which are forward looking, innovative and well run. There are strong
partnerships between the different agencies and the private sector. For people
receiving adult social care services there are particular benefits from having an
integrated structure between the council and primary care trust. The director of adult
social care is also chief executive for the primary care trust and many of the posts
across the organisations are joint appointments. In general people receive seamless
services as many of the teams delivering care and support are joined up.
At the outset Care and Support Swindon sets as its vision ‘to be recognised by the
local and wider communities as the health and well-being services provider of
choice.’ With a mission ‘to deliver high quality, safe and sustainable health and well
being services tailored to meet the needs of our local community.’
This vision puts Care and Support Swindon and our partners NHS Swindon and
Swindon Borough Council at the forefront of local work taking place to ensure that
Swindon is a happy, healthy, prosperous community and an attractive place to live
and work. We are continuing to work to integrate health and social care services,
placing our residents at the heart of all our work. In addition, we are working with
the wider community to improve life for people across the area.
Ensuring high quality service delivery is dependent on our strong partnerships with
other providers, The Great Western Hospitals NHS Foundation Trust, Avon and
Wiltshire Partnership Mental Health Trust, and a wide range of NHS, Independent
and Third Sector providers across the health community.
3.3 Patient Safety
Patient safety is a high priority for the staff of Care and Support Swindon and as part
of Clinical Governance across the organisations the Risk and Quality Teams support
managers to enable them to better support all staff in the reporting and management
of incidents.
3.3.1 Clinical Incidents
A Clinical Incident is defined as any unintended or unexpected incident, which could
have or did lead to harm for one or more patients receiving NHS funded healthcare.
For example Clinical Incidents may include unexpected death of a patient, a patient
fall, and incidents involving medical equipment, patient identity and confidentiality
issues to give a few examples.
Clinical incidents are reported for the primary motive of identifying weakness in
systems with the intention of improving the quality of clinical practice to reduce risk.
Clinical incidents can cover anything related to diagnosis, treatment and outcome for
the patient. Sometimes they may be referred to as an adverse event, medication
incident, critical incident – the generic term is Clinical Incident. Clinical Incidents
22
happen on a daily basis and most of them cause little or no harm however, all events
including those with a potential to cause harm are reported.
3.3.2 Incident reporting
There has been a consistent level of incident reporting by Care and Support
Swindon Services, with the majority of those reported being clinical incidents and a
high proportion of these being patient falls.
Reported Incidents by Category April 2010 to March 2011
180
Violence/abuse/harassment
160
Vehicle
140
Staff ill health
120
Staff Injury, accident
100
Security - theft, loss, building
Security - information
80
Other
60
Fire
40
Equipment
20
Clinical - no harm
0
Clinical - harm caused
Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11
During the same period there has also been ongoing training delivered by the risk
team, to enable electronic (on-line) incident reporting.
All reports of violence/abuse or harassment are copied to the Local Security
Management Specialist who responds directly to the affected staff and works closely
with the risk team to ensure that risks are assessed and managed appropriately.
The following chart demonstrates that there are three key areas of care in which the
majority of incidents occur. These are:
1. Patient accidents – falls
2. Access/Admission/Transfer/Discharge
3. Pressure area care – with resultant pressure ulcers
Patient Safety Incidents by Cause April 2010 to March 2011
180
160
140
Pressure Sore
120
Patient Accident
100
Patient Abuse
80
Medication Errors
60
Medical Device / Equipment
40
Infrastructure (including Staffing,
Facilities, Environment)
Infection Control
20
0
Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11
Implementation Of Care And
Ongoing Monitoring
Documentation
23
Since April 2010, all providers of health services have been required to report grade
3 and 4 pressure ulcers as serious incidents. These were reported to the Strategic
Health Authority via the Strategic Executive Information System (STEIS) which is a
Department of Health requirement and investigated using root cause analysis. The
risk team has been working collaboratively with Tissue Viability Nurses from the
community and acute settings. The wider clinical teams, along with the risk team
have also been participating in a regional patient safety improvement programme
with the Institute for Health Improvement and the South West Strategic Health
Authority.
It should be noted that whilst there has been increased reporting of pressure ulcers,
this also reflects a greater focus on the recognition of pressure ulcers and is coupled
with an ongoing education programme being led by the Tissue Viability Nurses. The
regional programme leads stressed the likelihood of increased reporting before an
eventual reduction in the likelihood and severity of pressure ulcers.
The reduced number of reports for February 2011 represented the number received
at the time of writing the report; however, this number may increase due to a number
of delayed reports which managers are investigating.
Early recognition of pressure damage is important in the overall management of skin
integrity. This is because early intervention, or better still, prevention, reduces the
risk of severe damage. It should also be noted that not all pressure damage is
preventable, depending on a number of risk factors that may affect patients.
Reported Pressure Ulcers by Severity 2010/2011
40
35
30
25
20
15
10
5
0
Category 4
Category 3
Category 2
1
r-1
Ma
1
b -1
Fe
-1 1
Ja n
0
c -1
De
0
v -1
No
0
t -1
Oc
0
0
p- 1
Se
g- 1
Au
Jul
-1 0
-1 0
Ju n
0
y -1
Ma
Ap
r-1
0
Category 1
3.3.3 Patient Falls
Patient falls represents the greatest number of incident reports submitted; however
there has been a downward trend in the number of reports during this period. The
24
clinical teams are also focusing on falls as part of the patient safety improvement
programme.
Falls by location at SwICC April 2010 to March 2011
40
35
35
33
30
28
25
28
21
20
Forest
25
24
Orchard
22
21
Ground Floor
19
16
14
15
15
13
15
14
12
10
Linear (Forest)
15
13
14
Linear (Orchard)
10
7
5
4
Fe
1
r-1
Ma
b-1
1
1
n -1
Ja
0
c -1
De
0
v -1
No
0
t- 1
0
p -1
Oc
Au
Se
g -1
0
l- 1
0
Ju
0
n -1
Ju
0
y -1
Ma
Ap
r-1
0
0
The chart shows that the majority of falls results in no or low harm and the aim of the
focus group is to lead the teams on achieving a reduced number of falls that result in
severe harm – this could be defined as resulting in a major fracture (e.g. fractured
neck of femur or head injury)
Falls by Severity April 2010 to March 20111
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0
Severe
Moderate
Low
Ma
r -1
1
Fe
b-1
1
Ja
n-1
1
De
c -1
0
No
v -1
0
Oc
t- 1
0
Se
p -1
0
Au
g -1
0
Ju
l- 1
0
Ju
n-1
0
Ma
y -1
0
Ap
r-1
0
No harm
25
3.3.4 Serious incidents reported to the Strategic Health Authority.
Serious incidents in healthcare are uncommon but when they occur Care and
Support Swindon has a responsibility to ensure there are systematic measures in
place. Managers and staff want to ensure that when a serious event or incident
occurs, there are systematic measures in place for safeguarding patients, property,
NHS resources and reputation this includes responsibility to learn from these
incidents to minimise the risk of them happening again.
When a serious incident occurs it can have a devastating and far reaching effect. It
may have an impact on those directly involved, patients, relatives, staff or visitors,
and also on the reputation of the organisation, the service or the profession within
which the incident occurred, and the wider community as well as the NHS.
During the period April 2010 to March 2011 there were 15 serious incidents that
were reported to the Strategic Health Authority via the Strategic Executive
Information System (STEIS.)
These consisted of the following:
 8 occurrences of pressure ulcers – grade 3 or 4 which were reported across
the health community.
 2 Norovirus outbreaks resulting in a ward closure
 1 Clostridium Difficile death
 1 MRSA Bacteraemia
 1 injuries sustained during respite care
 2 unexpected deaths
All serious incidents have been investigated and root cause analysis reports are
reviewed by the Clinical Governance Commissioning Forum and NHS Swindon
Board prior to closure and sign ff by the South West Strategic Health Authority.
Learning from these incidents is shared across the health community.
3.3.5 National Patient Safety Agency
The National Patient Safety Agency defines a patient safety incident as any
unintended or unexpected incident which could have or did lead to harm for one or
more patients receiving NHS care.
Care & Support Swindon reports all incidents which relate to patient safety to the
National Patient Safety Agency via the Reporting and Learning System on a weekly
basis. The organisation maintains a good level of reporting being the 7th best out of
a South West total of 40 organisations in reporting incidents – an indicator of a
healthy safety-conscious culture. There were 1247 incidents reported between 1
April 2010 and 31 March 2011, this compares to 1213 incidents in the previous year.
Reporting of incidents have been uploaded in a timely way, within 27 days,
compared with 57 days being the median time for reports to reach the NPSA across
the cluster.
26
The NPSA organisational report demonstrated a favourable comparison with other
organisations in the cluster as seen in the graph below.
160
140
120
Swindon
27 days
100
80
60
40
20
0
Positive feedback on the quality of data supplied to the Reporting and Learning
System confirmed that from the information taken from incident reports
demonstrates most incidents cause no or low harm to patients as shown in the
graph below.
Degree of Harm
90.0
80.0
77.7
70.0
60.0
50.0
40.0
30.0
17.4
20.0
10.0
4.0
0.0
0.9
Severe
Death
0.0
None
Low
Moderate
27
3.3.6 Risk recognition and assessment
There has been a continued and ongoing process of risk assessment, related to new
or changing work streams that have directly affected patient care. These have been
placed on the operational risk register and escalated to Directors as appropriate. An
ongoing process of review and archiving of risk assessments is in place.
3.3.7 Reduction of Venous Thromboembolism
Venous thromboembolism is a significant international patient safety issue. In
January 2010 NICE Clinical Guidelines 92 was published. This national guidance
relates to reducing the risk of Venous Thromboembolism (deep vein thrombosis and
pulmonary embolism) in patients admitted to hospital. Quality standards have been
established which cover all parts of the care pathway for the prevention and
management of venous thromboembolism.
Within Swindon, there has been close working arrangements between Care and
Support Swindon and Great Western Hospitals NHS Foundation Trust to have a
shared approach to delivering high-quality care to patients for preventing and
managing venous thromboembolism.
A community venous thromboembolism group has been established, the hospital
venous thromboembolism nurse specialist attends the meetings, and a Care and
Support Swindon service representative attends the hospital thrombo-prophylaxis
group. This has helped to ensure that policies and risk assessments are similar
across the care pathway, and there has been sharing of learning during the
implementation of the NICE guidelines.
To ensure a consistent approach to the management of venous thromboembolism
within Swindon Intermediate Care Centre (SWICC) there have been specific
procedures compiled, including clinical competencies for registered and non
registered nurses.
An audit pilot was undertaken in September 2010 to monitor compliance and quality
against DoH guidelines, NICE quality standards and local objectives.
Recommendations from the audit were put forward, and a re audit is planned for
early 2011.
There is early work in progress to establish management of venous
thromboembolism within the community (virtual ward), looking at the implementation
of management of venous thromboembolism for patients discharged from Swindon
Intermediate Care Centre and the Great Western Hospitals NHS Foundation Trust.
This work will continue into 2011 – 2012.
3.3.8 Health and Safety Audit
To ensure sustained compliance of all services in line with Care Quality
Commission, Outcomes 10 and 11 a health and safety audit was undertaken to
28
provide assurance to the NHS Swindon Board of compliance with the Health and
Safety at Work Act 1974 and Successful health and safety management (HSG65).
Safety auditing and performance review form the basis of self regulation and
enables NHS Swindon to comply with legal duties imposed by the Health and Safety
at Work Act 1974.
Objectives of the Audit
 To ensure patient and staff safety through consistently high standards of health
and safety.
 To highlight areas of weakness and make recommendations for improvement in
current practice.
 To ensure the development and implementation of recommendations across the
service
 To ensure compliance of all services to Care Quality Commission outcome 10
and 11.
 To ensure compliance with the latex policy.
 To ensure compliance with the Health and safety at Work Act 1974.
 To ensure compliance with the Asbestos regulations.
Summary of Findings
There was an increased response by service areas to the audit in 2010; some of this
is due to changes to working practice. 23 departments responded out of a possible
31.

All 23 areas that responded achieved the performance target of 75% or greater
 All 23 areas complied with the latex policy
 All 23 areas showed that asbestos awareness was raised
The average total compliance was 87% (min 75% and max 95%).
reflects the average proportion of standards met for all areas audited.
This figure
The Health and Safety Advisor has met with the managers of those services that
failed to respond to the audit.
Good practice identified
Over the past year, progress has been made in completing actions to address the
recommendations from the audit. Good practices identified include:

Health and safety and manual handling training available at Induction for all
new starters, some staff have used this session to refresh their manual
handling training.
29





Health and safety policies and procedures are available for all staff; this has
been promoted during the health and safety session within induction and by
some health and safety representatives in team meetings.
Fire training is mandatory and available for all staff on an annual basis. The
audit has highlighted the need for managers to ensure that their staff is
attending this training.
Communication of good health and safety practice is cascaded by the health
and safety representatives to their departments.
NHS Swindon now satisfies the legal duties imposed upon them as ‘Client’ by
the Construction Design and Management Regulations 2007, by changing
process, raising awareness and working with NHS Wiltshire to ensure correct
procedures are carried out in a timely manner.
Self assessment checklist has been developed for display screen users and
has been implemented in some areas.

Key Areas for development
There has been an improvement in the overall scores, but there are some key areas
for development that have been identified.
 All health and safety representatives require protected time to carry out their role.
 More work needed by some areas to identify health and safety documentation
and ensuring it is updated regularly as required.
 Risk assessments and CoSHH* documentation to be reviewed and updated on a
regular basis.
* The CoSHH regulations require employers to control substances that can harm
workers' health.
Using chemicals or other hazardous substances at work can put people’s health at
risk, causing diseases including asthma, dermatitis or cancer.
 Ownership and clear understanding of the responsibility of department heads for
managing health and safety of their department.
 All screen users must complete a self assessment checklist.
3.3.9 Supporting the Workforce
Sickness absence – supporting staff health and well being
Supporting staff to be well and at work has resulted in a reduction percentage time
lost from 4.13% in 2009/10 to 3.52% in 2010/11 against a target of 4% for the year.
Improvements in absence reporting and a revised sickness absence policy have
provided better information to support managers and staff. The number of staff
recorded as long term sickness has reduced and workshops supporting health and
wellbeing continue to support staff at work. The PCT reports workforce data monthly
to the PCT Board as part of the Integrated Performance Report.
30
Education and development
Improvements to the delivery of mandatory and statutory training have been made
following feedback from staff and managers. Staff can attend a whole day event or
pick elements of the day to update their skills and knowledge. Implementation of an
in-house coaching solution is supporting managers and staff in their learning and
development.
Staff engagement
We have been engaging and consulting with our staff about organisational change.
We have also listened to feedback about communication and have put some
changes in place to improve this.
Some of our staff are directly involved in the set up of a staff forum which will
support the proposed new organisation, and we work in partnership with our trade
union colleagues. Weekly briefings and staff newsletters and staff magazine keep
people updated and are available in electronic and paper copy.
3.4 Infection Prevention & Control
Monitoring and preventing the incidence of MRSA bacteraemia and clostridium
difficile (C Diff) infections is a Care Quality Commission, Essential Standards of
Quality and Safety, under Regulation 12, outcome 8
3.4.1 Reported MRSA Bacteraemia Rates
In 2010 - 2011 a national target for MRSA bacteraemias was set for the first time for
primary care trusts including community services. The target was to report no more
than 6 MRSA bacteraemias.
During 2010 - 2011 a total of 3 MRSA bacteraemias were reported as being
acquired in the community setting. Of these 3 bacteraemias, 1 was reported for Care
and Support Swindon in Swindon Intermediate Care Centre the remaining two within
the community setting.
The MRSA bacteraemia cases were fully reviewed by the relevant health care
service leads with support from the Infection Prevention and Control Team. Root
cause analysis reports were monitored by the Clinical Governance and Patient
Safety Forum and Infection Prevention and Control Committee.
3.4.2 MRSA Screening Compliance Rates
In line with a Department of Health and South West Strategic Health Authority
directive on MRSA screening, Care & Support Swindon is compliant with the
national MRSA screening programme for planned elective admissions.
All patients admitted to Swindon Intermediate Care Centre are screened for MRSA.
100% of patients are screened within the first 24hrs of admission in line with national
31
guidance however both inpatient wards have set a local target which aims to screen
all patients within 4 hours of admission.
Compliance to MRSA screening is continually monitored by Swindon Intermediate
Care Centre and reported via an infection prevention and control dashboard. This
dashboard is monitored via the Clinical Governance and Patient Safety Forum on a
monthly basis.
3.4.3 Reported Clostridium Difficile Infection Rates
In 2010 - 2011 the target for the primary care trust including community services was
to report no more than 129 cases of clostridium difficile infection. This was achieved,
with services reporting 31 cases of C Diff within the community (see table 1). This
was a slight increase on the previous year’s result of 24 cases.
Of these 31 cases, 1 was reported within Swindon Intermediate Care Centre. This
figure demonstrates a slight increase in the number of reported C diff infections
within the general community compared to the previous year (24 reported during
2009 - 2010), and a reduction in the number reported within Swindon Intermediate
Care Centre (2 reported during 2009-2010).
Table 1 Incidence of reported C Diff infections during 2010-2011
Local initiatives to manage and prevent C Diff infections within the general
community included:

Prompt isolation of patients with suspected infective diarrhoea (Swindon
Intermediate Care Centre) within four hours as per policy
32

Daily/weekly monitoring of environmental cleaning and adherence to infection
prevention and control practices, including hand hygiene

Continued collaborative working with GP’s, Dentists and independent prescribers.
Every reported case of C diff is followed up by a member of the Infection Prevention
and Control Team in order to discuss directly with the relevant health care
professional, enabling monitoring of known risk factors including the prescribing of
antibiotics
3.4.4 Infection Prevention & Control Audits and Care Bundles
A planned programme of audit and monitoring of care bundles was instigated
throughout 2010 - 2011 for all services.
The annual hand hygiene audit was carried out during January 2011 and
demonstrated an overall improvement in hand hygiene resources. Work needs to
continue in ensuring the facilities programme replaces those hand wash basins that
were identified as not being fully compliant with infection prevention and control
standards, i.e. replacing those basins without elbow/wrist operated taps.
Swindon Intermediate Care Centre – 60 bed inpatient unit
A programme of monitoring continued within Swindon Intermediate Care Centre
throughout 2010 - 2011. Standards around hand hygiene, cleanliness of patient
equipment and the ward environment were monitored on a weekly basis.
In addition to monitoring MRSA screening compliance, care bundles focusing on the
management of invasive devices such as urinary catheters and intravenous devices
were provided as required (i.e. for each occasion a device was present). All
compliance scores were illustrated via the infection prevention and control
dashboard reporting system, which was monitored on a monthly basis by the Clinical
Governance and Patient Safety Forum and on a quarterly basis by the Infection
Prevention and Control Committee and NHS Swindon Board.
All audit scores, MRSA bacteraemia and C Diff rates were made available to
patients and visitors via the ward information boards.
Compliance to the Code of Practice: The Infection Prevention and Control annual
plan 2010-2011 is produced by the Infection Prevention and Control Team in
conjunction with managers and monitored through the Clinical Governance
Commissioning Forum and Infection Prevention and Control Committee
The Infection Prevention and Control Team are assisting community services in
developing a similar dashboard in order to demonstrate compliance to the Code of
Practice and Care Quality Commission standards. First developed in August 2010,
work continues in this area as full participation and compliance to core care bundles
has not been achieved within all services. Progress continues to be monitored via
the Clinical Governance Commissioning Forum and Infection Prevention and Control
Committee.
33
Care and Support Swindon have met the requirements of the infection prevention
and control annual plan 2010 - 2011including adherence to mandatory education
and training requirements.
Swindon Borough and Local Care Homes
The Infection Prevention and Control Team have continued to work towards
achieving the priorities set out within its three year strategy for supporting local care
homes. This strategy, initially developed during 2009 - 2010, focuses on providing
infection prevention and control support and advice to all care homes within Swindon
with the aim of preventing the incidence of infection and reducing the number of
hospital admissions. This also complimented the work carried out by our community
matrons.
During 2010, the Infection Control Nurse Specialist visited 34 care homes in order to
assist managers in understanding their compliance to relevant Care Quality
Commission (CQC) standards. This was achieved by working through the Essential
Steps to safe clean care guidance (Department of Health 2006), which generated
reports highlighting any gaps in service. The exercise demonstrated that a significant
number of homes were unable to evidence annual training or audit reports. In
response to this the Infection Prevention and Control Team developed an audit
programme for all participating homes and commenced visits in January 2011.
Education and training was cascaded via the bi-monthly infection prevention and
control link network meetings, which had good representation from care homes. The
intention is to continue to meet the key objectives of the three year strategy,
ensuring that throughout 2011 - 2012 the audit programme is completed and
education and training is progressed through the link meetings.
3.4.5 Outbreaks of Norovirus
Norovirus was identified as being the cause of the outbreak which affected 17
patients and 7 members of staff between 7th and 20th January 2011. One ward within
Swindon Intermediate Care Centre was closed to admissions during this period. In
January 2011 an outbreak of diarrhoea and vomiting was managed within Swindon
Intermediate Care Centre. Outbreak reports were provided to the Infection
Prevention and Control Committee and Clinical Governance and Patient Safety
Forum. Detailed information was made available to patients, staff and visitors during
these periods.
The Infection Prevention and Control Committee received regular reports from the
South West (North) Health Protection Unit with regard to outbreaks of suspected
norovirus infection within local hospitals, care homes, schools and other community
settings.
34
3.5 Patient Experience
3.5.1 PALS and Complaints
Following the amalgamation of Health, Adult Social Care & Children’s health
complaints in 2009 the complaints team is now co-located with PALS at NHS
Swindon headquarters enabling a closer working relationship. This has allowed all
calls to be directed to the one area thus benefiting people by offering a more
comprehensive service with focussed support to resolve their concerns about
services.
The Complaints database was been updated with greater facilities to produce
reports for services. The complaints team have attended additional training in the
use of the upgraded system.
Comparisons from 2009 - 2010 where the number of complaints was 235 for the
year across health and adult social care shows there has been a slight increase in
complaints. During 2010-2011 1338 people contacted PALS of which 214 (16%)
related to services provided by Care and Support Partnership. Overall 195
complaints were dealt with of which 94 (48%) related to Care and Support
Partnership and 5 to private care providers used by the Partnership. The issues
raised through PALS are recorded under the five themes of patient experience and
are shown in the graph below.
114
91
42
39
10
Access & Waiting
Communication &
Choice
Relationships /
Attitudes of staff
High Quality Care
Clean Environment
For Care & Support Swindon the top five themes for complaints can be seen in the
graph below:
35
18
17
13
Clinical Treatment
Administration / Systems
8
8
Finacial Assessment
Access to Services
Attitude of Staff
There is much to be learnt from the patient / service user experience and their
journey through our services both from the times when things did not go well to
reviewing the comments in the compliments which shows what service users
appreciate and value in the care offered.
The next section illustrates some examples of positive action taken from the issues
raised through both PALS and complaints.
Clover Centre
What was said
Delay in obtaining oxygen
What happened as a result
Alert put on system to ensure this patient’s
oxygen levels are assessed on arrival
Patient on system under two Patient notes amalgamated and amended to
names causing confusion
prevent recurrence
Swindon Intermediate Care Centre
What was said
What happened as a result
Not given enough information Updating of patient information
about reasons for transfer to
SwICC
Family wanted more involvement Transfer sheet has been developed to gather
in decision making process
information about the patient and discharge
planning checklist has been updated
Patient request for newspaper WRVS agreed to provide a service
trolley service
Out of Hours
What was said
What happened as a result
Triage questions lacked clarity Further triage training provided to improve skills
leading to misdiagnosis
Dismissive attitude of nurse
All staff to attend update for DVT training
Podiatry
What was said
What happened as a result
36
Patients unhappy with changes to
service eligibility criteria
District nursing
What was said
As a result of a number of
complaints
about
discharge
arrangements
Speech and Language Therapy
What was said
Delays in referral process
Adult Social Care
What was said
Difficulty in contacting staff
Information provided about a new foot care
service
What happened as a result
A discharge co-ordinator was appointed to
ensure that correct info was received from the
hospital and that appointments are made
What happened as a result
Admin changes were made to ensure correct
allocation of referrals in.
Improvements made to data system
What happened as a result
Admin staff to advise caller of when social
worker will be next in the office
System created to check that service user
receives carer rotas
Carer arrived unexpectedly
3.5.2 OMBUDSMAN: Parliamentary and Health Services
Ombudsman (PHSO) - Local Government Ombudsman (LGO)
Just two people using services provided by Care & Support Swindon took their
complaints to the Ombudsman – one to the Parliamentary and Health Service
Ombudsman and one to the Local Government Ombudsman. In both cases the
complaints were not upheld.
3.5.3 Compliments
As the figures show it is unusual for a person to contact PALS to compliment a
service provider. However many people do write to individual service areas and
therefore PALS asks managers to provide information about the compliments that
they receive. This is not a complete list – just the ones that have responded to the
request for information.
Service
SwICC
NE Joint Community Team
Langton House
Clover Centre
Podiatry
Hearing and Vision Team
Contracts Team ASC
Social care
Number
8
5
23
3
31
5
2
8
Service
Wheelchair Service
Central SW Joint Community
Team
Contact & Assessment
Continence
Continuing Healthcare
NW Joint Community Team
Chronic Fatigue Service
Number
2
8
1
9
3
1
6
37
3.5.4 Service User’s comments
Numbers are only part of the story and some of the appreciative comments really
add to the value of a job well done. Here are just a few examples:
Langton House: ‘Thank you for the care and kindness …’ ‘Thank you to everyone
who looked after dad, he thinks you are all wonderful and he enjoyed the food so
much he put on weight!’
Clover Centre Out of Hours: ‘They immediately put our minds at rest as now we
knew what the problem was. Without this excellent service we would have spent a
sleepless night worrying. So a big thank you to all concerned and keep up the good
work.’
Podiatry: ‘Very professional, extremely informative, thanks.’
Adult Social Care: ‘Thank you to everyone who gave him care. He was very
grateful and said he couldn’t have managed without you.’ ‘She’s excellent, good
communication, consultation and prompt action.’
3.6 Clinical Effectiveness and Quality Measures
3.6.1 Supporting life after stroke.
In 2009 -2010 NHS Swindon was recorded as being one of the lowest performers for
stroke care. Following a major national review during 2010 by the Care Quality
Commission, NHS Swindon has come out as amongst the top 20 in the country for
long term care and support that people may need to cope with stroke related
disabilities. The quality markers set out in the national stroke strategy formed the
basis of the 'assessment framework' for this review. The review was across both
health and adult social care, and services which help people to rehabilitate and
participate in community life. The findings recognises the enormous progress that
has been made in local stroke care in Swindon after the patient leaves hospital, and
reflects a significant investment in local health and social care services provided by
NHS Swindon and Swindon Borough Council
NHS Swindon scored particularly well in the following areas
 Support for participation in community life.
 Range of information about stroke - this was evaluated by people who had a
stroke.
 Signposting co -ordination and personalisation.
This demonstrates improved care for stroke patients.
38
3.6.2 Patient Environmental Action Team (PEAT)
PEAT is an annual assessment of inpatient healthcare sites in England with more
than ten beds. The assessment was established in 2000 and managed by the
National Patient Safety Agency since 2006. The assessment ensures improvements
are made in the non-clinical aspects of a patient’s healthcare experience. PEAT
highlights areas for improvement and shares best practice across the NHS. The
annual inspection focused on key standards including, cleanliness, hygiene, privacy
& dignity and quality of food.
Results for 2010 – 2011 were as follows:
Environment
Excellent
Food
Excellent
Privacy & Dignity
Excellent
3.6.3 Eliminating Mixed Sex Accommodation
The Department of Health set up the Delivering Same Sex Accommodation (DSSA)
programme in 2009. Swindon Intermediate Care Centre has been actively involved
in auditing the standards and submits data to the Department of Health on a monthly
basis. To date there have been no breaches reported within the Centre. The Privacy
and Dignity policy has been updated, and guidance within the policy includes the
principles of Delivering Same Sex Accommodation.
3.6.4 Patient Experience
During the last 12 months teams have asked patients/service users and carers for
their opinions of the services they are receiving. In Swindon Intermediate Care
Centre there is a quarterly survey of patient and carer opinions which is used to
inform managers and staff of the ways in which they could improve the services they
are delivering.
3.6.5 CQC Review of physical health of people with Learning
Disability
Care & Support Swindon successfully led the work that resulted in NHS Swindon
achieving ‘green’ status for the Southwest Learning Disability Self Assessment.
3.7 Commissioning for Quality and Innovation framework (CQUIN )
A proportion of NHS Swindon Provider Services income in April 2010 –
March 2011 was conditional on achieving quality improvement and innovation goals
agreed between Care and Support Swindon and NHS Swindon Commissioners
through the Commissioning for Quality and Innovation framework. The amount of
CQUIN received by Care & Support Swindon from NHS Swindon Commissioners
was £269,663 which represents 1.5% of income.
This CQUIN will be used to drive forward an ambitious program of data quality
improvements to provide quality data as follows:
39






Relevant
Complete
Accurate
Timely
Valid
Reliable
High-quality information underpins the delivery of high-quality evidence based
healthcare, and many other key service deliverables. The data quality framework
sets out effective data management to ensure that information is available in line
with all data reporting requirements and the delivery of the performance indicators
within this contract.
The type and detail of information collected has been improved over the past year,
and staff training has addressed many of the issues identified. This work has been
supported by the Information Manager who has worked with the teams to tailor the
data collected as well as refining the systems in place. There is more work to do to
be able to have up to date accurate information which is produced in a style which
helps teams to react more quickly to issues in services and the needs for change,
however we have made considerable improvements in 2010.
3.8 Compliance with NICE Guidance
The National Institute for Health and Clinical Excellence (NICE) provides
guidance sets quality standards and manages a national database to improve
people’s health and prevent and treat ill health. Implementing NICE guidance
benefits everyone - patients, carers, the public, the NHS. It helps ensure consistent
improvements in people's health and equal access to healthcare.
During the period from April 1st 2010 and 31st March 2011, 25 pieces of guidance
have been issued by the National Institute for Clinical Effectiveness.
The guidance falls into 5 categories:





Cancer service guidance
Clinical guidelines
Interventional procedures
Public health guidance
Technology appraisals
Just over thirteen of the relevant guidance has been either implemented or
considered by the relevant service and an action plan has been developed as
appropriate, in order to achieve full compliance. Seven items of clinical guidance
distributed are awaiting comment or action plans from the provider service
Fully Compliant
CG92
venous thrombo embolism- reducing the risk
Partially compliant - action plan in place
CG88
low back pain
CG95
chest pain of recent onset
PH22
promoting mental wellbeing at work
40
Awaiting response
CG101 chronic obstructive pulmonary disease
CG103 delirium
CG109 transient loss of consciousness in adults and young people
CG94
unstable angina and NSTEMI
CG97
lower urinary tract symptoms
CG113 generalised anxiety disorder and panic disorder in adults
3.9 Care Quality Commission – continuous monitoring
The new system of regulation for Health and Adult Social Care in England came into
being as of 1st April 2010. The Health and Social Care Act 2008 requires all
providers of a regulated service to be registered with the Care Quality Commission.
To be registered by the Care Quality Commission a provider must show that it is
meeting new Essential Standards of Quality and Safety across all of its regulated
activities.
The Care Quality Commission continuously monitors compliance with essential
standards as part of a dynamic, responsive, robust system of regulation
accompanied by new enforcement powers. All provider services are required to
produce evidence that demonstrates that patients/clients are receiving essential
standards of quality and safety and that provider services are able to continually
demonstrate compliance with Care Quality Commission Regulations.
The Swindon Evidence Tool is a resource which has been developed following
workshops held in 2010. The evidence tool resource has been developed to support
services in collating evidence to meet Care Quality Commission requirements. This
resource has been widely shared with managers across services. It has recently
been further developed with the addition of tools such as the Generic Provider
Compliance Assessment documents, Care Quality Commission compliance
summary action plans and outcomes dashboard all of which will support services
with internal assurance and monitoring of compliance. This will enable Care and
Support Swindon to ensure robust processes are in place and give the Board
assurance. These are monitored through local staff meetings and the Clinical
Governance and Patient Safety Forum. The evidence is reviewed by the Non
Executive Directors of NHS Swindon and this is reported to the Board.
3.10 Policy Development
The development and review of procedural documents follows the guidance given by
the NHS Litigation Authority and the governance framework for NHS Swindon. New
and reviewed policies and procedures relevant to the provider services are
discussed and agreed by the Professional Forum then the Clinical Governance and
Patient Safety Forum before being presented to the relevant sub Board committee
for ratification. Since April 2010 in date policies and procedures have been published
on the NHS Swindon website so they are accessible to all staff irrespective of their
office base, to partner organisations and to the general public.
41
4.0 What Others Say About Us
4.1 NHS Swindon - Commissioner
Commentary on Care and Support Swindon Quality Accounts
High Quality Care for All, published in June 2008 set out the requirement for all
providers of NHS services to publish Quality Accounts annual reports to the public
on the quality of health care services they deliver.
NHS Swindon is pleased to endorse Care and Support Swindon’s first Quality
Account which provides information with regard to the quality of the services it
provides to the public.
Based on the knowledge NHS Swindon commissioners have of
Care and Support Swindon’s, we believe that this report is a fair reflection of the
healthcare services provided. The report celebrates the successes and
improvements in quality but is balanced in that it recognises those areas which
require further development.
NHS Swindon commissioners monitor the quality performance of Care and Support
Swindon monthly through the Clinical Quality Review Forums.
Performance data in relation to quality is presented and verified, and action plans
supported to address areas of less than optimum performance.
NHS Swindon supports the overall broad priority areas for quality improvements
identified by Care and Support Swindon’s in these quality accounts.
42
4.2 Health Overview and Scrutiny Committee
The Swindon Health Overview & Scrutiny Committee is encouraged by the work that
is already being undertaken to improve services amongst the four priority areas for
quality improvement.
The Health Overview & Scrutiny Committee is very involved in Privacy and Dignity,
having completed a Task Group review on this area a year ago and with constant
monitoring continuing into 2011/12. The Health Overview & Scrutiny Committee
would be keen to work with NHS Swindon and its provider services to improve this
service as it is an extremely important area. The Task Group would also be happy
to share its review findings with NHS Swindon’s Audit process if required.
There is a concern amongst the Health Overview & Scrutiny Committee relating to
the Wheelchair Service in Swindon. The Committee understand that improvements
have been made to the length of waiting lists and information booklets being handed
to patients, however there is no further detail on this. The Committee would be
interested to know how these compare to the national guidelines.
The Health Overview & Scrutiny Committee is committed to having a good working
relationship with NHS Swindon and, based on the Committee’s knowledge,
endorses the Quality Account for 2010/11.
The Committee supports the four areas for Quality Improvement and looks forward
to continuing to work with NHS Swindon to provide outstanding health and social
care services for the residents of Swindon.
Chair of the Health Overview & Scrutiny Committee
Swindon Borough Council
43
4.3 Local Involvement Networks ( LINKs)
44
5. Appendix 1
National Clinical Audits for inclusion in Quality Accounts 2011
Criteria for inclusion
• Coverage: intention to achieve participation by all relevant providers in
England.
• Data collected on individual patients
• Provides comparisons of providers
• Recruited patients during 2010-11
National Clinical Audits meeting inclusion criteria (n = 54)
Peri- and Neonatal
Perinatal mortality (CEMACH)
Neonatal intensive and special care (NNAP) Children
Paediatric pneumonia (British Thoracic Society)
Paediatric asthma (British Thoracic Society)
Paediatric fever (College of Emergency Medicine)
Childhood epilepsy (RCPH National Childhood Epilepsy Audit)
Paediatric intensive care (PICANet)
Paediatric cardiac surgery (NICOR Congenital Heart Disease Audit)
Diabetes (RCPH National Paediatric Diabetes Audit)
Acute care
Emergency use of oxygen (British Thoracic Society)
Adult community acquired pneumonia (British Thoracic Society)
Non invasive ventilation (NIV) - adults (British Thoracic Society)
Pleural procedures (British Thoracic Society)
Cardiac arrest (National Cardiac Arrest Audit)
Vital signs in majors (College of Emergency Medicine)
Adult critical care (Case Mix Programme)
Potential donor audit (NHS Blood & Transplant)
Long term conditions
Diabetes (National Adult Diabetes Audit)
Heavy menstrual bleeding (RCOG National Audit of HMB)
Chronic pain (National Pain Audit)
45
Ulcerative colitis & Crohn’s disease (National IBD Audit)
Parkinson’s disease (National Parkinson’s Audit)
COPD (British Thoracic Society/European Audit)
Adult asthma (British Thoracic Society)
Bronchiectasis (British Thoracic Society)
Elective procedures
Hip, knee and ankle replacements (National Joint Registry)
Elective surgery (National PROMs Programme)
Cardiothoracic transplantation (NHSBT UK Transplant Registry)
Liver transplantation (NHSBT UK Transplant Registry)
Coronary angioplasty (NICOR Adult cardiac interventions audit)
Peripheral vascular surgery (VSGBI Vascular Surgery Database)
Carotid interventions (Carotid Intervention Audit)
CABG and valvular surgery (Adult cardiac surgery audit)
Cardiovascular disease
Familial hypercholesterolaemia (National Clinical Audit of Mgt of FH)
Acute Myocardial Infarction & other ACS (MINAP)
Heart failure (Heart Failure Audit)
Pulmonary hypertension (Pulmonary Hypertension Audit)
Acute stroke (SINAP)
Stroke care (National Sentinel Stroke Audit)
Renal disease
Renal replacement therapy (Renal Registry)
Renal transplantation (NHSBT UK Transplant Registry)
Patient transport (National Kidney Care Audit)
Renal colic (College of Emergency Medicine)
Cancer
Lung cancer (National Lung Cancer Audit)
Bowel cancer (National Bowel Cancer Audit Programme)
Head & neck cancer (DAHNO)
Trauma
Hip fracture (National Hip Fracture Database)
Severe trauma (Trauma Audit & Research Network)
Falls and non-hip fractures (National Falls & Bone Health Audit)
46
Psychological conditions
Depression & anxiety (National Audit of Psychological Therapies)
Prescribing in mental health services (POMH)
National Audit of Schizophrenia (NAS)
Blood transfusion
O neg blood use (National Comparative Audit of Blood Transfusion)
Platelet use (National Comparative Audit of Blood Transfusion)
47
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