Quality Accounts
2011-12
Improving patient experience,
safety and clinical effectiveness
Version No.
Editor
Amendments
Date
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Sue Marshall
Written from original document
5/4/11
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Sue Marshall
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6/4/11
Version 1.2
Sue Marshall
Additions
27/4/11
Version 1.3
Sue Marshall
Additions
28/4/11
Version 1.4
Sue Marshall
Additions
2/5/11
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Version 1.8
Barry Cooper
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Version 1.9
Fiona Marsden
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Version 1.10
Susan Marshall
Amendments and additions
9/5/11
Version 1.11
Fiona Marsden
Amendments and additions
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Version 2
Sue Marshall
Amendments following comments
21/6/11
Version 3
Sue Marshall
Amendments and addition of
comments from Links and OSC
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2
Better health, local care
Information about this Quality Accounts
Copies are available from www.solent.nhs.uk
Our Quality Accounts is also available in larger print on request
Please contact us through:
Patient Experience and Engagement Service
Tel: 0800 013 2319
Email: soc-pct.schpatientexperience@nhs.uk
Post: Solent NHS Trust Headquarters
Adelaide Health Centre
William Macleod Way
Millbrook
Southampton
SO16 4XE
Quality Accounts 2011
3
Contents
Section 1 Introduction to Quality Accounts for
Solent NHS Trust 2011/12
Section 2 Priorities for improvement in 2011/12
and Statements or Assurance
2.1
Priorities for improvement 2011/12
2.2
Statements of Assurance
Section 3 Review of Quality Performance
3.1
Overview of performance
3.2
Update on the Quality Priorities from
2010/11
3.2
Existing Priorities from 2009/10
3.3
Learning from our Patients
3.4
Statement from Local Involvement
Networks (LinKs), Overview and
Scrutiny Committee (OSC) and Primary
Care Trusts (PCTs)
Section 4 Looking Ahead
4.1
4
Your Feedback is Important to Us
Glossary
Appendix
Better health, local care
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Section 1 - Introduction to our Quality Account 2011/12
Solent NHS Trust became a new independent organisation on the 1st April 2011. It has
been formed by the merger of what were formerly Southampton City Primary Care
Trust (PCT) community services and Portsmouth City Primary Care Trust (PCT) community
and mental health services. For the period April 2010 - April 2011 these combined
community services were known as Solent Healthcare.
Solent NHS Trust provides community solutions via a range of community and specialist
mental health services to over a million people living in Southampton, Portsmouth
and parts of Hampshire. These services are provided from over 100 different clinical
locations including community hospitals, outpatient settings and patients’ homes. The
organisation works in partnership with other originations, patients, service users and
carers.
The ultimate aim of Solent NHS Trust is to deliver the highest quality healthcare,
which puts patients at the heart of decision making. Solent NHS Trust will strive to
continuously improve the quality of its services for patients by putting quality, clinical
and non clinical, at the heart of all business.
The Department of Health (DH) set out a commitment to quality in the NHS report
‘High Quality Care for All’ (2008). This report defines “Quality” as “the combined and
continuous process of making changes that will lead to better outcomes, better system
performance and better professional development“. This they base around three key
areas:
•
Patient Safety
•
Patient Experience
•
Clinical Effectiveness
These areas are then underpinned by:
•
Regulation and Assurance - to ensure a standardised approach to quality outcomes
Quality Improvement is also at the heart of our organisational objectives for 2011/12,
which include an ambition to “achieve or exceed quality targets in the above three key
areas.
The Trust’s Strategy for Quality Improvement 2011 - 16 also sets out the specific strategic
objectives for quality, which include:
•
Ensuring that quality improvement drives the planning process
•
Working in partnership with staff, patients, partners and commissioners to determine
quality improvement priorities
•
Driving up clinical quality across all services within a process of quality improvement
that operates from the front line of service delivery to the Board (Floor to Board)
•
Increasing patient, service user and carer feedback on the quality and safety of care,
improving their ability to influence the services that they use.
Quality Accounts 2011
5
From a GP in Portsmouth re Lower Limb MSK Pathway
(Physiotherapy)
“I am writing to thank you for my copy of your letter about this 55 year old
patient of mine. This describes an incredibly good quality effective intervention
summarised in an excellent letter and obviously the best possible outcome for
the patient. You seem to have done everything very well including consulting
with the appropriate consultant and working the patient up in all regards preoperatively. I cannot imagine that his care could have been improved in any way
and I should just like to record that I think we are very fortunate to have this
standard and quality of care available to patients here in Portsmouth.”
From relatives a patient
at Tannersbrook
Stroke Unit
“We as a family would first
like to take this opportunity
to thank all the staff who
without a doubt are the most
caring, compassionate and
friendly we have ever had
the pleasure of meeting. So
thank you from the bottom
of our hearts, you are truly
inspirational. Secondly
thank you for the
wonderful care you
have given my mum,
her recovery has
been a success due to
the commitment of
every professional
within Tannersbrook
Stroke Unit. Please
continue with the
outstanding care
that is known
throughout the
city.”
6
Better health, local care
Welcome from Chief Executive, Dr Ros Tolcher
Over the year, Solent NHS Trust has experienced significant improvements in key quality
measures. This includes improvements in offering same sex accommodation, reductions
in infection control rates, reductions in medication and prescribing incidents and
continued progress on the “Productive Care Planning Approach” to empower front line
staff to provide more direct line care.
Solent NHS Trust has been registered with the Care Quality Commission (CQC) without
conditions in the national registration system for NHS providers and has received
positive feedback from external reviews of the quality of our services .
As well as focusing on the progress made, our Quality Account also describes some of
the challenges we face and the priorities for the year ahead (these can be found in
Section 2).
Throughout the year Solent NHS Trust
has worked closely with Patient
Groups in many areas and
has had the support and
involvement of the Non
Executive Directors.
Declaration
As declared by the
Secretary of State,
the Chief Executive
is the Accountable
Officer for the Trust.
This role carries
responsibility for
the clinical quality
and safety of the
care delivered by
staff within the
organisation.
To the best of my
knowledge and belief the
Trust has properly discharged
its responsibilities for the quality
and safety of care and the information
presented in the Quality Account is accurate.
Dr Ros Tolcher
Chief Executive
Quality Accounts 2011
7
Section 2 - Developing the Quality Priorities
2.1 Priorities for Improvement
This section provides an opportunity to set areas where the organisation feels
improvements could be made to the quality of services. There should be priorities linked
to each of the key areas of quality, e.g. patient safety, patient experience and clinical
effectiveness, and should also demonstrate how the Trust is developing its capacity and
capability for quality improvement.
2.1.1 Developing the Quality Priorities for 2011/12
When developing priorities for the coming year, a number of factors are considered :
•
Areas where service users have identified they would like to see improvements made,
e.g. through comments, concerns, complaints and patient satisfaction surveys
•
Improvements that all NHS organisations have to make (national targets/priorities)
•
Issues that have been highlighted by staff (staff survey, incident reporting)
•
Areas highlighted by partner organisations (Overview and Scrutiny Committee (OSC),
Links, Local Authority)
•
Areas agreed with commissioners of services to ensure significant progress in quality,
e.g. Commissioning for Quality and Innovation (CQUIN payment framework)
•
Areas where our performance falls behind other NHS organisations and there is
scope for improvement
•
Areas highlighted through our risk management systems, e. g. incident reporting.
These areas were considered during numerous meetings and correspondence with
staff, commissioners, service users, patients and carers and LINks members and through
feedback from focus groups held regularly in service areas. Based on the feedback
received and the discussions held, 9 quality priorities for 2011/12 were agreed with an
additional 2 priorities from last year’s Quality Account being carried forward to ensure
they are fully evaluated.
More information on these can be found in the following pages.
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Better health, local care
Priority Areas
Priorities for 2011/12
Patient Safety
1. Ensure patients are safe from infections
2. Reducing incidents of falls per 1000 bed days by 10%
3. Develop an early warning sign system for recognising the
deteriorating patient across inpatient services
Patient Experience
4. Improve communication with service users by improving the
quality of leaflets and patient information
5. Increase direct care time for patients
6. Ensure we meet all of the ten Dignity Challenges laid down
by the Department of Health
Clinical
Effectiveness
7. Reduce the incidence of Grade 3 and Grade 4 pressure sores
8. Decrease levels of dehydration and improve the nutritional
status for patients across all inpatient units
9. Improve clinical leadership and openness within the
organisation
Remaining Priorities from 2010/11
Patient Safety
•
No priorities carried forward from last year’s account
Patient Experience
10. Improving care for patients with schizophrenia
11. Audit of pathway developed for people with Borderline
Personality Disorder following last year’s Quality Account
Priority
12. To improve overall levels of satisfaction within the early
onset dementia services
Clinical
Effectiveness
•
No priorities carried forward from last year’s account
Quality Accounts 2011
9
2.1.2
Priority Area 1
Patient Safety
10
Better health, local care
Priority 1: Infection Control: Keeping patients safe from infections
developed in our healthcare settings
Working hard with other healthcare organisations, significant progress has been made
in reducing the rates of Multi Resistant Staphylococcus Aureus (MRSA) and Clostridium
Difficile (C diff) within Solent NHS Trust. Although we measure our rates of infection
control and work towards a reduction target, targets for reduction in infection control
rates are set across the health economy and so are not specific to Solent NHS Trust. We
have seen large reductions in rates across Solent NHS Trust; in Southampton City we saw
a 78% reduction and Portsmouth City a reduction of 60% in the number of Clostridium
difficile cases last year compared to 2008/09 (Figure 1). We want to continue to decrease
our rates of avoidable infections and strive to have zero levels of infection.
Figure 1 - Clostridium difficile infections in patients aged 2 years and over by Primary Care
Organisation
400
300
200
100
0
2007/08
2008/09
2009/10
Southampton PCO
Portsmouth PCO
Linear (Portsmouth PCO)
Linear (Southampton PCO)
Why did we make this a priority?
Although the Trust was successful in achieving its targets for MRSA and C diff for
2009/10 and 20010/11, it is vital that this is still given the highest priority to ensure these
figures keep moving on the downwards trend to maintain public confidence in our
services and ensure patient safety.
It is difficult to completely eradicate these infections as some patients may be admitted
to our services with infection. If this happens it is essential that we prevent the spread of
infection to other patients and we treat the infection promptly and efficiently.
Whilst targets have already been achieved we wish to achieve even further reductions
towards the zero target and start to gather baseline data against other infections such
as Meticillin Sensitive Staphylococcus Aureus (MSSA) and E. Coli to identify current rates.
Quality Accounts 2011
11
Current Status - Annual Counts of MRSA
Figure 2 - Identifies the rates of MRSA across the local NHS organisations (please note: at the
time of composing this Quality Account the complete figures for March 2010 were not available)
40
35
Portsmouth City
PCT
Southampton City
PCT
IOW
30
25
20
15
10
Hampshire PCT
5
0
2008/09 2009/10 2010-11
Figure 3 - Current Status - Annual Counts of Clostridium Difficile
900
800
700
Portsmouth City
PCT
600
500
400
300
200
100
0
Southampton City
PCT
IOW
Hampshire PCT
2008/09 2009/10 2010/11
The Annual rates of MRSA Bacteraemia and C diff can be found on
www.hpa.org.uk for the year March 2010 - 11.
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Better health, local care
How do we achieve reductions in infection rates?
•
Hand hygiene training and infection control training for all staff
•
Routine audit activity of infection control practice across all services
•
Expansion of MRSA screening programmes across inpatient units and mental health
services
•
Regular infection control meetings monitor data and progress on healthcare
acquired infections
•
Improvements to the antibiotic prescribing policy
A Root Cause Analysis investigation of each MRSA bacteraemia identified is undertaken.
Quality Accounts 2011
13
External Review of Healthcare Acquired Infections
Several external reviews and validation processes takes place for healthcare acquired
infections, which are included in the table below.
Care Quality
Commission (CQC)
As part of national requirements for all NHS organisations,
we are required to register with the CQC regarding the way
in which we protect staff, patients and the public against
acquiring healthcare acquired infections.
We also have to demonstrate our commitment to reducing
the risk and achieving greater control of infections and
the maintenance of appropriate standards for premises
and equipment. The CQC undertake unannounced visits to
organisations to monitor compliance with their standards.
Organisations can be refused registration or be registered with
conditions where the CQC has concerns. Solent NHS Trust was
registered with the CQC without conditions.
National Patient
Safety Agency
(NPSA) Patient
Environment
Action Team
Inspections (PEAT)
All NHS organisations participate in an annual inspection
process coordinated through the NPSA. The teams of inspectors
include service users and patient representatives as well as
independent inspectors.These teams inspect many aspects of
the environment including cleanliness and hygiene methods.
Commissioners
Commissioners set targets for reduction in rates of infections
and compare local results with national statistics across the
country. Regular review meetings are held with commissioners
to ensure a coordinated approach to prevention and control of
infections.
Trust Board,
committees,
working groups
Solent NHS Trust produces an annual report on healthcare
acquired infections and regularly publishes its rates of infection
on the trust website.
In 2010/11 Solent NHS Trust maintained its excellent/good
rating for all of its services (Table 1)
www.solent.nhs.uk
Infection prevention and control is discussed and reported on
a monthly basis at the Trust Board and sub committee of the
Board and a regular newsletter is published to inform staff of
progress being made. Infection control rates are also published
on every inpatient unit for visitors to observe.
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Better health, local care
Table 1: Patient Environment Action Team Assessment 2010
Site
Score
Western Community Hospital
Excellent
Royal South Hants Hospital
Excellent
St James’ Hospital
Good
What is our plan for 2011/12?
There is still room for improvement and we are in the process of introducing a number
of initiatives to achieve this, including:
•
Antibiotic prescribing:
Some antibiotics destroy natural ‘good’ bacteria and increase the risk to patients of
getting Clostridium difficile. Improving the prescribing of appropriate antibiotics to
patients will help keep our patients/service users safe from infection.
•
Learning from cases of infection:
To make sure we learn from cases where patients/service users do acquire an
infection whilst they are in hospital, we look closely at these cases to identify any
changes we can make that might protect patients/service users from infection in the
future. One such action is the introduction of an integrated care pathway for the
care of patients in our hospitals with unexpected/unexplained diarrhoea.
•
Hand Hygiene:
Thorough hand hygiene between caring for people is imperative in helping to
reduce cross-infection. We want to do the best we can to keep our patients/service
users safe from infection whilst in our care. There will be a renewed focus on further
improving hand hygiene through mandatory training of all staff groups, ensuring
staff undertake hand hygiene before and after having physical contact with each
patient/service user and instigate improved hand hygiene audit activity.
•
Develop a process for obtaining data on the levels of Meticillin Sensitive
Staphylococcus Aureus (MSSA) and E. Coli to form a baseline so the cause for the
increase in the levels of these infections nationally can be determined and to define
to what extent these are healthcare associated.
Monitoring our progress
To ensure that we achieve this priority our progress will be reported to and monitored
through a number of committees within the organisation. These include the Infection
Prevention and Control Committee; the Health and Safety Committee; the Integrated
Governance and Performance Committee; and the Trust Board. Progress monitoring
will also form part of our monthly quality monitoring with NHS Southampton and NHS
Portsmouth, the main Primary Care Trusts which commission our services for the local
populations.
Quality Accounts 2011
15
Board Lead:
Judy Hillier, Director of Nursing and Quality/Director Infection Prevention and Control
Implementation Lead:
Susan Marshall, Associate Director of Nursing and Quality
Project Lead:
Infection Control Specialist Nurse
Priority 2 : Reducing the incidence of inpatient falls
Why did we make this a priority?
The ‘How to Guide for Preventing Harm From Falls’ (Patient Safety First 2009)
emphasizes the importance of preventing falls in hospital. There is a high incidence of
falls in hospitals nationally with 26,000 falls reported annually from mental health units
and 28,000 from community hospitals.
Falls impact greatly on quality of life and can increase mortality rates in older people.
Falls can cause moderate or severe harm (such as fractures and serious lacerations).
1,295 cases are reported annually in community hospitals nationally and 1,411 cases in
mental health units (NPSA 2007). The individual involved can lose confidence and lose
their independence as well as suffer from pain and distress following their fall. This
loss of independence can result in increased health and social care costs to meet the
needs of this increasingly dependent group of patients in the community. The financial
implications of managing the immediate health needs of patients following inpatient
falls is £15 million pounds per annum across the NHS.
Whilst some falls are hard to prevent, appropriate multi-factorial falls risk assessments
can reduce the incidence of falls. “Staying Safe - Preventing Falls” has been identified as
a high impact action for nurses and midwives within the NHS in England.
Current Status and Comparison to other Trusts
Solent NHS Trust has already developed a “Falls Policy” that outlines how patients’ risk
of falls will be reduced whilst they are in–patients under our care. This comprehensive
policy also highlights clear pathways for patients to access evidence based assessments
and interventions required to reduce their falls risk and promote their independence.
In line with guidance from the Patient Safety First Campaign, an emphasis on both
leadership and frontline actions across the organisation to reduce falls is being
developed. This includes comprehensive plans for staff training and development in
falls prevention, establishment of a new ‘Post Fall Protocol’ in line with NPSA guidance
issued in January 2011.
The organisation participated in the National Falls and Bone Health Audit in 2010 and
has set up a falls prevention program led by prevention groups set up across the Trust.
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Better health, local care
The national rate of falls per 1000 occupied bed days is 8.4 for community hospitals. For
units caring for older people with mental health problems it is between 13 and 25 per
1000 bed days.
Mandatory Statement
In 2010/2011 the falls rates for our community hospitals was 18.8 per 1000 bed days for
rehabilitation beds for older people and for our older persons’ mental health beds 17
per 1000 bed days.
There are some limitations to this data in as much as community hospitals can be made
up of a wide variety of case-mixes and the most up to date data is from 2007. Caution
should be exercised in benchmarking performance against this national data. When
comparing these rates to other community hospitals it is important to recognise that not
all hospitals care for the same types of patients.
For example, a community hospital caring for stroke patients or the frail elderly may
have a higher rate of falls than a hospital where such cases are less common unless
major restrictions are placed on patients independence. It is clinically unlikely that
hospitals caring for some groups of patients will achieve zero falls although minimising
the number of falls remains an absolute goal.
Solent Risk Management Team report monthly on our falls rates per inpatient area
which will enable us to continue to benchmark our performance against this data and
analyses following reduction methods.
We have devised a monitoring system so that we can analyse and reduce our falls rates
and we are working to improve our numbers of avoidable falls. We are improving the
risk assessment process, care planning process, working together with other agencies,
e.g. the ambulance service, and by making environmental changes.
How will we achieve a reduction in falls?
•
Using a joint agency working group to lead this work
•
Undertaking a review of current paper work and the care planning process
•
Ensuring all health staff working with older people receive basic Falls Prevention
Training on a regular basis
•
Asking every inpatient clinical area where older people are cared for are to identify a
staff member nominated to act as a ‘Falls Link Champion’. These people will receive
additional training to provide expertise within their area in falls prevention. They
will also carry additional responsibility for implementing falls prevention measures
in their clinical area and monitoring, analysing and learning from falls events
happening in their area
•
Implementing our revised falls policy and monitor it against clearly defined success
criteria
Quality Accounts 2011
17
•
Working with our risk and governance teams to improve analysis and learning from
falls.
•
Conducting bi-annual falls audits in inpatient areas to ensure effective screening
processes are used and that patients are accessing appropriate assessments.
What is our plan for 2011/12?
•
Monthly reports will be collated per inpatient ward/unit of the falls rates against
occupied bed days, the number of repeat fallers and the number of falls resulting in
serious injury.
•
Monthly reports will then be fed back to the inpatient areas so they can see the
prevalence of falls within their ward/unit.
•
The Trust Falls Prevention Coordinator will provide analysis of this data and facilitate
audit of compliance against the Trust’s Falls Policy.
•
Develop new falls assessment documentation/systems
•
Identify named Inpatient Link Champions for falls.
•
Develop a new training programme for the Link Champions and deliver Basic Falls
training for other staff.
•
Solent NHS Trust will work with partner organisations to obtain further data
regarding:
I. Numbers of Emergency Department Attendances with falls and repeated fall
II. Monthly numbers of patients referred to South Central Ambulance service with a fall
III. Number of patients admitted to hospital with hip fractures
IV. Number of patients attending hospital or minor injury units with other fragility
fractures.
•
Develop targets, for reduction in the numbers of falls once the baseline figures are
known.
•
Participate in the National Falls and Bone Health
•
Agreed a Protocol on how to deal with the after effects of a fall.
Board Lead:
Judy Hillier, Director of Nursing and Quality
Implementation Lead:
Susan Marshall, Associate Director of Nursing and Quality
Project Lead:
Melody Chawner, Clinical Physiotherapy Specialist (Older People) and Falls Coordinator
Senior Physiotherapist Lead
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Better health, local care
Priority 3: Develop early warning systems to recognise the
deteriorating patient
Acknowledging that safeguarding quality is a continuous process, Solent NHS Trust
constantly seeks ways in which to improve the way we do things to ensure patients
remain safe. Robust monitoring systems to regulate the quality of care provided are
key to this and development of early warning systems relies on the culture within an
organisation as well as the cooperation of the staff that work there.
Developing Modified Early Warning Systems (MEWS) provides staff with a clear
framework regarding the early identification of the acutely ill adult patient who is
at risk of physiological deterioration. This enables the nursing staff to promptly refer
to the medical staff. The development and roll out of MEWS is recommended by the
Department of Health and is seen as a useful adjunct to enhancing ward based care
(DOH 2008). The National Institute for Clinical Excellence has also produced clinical
guidelines for the management of acutely ill patients (NICE 2007). The introduction of
the MEWS procedure reinforces the community hospitals inpatient services commitment
to raise the awareness and management of sick/deteriorating adult patients.
MEWS is a track and trigger system designed to identify adult patients at risk of
deteriorating and relies on the accurate recording of simple physiological patient
observations.
Current status
Work has already commenced and a physical healthcare matron has been working in
mental health services to develop a better understanding among mental health staff of
physical healthcare deterioration. A policy has been developed, an identification check
list devised and training delivered. A physical observation chart for use in mental health
services has also been devised and is already in use.
What is our plan for 2011/12?
•
Further develop systems for early identification of the deteriorating patient across all
community hospital and inpatient units
•
All registered nurses and medical staff within Community Hospitals in patients wards
to receive training in the use of MEWS
•
Strengthen engagement with patients and the public
•
Strengthen and audit ‘hand over’ processes
•
Hourly rounding on wards
•
Monthly audit of 50 random case notes to identify if there were any near misses and
change systems based on these audits.
Quality Accounts 2011
19
2.1.3
Priority Area 2
Patient
Experience
20
Better health, local care
Priority 4 : Improve the patient’s experience and
satisfaction when using our services
In line with previous research into service and quality improvement programmes which
reinforced the importance of ‘getting the basics right’, it was felt the organisation
needed to give priority to and identify factors that help or hinder progress in care
delivery.. The NHS Improvement Plan (2004, DH) also highlighted the need to put people
at the heart of public services.
A positive patient experience is vital in delivering high quality patient care and Solent
NHS Trust is striving to be an exceptional customer-focused provider of care, which is
committed to giving people a stronger voice so that they are the major drivers of service
improvement.
We believe that everyone’s views are important and hope that by listening to and
learning from the experiences of our service users we will be able to see where change
is required to ensure that people will be satisfied with the experience they have when
using our services.
In an effort to give patients, relatives and visitors the standard of care we strive for, we
will be working to improve CARE:
C
Communication
A
Attitude of staff
R
Responsiveness
E
Environment
From the information we have received through complaints and concerns, we have
found that these are some of the main reasons our service users are unhappy with
the service they have received. Solent NHS Trust have a “Patient Experience Service”
who not only provide an efficient, easily accessible and flexible complaints handling
procedure for patients, carers or visitors, offer the public a point of contact for queries
or concerns regarding local NHS and Social Care.
Communication – Most complaints arise from a breakdown in communication. We
intend to provide good customer care training which emphasises our expectation that
staff involve patients and/or their carers in all aspects of their treatment. It is essential
that patients are kept fully informed about their treatment and feel comfortable in
asking for things to be explained to them more clearly or in having their say about how
their treatment is provided.
It is also essential that staff are made aware of the importance of keeping accurate and
up to date information on paper based files as well as electronic. Regular Information
Governance training is required to be undertaken by every member of staff and this
will continually be monitored to ensure that staff have the knowledge and skills to
communicate well in writing as well as in person.
Quality Accounts 2011
21
Attitude of staff – All staff working for Solent NHS Trust will try to make each patient
and visitor feel welcome and satisfied with the support and advice they have been
given. We do appreciate however that at times things can go wrong and patients/
visitors may feel dissatisfied with the way they have been treated.
Unfortunately in a busy environment if staff are feeling under pressure this can have an
impact on the way they carry out their duties. Solent NHS Trust expects all staff to be
polite and professional at all times in spite of these pressures. We aim to make sure that
all staff will attend Customer Care training and given coping mechanisms for dealing
with stressful situations in an appropriate manner.
Responsiveness – When patients, carers or visitors feel distressed and ask for help, it
is our aim to ensure that they receive a quick and helpful response to their concerns.
The Patient Experience Service will ensure that all complaints are acknowledged within
three working days of receiving the complaint and responded to within 30 working
days, unless the complaint concerns a serious incident which may require a longer
investigation, in which case the timescales will be fully explained to the complainant
and meetings with staff can be arranged if required.
The first responsibility when dealing with complaints is to ensure that any immediate
healthcare needs are being met for the patient involved. Therefore on occasions a
telephone call may be more appropriate than a formal written response, but each case
will be handled on its own merits.
Environment – Solent NHS Trust want all visitors to our services to feel they are in a
comfortable and safe environment. The Patient Experience Service carry out “mystery
shopper” type visits to services to get an idea of what it feels like to be a patient
walking into a unit or sitting in a waiting room area.
Current Status
Service users have been involved in developing new inpatient accommodation for older
people’s mental health services and the Local Involvement Networks (LINks) have carried
out unannounced visits to some of our services, including Substance Misuse inpatient
services.
As well as dealing with complaints which are received from service users, the Patient
Experience Service also carries out patient satisfaction surveys across all of its services
on a rolling programme throughout the year. These assess whether service users are
satisfied with the care they are receiving. Various services also hold regular focus groups
with their service users to receive feedback and to work on service improvements.
Patient stories and observational visits are also carried out by staff which provides a
different perspective to the patient experience.
The patient satisfaction survey results are collated, analysed and presented to the Trust
Board with a summary of the actions undertaken to resolve any issues raised.
The results are presented as a percentage of the overall number of complaints and
traffic lights are attached dependent on the amount of patients that reported they
were “satisfied” or “very satisfied” with the care they received. Figure 3 demonstrates
how the surveys are presented. Figure 4 provides an example of one type of survey
carried out in the Contraception and Sexual Health Service.
22
Better health, local care
Figure 3
Devices
Services
Contributing
Responses
analysed
Overall Satisfaction
Handheld
Contaception and
Sexual Health (CASH)
174
100%
Handheld
Health Visiting and
School Nursing
72
95.35%
(very satisfied & satisfied)
>80% Green / >70% - 79% Amber / <69% Red
Figure 4
Contraceptive and Sexual Health Service
Strongly
Agree
80.00%
Agree
70.00%
60.00%
Disagree
50.00%
40.00%
Strongly
Disagree
30.00%
20.00%
10.00%
0.00%
Do you feel you received
the right care?
Do you feel you have
received care in the right
place?
Do you feel care at the right
time?
Strongly Agree
70.59%
70.59%
64.71%
Agree
29.41%
29.41%
35.29%
Disagree
0.00%
0.00%
0.00%
Strongly Disagree
0.00%
0.00%
0.00%
Comparison to other Trusts
In comparison to other Trusts nationally, it is reassuring that Solent NHS Trust receives a
low number of complaints compared to other NHS organisations of a similar nature. In
total 527 complaints were received this year (April 2010 – March 2011). Figure 5 shows
the percentage of complaints received by divisions.
Quality Accounts 2011
23
Figure 5
External Review
The Ombudsman monitors complaints that are referred to them by patients if they are
unhappy with the way in which their complaint has been handled by the organisation
concerned. Solent NHS Trust supplies the Department of Health with annual figures on
the number of complaints that have been referred to the Ombudsman. Six complaints
for 2010-11 were referred to the Ombudsman for the period of this report and for each
of these complaints no further recommendations were made.
However the Ombudsman felt that: “ it would be beneficial to the complainant to have
a further written response to try and resolve the outstanding issues in their complaint”
and this was undertaken. As part of the CQC Essential Standards framework, patient
satisfaction and patient experience is assessed, monitored and reported across all service
areas.
The organisation also participates in the annual inpatient satisfaction survey which helps
to form the basis for identifying areas where improvements can be made.
What is our plan for 2011/12?
In 2010/11 our customer satisfaction survey highlighted that some service users were
dissatisfied with communication between staff and service users which had caused them
to have a poor patient experience. It is important therefore that we aim to improve the
quality of customer services in 2011/12 and therefore improve the patient experience
when accessing healthcare within Solent NHS Trust.
We plan to:
•
Ensure all staff attend Customer Care Training
•
Ensure all staff attend Information Governance training
•
Develop a more robust process for analysing concerns into themes and targeting
these areas
24
Better health, local care
•
Further develop service user focus groups in areas that do not currently have them
•
Set up a patient experience group that will involve service users in the identification
and delivery of changes within local service areas
•
Further develop processes for triangulation of information from complaints,
incidents and workforce information to identify any linkage.
Board Lead:
Judy Hillier, Director of Nursing and Quality
Implementation Lead:
Fiona Marsden, Head of Quality
Project Lead:
Marion Wood, Patient Experience Manager
Priority 5 : Increase the time that staff have for direct
patient care using the “Productive Ward and Productive
Care” Programme
The concept of the Productive Care Series (PCS) has been developed by the NHS Institute
for Innovation and Improvement, in collaboration with trusts in England and has
resulted in the launch of a series of modules that enable clinical staff to increase the
time spent on direct patient care. “Releasing Time to Care - The Productive Care” series
focuses on improving processes and environments to help nurses and therapists spend
more time on patient care thereby improving patient safety, quality and efficiency.
Much work has already been undertaken and staff across all services have been trained
in this methodology.
Why did we make this a priority?
Although staff have commenced this work and been successful in increasing the amount
of direct patient contact they have on a daily basis, his has not yet taken place across all
services as part of a service improvement programme.
Current Status
The PCS has now been running since January 2009 and to date 10 residential and 12
community teams have been through the project phase of implementing the PCS. All
these teams are working systematically through the foundation modules (as listed
below) within the project phase and each service is monitoring and sustaining the
changes initiated by the teams to improve face to face contact time with their patients,
examples of which are below. A champion’s network has been established to energise
and help the teams sustain the changes they have made and a third celebration event
is planned for September 2011 to share good practice across the service areas. Progress
is reported regularly and the project lead works closely with the transformation team,
which focuses on redesigning services to improve efficiency and increase effectiveness.
Quality Accounts 2011
25
How does that compare to other Trusts?
The Productive Ward has been in use extensively across other acute organisations and
has demonstrated it is a programme that improves the leadership skills of clinical staff
at a time when enhancing their skills and competencies will be critical in helping drive
quality improvement across the NHS.
How do we achieve an increase in direct patient contact care?
Initially services chose to take part in the programme; then as they achieved success they
fed back to other service areas, identifying the problems they had encountered along
the way and the way in which they resolved these issues. A project lead was appointed
to facilitate this process and regular updates on progress were presented to the Board.
An example of the methods used is listed below.
The three foundation modules comprise of the following:
•
Knowing how we are doing - using clinical outcomes to drive improvements in care
and direct face to face activity
•
Well organised working environment - reviewing the clinical environment to identify
waste, create space, reviewing stock and store cupboards to ensure staff do not
waste time looking for equipment
•
Patient Status at a glance - using visual boards in public ward areas to show
information to patients, their relatives and staff in order to aid communication and
openness.
What are our plans for 2011/12?
The plans for 2011/12 are to offer two further project phases to involve 10 further teams
and educate them in the quality improvement tools and techniques involved. There are
further plans to align the PCS work with that of the business transformational schemes
to ensure quality and productivity go hand in hand.
Board Lead:
Judy Hillier, Director of Nursing and Quality
Project Lead:
Fiona Marsden: Head of Quality
Implementation Lead:
Jo Odell, Project Facilitator
26
Better health, local care
Priority 6 : Ensure we meet all the dignity challenges laid
down by the Department of Health
The Dignity and Compassion in Care Campaign was launched in November
2006, putting dignity at the heart of care delivery and creating a
system in which there is zero tolerance of abuse and disrespect. The
need to deliver the highest standards of privacy and dignity applies
to all areas of health care and is reflected in the following
challenges laid down by the Department of Health:
The Ten Dignity Challenges
1. Have a zero tolerance of all forms of abuse
2. Support people with the same respect you
would want for yourself or a member of
your family
3. Treat each person as an individual by
offering a personalised service
4. Enable people to maintain the maximum
possible level of independence, choice
and control
5. Listen and support people to express their
needs and wants
6. Respect people’s right to privacy
7. Ensure people feel able to complain
without fear of retribution
8. Engage with family members and carers
as care partners
9. Assist people to maintain confidence and
a positive self-esteem
10. Act to alleviate people’s loneliness and
isolation.
Why did we make this a priority?
Whilst a lot of work has already taken place
in order to ensure we meet all the dignity
challenges, it was felt that we need to
maintain this as a priority as it is core to the
values of Solent NHS Trust.
We believe that every patient has the right to
receive high quality care that is safe, effective
and respects dignity. Solent NHS Trust ensures
that all staff are supported and trained in
dignity and privacy.
Quality Accounts 2011
27
Current Status
All work is led through the Solent NHS Trust Dignity and Compassion in Care Group
which is responsible for ensuring there is organisational focus to delivering dignity in
care and that compassion is kept central to the ways of working for patients, carers and
staff within Solent NHS Trust. The group feeds into the Trust Board though the Dignity
and Safeguarding Committee and demonstrates progress and improvements in each of
the ten dignity challenges.
A local training resource pack has been developed for staff based on the challenges
highlighted above. The resource pack uses a DVD to give examples of experiences from
local service users and provides a building block to build on the significant activity
undertaken already to promote dignity and compassion in care. The training pack
contains leaflets on each of the ten dignity challenges for patients, carers and staff.
The resource pack is generic enough to be used by individual services, prompting
each individual or trainer to debate examples that are meaningful to the staff, carers
and service users of each individual service. Solent NHS Trust can confirm that we are
compliant with the Government’s requirements to eliminate mixed sex accommodation.
We have the necessary facilities, resources and culture to ensure that patients who are
admitted to our wards will have either have their own bedroom or only share the room
where they sleep with members of the same sex, and same sex toilets and bathrooms
are close to their bed area. There has been significant building work undertaken to
meet the same sex accommodation requirements such as new shower blocks and
reviewing door handles and locks. Same sex accommodation signage has been reviewed
and updated.
If our care should fall short of the required standard, we report it both internally and
externally and act on it immediately. Solent NHS Trust monitors privacy and dignity
through incident reports, complaints and through patient experience feed back.
What are our plans for the future?
Solent NHS Trust undertakes an annual dignity and privacy audit across all service areas
to highlight where further improvements can be made. During 2011/2012 we will
continue with these audits and use the results of these to improve our care environment
and to learn from patient and carer feedback how we can strengthen privacy, dignity
and patient safety. Service areas will identify dignity champions to lead this agenda
locally within their service areas.
Board Lead:
Judy Hillier, Director of Nursing and Quality
Implementation Lead:
Susan Marshall, Associate Director of Nursing and Quality
Project Lead:
Ann Smart, Quality and Patient Safety Manager
28
Better health, local care
Quality Accounts 2011
29
Priority 7 : Reduce the incidence of pressure sores
Pressure sores not only cause the patient great distress and discomfort, they are a major
financial drain on NHS resources. It is estimated that up to 30% of patients may suffer
from a pressure sore at some stage in their life, although there is currently no reliable
data to support this suggestion. Pressure sores are areas of localised damage to skin
caused by pressure, shear and friction and usually occur over a bony prominence. A
tool is used to grade the severity of any damage. This ranges from Grade 1 where there
is discolouration, swelling or hardness of the skin through to Grade 4 where there is
extensive damage to the muscle or bone. Solent NHS Trust uses a widely recognised tool
to do this (European Pressure Ulcer Advisory Panel 1999).
Why did we make this a priority?
In 2010/11, Solent NHS Trust undertook a programme of case reviews of patients who
had developed a pressure sore in order to identify those risk factors which predispose to
the development of pressure sores. Pressure sores can occur in any patient but they are
particularly prevalent in those patients who are chronically sick, malnourished or obese.
“Your skin matters” was also a high impact action for nurses and midwives (as identified
by the Chief Nursing Officer for England).
Current Status
As a result of case reviews, care planning and risk assessments, documentation has
been improved and a programme of events to reduce the incidence still further has
commenced.
Please see below which represents the incidence of pressure sores by grade within
Solent NHS Trust.
Figure 6
Solent NHS Trust have an average number of Grade 3 and Grade 4 pressure sores
in comparison to other NHS organisations locally. Currently we have no national
benchmarking data we can use as a comparison. This will become more readily available
once organisations have reliable baseline data to share.
30
Better health, local care
What are our plans for 2011/12?
•
Aim to reduce the high grade pressure sores by 25% in the next year
•
We will continue to do a thorough root cause analysis investigation on all grade 3
and grade 4 pressure sores acquired in our care
•
Ensure that a risk assessment tool is used by staff to assess a patient vulnerability in
terms of acquiring a pressure sore
•
Ensure the patient has an equipment assessment and is placed on the appropriate
equipment to alleviate the risk of developing a pressure sore
Board Lead:
Judy Hillier, Director of Nursing and Quality
Implementation Lead:
Fiona Marsden, Head of Quality
Project Lead:
Denise Woodd, Tissue Viability Lead Nurse
Priority 8 : To prevent avoidable malnutrition and
dehydration
Ensuring patients receive adequate nutrition and hydration is fundamental to good
care, however malnutrition and dehydration is common and is associated with negative
impacts on health. ‘Poor nutritional care can threaten the safety of people in all care
and community settings’ (NPSA, 2009). It is estimated to affect over 3 million people in
the UK , 3% in hospitals or other NHS settings, with associated health costs of £13 billion
every year (British Advisory Parental Enteral Nutrition (BAPEN, 2009)).
Why did we make this a priority?
The Chief Nursing Officer’s High Impact Action ‘Keeping Nourished, Getting Better’ and
Age Concerns ‘Hungry to be Heard Campaign’ 2010 are a couple of the national drivers
that focus on nutrition. In addition a staff consultation exercise identified nutrition as a
key clinical priority within the organisation.
Current Status
A Nutrition and Hydration Strategy Group with representatives from across the
organisation has been established which will raise the profile of the importance of
nutrition and hydration and will develop, progress and monitor an action plan for
ensuring standards of nutrition and hydration in care. Nutrition audits have already
been undertaken and patient feedback regarding nutrition is monitored. A nutrition
policy is underway and inpatient menus are now available in other accessible formats
(e.g pictures) in some inpatient areas. Following a successful bid for some external
funding a project has been undertaken to deliver swallowing training to nursing home
staff in Portsmouth City, which will now be evaluated.
Quality Accounts 2011
31
This was a joint initiative between Portsmouth Hospital Trust and between Solent NHS
Trust and between Dieticians and Speech and Language Therapists. The aim being to
ensure Nursing Homes offer more nutritionally fortified foods rather than supplements
and for staff to have an improved awareness of safer swallow strategies at meal times
with an overall aim of improving nutritional screening and care planning. What are
our plans for 2011/12?
•
Develop the nutrition and hydration policy
•
Roll out the established training programme to all relevant clinical staff
•
Finalise the report from the project and explore the potential for funding to extend
and continue the roll out of training across more nursing homes.
Board Lead:
Judy Hillier, Director of Nursing and Quality
Implementation Lead:
Ann Rice, Senior Dietician
Project Lead:
Ann Smart, Quality and Patient Safety Manager
Priority 9: Increase openness and transparency in
the organisation via a “Patient Safety Walkaround”
programme
The international literature shows that the culture of an organisation and the
commitment to quality of all members of staff is a crucial determinant of quality
performance. The Trust Board has a key role in fostering this culture through their own
focus on quality issues and one way of doing this is by the introduction of a regular
walk about by senior leaders into front line services within an organisation. This enables
staff to have easy access to Board members and for Board members to truly understand
the operational service delivery issues. Patient safety is the number one priority of the
Board and the top of the monthly Trust Board agenda.
Why did we make this a priority?
Although staff regularly present to the Integrated Governance Committee, which
reports to the Trust Board and staff present on a monthly basis to commissioners via
the Clinical Quality Review meetings, it was felt that the introduction of Patient Safety
and Leadership Walkarounds by senior leaders in the organisation would enhance the
current process and improve communication. It has also been highlighted in several
patient safety and quality initiatives as a way of reducing the communication gap
between services and Board members and leading and promoting a culture of patient
safety and quality.
32
Better health, local care
Current Status
A number of walkabout visits have already taken place very successfully as a pilot and
have resulted in verbal feedback at Trust Board by the Chief Executive and directors
involved. Both directors and clinical staff involved have fed back following the visit to
highlight areas of good practice and areas where it is felt that improvements could be
made.
What are our plans for 2011/12?
Following on from the pilot, Solent NHS Trust will develop a rolling programme of
services to visit on a monthly basis by both Directors and Non Executive Directors.
Feedback from these visits will be formally reported via our governance committee
structure and any action plans developed as a result of the visits will follow through
similar routes. Each director is responsible for giving a verbal feedback at board level
following the visit.
How will we monitor progress to improve quality?
The Trust Integrated Governance and Performance Committee is the main committee
where all of the quality priorities and performance is measured and scrutinised. For each
quality priority an Board executive lead, project manager and implementation lead will
be responsible for ensuring the progress against these priorities. For these priority areas
there is also an opportunity for service users to have a voice in identifying areas for
improvement and monitoring the progress. Various focus groups are held across service
groups which feed into the quality work streams e.g. productive ward and dignity and
compassion in care.
A monthly clinical review meeting is held with commissioners where services present
their work and scrutiny takes place to ensure quality measure are progressing and
where challenges to service improvement are identified.
Engagement with local LINks and community patient involvement networks takes place
regularly to maintain and improve the relationship between the organisation and
patient and public involvement. Transformation schemes are discussed and members are
consulted on new models of service delivery and feedback is obtained.
Each service area has a system in place to monitor their own performance against
quality measuresand standards, which includes local clinical governance groups.
More information can be found in the Trust Quality Improvement Strategy 2011 – 16.
Board Lead:
Judy Hillier, Director of Nursing and Quality
Implementation Lead:
Susan Marshall, Associate Director of Nursing and Quality
Project Lead:
Jo Odell, Productive Facilitator
Quality Accounts 2011
33
2.2 Statements of Assurance
The section of Statement of Assurance is a common statement provided by all NHS
organisations to help readers compare between different organisations and to provide
assurance that Solent NHS Trust takes part in national audits and enquiries.
The wording for this section is set out in legislation and follows a common format for all
organisations.
2.2.1 Review of Services
Mandatory Statement
During 2010/11 Solent NHS Trust provided 37 Services.
Solent NHS Trust has reviewed all of the data available to them on the quality of care in
all of these services.
The income generated by the NHS services reviewed in 2010/11 represents 100% of
the total income generated from the provision of NHS services by Solent NHS Trust for
2010/11
The amount of services provided is based on the services commissioned by local NHS
commissioners.
The category of services provided by Solent NHS Trust is as follows:
•
Adult Services
•
Children and Young People
•
Mental Health and First Response Services
•
Specialist Services and Primary Care
Our services are provided in four Business Units:
Adult Services
•
Community District Nursing (including
Community Matrons, continence and
stoma)
•
Stroke Rehabilitation
•
Occupational Therapy Specialist Nurses
•
Safeguarding Adults
•
Community Equipment Services
•
Specialist Palliative Care including
psychology
•
Wheelchair Services
•
Pain Service
•
Continuing Care/End of Life Care
(Jubilee House)
•
Musculoskeletal Service
•
Intermediate Care and Rapid Response
•
Podiatry
•
Inpatient Units (Rehabilitation Units –
Rembrandt, Western Community and
Royal South Hants Hospital)
•
Diabetes
•
Physiotherapy
34
Better health, local care
Children and Young People
•
Community Paediatric Medical Service
•
Sexual Abuse Referral Centre
•
Community Children’s Nursing Service
•
Inscape
•
Speech and Language Therapy
•
Health Visitors
•
Contraception and Sexual Health
•
School Nurses
•
Genito-urinary Medicine/HIV
•
Safeguarding Children
Mental Health and First Response Services
•
Adult Mental Health Services
•
Child and Adolescent Mental Health
•
Learning Disabilities
•
GP Out of Hours
•
Substance Misuse Services
Specialist Services and Primary Care
•
Offender Health
•
Paulsgrove Healthy Living Centre
•
Dental Services
•
Patient Call Centre
•
Nicholstown, Adelaide, John Pounds GP •
Surgery
•
Walk in Centres/Minor Injuries Unit
Homeless Health
The majority of our services are provided from two main locations - St James’ Hospital,
Portsmouth and the Adelaide Health Centre in Southampton, although we do provide
services from other community clinics, health centres and community hospitals across
the two cities.
2010/11
Activity
% of Total Mental Health and Community contract Income
Mental Health
33%
Community
67%
2011/12
Activity
% of Total Mental Health and Community contract Income
Mental Health
31%
Community
69%
Quality Accounts 2011
35
2.2.2 Internal assurance regarding the quality of our services
This section of the Quality Account provides information about our involvement in
clinical audit. Clinical audit is the process of continuous monitoring of clinical standards
to ensure best practice is maintained and improved where gaps are identified.
2.2.3 Clinical Audit
Mandatory Statement
During 1 April - 31 March 2011 there were 54 national clinical audits (of which six were
applicable to the services that Solent NHS Trust provides) and 1 confidential enquiry
covered NHS services that Solent NHS Trust provides.
During that period we participated in 50% of the eligible national clinical audits and did
not participate in the national confidential enquiry that we were eligible to participate
in. The National clinical audits that Solent NHS Trust was eligible to participate in during
2010/11 are presented in Table 1. This table also shows the number of cases submitted to
each audit as a percentage of the number registered cases required by the terms of that
audit.
Table 2
National Clinical Audits and National Confidential
Enquiries that the Trust was eligible to participate in
Did the Trust
participate?
Stroke Care
Yes 100%
Falls and Non-hip Fractures
Yes 100%
Chronic Pain
Yes 100% Phase one
Depression and Anxiety
No
Prescribing in Mental Health Services
No
National Audit of Schizophrenia
No
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Better health, local care
2.2.4 Local Audits
Business Unit
Audit
Action Being Taken
All Services
Records
management
NHS numbers, medical alerts, dates, times and
signature of entries are all now included in
Patient in Electronic Records (RiO). Staff record
in records consent to share information with
others
Improved system for archiving records in place.
Records reviewed at clinical supervision
Dignity and
privacy
All patients asked how they wished to be called
on initial assessment. And this is documented
in the records Choice of appointment time and
choice of venue
Consent
Patients given clear information on treatment
choices available which is documented in the
records. Trust permission to share form has been
put in the front of the patient records and a
check list for completion of initial assessment.
Verbal consent tick box now in front sheet of
patient records. Patients are involved in decision
making with regards to mental capacity and
consent, ensuring best interest processes are
followed for patients who lack capacity
All services
involved in
providing
care on going
care with an
individual with
an indwelling
urinary catheter
Infection
Control and
Essential steps
There is a reduction in the number of infections
reported
Catheter care
Catheter care plans in place for all patients with
indwelling urinary catheters
Quality Accounts 2011
37
Inpatient Units
Medicine
Management
Missed Doses
Pharmacy highlight missed doses to nurse in
charge as it occurs. Nurses ensure stock items are
ordered for the ward when needed
Falls
Falls risk assessments are completed within
six hours of admission. Falls care plans are
now in place for patients identified at risk of
falling. Staff check that patients understand
explanations given for causes of falls/risk factors
Discharge
summary
Service users discharge summary is issued within
24 hours of discharge. Copies of letters are
uploaded onto electronic recording system.
Mattress
audits
These are carried out monthly on the units using
the Infection prevention mattress audit tool,
any concerns or problems with the mattresses re
dealt with immediately
Inpatient units
using MUST
screening tool
Nutrition
All patients screened within 24 hours of
admission. MUST repeated weekly. Use of
nursing handover sheets to highlight patients
who need screening when admitted late in the
day. Patients at risk of malnutrition have MUST
care plans in place which are reviewed and
followed by staff
Inpatient
Services/
Community
Nursing
Pressure
ulcers
management
Patients receive an initial pressure ulcer risk
assessment within six hours of admission. There
is now a bone health assessment prompt in
nursing care plan to ascertain risk of fragility of
fractures and osteoporosis risk. Advice given to
patients and relatives/carers recorded in records.
Pressure ulcers prevention booklet to all staff in
line with NICE guidance
Community
Nursing/
Podiatry
Wound care
Would care formulary discussed and given to
all new staff at induction. Staff attending the
tissues viability specialty course on doppler,
bandaging and dressing’s .NICE patient /carer
information leaflet given to all patients and
recorded in the records. Assessment of patient
pain recorded in care plans
38
Better health, local care
Mandatory Statement
“The reports of twelve local clinical audits were reviewed by the organisation in 2010/11
and Solent NHS Trust intends to take the actions highlighted above to improve the
quality
Local clinical audits are carried out by individual healthcare professionals evaluating
aspects of care that they themselves have selected as being important to them and/or
their team.
2.2.5 Participation in Clinical Research
This section of the Quality Account describes our participation in clinical research.
Research and service evaluation sit at the heart of quality, excellence and innovation in
healthcare. A healthy and active research culture will promote high quality healthcare
provision.
Mandatory Statement
The number of patients provided or sub contracted by Solent NHS Trust that were
recruited during that period to participate in research approved by the Research Ethics
Committee was 432 patients.
The level of participation in clinical research demonstrates the commitment by Solent
NHS Trust to improving the quality of care we offer and to making our contribution to
wide health improvement.
Solent NHS Trust are also current collaborators in 60 open studies and host two National
Institute of Health Research (NIHR) grants totalling £4m.
Solent NHST Trust has demonstrated an increased commitment to research activity in
2010 – 11, supporting services to open up opportunities for their patients to participate
in research. We have also consolidated the infrastructure surrounding research and
development to ensure a robust governance process and to facilitate the links between
research and service delivery.
A table of all the research activity currently taking place within the organisation is
presented as Appendix 1.
2.2.6 Use of the Commissioning for Quality and Innovation (CQUIN )
Framework
This section of the Quality Account describes how the CQUIN payment framework is
used locally. The CQUIN payment framework provides a means by which payments can
be made to providers of services dependent on achievement of locally agreed quality
targets. It supports the overriding principle of commissioning to be focussed on quality
outcomes for patients. For Community providers of services this equated to 1.5% of the
overall contract value for 2010/11.
Quality Accounts 2011
39
Mandatory Statement
A proportion of Solent NHS Trust’s income in 2010/11 was conditional on achieving
quality improvement and innovation goals between Solent NHS Trust and any person
or body they entered into a contract, agreement or arrangement with for the provision
of NHS services through the Commissioning for Innovation and Payment Framework.
Details of the goal agreed for 2010/11 are available below.
During 2010/11, 1.5% of our contract with Primary Care Trusts was based on
achievement of 11 performance indicators. Each performance indicator has an indicator
% weighting of the overall 1.5% CQUIN payment. These are summarised in the table
below:
CQUINS 2010/11
CQUIN Performance
Indicator Goal
Quality Indicator
Percentage of
overall CQUIN
weighting
against payment
IT Systems
Development
All people with a long term condition
will have a personalised care plan which
is available electronically.
20%
IT Systems
Development
All people with a long term condition
will have a personalised care plan which
is available electronically and that is
accessible to other appropriate providers
of healthcare.
Long Term
Conditions
All people with a long term condition
will be offered a personalised care plan.
Long Term
Conditions
All people with a long term condition
have a health record that clearly
demonstrates that a personalised care
plan that has been offered to them
Long Term
Conditions
All people with a long term condition
have a written record of their
personalised care plan provided to them,
if they have chosen to have one
Community
40
Better health, local care
40%
Provider to set
up systems and
processes for
identifying patients
who are dying and
identifying the
needs of patients
that are dying
Staff training for End of Life Care
10%
Provider to set
up systems and
processes for
identifying patients
who are dying and
identifying the
needs of patients
that are dying
Systems for Identifying patients
10%
Implementing
training re: caring
for people with
dementia
Dementia awareness training
10%
Implementing
training re: caring
for people with
learning disabilities
Learning disability awareness training
10%
Service Line/Patient
Level reporting
and performance
management
VFM data
40%
All service users in
high cost out of city
placements to have
received an annual/
in year review of
their needs
Out of area placements
60%
Mental Health
Quality Accounts 2011
41
During 2011/12 1.5 % of our contract will be based on the achievement of CQUINS.
These have been agreed for the Mental Health contract and currently in draft for the
Community. It is expected that each performance indicator will have a weighted %
contribution to the overall CQUIN payment. These are summarized in the table below:
These may be subject to change
CQUINS 2011/12
CQUIN Performance
Indicator Goal
Quality Indicator
Percentage of
overall CQUIN
weighting
against payment
VTE prevention
Reduce avoidable death, disability
and chronic ill health from Venousthromboembolism (VTE)
TBC
Patient experience personal needs
Improve responsiveness to personal
needs of patients
TBC
Health care
associated infection
-urinary catheters
To reduce the number of patients having
an indwelling urinary catheter inserted
during their hospital stay.
TBC
Increase the
number of people
who are able to die
in a place of their
choice
Ensure people at the end of their life are
placed on the Liverpool Care Pathway
and are able to die in a place of their
choice.
TBC
Ensure people
receive care in the
most appropriate
healthcare setting
To reduce inappropriate admissions
TBC
Improve
unscheduled care
services (NHS
Portsmouth)
To improve the overall experience of
patients using unscheduled care services
TBC
Health care
associated infection
-urinary catheters
To reduce the number of patients having
an inappropriate indwelling urinary
catheter inserted during their hospital
stay.
TBC
Draft Community
42
Better health, local care
Excess bed days
Excess bed days (XBDs) are considered
excess for spells that extend beyond five
bed days. Up to and including five days
will be considered on the same tariff.
There is a short-stay tariff of 0-1 bed
days (i.e. less than 24 hours) which is
computed as less than the standard as
set by the Department of Health.
TBC
Dual Diagnosis
People with dual diagnosis receive
appropriate assessment, treatment and
support in line with the provider’s dual
diagnosis procedure
20%
Effectiveness of
Substance Misuse
Interventions
Systems are developed to ascertain
the effectiveness of substance misuse
interventions after discharge from
services
15%
Support for Carers
Identify, involve and support all carers of
patients and service users with long term
conditions
25%
Readmission Rates
Reduction in re-admission rates
25%
Recovery Approach
Demonstration of recovery/improvement
in the quality of life of service users
through the use of recovery tools such as
Recovery Star
15%
Mental Health
Quality Accounts 2011
43
2.2.7 Registration with the Care Quality Commission
Mandatory Statement
Solent NHS Trust is required to register with the Care Quality Commission and its current
registration status is “Registered without conditions“.
Solent NHS Trust has no conditions on registration.
The Care Quality Commission has not taken enforcement action against Solent NHS
Trust during 2010/11.
Solent NHS Trust is subject to periodic reviews by the Care Quality Commission and the
last review was the Annual Health Check for 2008/9, published in October 2009. The
Care Quality Commissions assessment of Solent NHS Trust was “Good” for quality of
services and “Fair for financial management”.
The Trust has not participated in any special reviews or investigation from the Care
Quality Commission during the reporting period.
All our locations are registered with the Care Quality Commission to undertake the
following regulated activities:
•
Treatment of Disease, Disorder or Injury
•
Diagnostic and Screening Procedures
•
Accommodation for persons who require personal or nursing care
•
Accommodation for persons who require treatment for substance misuse
•
Assessment or medical treatment for persons detained under the Mental Health Act
1983
•
Family Planning
•
Nursing Care
•
Personal Care
•
Termination of Pregnancies
•
Transport services, triage and medical advice provided remotely
In April 2010, all health and adult social care providers who provide regulated activities
were required by law to be registered with the Care Quality Commission. To register,
NHS organisations were required to demonstrate that they were meeting the new
essential standards of quality and safety across all of the regulated activities they
provide. There are now 28 outcomes which relate to the Health and Social Care Act 2008
(Regulated Activities) Regulations 2009, which are grouped into six main headings:
44
Better health, local care
•
Involvement and information
•
Personalised care, treatment and support
•
Safeguarding and safety
•
Suitability of staffing
•
Quality and management
•
Suitability of management
This system was designed to ensure that people can expect a universal standard within
services that meet essential requirements of quality and safety that respect their dignity
and protect their rights. The new system focuses on outcomes, rather than systems
and processes, and places the views and experiences of people who use services at the
centre.
Ongoing monitoring of all evidence against the regulated standards for quality and
safety takes place via the Essential Standards Steering Group and internal assurance
processes ensure the evidence is of a robust nation that is focussed on patient outcomes
rather than process.
2.2.8 Data Quality
Mandatory Statement
Solent NHS Trust submitted 27,798 records during 2010/11 to the Secondary Uses Service
for inclusion in the Hospital Episode Statistics which are included in the latest published
data. The percentage of records in the published data:
Which included the patient’s valid NHS number:
•
98.5% for admittedpatient care
•
99.1% for outpatient care
•
0%*for accident and emergency care.
Which included the patient’s valid General Practitioner Registration Code was:
•
99.7% for admitted patient care
•
99.9% for
•
outpatient care
•
0%* for accident and emergency care (Solent NHS Trust does not provide accident
and emergency care)
Solent NHS Trust’s score for information governance and records management assessed
using the information governance toolkit was 81%.
During 2010/11 the audit commission undertook a routine Payment by Results clinical
coding audit of which Solent NHS Trust was not subject to.
Quality Accounts 2011
45
Figure 7 identifies the percentage of records identified with the ethnic category
recorded.
Figure 8 identifies the number of records that had an NHS number recorded.
Figure 9 identifies the number of records that had a GP Practice recorded.
Current Status
[Data source – Secondary Uses Service Data Quality Dashboard – Month 11 2010/11]
Figure 7 - Recording of Ethnic Category
Outpatient CDS - % of records with a valid Ethnic Category
(April 2010 to February 2011)
Inpatient CDS - % of records with a valid Ethnic Category
(April 2010 to February 2011)
100%
100%
90%
90%
80%
80%
70%
70%
60%
60%
50%
50%
40%
40%
30%
30%
20%
20%
10%
10%
0%
0%
% Va l i d
SUHT
Sol ent
HCHC
SC SHA
Avera ge
Na ti ona l
Avera ge
HPFT
PHT
94.6%
90.2%
83.0%
44.5%
28.6%
7.2%
0.0%
% Va l i d
HCHC
PHT
Sol ent
HPFT
SC SHA
Avera ge
Na ti ona l
Avera ge
SUHT
100.0%
100.0%
99.7%
99.4%
99.1%
98.2%
97.7%
Figure 8 - Recording of NHS Number
Outpatient CDS - % of records with a valid NHS Number
(April 2010 to February 2011)
Inpatient CDS - % of records with a valid NHS Number
(April 2010 to February 2011)
100%
100%
90%
90%
80%
80%
70%
70%
60%
60%
50%
50%
40%
40%
30%
30%
20%
20%
10%
10%
0%
% Va l i d
HPFT
HCHC
PHT
SC SHA
Avera ge
99.8%
99.3%
99.3%
99.1%
0%
Sol ent
Na ti ona l
Avera ge
SUHT
99.0%
98.8%
97.8%
% Va l i d
HPFT
HCHC
Sol ent
Na ti ona l
Avera ge
PHT
SC SHA
Avera ge
SUHT
99.6%
99.2%
98.6%
98.5%
98.4%
98.3%
96.8%
Figure 9 - Recording of GP Practice
Outpatient CDS - % of records with a valid GP Practice
(April 2010 to February 2011)
Inpatient CDS - % of records with a valid GP Practice
(April 2010 to February 2011)
100%
100%
90%
90%
80%
80%
70%
70%
60%
60%
50%
50%
40%
40%
30%
30%
20%
20%
10%
10%
0%
% Va l i d
46
0%
HPFT
HCHC
PHT
SC SHA
Avera ge
Sol ent
Na ti ona l
Avera ge
SUHT
100.0%
100.0%
100.0%
100.0%
99.9%
99.8%
99.7%
% Va l i d
HPFT
HCHC
PHT
SC SHA
Avera ge
SUHT
Na ti ona l
Avera ge
Sol ent
100.0%
100.0%
100.0%
100.0%
100.0%
99.8%
99.6%
Better health, local care
What are plans for 2011/12?
The Trust’s clinical information system RiO system will be rolled out over the next 12
months which will result in improvements to the availability of data and subsequently
the timeliness and quality of this data.
There will be increases to the frequency of internal audits on data coding, with a
greater feedback to clinical teams from data coders which is anticipated to lead to
improvements in the accuracy of coding.
During 2011/12 there will be a number of new national data sets which are currently in
development released. Each of the data sets will have a set of standards which we will
monitor and benchmark against other organisations.
Next year’s information governance and records management targets for 2011/12 is to
continue to achieve at least a level 2 in all requirements and develop towards achieving
a level 3. Additional and specific targets will be unknown until the new toolkit is issued
in July/August; currently it is unknown what toolkit NHS Trusts will be required to
complete.
Quality Accounts 2011
47
Section 3: Review of Quality Performance in 2010/11
Section 3 of the Quality Account lays out information about the quality of our services
in 2010/11 based on the above review process
3.1 Overview of Performance
We review and monitor the quality of our services in a variety of ways and settings as
laid out in the table below:
Assurance
Process
Description
Integrated
Performance
Committee
and Monthly
Report
This monitors a dashboard of clinical quality and safety
performance against quality indicators which are presented and
reviewed on a monthly basis. This information is reviewed by the
Board, IGAP and Finance and Executive Committee which consists
of executive and non executive representatives and allows for
scrutiny to take place and acts as the main focus for wider review.
Quality
Improvement &
Patient Safety
Subcommittee
This is a clinical and operationally focused group that monitors all
quality and safety initiatives taking place within the organisation
to ensure a coordinated approach to quality and safe delivery is
achieved. This reports on a monthly basis to IGAP and is chaired by
the Director/Associate Director of Nursing and Quality.
Quality
Improvement
Strategy
This strategy puts in place a clear quality and performance
management framework. It places a commitment that quality
will be at the heart of the Trust and brings all the aspects that
contribute to quality together.
Risk Assurance
Subcommittee
This monitors, reviews and provides assurance regarding the
triangulation and learning from incidents, complaints, claims and
other sources of data.
Serious
Incidents
Requiring
Investigation
Group
This group reviews any serious incidents requiring investigation,
ensuring that each incident has an in-depth investigation to
identify all root causes, which are presented to the group. All
recommendations are captured and monitored in action plans.
Clinical
Audit and
effectiveness
Group
All of the national guidelines, guidance, national enquiries, and
national and local audit is analysed and reviewed through this
group.
48
Better health, local care
Research and
Development
Group
Reviews research governance policies, research activity and
funding, processes for allocating funding to researchers. Also
reviews performance in relation to national targets and metrics
and feeds national and local research initiatives/guidelines into
the organisation. Promotes evidence based practice and patient
and public involvement in research.
Patient
Experience
Reporting
Members of the public are involved as group members in this
forum and are involved in reviewing themes from complaints and
in service transformation schemes
NHS Litigation
Authority
(NHSLA)
The Trust is a member of the NHS Litigation Authority indemnity
schemes. The NHSLA ensure through vigorous external assessment
and accreditation that the Trust is operating at a sound level of
risk management and governance.
Infection
Prevention
and Control
Committee
This monitors compliance against the Hygiene Code (as part of
Essential Standards).
National
Reporting
& Learning
System (NRLS)
The Trust anonymously reports all patient safety incidents to the
National Patient Safety Agency, via NRLS. This allows the Trust
to make comparisons with similar organisations in regards to
the number and severity of incidents. This help us measure and
improve.
Health & Safety
Subcommittee
Is responsible for overseeing the strategic and operational
implementation of all health and safety related policies in every
operational area and activity of the Trust.
There are many other groups
that lead the quality and patient
safety workstreams
Quality Accounts 2011
49
3.2 Update on the Quarterly Priorities from 2010/11
In 2010/11 Mental Health Services were required to develop a Quality Account with
priorities for action. These have been monitored throughout the year and the results of
which are highlighted below.
For those areas where it was felt that improvements can still be made, they have
remained a priority in this year’s account
Safety
Objective
Measure
Outcome
Improve on patients
feeling safe within
our clinical settings
90% of service
users report a
positive response
100% of surveys returned reported
positive response of feeling safe within
their clinical environment
Improvements to
7 day follow for
patients discharged
from hospital
100% of all
patients to be
followed up
within 7 days
99% of patients followed up within 7
days of discharge
To screen all elective
admissions for MRSA
100 % of clients
admitted
screened for
MRSA
100% of patients screened within Older
People Mental Health services. Other
mental Health Services do screen for
MRSA but their admissions are mainly
emergency admissions rather than
planned (elective) admissions
50
Better health, local care
Patient Experience
Objective
Measure
Outcome
To improve levels of
customer satisfaction
90% positive responses in
Customer survey
90% of patients either
Strongly agree of partly
agree that they are
satisfied with the service
they have received
To improve overall levels
of satisfaction within the
early onset dementia
services
90% positive responses
within the early onset
dementia services
Awaiting analysis of data
To ensure that young
people’s experience
during transition is
positive
90% of young people in
CAMHS report positive
experience during
transition to Adult Services
90% young people agreed
that service was of high
standard
To offer choice of clinic
times and venues for all
patients
100% of children and
young people in CAMHS
offered choice of time and
venue with appointments
100% were offered choice
with time and venue of
appointments
Quality Accounts 2011
51
Effectiveness
Objective
Measure
Outcome
Improve access to
family interventions
Respond to DOH
audit measuring
78% of people
offered family
interventions
DOH did not send out audit in
2010, however all the actions from
the improvement plan have been
implemented. Main actions completed
are:
1. All staff have cue cards with NICE
guidance on them
2. Schizophrenia Care plan has been
embedded on RiO
This Objective and the measures
will be carried through to 2011 in
anticipation of the DOH National
Audit of Schizophrenia
Evidence will show
all clients with
Schizophrenia have
been given the
opportunity to make
Advance Decisions
DOH audit
measuring 24%
of clients having
advance decisions
in place
As above
Improve Information
about Schizophrenia
to patients and
relatives.
DOH audit
measuring 71%
of patients have
information
about
schizophrenia
As above
Develop a pathway
for people with
borderline
personality disorder
Agreed pathway
to be in place by
April 2011
Multi agency pathway mapping
day took place and pathway has
been agreed. This is now been
taking into the project phase via the
Transformation of Community Mental
Health Services. Agreed pathway will
be embedded into the new model
Reduce the 28 day
admission rate
To reduce by
between 2-4%
Readmission rate reduced by 3% as of
Feb 2011.
Improve levels of
dehydrations and
nutrition in older
peoples mental
health
50 records to
be audited and
100% to have
food and fluid
charts in place
100% of records audited had this in
place
52
Better health, local care
3.2
Existing
Priorities
from 2009/10
Quality Accounts 2011
53
3.2.1 Improving care for patients with schizophrenia
Why did we make this a priority?
This is an existing priority for Solent NHS Trust that was identified last year in the
Portsmouth Community and Mental Health Services Quality Account and will remain a
priority for this year’s account.
In 2008 the Department of Health circulated a national audit to measure the extent to
which clinical practice for people with schizophrenia as their primary diagnosis was in
line with the National Institute of Clinical Excellence (NICE) guidance on schizophrenia.
Adult Mental health Services scored below the national average when compared
to other mental health organisations. As such, this formed one of the priorities for
last year and will continue to be a priority until all action plan outcomes have been
implemented, improvements have been made and the re - audit has taken place.
3.2.2 Development of pathway for people with Borderline Personality
Disorder
This is also an existing priority for Solent NHS Trust that was identified last year in the
Portsmouth Community and Mental Health Services Quality Account last year. The
pathway has been developed and is now being implemented. This will remain a priority
until the pathway has been audited to see if any additional improvements are required..
3.2.3 To improve overall levels of satisfaction within the early onset
dementia services
This is an existing priority from last year’s Quality Account as the necessary data is not
yet available. Any action plans following analysis of the data will be monitored through
the Patient Experience and Involvement Group and will remain a priority until such time
as this target has been achieved.
3.3
Learning from our patients
Evidence from the inpatient audit for Mental Health Services highlighted that a
proportion of Care Programme Approach respondents to the Community Mental Health
survey stated that they had not been given (or offered) a written or printed copy of
their care plan, did not know what was in their care plan and did not think their views
were taken into account when planning their care. Due to these findings and following
additional work a local re-audit was completed in April 2011 where a sample of 40
random patients has shown that 100% of those records audited showed evidence of
care plans being handed to patients and involvement in care planning. Another audit
that will take a qualitative approach (Interviews 60 patients) is under way to explore
why there seems to be a contradiction between what is being recorded and what
is being reported by patients. Staff are also focusing on “branding” to ensure that
patients understand the language that is being used regarding the Care Plan Approach.
In the same national survey some respondents identified that the last time that they
called their local mental health services out of office hours they did not get the help
they wanted. Because of this, out of hours working has been built into the current
proposals for the ongoing Community Mental Health Transformation project which is
due for implementation in September 2012.
54
Better health, local care
3.3.1 Learning from our staff
Our annual staff survey, which is sent out to all staff, received a response rate of 58.5%
for 2010. The survey highlights areas for improvement and areas where staff feel
improvements can be made. Figure 10 demonstrates how many questions the Trust did
better, how many worse and how many stayed the same from last years survey. Areas
where staff feel significant improvements have already been made this year are in areas
of learning and development, where staff felt they had received more training and also
more staff highlighted they had a personal development plan in place.
Figure 11 demonstrates how we compare to other Trusts. Staff also reported that they
had seen errors or near misses occurring whilst at work but that those errors and near
misses had been reported appropriately. This reflects the national data received which
highlights that Solent NHS Trust has a healthy reporting culture and that staff know
how to report incidents, errors or near misses.
An area where Solent NHS Trust showed a lower score than expected was regarding
having sufficient staffing. Solent NHS Trust recognises the need to maximise efficiency
of front line and corporate services and is engaged in a range of service transformation
and productivity initiatives to achieve this. The Solent Healthcare Productivity
Programme deploys tested methodologies to study activities and processes and inform
planning to ensure optimum skill mix and promote patient-facing time for clinicians.
Solent NHS Trust is also engaged in the NHS Institute Productive Series to foster
leadership, reduce waste and promote efficiency and quality within our front line teams
Figure 10 - Have we improved since the 2009 survey?
Figure 11 - How do we compare to other trusts?
Quality Accounts 2011
55
3.4 Statement from Local Involvement Networks, Overview and Scrutiny
Committee and Primary Care Trusts
This Account was shared with the Local Involvement Networks (Links) and Overview
and Scrutiny Committees (OSC) in Portsmouth, Southampton and Hampshire for their
comments.
The Overview and Scrutiny Committees declined to respond With Hampshire stating:
“they are clear that they can always exercise the option for them to approach the CQC
if they have concerns and they couple that with an emphasis on working closely with
colleagues in the NHS. This enables us to flag issues of concern formally and informallyand in ‘real time’ rather than a reporting cycle”.
3.4.1 Local Involvement Networks
3.4.2 Southampton Link
“Southampton Link is content that the quality account for Solent NHS trust is
representative and gives good coverage of the trust’s services with no significant
omissions. Unfortunately, we were not given much time to review the draft document
and we hope that this will be rectified in future.
This is the first year that Solent NHS trust have produced quality accounts for the
services provided in Southampton and as a consequence there are few comparative
statistics where relevant comparative statistics have been provided against national or
comparable trusts.
We were pleased that the quality accounts were in a format that was easy to read,
follow and understand. The priority areas are clearly defined and laid out.
We are of course pleased that big improvements have been made on infection control.
Although the Quality Account cautions against benchmarking against national averages
for community hospital falls, it is nevertheless a disappointment to see figures for Solent
that are more than twice the national average; we trust the proposed monitoring
system will bring about significant reductions.
We are very pleased to see that the trust is planning to provide customer care training
and improve communication. A “Patient Safety Walkaround” programme should also
help.
We support the “Productive Ward and Productive Care” Programme and believe it will
make a difference. Dignity is clearly important and we are pleased to see that the trust
comply with the single sex requirements.
We hope the plan to reduce pressure sores by 25% is achieved.
56
Better health, local care
3.4.3 Portsmouth Link
The Link acknowledges that the year covered by these Quality Accounts has been
another of almost continuous change and development for Solent NHS Trust and
NHS Portsmouth, both of whom have worked hard to ensure that patients were not
disadvantaged by the changes being made to the NHS in our area.
During the year, Portsmouth Link has continued to work on many issues. This work
has been facilitated by information gathered directly from the public, from service
providers, from meetings with managers and clinicians, from membership of internal
committees formed by provider organisations, from observations by Link members
during visits to hospitals and clinics and from desktop research conducted by individual
members and by the Link host organisation. The Portsmouth Link wishes to emphasise
the significant contribution made through Link membership of existing internal
provider committees, contributions that often go unrecorded but nevertheless affect
the patient/client experience.
Two major projects have been covered by the Portsmouth Link during 2010-11: one
covering Dual Diagnosis (reported to Solent NHS Trust) and another on Transfer of Care,
which is still ongoing although the Link host organisation made an interim report to the
Portsmouth Link at year end (also forwarded previously).
The aspect of dual diagnosis highlighted was that of clients/patients having difficulty
accessing help/treatment with substance misuse problems whilst also suffering mental
health problems. The Link worked in conjunction with Portsmouth Users Self Help
(PUSH) to produce a report which has been widely circulated in the Portsmouth area,
including to Solent NHS Trust.
The Transfer of Care project came into being during the autumn of 2010 following
reports that patients whose acute clinical care was complete continued to occupy
hospital beds due to both internal and external delays. By the beginning of 2011, it
had become clear to Link members working the issue that there was no single reason
and that the issue is complex. By the end of March, sufficient data had been gathered –
some by Link members seeking information from patients passing through the hospital
discharge lounge; partly from data supplied by the Acute Trust; and other information
from desktop research – for the Link host organisation to make an interim report to
the Link. Usefully, this document provided a number of ‘quick win’ proposals which
can be examined while the project continues. The interim report has been distributed
widely and the Link has decided to follow two threads of work: to continue to examine
transfer of care from the acute hospital, whether to another care organisation or
to the family home; and transfer of care from detox and rehab units under similar
circumstances.
Of course, many other issues have been worked alongside these major ones. The
breadth and scope of these can be seen from the section of the Link Annual Report
entitled Demonstrating Impact through Action.
Quality Accounts 2011
57
LINK Co-ordination with Patient Experience Audit Team (PEAT) Activities. The
Portsmouth ink has participated in PEAT visits to Portsmouth healthcare sites to assess
patient experience in terms of the environment for patients at these sites. These visits
were arranged by Solent NHS Trust and included Jubilee House, St James’ Hospital and
St Mary’s Hospital. The results were reported to the Patient Experience Audit Group
(PEAG) and the Link receives minutes of meetings. The Link continues to conduct
collaborative activities with both PEAT and PEAG.
Visit to Baytrees. In the autumn of 2010, the Portsmouth Link invited Solent NHS Trust to
allow a visit to the Baytrees rehabilitation unit on the St James’ Hospital site. This took
some months to come to fruition due entirely to difficulty in identifying common times
because of the changing circumstances within both our organisations. Although outside
the timescale of this Quality Accounts period, we include it here as a good example of
cooperative work which resulted in Link members having access to management, clinical
staff and clients at Baytrees. The Link believes it has established a ‘yardstick’ by which
other services may be measured which will usefully inform its Transfer of Care project.
Solent Healthcare Public Consultation. Link members attended a meeting hosted by
Solent Healthcare in Portsmouth Guildhall to hear more about local community services
in the Portsmouth area.
The Portsmouth Link looks forward to continued development of its working
relationship with Solent NHS Trust, especially during these times of almost continuous
change, and particularly in the areas of mental health and community care.
58
Better health, local care
3.4.4 Statement from Commissioners
Solent NHS Trust Quality Accounts Statement
Solent NHS Trust is a new organisation. On 1st April 2010, Solent Healthcare was formed by the
provider arm of Portsmouth City Primary Care Trust (PCT) separating from its host organisation
and merging with the provider arm of Southampton City PCT to form Solent Healthcare. During
this period it has not only managed this merger but it has also successfully prepared for and
achieved separation from Southampton City PCT to form the stand alone organisation Solent NHS
Trust on 1st April 2011.
Therefore, over the last year, Solent NHS Trust has been through a period of major organisational
change which the quality accounts need to be viewed against. Also, last year, only quality
accounts for the mental health services of Portsmouth City PCT provider arm had to be developed
as these were not required to be produced by providers of community services. A key part of the
process of the merging and subsequent separation of the organisation has been the consolidation
of governance systems. Much progress has been made and there is now a unified clinical
governance structure and separate arrangements for clinical governance within the out of hours
service which is managed through an APMS contract. This has been a considerable achievement.
As with any complex organisational change there have been some issues but when identified
actions have been quickly put in place to resolve the situation. Solent NHS Trust has also been
developing its relationship with Commissioners, who have also changed as a result of the merger.
There are monthly contract meetings to discuss clinical quality, which are attended by the
Director of Nursing and Clinical Standards. Although these meetings are at an earlier stage of
development when compared with other Trusts they are rapidly evolving.
A culture of open and honest cooperation is forming between all stakeholders. However, it is
essential that this momentum continues despite the changes to commissioning structures across
the health economy. Progress on achievement of the priorities set out in these accounts will be
monitored by commissioners at these meetings.
Last year, the mental health services of Portsmouth City provider arm achieved the majority of the
aims set out in last year’s mental health quality accounts. However, three have been carried
forward and are key commissioning priorities. The new priorities included in this year’s accounts
are a fair reflection of the quality issues facing Solent NHS Trust. Improving clinical leadership and
openness is absolutely essential to maintaining quality standards within the new organisation.
Not only has Solent NHS Trust gone through a merger of two organisations with their own
cultures it services are also spread across a wide geographical area.
The information provided in these quality accounts is accurate from the checks the commissioners
have undertaken. Over the next year commissioners expect to see Solent NHS Trust building
on the priorities contained within these quality accounts. It is essential, as they move towards
achieving Foundation Trust status; they demonstrate a strategic approach to quality.
Print Name: …DEBBIE FLEMING..……….......
Title: …...........CHIEF EXECUTIVE…………….
Date: …..........23 JUNE 2011…………………..
Quality Accounts 2011
59
Section 4: Looking Ahead
For the journey ahead towards Foundation Trust status, the organisation has developed
a new vision with some new values.
Becoming a Foundation Trust is a long established aspiration for Solent NHS Trust
and has been consistently appraised as the preferred organisational model to deliver
transformed community services for our local population. This has been given renewed
impetus by the DH requirement that all NHS Trusts should become or become part of a
Foundation Trust by April 2014 Authorisation as a Foundation Trust represents the third
stage of our organisational transformation journey which commenced in January 2009
with the publication of “Transforming Community Services – Enabling New Patterns of
Delivery”.
Phase 1
(2009-10)
The two provider arms of Southampton City PCT and Portsmouth City
PCT undertook an options appraisal which recommended:
• Integration to establish a single sustainable community provider
• Community Foundation Trust as the preferred end-state
organisational form.
Phase 2
(2010-11)
Solent Healthcare was created on April 1 2011 through the integration
of Southampton Community Healthcare and Portsmouth Community
and Mental Health Service and operated as an arms length body of
Southampton City PCT.
Phase 3
(2011-13)
Solent NHS Trust was created on April 1 2011 as an independent NHS
community and mental health provider.
Approval has been received to join the Foundation Trust pipeline with
a proposed authorisation date of April 1 2013.
Becoming a Foundation Trust is not an end to our journey but it is a significant
milestone. Achievement of this milestone will reflect the skill and commitment of our
clinical and corporate teams to deliver clinical and business excellence and assure our
position as a leading community NHS provider delivering first class, patient-centred
services to our local populations
60
Better health, local care
The following translates what these values may look like in terms of behaviours and
actions:
Involved
We strive
to involve,
engage
and value
individuals,
teams and
patients
We bring this value alive through:•
Ensuring each and every member of Solent NHS Trust, clinical
and non clinical are valued, involved and proud
•
Keeping each other informed of our actions
•
Listening and involving each other in all we do
•
Engaging all our people through effective communications
•
Recognising the achievements of individuals and teams
•
Valuing our compassion for improving lives and wellbeing
•
Providing a forum for our staff to make suggestions
Nurturing
We are
committed
to providing
a learning
environment
that achieves
success and
nurtures
talent
We bring this value alive through:•
Striving to achieve full potential of all individuals
•
Recognising and nurturing our talent throughout the organisation
•
Committing to 1-1 meetings and appraisals
•
Celebrating our achievements and successes
•
Taking ownership of our own development
•
Having a willingness to embrace change
•
Giving and receiving feedback
Striving for Excellence
We are proud
about the
quality of
our work and
continually
strive to
exceed
expectations
to achieve
the best
outcomes for
patients and
staff
We bring this value alive through:•
Having a passion for improving lives and wellbeing
•
Being passionate about our roles
•
Providing clinical excellence through evidence based practice
•
Placing our patients at the centre at all times
•
Providing quality effective care always
•
Maintaining our levels of skills, knowledge and expertise at all
times
•
Listening to what each other have to say
Quality Accounts 2011
61
Passionate
We know and
care about
what we
deliver and
encourage
each other to
get it right
first time
We bring this value alive through:•
Being focused, motivated and inspirational to others
•
Ensuring patients are at the centre of all we do
•
Being proud of what we do and why we do it
•
Keeping going even when the going gets tough
•
Prioritising our energy into what makes a difference
•
Showing a sense of can do and urgency
•
Delivering whilst sticking to our core values
Innovative
We are
creating
the future
through
researching
new and
improved
ways of
working and
adopting best
practice
We bring this value alive through:•
Understanding what matters to the patient
•
Embracing change and acting swiftly
•
Encouraging innovation through R & R and patient feedback
•
Adapting processes and supporting people
•
Developing all our staff for the future
•
Having an open mind to all new ideas
•
Celebrating and valuing new ways of working
Respectful
We are
respectful of
individuals,
services and
organisations,
by being
transparent
and honest
and our
actions reflect
our words
through our
integrity
62
We bring this value alive through:•
Our integrity and inclusivity of all
•
Being professional with each other and in all our contacts and
partnerships
•
Appreciating each others perspectives
•
Actively listening and seeing others points of views
•
Demonstrating compassion and valuing diversity
•
Having a clear and active commitment to Equality and Diversity
Better health, local care
Empowered
We are all
empowered
to participate,
communicate,
innovate and
lead
•
We bring this value alive through:-
•
Being empowered to challenge the practices of others
•
Supporting accountability and keeping our promises
•
Providing a supportive working environment that encourages
freedom
•
Trusting people and giving them the opportunity to perform
•
Listening and encouraging decisions into actions
•
Taking pride in our work and who we are
•
Holding self and others to account without blame
4.1 Your feedback is important to us
We welcome your feedback, along with any suggestions you may have for next year’s
publication or thinking ahead, for the quality priorities for 2012/13.
Please contact our communications team at:
Email: communications@solent.nhs.uk
Telephone: 023 8060 8937
Join us as a member and have a say in our future plans
A representative and meaningful membership is important to the success of the Trust
and provides members of our local communities the opportunity to be involved in how
the Trust and its services are developed and improved. Membership is free and the
extent to which our members are involved is entirely up to them. Some are happy to
receive a newsletter twice a year while others are keen to be involved in consultations
and come along to meetings.
Some have even become members of our Council of Governors. For further information
please contact our Communications Team on:
Email: communications@solent.nhs.uk
Check out our website: www.solent.nhs.uk
Solent NHS Trust provides comprehensive details of the Trust’s services and where they
are provided, links to other useful websites.
There is also a section about Foundation Trust membership on the website
This Quality Account can be found on the NHS Choices website at www.nhs.uk.
By publishing the report with NHS Choices, Solent NHS Trust complies with the Quality
Accounts Regulations.
Quality Accounts 2011
63
Glossary
Care Quality Commission
The Care Quality Commission (CQC) replaced the Healthcare Commission, Mental Health
Act Commission and the Commission for Social Care Inspection in April 2009. The CQC
is the independent regulator of health and social care in England. It regulates health
and adult social care services, whether provided by the NHS, local authorities, private
companies or voluntary organisations.
Visit: www.cqc.org.uk
Clinical Audit
Clinical audit measures the quality of care and services against agreed standards and
suggests or makes improvements where necessary.
Clinical Effectiveness
Clinical effectiveness s a measure of the extent to which a particular intervention works.
Clostridium Difficile (C.difficile)
A healthcare associated intestinal infection that mostly affects elderly patients with
other underlying diseases.
Commissioners
Commissioners are responsible for ensuring adequate services are available for their
local population by assessing needs and purchasing services. Primary care trusts are the
key organisations responsible for commissioning healthcare services for their area. They
commission services (including acute care, primary care and mental healthcare) for the
whole of their population, with a view to improving their population’s health
Commissioning for Quality and Innovation
High Quality Care for All included a commitment to make a proportion of providers’
income conditional on quality and innovation, through the Commissioning for Quality
and Innovation (CQUIN) payment framework.
Visit:www.dh.gov.uk/en/Publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH_091443
Community services
These are health services provided in the community, for example Health Visiting, School
Nursing and Podiatry (footcare).
Department of Health (DH)
The Department of Health is a department of the UK government but with
responsibility for government policy for England alone on health, social care and the
NHS.
64
Better health, local care
Hospital Episode Statistics
Hospital Episode Statistics is the national statistical data warehouse for England of the
care provided by NHS hospitals and for NHS hospital patients treated elsewhere.
Information Governance
This concerns the way by which the NHS handles all organisational information. It
monitors this through the standards laid out in the information governance toolkit.
Local Involvement Networks
Local Involvement Networks (LINks) are made up of individuals and community groups
which work together to improve local services. Their job is to find out what the public
like and dislike about local health and social care. They will then work with the people
who plan and run these services to improve them. This may involve talking directly to
healthcare professionals about a service that is not being offered or suggesting ways in
which an existing service could be made better. LINks also have powers to help with the
tasks and to make sure changes happen.
Methicillin Resistant Staphylococcus Aureus (MRSA)
Bacteria that can cause infection in a range of tissues such as wounds, ulcers, abscesses
or bloodstream.
Malnutrition Universal screening Tool - MUST
A screening tool to identify adults who are malnourished or a risk of malnutrition.
National Patient Safety Agency
The National Patient Safety Agency is an arm’s-length body of the Department of
Health, responsible for promoting patient safety wherever the NHS provides care
Visit: www.npsa.nhs.uk
NHS Trust
A trust is an NHS organisation responsible for providing a group of healthcare services.
National Institute for Health and Clinical Excellence (NICE)
NICE is an independent organisation that provides national guidance on the promotion
of good health and the prevention and treatment of ill health.
National patient surveys
The National Patient Survey Programme, coordinated by the Care Quality Commission,
gathers feedback from patients on different aspects of their experience of recently
received care, across a variety of services/settings.
Visit: www.cqc.org.uk/usingcareservices/healthcare/patientsurveys.cfm
Quality Accounts 2011
65
Overview and Scrutiny Committees
Since January 2003, every local authority with responsibilities for social services (150
in all) has had the power to scrutinise local health services. Overview and scrutiny
committees take on the role of scrutiny of the NHS – not just major changes but the
ongoing operation and planning of services. They bring democratic accountability into
healthcare decisions and make the NHS more publicly accountable and responsive to
local communities.
Patient Safety
DH’s approach and long term strategy for ensuring patient safety in all healthcare
settings.
PEAT (Patient Environment Action Team)
The PEAT assesses environmental cleanliness and food standards in hospitals.
Patient and Public Involvement
Involving the public in shaping a care system’s development, and keeping patients well
informed of clinical processes and decisions.
Primary Care Trust (PCT)
NHS bodies with responsibility for delivering health care services and health
improvements to their local areas.
Priorities for Improvement
Mandating providers to report on success of improvement priorities in subsequent years
and to demonstrate how the priorities are linked to their review of services.
Quality Accounts
Quality Accounts are annual reports to the public from organisations which provide
NHS services. They provide information about the quality of the services which that
organisation delivers.
Indicators for Quality Improvement
The Indicators for Quality Improvement (IQI) are a resource for local clinical teams
providing a set of indicators which could be used for local quality improvement and as a
source of indicators for local benchmarking.
The IQI can be found on the NHS Information Centre website at:
www.ic.nhs.uk/services/ measuring-for-quality-improvement
Research
Clinical research and clinical trials are an everyday part of the NHS. The people who do
research are mostly the same doctors and other health professionals who treat people.
A clinical trial is a particular type of research that tests one treatment against another. It
may involve either patients or people in good health, or both.
66
Better health, local care
Root Cause Analysis (RCA)
An RCA is an investigation method used to establish the cause of an incident or address
a problem.
Transformation Schemes
Changes to service delivery with the aim to improve service excellence to patients and
improvements to productivity, efficiency and cost reduction.
Trust Board
The role of the Trust’s Board is to take corporate responsibility for the organisation’s
strategies and actions.
The chair and non-executive directors are lay
people drawn from the local community and
are accountable to the Secretary of State. The
chief executive is responsible for ensuring
that the Board is empowered to govern the
organisation and to deliver its objectives.
Quality Accounts 2011
67
Appendix 1
Summary of Research Studies Active in 2010/11
Service Area: Mental Health
Study Title
Recovering an Ordinaryy Life
fe : Mental Health Service Users Experiences of Living at Yew House Assessment
and Resettlement Service
rvice
e : An Exploratory Qualitat
Qualitative Study
Program for the Earlyy D
Detection and Interventio
Intervention for ADHD (PEDIA))
Case Control Studies
es of Psychiatric Inpatients and Those Discharges
ges
DRAMa: Decision
Decisions
ons Regarding ADHD Mana
Management
Very Low
ow Frequ
Frequency
quency EEG Oscillations an
and the Resting Brain
n in ADHD
AGE: A Prospective
Pro
rospective Follow-up Stud
ychiatric and Functional
Functio
IMAGE:
Study of the Adolescentt and Young Adult Psych
Psychiatric
utcome of Children with ADHD an
Outcome
and their Siblings
Neural Ma
Markers of Reward and De
Delay Processing in Adolescents
dolescents with Attention
Attent
ntion Deficit Hyperactivity
Hyp
Disorderr
SHARe SSouth Hampshire ADHD Register
People’s Liaison Mental
Service
ce Mapping 2010: Older P
ntal Health Services
es
Feasibility
Feasi
ibility Study of Culturally Adapted Cognitive
e Behaviour Therap
Therapy
apy
OCTET
OCT
TET - Oxford Community Treatment Order Evaluation
valuation Trial: A Randomised
Random
Controlled Trial
REAL:
REA
AL: Rehabilitation Effect
Effectiveness & Activities for Life
Assessing
Ass
sessing the Impact of Ch
Children with ADHD and
nd Well-being of
o Families.
Fam
Version 1
Op
Open
pen Label Trial of Atoxom
Atoxometine For Attention
n Deficit Hyperactivity
Hypera
ractivi Disorder (ADHD) in Children
dren with
h
Sp
Special
pecial Education Needs
Ho
How
ow do children experien
experience a support group for the siblingss of children with identified mental
ental health
hea
difficulties?
diffi
Emotion
Em
motion Recognition: An ERP Study
Patients/Carers
Treatment
Pa
atients/Carers Hopes and Expectations for their
eir Child’s Psychotherapy
Psycc
Evaluation
Supporting the
Health
Eva
aluation of the Impact of
o the Choosing Health
h Financial Commitment
C
e Physical
Phy
Care
Carre Needs of People with Severe Mental Illnesss at National,
National Regional and PCT Level in England
Eng
A Study
of Mental Illness Among
Sttudy to Investigate the Prevalence
P
Amo Victims of Homicide and
d the
th Demographic,
Clinical
of Victims
Cliniical and Criminological Characteristics
C
ms
68
Better health, local care
Service Area: Physiotherapy/Occupational Therapy
Study Title
Clinical Reasoning Processes of Extended Scope Physiotherapists
The Expectations and Experiences of Overseas Trained Physiotherapists Working in the UK NHS
Acuback Observational Study
The Impact of Injuries Study: Longitudinal Study (study A) with Nested Qualitative Study (Study B)
OTCH: RCT of an OT Intervention for Residents with Stroke in UK Care Homes
Patient Adherence to Pulmonary Rehabilitation
Service Area: Health Promotion
Study Title
TXT2STOP. A Randomised Controlled Trial of Mobile Phone Based Smoking Cessation Support
Local Implementation of National Alcohol Strategy
Service Area: Sexual Health
Study Title
Exploring Diversity within the Sex Industry: An Investigation into the Structure and Composition of Sex
Markets in Britain
Socioeconomic Inequalities in Chlamydia & Screening in Young People
Does SMS Message Follow Up of Genitourinary Medicine Clinic Non Attendees Improve Subsequent
Attendance Rates?
Tests-of-cure for Sexually Transmitted Infections- What Do Patients Think?
Service Area: Stroke
Study Title
Stoke Survivor and Carer Perceptions of the Role of a Work Rehabilitation Service
Recovery and Rehabilitation Following Stroke: An Intervention to Improve Standing Balance and Weight
Transfer in Acute Stroke Patients
Quantitative Measurements of Impairment and how they relate to Function in the Upper Limb of the
Older Adult Post-stroke
Do Implicit and Explicit Learning Strategies Applied During Gait Re-education Influence Concurrent
Expression of Associated Reactions in Individuals with Hemiplegia?
Cortical Activity Changes Among Stroke Patients
The Tuning Fork Test - An Accurate and Efficient Method of Improving the Diagnostic Accuracy of the
Ottawa Ankle Rules
Quality Accounts 2011
69
Service Area: Long Term Conditions
Study Title
Men as Carers in Multiple Sclerosis
ASCEND: A Randomised 2x2 Factorial Study of Aspirin versus Placebo, and of Omega-3 Fatty Acid
Supplementation versus Placebo, for Primary Prevention of Cardiovascular Events in People with Diabetes
A Study of the Surface Temperature Over Lower Extremity Wounds
Preventing the Emergency Readmission of Older People with Long-term Conditions: A Health Needs
Assessment
A Qualitative Study to Investigate the Psychological Consequences of Self-monitoring Blood Glucose
(SMBG) in People Newly Diagnosed with Type 2 Diabetes After Attending DESMOND (Diabetes Education
& Self Management for the Ongoing & Newly Diagnosed)
Once Weekly Exenatide Versus Insulin Detemir in Type 2 Diabetes
An Investigation of the Mechanism of Action of Seretide in COPD
Service Area: Cancer
Study Title
A study to explore the experience and support needs of older caregivers caring for family members (or
friends) with cancer
A Trial of Devices for Intractable Urinary Incontinence Following Prostate Cancer Surgery
Service Area: Paediatrics
Study Title
Validation of Parental Assessment of Croup Severity
DUTY: Diagnosis of UTI in Young Children
MENDS: The Use of Melatonin in Children with Neuro-developmental Disorders and Impaired Sleep
Respiratory Function in Children Using Night-time Postural Equipment
An Investigation into Embryonic Human Development
The TARGET Cohort Study
Powdered Infant Formula: Caregiver Perspectives
A study to determine whether social stories improve settling difficulties at bedtime in children with Down
Syndrome.
Sleep & Daytime Function in Children with Autism
A New Combination Vaccine Against 6 Childhood Diseases
Can We Reduce the Number of Vaccine Injections for Children?
Therapeutic services for sexually abused children and young people: developing the evidence base
An Investigation into the Effectiveness of Primary Prevention of Speech and Language Difficulties
Through Supporting the Home Environment
VIPA - Viral Induced Paediatric Asthma Study
70
Better health, local care
Service Area: Adult Services
Study Title
ALDDES - Targeted Screening for Alcohol-related Liver Disease in Primary Care: Feasibility Pilot and Main
Study
Investigation of the Regulation of Immune Responses in Humans. V.2.
The MACaSA Study. Maternity after Childhood Sexual Abuse: The Maternity Care Experiences of Women
who were Sexually Abused as Children
Offender Health Needs and Access to Healthcare Services
STOPAH
Support Matters v.1
Screening for Malnutrition by Nurses: Barriers and Facilitators
A Heideggerian Hermeneutic Exploration of the Meaning of Leading a Clinical Nurse Leaders of Hospital
and Community Nursing Teams Caring for an Older ‘Unpopular Patient’
HLP - Healthy Living Pharmacies
Swine Flu (Novel Influenza A H1N1) Vaccine Study
The PADPROM Project: Quality of Life of Pad Users Questionnaire
Service Area: Corporate
Study Title
The Implementation of Accessible Information
Evidence in Management Decisions
Evaluating High Quality Care for All
Negative Acts and Occupational Health Outcomes in NHS Psychologists
Evaluation of the Personal Health Budgets Pilots
Contracting with General Dental Services
Quality Account compiled by Susan Marshall
Associate Director - Nursing and Quality
Solent NHS Trust
Quality Accounts 2011
71
Designed by Communications
Solent NHS Trust 2011