Quality Account | 2010 – 11
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Quality Account
2010 - 11
Quality Account | 2010 – 11
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Contents
Section
Title
Page
Part 1
Statement on quality from the Deputy
Director of Solihull Community Services
3
Part 2
Priorities for improvement and statements
of assurance from the Board
5
Part 3
Review of quality performance (provider
determination)
13
Part 3b
Review of quality account priorities
(2009/10)
22
Part 4
Statements about this Quality Account
26
Part 5
Feedback
28
Quality Account | 2010 – 11
Part 1
Statement on quality from the Deputy Director and Lead
Nurse of Solihull Community Services
NHS regulations and guidance were published in 2011 confirming that a Quality
Account would need to be published by all Community Services relating to
performance in the 2010/11 reporting year (ending 31 March 2011). Solihull
Community Services has been provided under the Solihull NHS Care Trust umbrella
from October 2006 until the end of March 2011. Solihull Community Services did
produce a Quality Account for 2009/10 that covered the one service captured by the
regulations in 2009/10 – podiatric surgery. This exercise served to provide important
learning and a good basis for further improvements this year as the Quality Account
expands to cover all services provided by Solihull Community Services. Solihull
Community Services are committed to providing patients and the public with clear
information about quality and safety.
Solihull NHS Care Trust went through intense organisational change during 2010/11
including the transfer of Community Services to three other organisations on 1 April
2011: Community Health Services moved to the Heart of England NHS Foundation
Trust, Community Learning Disability Health Services moved to Coventry and
Warwickshire NHS Partnership Trust, and Equipment and Community Learning
Disability Residential Services transferred to Solihull Metropolitan Borough Council.
The Quality Account represents the delivery of these services whilst still under the
umbrella of Solihull NHS Care Trust from 1 April 2010 to 31 March 2011.
Solihull NHS Care Trust itself changed on 1 April 2011, to become Solihull Primary
Care Trust. All health partners in Solihull are keen to ensure that the priorities for
Solihull Community Services are reflected within their organisations. The Quality
Account provides a focus on the 2010/11 reporting year and looks back at
achievements as Solihull Community Services setting priorities for 2011/12 in
partnership with the new health provider of Solihull Community Services – the Heart
of England NHS Foundation Trust.
Within this Quality Account Solihull Community Services aim to present a clear
picture of what Solihull Community Services deliver, the quality of services based on
the information provided to Operational Managers and the improvement plans for
2011/12.
Solihull Community Services is keen to make it easy for patients and members of the
public to see information about quality and safety. During 2010/11 Solihull
Community Services has provided monthly information on quality and safety as part
of the Community Services Board reports. These reports are available on the Solihull
NHS Care Trust internet site www.solihull.nhs.uk. These reports have included
information such as incidents, complaints, patient satisfaction and various other
measures covering each of the three domains of quality – patient safety, clinical
effectiveness and patient experience.
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Quality Account | 2010 – 11
Based on the information available and considered by the Community Services
Board during 2010/11 Solihull Community Services believe that the quality of
services provided is good. Most significantly an average of 90% of patients giving
feedback were satisfied or more with the care received.
Solihull Community Services has continually worked towards delivering care that is
safe and effective measured in part by patient’s experience. Information in this
Quality Account shows the good progress and achievements made over the reporting
year through monitoring and benchmarking the quality of services. Areas where
changes can be made to improve the quality of service have been identified.
Examples of achievements in the reporting year include:
Supporting patients needing end of life care in the community and enabling
them to die at home if this is their preferred place of care through the
nationally recognised End of Life Service. Performance in this area has
increased from 78% to 87%;
Routinely obtaining patient views and experiences across a number of health
services. This is evidenced by monthly reporting of patient satisfaction across
Solihull Community Services to the Solihull Community Services Board;
Monitoring the number of clinics and operations cancelled to ensure that
patients receive timely care without any unnecessary inconvenience.
Performance in this area has been 2% and 3% retrospectively and this data
will be used to measure improvement against in the following reporting year;
Staff being up-to-date with the mandatory training and skills needed to deliver
safe and effective care. By the end of the reporting year the level of staff
meeting mandatory training requirements had risen to an average of 90%.
Solihull Community Services will continue to improve and develop services for
patients in 2011/12 that will include work around prevention and will reflect
achievements and progress in future Quality Accounts that are published by
organisations that now run Community Services commissioned by Solihull Primary
Care Trust.
Solihull Community Services has widely consulted with the public, staff, lead
Commissioner and external forums around the development of this Quality Account
to help include the areas that were important to others.
Solihull Community Services hope that you find this Quality Account useful and would
welcome any feedback you wish to send through the feedback form at the back of
the Quality Account. Solihull Community Services will ensure this is considered when
producing future Quality Accounts.
To the best of my knowledge the information in this document is accurate.
Vanessa Stuckey
Deputy Director and Lead Nurse for Solihull Community Services
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Quality Account | 2010 – 11
Part 2
Priorities for improvement and statements of assurance
from the Board
The 2010/11 reporting year represented a period of intense organisational change for
Solihull NHS Care Trust that has included the transfer of Community Services from
Solihull NHS Care Trust on 1 April 2011. All services provided by the Care Trust
transferred to one of three new organisations from 1 April 2011. The Quality Account
represents the delivery of these services whilst still under the umbrella of the Solihull
NHS Care Trust between 1 April 2010 to 31 March 2011.
Solihull Community Services consulted widely on a number of priorities for
improvement for 2011/12 related to the Community Health Services that transferred
to Heart of England NHS Foundation Trust on 1 April 2011. Staff, patients, public,
lead Commissioner, local involvement networks and the local Overview Scrutiny
Committee were consulted. If you would like to obtain a full list of the priorities
consulted on, please email cspt@solihull-ct.nhs.uk to request further information.
From the responses received there were three priorities that received most interest
and these have been listed below, aligned to each of the three domains of quality.
Each domain is listed below setting out the description of the Quality priority, how this
will be monitored in 2011/12 and the reporting process planned to confirm
achievement of quality improvement. Solihull Community Services will demonstrate
achievement against these priorities within the Quality Account published or 2011/12.
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Quality Account | 2010 – 11
Patient Safety
Incident Reporting
Description / rationale – It is important to continue to monitor the incidents that occur
within services, as it will support improvement in the safety around the care Solihull
Community Services deliver. Themes and trends will be reviewed and monitored
with support provided to implement actions, and ensure that lessons learnt are
shared.
Solihull Community Services needs to improve the timeliness of current reporting of
serious untoward incidents (SUIs) according to set local and national targets, in order
for lessons to be learnt, adverse trends to be identified and advice to be sought in a
timely fashion. The use of online incident reporting in Heart of England NHS
Foundation Trust will help front line staff report more quickly.
Monitor – SUI’s will be monitored through a dedicated forum which will support and
drive improvements by offering advice on actions, monitoring the implementation of
actions and ensuring lessons have been learnt. The forum will also focus on the
timeliness of reporting of SUIs.
Solihull Community Services will continue to review all other incidents reported
across the services including the review of themes and trends, supporting the
improvements identified through risk management structures and reporting
arrangements.
Report – Progress and updates will be reported to the lead Commissioner through
the Clinical Quality Review Group and internally through the Divisional Management
Team. This will be done through data presented on the quality and safety reporting
dashboard and through reports.
Patient Experience
Quality of life measures
Description / rationale – This priority is linked to a Commissioning for Quality and
Innovation (CQUIN) agreed with the lead Commissioner for 2011/12. Solihull
Community Services have continued to collect and review valuable patient
satisfaction feedback across all Community Health Services. This has given insight
into the experience patients had after receiving care and has supported towards
making the necessary changes within services. Solihull Community Services will now
focus on developing other patient experience tools to review the impact and
improvements care delivered has had on patient’s lives. This addresses a core
aspect of Lord Darzi’s High Quality Care for All report and also the Care Quality
Commission standards.
Monitor – Progress around this priority will be monitored by a group made up of
senior operational managers and supported by the Service Improvement Team. Staff
will also be monitoring progress at a service level through local meetings.
Report – Feedback will be reported to the lead Commissioners through the Clinical
Quality Review Group and internally at the Divisional Management Team. It will also
be locally reviewed by staff within the relevant services to help them review their
practice and make the necessary changes.
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Quality Account | 2010 – 11
Clinical effectiveness
Public Health Training
Description / rationale - This priority is linked to the CQUIN agreed with the lead
Commissioner for 2011/12 and is co-dependant on the training to be delivered
through the PCT. Public health service provides a preventative aspect of healthcare
and preventing health issues before occurrence, improving the population’s quality of
life. Solihull Community Services will build on and invest towards ensuring public
health training is received by front line staff, in relevant services, to provide them with
the knowledge and awareness to assist them to give advice to patients when
delivering care within their service.
Monitor – The Business Information Unit will monitor progress through data received
from staff. Training will be reviewed by managers through staff development and
training records.
Report - Progress and updates will be reported to the Commissioners through the
Clinical Quality Review Group and internally at the Divisional Management Team. It
will also be locally reviewed by the relevant services.
Review of services
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Quality Account | 2010 – 11
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During 2010/11 Solihull Community Services provided and/ or sub-contracted 35
NHS services. Solihull Community Services has reviewed all the data available and
reported to the Community Services Board regarding the quality of care in all of these
NHS services.
The income generated by the NHS services reviewed in 2010/11 represents 100%
per cent of the total income generated from the provision of NHS services by the
Solihull Community Services for 2010/11.
Details of the services provided in 2010/11 are list below:
Audiology
CAMHS -Child &
Adolescent Mental Health
Services
Community Children’s
Nursing Team
Community Liaison Nurses
Community Learning
Disability Team
Community Paediatric
Service
Community Psychology
Service
Community Respiratory Service
Continence Advisory
Service
Contraception & Sexual
Health
Dermatology and Tissue
Viability
Dental Services
Diabetes Service
Health Visiting
Heart Failure
Improved Access to Psychological
Therapy (IAPT)
Integrated Musculosketal
Service
Intermediate Care
Services (ICS)
Integrated Falls Service
Integrated Locality Teams
(Community Nursing)
Learning Disabilities Short Breaks
Logistics
Macmillan Specialist
Palliative Care
Meadow Centre for Children’s
Services
Nutrition Support
Services
Paediatric Occupational
Therapy
Physiotherapy - Paediatric
Podiatry
Podiatric Surgery
Port Health Service
School Nursing
Short Breaks
SPA Single Point of
Access (SPA)
Speech Language
Therapy - Adults
Speech and Language
Therapy - Children
Participation in clinical audits
During 2010/11, 2 national clinical audits covered NHS services that Solihull
Community Services provided. There were no national confidential enquiries that
covered NHS services that Solihull Community Services provided.
During that period Solihull Community Services participated in 100% of the national
clinical audits which it was eligible to participate in.
There were no national confidential enquiries which it was eligible to participate in.
The national clinical audits and national confidential enquiries that Solihull
Community Services were eligible for and actually participated in during 2010/11 are
on the following page.
Quality Account | 2010 – 11
Topic
National Audit - Continence Care
National Audit – Falls and Bone Health
National Audit - National Epilepsy
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Eligible
Participated





*
(*commenced in
March 2011)
The national clinical audits and national confidential enquiries that Solihull
Community Services participated in, and for which data collection was completed
during 2010/11, are listed below alongside the number of cases submitted to each
audit, or enquiry, as a percentage of the number of registered cases required by the
terms of that audit or enquiry:
Topic
National Audit - Continence Care
National Audit – Falls and Bone Health
Submitted data as a percentage of
required sample %
35%
There were no cases required as
undertook organisational audit
The reports of 2 national clinical audits were reviewed by Solihull Community
Services in 2010/11 and the following actions will be taken to improve the quality of
healthcare provided:
Improving communication and provision of local, long term, evidence-based
exercise interventions for falls;
Developing the use of patient experience to improve the care around falls;
Reviewing screening tools and care plan documentation used by the
continence service;
Empowering patients to increase their expectations of care through setting up
of a user group within the continence service.
The reports of 15 local clinical audits were reviewed by Solihull Community Services
in 2010/11 and the following actions will be taken to improve the quality of healthcare
provided:
Reviewing resources and techniques within community paediatrics focusing on
childhood obesity;
Strengthening communication and clarity of responsibilities with other care
providers, such as GP’s and social care, working alongside community
paediatricians around looked after children;
Reviewing indicators and pathways within the sexual health services and the
services offered;
Quality Account | 2010 – 11
Supporting and improving communication, training and resources between
GP’s and learning disabilities services;
Introducing a greater level of prospective surveillance of wound infections via
a regional database;
Improving communication and training for staff within the Adult Speech and
Language Service; and
Reviewing models of care and structures to meet patient needs in Podiatric
Surgery.
The list above demonstrates some of the examples of recommendations and actions
that have been reported through the clinical audit projects undertaken within Solihull
Community Services.
Participation in clinical research
The number of patients receiving NHS services provided or sub-contracted by
Solihull Community Services in 2010/11 that were recruited during that period to
participate in research approved by a research ethics committee was 12. Listed
below are some of the examples of the research projects that have been undertaken:
Survey of well-being in young adults with down syndrome;
Powdered Infant Formula: Caregiver Perspectives; and
Reliability of radiographic measures for flat foot.
Goals agreed with Commissioners
Use of the CQUIN payment framework
A proportion (1.5%) of Solihull Community Services income in 2010/11 was
conditional on achieving quality improvement and innovation goals agreed between
Solihull Community Services and any person or body they entered into a contract,
agreement or arrangement with for the provision of NHS services, through the
Commissioning for Quality and Innovation payment framework. Solihull NHS Care
Trust signed off the achievements and did not impose any financial penalties.
Further details of the agreed goals for 2010/11 and for the following 12 month period
are available electronically at cspt@solihull-ct.nhs.uk.
What others say about the provider
Statements from the Care Quality Commission (CQC)
Solihull Community Services is required to register with the Care Quality Commission
and its current registration status is compliant. Solihull Community Services had
conditions on registration prior to 1 April 2011 for three of its locations. These
locations will transfer over to Coventry & Warwickshire Partnership Trust.
Solihull Community Services worked with the new provider Coventry & Warwickshire
Partnership Trust to ensure conditions could be lifted on transfer of services under
transforming community services.
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Quality Account | 2010 – 11
From 2011/12 onwards, provider registration as part of Solihull NHS Care Trust will
cease, and the three receiving organisations under the Transforming Community
Services Agenda will take on registration of the services they provide.
The Care Quality Commission has not taken enforcement action against Solihull
Community Services during 2010/11.
Solihull Community Services has not participated in any special reviews or
investigations by the CQC during the reporting period.
Data quality
All Solihull Community Services review their data quality on a regular basis and are
supported to do this through the Balanced Scorecard performance management
system. Data quality measures include 'time taken to enter information' 'ethnicity
coding' and 'people waiting outside 18 weeks' are available to managers on a daily
basis. Service managers have local practices which provide assurance around data
quality, which are monitored through service team meetings and monthly Quality and
Performance Forums to help improve the safety, effectiveness and experience of the
care delivered.
The Performance Team supports and develops internal systems for recording and
monitoring data quality. Continuous review will be sought through working with
individual service managers and through the Quality and Performance Forums to
check the quality of the data
Solihull Community Services will now be working towards improving our data quality
in line with Heart of England NHS Foundation Trust’s Data Quality framework.
An example of how Solihull Community Services are working towards improving the
recording of ethnicity data is by supplying front line staff with an easy read template
of the ethnicity codes to help approach patients and make it easier to select the
ethnicity code that best represents the patient.
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Quality
Account
| 2010
– 11
Quality
Account
| 2010
– 11
NHS Number and General Medical Practice Code Validity
Solihull Community Services did not require to submit records during 2010/11 to the
Secondary Uses service for inclusion in the Hospital Episode Statistics which are
included in the latest published data.
Information Governance Toolkit attainment levels
The Solihull Community Services Information Governance Assessment Report
registered an overall score for 2010/11 of 72%. This was graded ‘not satisfactory’
based on two areas where the score achieved was level 1, identifying further work
needed.
Community Services remain compliant with the NHS Statement of Compliance, as
both areas are not key compliance areas. However, the following improvement
activities are planned within these two specific areas:
Requirement 309: Information Asset Officers within Community Services will be
identified. Their role will be to risk assess their business functions in relation to
information assets, link these to the risk register and ensure that business continuity
plans are in place to mitigate any known risks.
Requirement 515: Solihull Community Services will implement a robust programme
of Data Quality assurance formally documented and embedded into policy and
procedure.
Clinical coding error rate
Solihull Community Services was not subject to the Payment by Results clinical
coding audit during 2010/11 by the Audit Commission.
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Quality Account | 2010 – 11
Part 3
Review of quality performance (provider determination)
How quality is managed within Community Services
The quality of the care that Solihull Community Services deliver across Community
Health Services is managed in a number of ways, this includes:
Through a number of expert committees and forums, such as the Policies and
Procedures Committee, which review new and existing documentation and
ensure that this reflects best practice, considers patient safety and the
effectiveness of the care and it is readily accessible by staff;
Information reflecting the safety, effectiveness and experience of the care
delivered is scrutinised by experts and professionals, including our nonexecutive directors that are members of the Board and public representatives
who are members of various committees and groups within the organisation;
and
Quality, safety and performance information is sent through to each service
and this is reviewed by staff at their Quality and Performance Forums and
action plans are put in place to address any issues.
Below are further examples of the ways in which quality is managed and supported
through systems and procedures within the organisation:
Serious Untoward Incident Forum
The forum has ensured that Community Services has a robust mechanism for
identifying and acting on SUI’s. In addition, on going actions are reviewed and
service managers attend meetings to discuss progress. This has given assurance
that actions have been implemented and supported where necessary.
Learning Lessons Bulletin
The Tissue Viability Nurse Specialist noticed from collected data that Nurse
Prescribers were prescribing simple items (surgical tape, simple wound dressings)
that were not on the wound care formulary which identified the most cost effective
option. A simple ‘switch’ message was included in the Lessons Learnt Bulletin at the
same time as an A5 laminated easy reference formulary guide was sent to all
prescribers as a reminder of the first options for treatment. These simple messages
bought prescribing back into line with contractual requirements and supported
delivery of cost effective care.
How did Solihull Community Services seek views?
Solihull Community Services engaged widely throughout the year on the publication
of the Quality Account for 2010/11 to help shape and include areas that meant most
to others. This included engagement with the organisations that services have
transferred to from 1 April 2011.
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Quality Account | 2010 – 11
Solihull Community Services engaged with staff and the public through a survey, the
Annual General meeting and open days.
Engagement also took place with the lead Commissioners, Health Overview and
Scrutiny Committee and Solihull Local Involvement Network (LINks). Statements
from these organisations have been provided in section 4 of this Quality Account.
What measures mean most to Solihull Community Services
patients?
Consultation around the 2011/12 priorities for the Solihull Community Services
transferring over to Heart of England NHS Foundation Trust has taken place with the
following groups:
-
Members of the public, through an online survey;
The Health Overview and Scrutiny Committee, containing elected members
from Solihull Metropolitan Borough Council;
Solihull Local Involvement Network (LINks), containing representation of
service users, patients and carers;
The Clinical Quality Review Group, Solihull NHS Care Trust Commissioners;
and
Three groups of staff from the Community Services Clinicians Forum.
The table on the next page illustrates and summarises the priorities which each
group consulted felt were most important. There were three groups identified through
the clinicians forum and these have been grouped individually as their priorities,
patient groups and services are different and are to be recognised separately. There
was general feedback that all the priorities were good and suitable, but that priorities
which applied to all services within Community Services would be the most suitable
for inclusion in the Quality Account.
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Quality Account | 2010 – 11
2011/2012 Community
Services CQUINs
Community Services
Clinicians Forum Group 3
Community Services
Clinicians Forum Group 2
Community Services
Clinicians Forum Group 1
Solihull LINKs priorities
SMBC scrutiny priorities
Public survey priorities
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1.Managament and investigation of avoidable pressure
sores
2. Reducing hospital admissions and interventions
3. Interacting and seeking views of patients, carers and
the public
4. Incident reporting
5. Quality of Life Measures / outcomes / patient
experience
6. Ensuring staff have core professional and mandatory
training
7. Preferred Place of Care
8. Urinary Catheters
9. Public Health – education / smoking cessation
Reflecting on this feedback, Solihull Community Services has demonstrated some
achievement to date within these areas and set out below is how Solihull Community
Services continue to manage and improve quality through care that is delivered by
services headed under the three domains of quality:
Patient Safety
1. Management and investigation of avoidable pressure sores
A dedicated SUI forum reviews the incidents related to pressure sores to see where
improvements could be made to managing the care of the pressure sores and where
cases can be avoided. Corrective action plans are supported and lessons learnt are
shared across the services. The number of pressures sores reported as SUIs is also
reviewed by the forum and will use the data from 2010/11 as a benchmark to review
improvements resulting from the work driven through the forum. The timeliness of
current reporting needs to be improved and the forum will continue to work with
senior managers to support improvement in this area.
2. How Solihull Community Services responded to national patient safety alerts
(NPSA)
Solihull Community Services continues to achieve 100% compliance with
implementing NPSA alerts within the set timescales. This is supported through the
Service Improvement Team and Solihull Community Services will be looking towards
strengthening governance arrangements by providing detailed reports to service
Quality and Performance meetings where alerts are reviewed, monitored and
supported by service managers.
Quality Account | 2010 – 11
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Clinical Effectiveness
3. The number of staff who had core and professional mandatory training
Solihull Community Services are committed towards ensuring staff are trained and
have worked towards significantly improving the numbers of staff that received
mandatory training to an average of 90% including safeguarding and infection
control. Solihull Community Services also invested in training and developing care
staff around medicines management. Service managers identified staff that required
this particular training within the reporting year 2010/11. This gave staff skills and
awareness for delivering safe and effective care and supported compliance with Care
Quality Commission standards.
4. Infection rates for MRSA and Clostridium Difficile and compliance around
screening
Solihull Community Services decreased the number of MRSA and Clostridium
Difficile cases recorded from the previous year to nil in 2010/11.
Solihull Community Services also continued to achieve 100% compliance in
screening this year, as done previously in 2009/10 of all surgical cases. This helped
measure and improve the safety and effectiveness of care.
MRSA and Clostridium Difficile
Compliance in screening
2010/11
2009/10
0
3
100%
100%
5. The cleanliness of clinical areas
Solihull Community Services achieved above the set target of 90% for reviewing the
cleanliness of clinical areas through clinical audit. Results and recommendations are
implemented and progress is monitored through the Clinical Quality Review Group,
Infection Prevention Committee and by the Infection Control Team.
6. How Solihull Community Services make use of evidence based guidance, such as
National Institute for Health and Clinical Excellence (NICE) guidance
Best practice is maintained through the implementation of NICE guidance that
continues to be reviewed and monitored monthly through the Service Improvement
Team and reported to management teams and Commissioners. Solihull Community
Services have reviewed implementation by undertaking clinical audits related to a
number of relevant guidance. Monitoring arrangements are strengthened by
reviewing routine reports at service Quality and Performance Forums to gain further
assurance that actions and recommendations are being supported and implemented.
Quality Account | 2010 – 11
Patient Experience
7. Results of satisfaction survey
The graph below illustrates the responses within March 2011 and the previous three
months from the patient satisfaction surveys across services. It demonstrates that
the majority of service users have given positive feedback, but where there is an
indication of any negative feedback, this is followed up with the service in question to
review. Some examples of how Solihull Community Services responded to feedback
received are detailed further on in the Quality Account. Solihull Community Services
will be looking to review how to include carers’ views as well as the patient in future
surveys.
Patient satisfaction feedback March 2011 and previous 3 months
8. The number of appointments and clinics that Solihull Community Services
cancelled
Illustrated below is the number of appointments cancelled by Solihull Community
Services over the last two years between 2009/10 and 2010/11. Solihull Community
Services will continue to use this data to measure against and improve the timeliness
of care delivered in 2011/12.
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Quality Account | 2010 – 11
18
Number of cancelled appointments 2009/10 and 2010/11
2009-10
2010-11
Solihull Community Services also continues to review the number of clinics cancelled
and the number of patients affected. Reasons are reviewed at service Quality and
Performance forums and the Divisional Management Team. This information is also
reported to and reviewed by the lead Commissioners. The peak seen in March 2012
represents the impact to changing of buildings where appointments had to be
rescheduled to other premises.
The graph below illustrates the number of clinics cancelled during 2010/11. On
average 2% of clinics were cancelled and Solihull Community Services will use this
data to benchmark measure improvements against for the coming year.
Quality Account | 2010 – 11
9. The number of complaints and compliments Solihull Community Services
received
Solihull Community Services continue to achieve 100% compliance in responding to
complaints within the response times set nationally. Solihull Community Services
actively monitor a number of compliments and complaints received through the
Quality and Safety dashboard. Solihull Community Services will be working towards
service managers having an insight of the types of complaints and the responses
sent to patients and their carers for their service. Information around the complaints,
compliments and Patient Advice Liaison Service queries will be reviewed at future
service Quality and Performance meetings.
10. Preferred place of care
The Macmillan service which work in partnership with community nursing has
demonstrated an improvement in achieving an increased number of patients dying in
their preferred place of care. Performance information indicates that there has been
an increase in the number of patients having an advance care plan to indicate
preferred place of care. In 2009/10 72% indicated a preferred place of care, this
increased to 94% in 2010/11 of all patients that died. Performance information also
indicates an increase in patients dying in their preferred place of care. In 2009/10
78% died in their preferred place of care, increasing to 87% in 2010/11. This
indicates an improved patient experience for this service. Supporting people to die in
the place of care means that proactively managed care decrease the need for
inappropriate hospital admissions.
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Quality Account | 2010 – 11
Listening to Solihull Community Services patients
Solihull Community Services actively collects feedback from service users around
their experience and satisfaction around the care that they received. Below are
examples listed of the positive and negative comments that Solihull Community
Services received. These are shared with staff within services and members of the
Board. Comments are reviewed by service managers and action plans for
improvement are put in place where appropriate.
“The staff were very thorough in producing information and trying to find the
best solution for me. They tried hard to get me an appointment asap.”
Service user comment about the Contraceptive and Sexual Health Service
“Very happy and felt comfortable.”
Service user comment about the Pregnancy Counselling Service
“Very happy with my treatment.”
Service user comment about the Podiatric Surgery Service
“People who attended to me were very kind and efficient – I have nothing but
praise for the NHS.”
Service user comment about the Audiology Service
“Very satisfied - went over lots of questions I had - and it is great comfort to
know I can have help if required.”
Service user comment about the Adult Speech and Language Service
“An excellent meeting with [the nurse]. Very helpful.”
Service user comment about the Macmillan Nursing Service
“I am very happy with everything we can’t thank the nurse enough for
everything she has done.”
“Great help, as skin has improved, thank you.”
Service user comments about the Dermatology Service
“My life has been much improved courtesy of the continence advisor and
improved and better continence pads”.
Service user comment about the Continence Service
“Acoustics in the hall are difficult at times – even with a hearing aid.”
“The respiratory care staff are excellent in every way possible. Nothing too
much for them to help you.”
Service user comments about the Community Respiratory Team
“I am unaware that I was making a decision and I had no idea of what the
outcome would be”.
“I found the meeting and the information I received helpful.”
Service user comments about the Community Liaison Nurse Team
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Quality Account | 2010 – 11
An example of how Solihull Community Services made improvements following
negative feedback received from our patients using one of our services has been
given below. This demonstrates the commitment to review comments received and
make the necessary actions to improve care.
Example of improvements made following a negative comment:
Listed below are two cases where the Community Liaison Nurse Team have made
improvements from the feedback received from patient’s carers and relatives:
Comment: Patient’s relative was not happy about the patient being moved from a
care home to a nursing home.
Action: A briefing note to staff to re-affirm need to explain why the service needs to
move patients.
Comment: Patient’s relative’s feedback regarding the information communicated to
them relating to the patient’s discharge.
Action: The service reviewed the method of how discharge plans are communicated
and explained not only to the patient but also to their carers and relatives.
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Quality Account | 2010 – 11
Part 3b
Review of quality account priorities (2009/10)
Quality Account Priorities focusing on Podiatric Surgery
Service - progress over 2010/11
1. Capture regular service user experience information (patient experience)
In order to gain valuable feedback from our service users and to work towards the
development of Patient Recorded Outcome Measures (PROMs) Solihull Community
Services started using a Service User Satisfaction Survey within our community
services from June 2010. The Survey was extended out through the reporting year to
cover all health services by 31 March 2011. This allows services to capture
satisfaction information on a regular basis and results were reported to the
Community Services Board All health services receive a monthly breakdown of
results set against results for the previous three months. In addition any qualitative
comments on surveys are sent to service managers for them to consider and where
appropriate make improvements to services involving staff in the feedback and
change. Solihull Community Services also share compliments received from patients.
The Community Services Board receives monthly results for the service overall and a
selection of comments from the surveys, both good and bad, each month within the
community services quality report.
The following graph demonstrates the overall patient feedback received for podiatric
services over 2010/11 and where there were signs of negative feedback this was
reviewed by the service.
Patient satisfaction feedback 2010/11 for Podiatric Surgery Services
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Quality Account | 2010 – 11
Below are examples of the comments and feedback received and some of the
actions Solihull Community Services have put in place in the Podiatric Surgery
Service to improve the care that is delivered:
“Re appointment - told I would receive a letter, never arrived.
Required to telephone two months later.”
“Excellent service and diagnosis.”
“Treatment and care could not have been better.”
Examples of some of the improvements made following negative comments received
from our service users:
In house training of nursing team with regard to casting techniques and
potential complications;
Post operative telephone contact within 24 hours of surgery to follow patient’s
immediate recovery.
2. Deliver 100% compliance with Same Sex Accommodation (patient
experience)
Solihull Community Services declared that services required to comply with DSSA
(Delivering Same Sex Accommodation) did so for 2010/11. This related to the
Podiatric Day Surgery Team. Solihull Community Services revised the process to
create day surgery lists in this service to make them single sex from 1 June 2010.
The service had one breach, (three people affected) of same sex accommodation
within the service on 29 June 2010. The breach related to patient recovery beds.
Solihull Community Services reported this breach to Commissioners and took the
following actions:
To ensure there were no further breaches the following actions were taken and
embedded:
All advance theatre lists are checked weekly by the Business and Waiting List
Manager, the Consultant Podiatrist and the Theatre Manager.
To ensure that any further breaches were managed effectively:
Consent would be sought from all those involved in an unforeseen breach;
If consent was not gained from all those affected the patient was to be sent
home to ensure a single sex list was maintained;
All breaches would be reported via our incident reporting processes;
All breaches would be investigated to identify the cause.
Solihull Community Services did then achieve 100% compliance with the DSSA
requirement from July 2010.
Following Department of Health change in guidance, this service is not longer
required to comply with DSSA as it relates to day surgery only.
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Quality Account | 2010 – 11
24
3. Audit post-operative complications following podiatric surgery (clinical
effectiveness)
Solihull Community Services audits and monitors the number of post operative
complications following podiatric surgery, which supports the effectiveness of care
delivered.
These are minor complications seen within this service and to give an idea of how
Solihull Community Services address these, some examples have been listed below
along with the actions that are put in place by the service to ensure that the service
improve the quality of the service delivered.
The graph below illustrates the number of complications per month as a percentage
of cases seen. Between the periods of April 2010 - March 2011 the average
complication rate as a percentage for the total number of cases that had
complications is 2.85%.
of
cases
Types of complications seen:
Post operative infections
Tight dressings post operative
Below knee casts requiring bi-valving due to post operative swelling
Transient metatarsalgia after surgery (pain related to a specific area within the
foot)
Post operative pain.
Quality Account | 2010 – 11
25
Actions taken to manage the complications:
Operate an emergency on-call service manned by the consultant and/or
registrar for the first 48 hours post operatively so that any patient concerns or
problems can be dealt with immediately. This includes advice and further post
operative local anaesthesia for pain control
All patients GPs are informed by fax on the day of surgery of the procedure,
analgesics issued, type of anaesthetic used, expected recovery time and
advice given to patient at discharge
All patients are aware that if difficulties arise after this period they can contact
the department directly and advice or an earlier appointment if appropriate will
be arranged.
4. Surgical site infection rates in podiatric surgery (patient safety)
As well as looking at the number of complications resulting after post operative
cases, Solihull Community Services separately monitors the number of cases that
result in an infection after surgery. The graph below illustrates the number of
complications related to infections per month as a percentage of cases. The average
complication rate as a percentage for the total number of cases that resulted in an
infection is 1.9% between April 2010 – March 2011. The cases relate to a small
number of patients seen within the service.
of cases
of
cases
Solihull Community Services have established a baseline infection rate within this
service and will be looking at ways to reduce the infection rates in the future. The
service reviews all case and trends on a regular basis at team meetings and make
the necessary improvements identified.
Quality Account | 2010 – 11
Part 4
Statements about this Quality Account
Solihull Metropolitan Borough Council Healthier Communities Scrutiny Board
‘The Board is pleased to have had the opportunity to comment on the draft and final
Quality Accounts of the Solihull Care Trust.
The Board is able to confirm that Solihull NHS Care Trust have attended a number of
their Scrutiny Board meetings to present the draft and final Quality Accounts. In
March 2011, the Board was presented with the draft and emerging Quality Accounts
and in June 2011 they were presented with the final Quality Accounts. The Board
was supportive of the intended process to be followed.
The Board was in principle supportive of the Quality Accounts. However, there were
some areas which they had identified where they would like to see improvements
being shaped and prioritized over the next 12 months. These were as follows;
The need to rigorously monitor and review incidents which are reported
including ‘near-misses’
The need to reduce infection rates in podiatric surgery in response to the
recent rise in infection rates in this area.
The need to significantly reduce the number of appointments which are
cancelled.
To aim for 100% of staff to attend and receive mandatory training.
The Board was broadly supportive of the move to offer more community-based health
related provision in place of more costly acute services; however it was highlighted
that investment in community-based health provision needed to have a Solihull focus
and be accessible to the local community.
The Board felt it was very useful to receive some service user feedback within the
Quality Accounts but felt that in future reports, it would like to see a more balanced
number of case studies from patients whose experience hadn’t been so positive and
what lessons had been learnt from this experience.
The Board was conscious of all the structural changes which has recently taken
place and possible impact on performance and patient experience and would
continue to monitor the impact of the transferring community services over the next
12 months.
In future Quality Accounts reports for community services, the Scrutiny Board
illustrated that they would like to see other information in addition to podiatric surgery
service and, receive more detailed information about the financial implications of
offering poor quality services.’
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Quality Account | 2010 – 11
Solihull Local Involvement Network
‘Solihull Local Involvement Network (LINk) is a network of individuals and voluntary
organisations whose aim is to represent the voice of local people on health and
social care issues. Solihull LINk welcomes this Quality Account from Solihull NHS
Care Trust, and we are pleased to see a commitment to seeking service user
feedback and to improving services. The LINk supports the priority areas identified
for community services for the next 12 months. The LINk would like to see more
information with regard to how progress is monitored on the issues in this Quality
Account, and would like to know more detail about the corrective action in place. We
would particularly be interested to see more information available to the public about
the trends and themes in patient feedback and the resulting changes in services.
Now that Community Services have transferred to three different providers, the LINk
remains committed to working with providers, and to promoting service
user engagement and involvement.’
Contracting Quality Review Group (on behalf of Solihull NHS Care Trust as
Commissioner)
Corroborating Statement from Solihull Primary Care Trust – Lead Commissioning
PCT
‘Solihull Primary Care Trust is pleased to review and to comment about this
Quality Account. A strategic goal of Solihull PCT is to ensure the ‘right care, right
place, right quality’ of services for the population it serves and this Quality Account
contributes towards that.
Solihull PCT through its Clinical Quality Review Group fulfils a remit of quality
assurance and improvement and holds Solihull Community Services to account for
the quality of services delivered. Members of the group formally review and discuss
each month, without limitation, any issues or concerns relating to the quality and
safety of care. They also identify and ensure implementation of recommendations
and requirements for improvement.
Community Services have been very proactive in their approach to Infection
Prevention and made significant improvements through out the year. It is
encouraging that infection rates are available for podiatric surgery and that overall
the rate is less than 2%. We would support and recommend a system of ongoing
prospective surveillance to understand the epidemiology of these infections in this
patient group.
The data provided in this Quality Account is consistent with that supplied to
and reviewed by the Clinical Quality Review Group during the year. The work
throughout the year and demonstrated within this quality account also
identifies Community Services ongoing commitment to improving the quality of care
and patient experience. On this basis, Solihull PCT can confirm that this Quality
Account represents a fair reflection of the quality of services provided by Solihull
Community Services.’
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Quality Account | 2010 – 11
28
Part 5
Feedback
To view this Quality Account electronically, please go to the NHS Choices
website.
Evaluation form
What best describes you? Please circle
Patient
carer
member of the public
staff member
other
How can we improve on the Community Services Quality Account next year?
What section did you find the most interesting?
Did you find the data and information easy to read? If not, please let us know
how we could improve on this.
Are there any other topics you would like to see in the Quality Account next
year?
Please send your response to Service Improvement Team, Solihull Community
Services, 3rd Floor, Union Road, Solihull, B91 3EF.
If you would like to be involved in consultation around next years Quality Accounts,
please write to the address above or email cspt@solihull-ct.nhs.uk.
Quality Account | 2010 – 11
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