recovery
journeys
Quality accounts for 2010/11
2 | Quality accounts for 2010/11
contents
Part one - tracking progress
3
Part two - regulatory information
8
Part three - on track with patient safety, clinical
effectiveness and patient experience
12
Tracking progress
The past year has seen major changes
in the healthcare landscape. We’ve
seen a new government take control;
significant changes starting to affect
sector funding; and the launch of a
series of health bills proposing greater
local accountability, support and
choice for service users.
It’s clear that the world is changing and that means both challenges and
opportunities for healthcare providers.
The key challenges organisations like
St Andrew’s must face are:
n
Proving that we offer the
best quality services for a
reasonable price
n
Showing that value can be
achieved through shorter recovery
times as well as keener pricing
n
Setting new standards to attract,
develop and keep the highest
calibre staff.
On the other hand, there are
opportunities for the charity:
n
Investing any surpluses we make
into specialist therapies, services
and environments that help service
users recover more quickly
n
Spending more time and effort on
service user engagement, making
sure that we actively respond to
their ideas and concerns
n
Developing new tools and
techniques - testing their
effectiveness and then sharing the
results across the sector
n
1
Working with partners to develop
new services, in response to
specialist needs.
Our direction of travel is clear.
St Andrew’s vision is to be a
world-class mental healthcare provider,
whose services across the UK set the
benchmark for excellence. We’re
totally dedicated to making that vision
real - putting quality healthcare on the
map, and our service users in the
driving seat.
This strength of vision explains why
we’ve remained ahead for more than
170 years; why we’ve tirelessly
supported the NHS since its inception
in 1948; and why we’re still growing
in difficult times.
We firmly believe that with the right
people, partners and attitude, we can
look forward to the future together
with optimism.
I hope that you enjoy reading this
account of our work.
Professor Philip Sugarman
Chief Executive Officer and
Medical Director
1. Professor Philip Sugarman,
Chief Executive Officer and
Medical Director
Quality accounts for 2010/11 | 3
PART ONE TO THE ACCOUNTS
“We aim to provide the highest quality clinical training
through specialist services, engaging and supervising
people, supporting studies and providing our own
continuing professional development programme.”
Tracking progress
1
This is the official quality accounts report
for St Andrew’s Healthcare, covering the
period 1 April 2010 to 31 March 2011.
It outlines how the charity is performing,
and our plans to improve.
well. More than 3,500 people work in
our Northampton, Birmingham, Essex
and Nottinghamshire hospitals;
employing and keeping the best staff is
fundamental to our success.
Since last year’s report was published,
St Andrew’s has opened two new
regional hospitals and a specialist
national facility. We’ve won national
awards for innovation and healthcare
outcomes. We achieved 80 per cent
service user satisfaction with food
quality, and were described as excellent
practice in the Soil Association’s First Aid
for Hospital Food report. We were also
the only independent healthcare provider
chosen for the Implementing Recovery,
Organisational Change (ImROC) national
recovery programme pilot.
We aim to provide the highest quality
clinical training through specialist
services, engaging and supervising
people, supporting studies and providing
our own continuing professional
development programme. Our academic
partnership with the Institute of
Psychiatry, King’s College London, also
develops research opportunities.
But we must keep moving and
improving, if we’re going to be the best
in the sector. We’re currently trialling our
first length of stay ‘price promise’ in
Nottinghamshire, and aim to develop
this further across other services. We
need to improve the quality of reporting
information, which will free up more
clinical time for patient care. And we
must ensure that service users remain
centred at the heart of our work helping us to make the right decisions.
During 2010/11 we launched two new
specialist qualifications in partnership
with the University of Northampton:
a BSc (Hons) degree in Mental
Healthcare, and the Certificate in Higher
Education in Mental Health. These
courses will create training opportunities
for our own staff, and support NHS
professionals with formal study
options - helping to develop and grow
the healthcare leaders of the future.
On behalf of St Andrew’s, I confirm that
to the best of my knowledge, the
information contained in this document
is accurate. These accounts were also
approved by the charity’s Board of
Directors on 27 May 2011.
We have identified clear priorities for
improving patient safety, clinical
effectiveness and people’s experiences
of our services. Page 5 lists these
priorities, what we plan to do and how
we’ll track progress.
To achieve great results, we must ensure
that everyone is equipped to do their job
Caroline Rose
Director of Nursing and Quality
1. Caroline Rose,
Director of Nursing and Quality
4 | Quality accounts for 2010/11
1
1. We use various performance
measures to assess patient satisfaction
with food
2
2. St Andrew’s is determined to provide
great value for partners through strong
performance management
Quality routes
St Andrew’s wants to set the quality
standards for service users across the
mental healthcare sector. The quality
of care we provide is vital to helping
people on their journey to recovery; it
often changes their lives. So of
course we aim to give the very best
support and make sure that everyone
achieves their maximum potential
whilst staying with us.
In this report, you’ll find some
real-life patient stories and see how
people have overcome difficult and
traumatic situations to live the most
positive life they can. The people we
work with inspire us and we hope
their stories inspire you too.
Of course, it’s easy to focus on the
highlights, compliments and awards.
But we don’t look at these things in
isolation. We use a range of
performance measures to gauge how
good our services are. These include:
n
Listening to views from service
users on the care they receive
from us
n
Assessing patient satisfaction on
their experiences of dignity, food,
living spaces and the way we
communicate with them
n
Monitoring the ‘outcomes’
(results) that our clinical
treatments deliver - such as
people moving into less secure
settings, and returning to
community life
n
Checking the length of time
that our service users stay with us
n
Comparing our work to other
healthcare providers, by
sharing performance data and
service information
n
Taking part in local and national
service audits and listening
to feedback from regulators
and commissioners
n
Being accountable to our board of
trustees, who provide
independent feedback and input.
Taken together, this information gives
us a ‘dashboard’ of statistics and
feedback that helps us to keep
track of the charity’s performance,
and make sure we’re spending
money wisely.
That’s important because the
Government’s Quality, Innovation,
Productivity and Prevention
programme wants to make sure that
health spending achieves maximum
benefit and quality of care. And we
want the same thing - great value for
the services we provide to our
NHS partners.
Quality accounts for 2010/11 | 5
Improvement planner
In preparing these accounts, St Andrew’s discussed quality priorities with service users, staff and trustees. The results of
these conversations have led to us agreeing the following improvement priorities for 2011/12.
Quality priorities
Patient safety
Essen Climate
Evaluation
Scale
(EssenCES)
Why this is important
Objectives for 2011/12
This scale explores how much
service users feel safe and
supported, by both their peers and
care staff. Evidence suggests that
patients respond better, engage
more and recover more quickly
where they feel safe and
comfortable. This indicator is part of
the Commissioning for Quality and
Innovation (CQUIN) payment
framework and a Care Quality
Commission requirement.
n
n
n
Identify a service development
or improvement based on the
2010/11 surveys (patient
perceptions of the risk
status system)
Produce an implementation plan
to achieve the improvement
within 2011/12
Monitor progress throughout
the year
Patient safety
Design manual
We need to make sure that our
hospitals provide safe and secure
environments for patients and
staff. Having agreed quality
standards and sharing information
on product testing means that all
of our facilities can learn from
past experience.
n
Less incidents relating to
buildings, fixtures and fittings
Patient safety
Safe access to
technology
Patients benefit from using
technology for work, leisure,
education and communication. We
want to
help
help
people
people
access
access
technology
technology
safely, whilstsafely,
making
whilst
suremaking
sure
equipment
equipment
is used
is used
appropriately.
appropriately.
n
Organise charity-wide training
on managing risks safely
Provide regional testing
equipment and training
Increase resources for forensic
screening
Investigate potential for music
library and patient intranet
Explore ways of helping service
users connect with relatives
(such as video conferencing)
n
n
n
n
Clinical
effectiveness
Recovery
planning
Where service users and care staff
work in partnership to achieve a
shared understanding of recovery,
it’s assumed that length of stay will
be shorter and patient experiences
of care improved.
This indicator is part of the
Commissioning for Quality and
Innovation (CQUIN) payment
framework.
n
n
n
n
All service users offered the
opportunity to complete a
recovery plan appropriate to
their needs
Plans reviewed formally
Monitor uptake and report
quarterly on performance
Progress the Implementing
Recovery, Organisational Change
pilot, which will in turn impact
on all aspects of service user and
staff experiences of care
6 | Quality accounts for 2010/11
Quality priorities
Clinical
effectiveness
Care
Programme
Approach
(CPA)
Why this is important
Through CPA, St Andrew’s supports
service users to help them achieve
optimal mental health and recovery.
The focus is on working in
partnership with service users to
plan and manage their treatment
programmes. This helps them to
move out of secure care and back
into the community.
Objectives for 2011/12
n
n
n
n
Clinical
effectiveness
Enhancing
physical
healthcare
People with mental health
difficulties need access to good
physical healthcare. Through regular
health checks, screening
programmes and vaccinations we
can spot possible problems and
make sure service users get any
treatments they need. That’s good
for their long-term physical and
mental health.
n
n
n
This indicator is standard to most of
our NHS contracts.
Clinical
effectiveness
25 hours
therapeutic
activity
Evidence suggests that boredom
and reduced motivation results in
poorer clinical outcomes for service
users in secure care. This indicator
promotes a balanced and structured
day of meaningful activity, linked to
agreed care plans that promote
recovery.
n
This indicator is part of the
Commissioning for Quality and
Innovation (CQUIN) payment
framework.
n
n
n
Review the charity’s CPA
processes to bring together
clinical practice and contractual
requirements
Make sure that service users
contribute to the review
Review the charity’s policy, key
roles and responsibilities in
Spring 2011
Review CPA measures as part of
the St Andrew’s ‘balanced
scorecard’ for managing
performance
Introduce the new Patient
Environment Action Teams
(PEAT) tool to monitor patient
satisfaction with the cleanliness
of ward environments
Achieve the National Institute for
Clinical Excellence quality
standards for diabetes in adults
by year end
Exceed the World Health
Organisation influenza
vaccination targets (75 per cent
for both over-65s and under-65s
‘at risk’)
Align the charity’s systems and
treatment programmes with the
agreed national definition of
‘meaningful activity’
Audit services using new agreed
national benchmarking tool
Develop and implement work
plan to address any needs
identified in audit
Develop new performance
framework using timetabling
module in patient records
system
Quality accounts for 2010/11 | 7
Quality priorities
Patient
experience
Dining
Why this is important
Food quality and menu choices are
very important to the daily life of
most service users.
Objectives for 2011/12
n
n
By giving people freshly-cooked,
tasty produce, we can help improve
their quality of life as well as their
physical and mental health.
n
n
n
n
Patient
experience
Patient
experience
Dignity
Involvement
and
personalisation
strategy
Helping vulnerable service users to
retain their dignity whilst in secure
care is hugely important to
St Andrew’s. Supporting people
to give them the best quality of life
throughout their stay is likely to
achieve better service user
experiences of care.
n
Where service users and care staff
work in partnership, patients are
likely to move through a shared
pathway more quickly. This is likely
to mean shorter stays and better
service user experiences of care.
n
This indicator is part of the
Commissioning for Quality and
Innovation (CQUIN) payment
framework
n
n
Complete nutritional analysis of
charity recipes and share
‘healthiest options’ on intranet
Maintain level of sustainable and
ethical food produce as
proportion of total spend
Complete initial nutrition and
wellbeing training programme
Maintain customer satisfaction
levels with the dining experience
Develop on-site herb gardens to
support the charity’s kitchens
Support service users to grow
fruit and vegetables and build
understanding of food
production
Comprehensively review the
charity’s dignity, choice and care
policy by June 2011 and
implement practice changes
during the year
Identify key actions and
milestones to make sure our
approach to dignity is consistent
with the very latest sector
practice
Implement service user
involvement strategy for the
charity, linked to the national
service user groups
Produce joint service user and
staff report to show how the
charity can achieve the choices
made by patients for the year
This report is not intended to sit on a shelf gathering dust; we will use it regularly to monitor performance against
targets and invite feedback from our partners. St Andrew’s will track progress in the following ways:
n
Document the targets and key information on our intranet
n
Report updates against targets to Board meetings
n
Invite input on key targets and ongoing performance from service users.
8 | Quality accounts for 2010/11
PART TWO TO THE ACCOUNTS
This section provides information in the official format
required under the National Health Service (Quality
Accounts) Regulations 2010.
Reporting period: 1 April 2010 to 31 March 2011
Name of provider: St Andrew’s Healthcare
Driving improvements
1
Review of services
During the reporting period
2010/2011 St Andrew’s Healthcare
provided clinical services in the
field of mental health to over 700
service users, commissioned by more
than 130 different NHS Services and
other organisations.
2
St Andrew’s Healthcare has reviewed
all the data available to it on the
quality of care in respect of all
the services for which it provides
clinical services.
The income generated by the NHS
services reviewed in 2010/2011
represents 100% per cent of the
total income generated from the
provision of NHS services by
St Andrew’s Healthcare for 1 April
2010 to 31 March 2011.
Participation in clinical
audits
1. During the year, St Andrew’s
provided clinical services to over 700
service users
2. Hospital cleanliness is a key priority
for the charity
During 1 April 2010 to 31 March
2011, three national clinical audits
and zero national confidential
enquiries covered NHS services that
St Andrew’s Healthcare provides.
During that period St Andrew’s
Healthcare participated in 100 per
cent of the national clinical audits
which it was eligible to participate in.
The national clinical audits that St
Andrew’s Healthcare was eligible to
participate in during the reporting
period are as follows:
Clinical audits
Prescribing Observatory for
Mental Health
n
Prescribing of Antipsychotics for
Children and Adolescents
n
Monitoring of Patients Prescribed
Lithium
n
Medicines Reconciliation.
The national clinical audits that St
Andrew’s Healthcare participated in
during the reporting period are as
follows:
Prescribing Observatory for
Mental Health
n
Prescribing of Antipsychotics for
Children and Adolescents
n
Monitoring of Patients Prescribed
Lithium
n
Medicines Reconciliation.
Quality accounts for 2010/11 | 9
1
The national clinical audits that St Andrew’s Healthcare participated in, and for which data collection was completed
during the reporting period, are listed below alongside the number of cases submitted to each audit as a percentage of
the number of registered cases required by the terms of that audit.
Audit
Participation
Participant numbers
Sample size
Prescribing of Antipsychotics for
Children and Adolescents
Yes
67 service users*
100%
Monitoring of Patients Prescribed
Lithium
Yes
22 service users*
100%
Medicines Reconciliation
Yes
10 service users*
100% of two
admission wards as
sample base
• Figures based on service users who met the criteria in the auditing period
The report of one national clinical
audit was reviewed by the provider in
the reporting period and St Andrew’s
Healthcare intends to take the
following actions to improve the
quality of healthcare provided:
n
n
Information used as a baseline to
improve Medicines Policy and
Procedures, particularly in regard
to complying with NPSA alerts
Presentation at in-house training
event - Prescribing Observatory
for Mental Health, Audit Process
and Lithium Report.
These are reports published in 2010
that may relate to data collected in
2009/10 but may also relate to an
earlier collection of data, that is, the
audit and report of the audit fall in
different financial years.
St Andrew’s Healthcare has a
comprehensive clinical audit
programme supported by
governance structures.
The reports of 77 local clinical audits
(applied to all wards) were reviewed
by the provider in 2010/11 and St
Andrew’s Healthcare intends to take
a range of actions to improve the
quality of healthcare provided.
Further details are available
electronically from Caroline Rose,
Director of Nursing and Quality;
please email
crose@standrew.co.uk for this
information.
Research
The number of patients receiving
NHS services provided or
sub-contracted by St Andrew’s
Healthcare in 1 April 2010 to 31
March 2011 that were recruited
during that period to participate in
research approved by a research
ethics committee was 159.
Use of the CQUIN payment
framework
A proportion of St Andrew’s
Healthcare’s income in 1 April 2010
to 31 March 2011 was conditional
on achieving quality improvement
and innovation goals agreed
between St Andrew’s Healthcare 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.
Further details of the agreed
goals for the reporting period are
available electronically from
rjones@standrew.co.uk upon
request.
1. St Andrew’s Healthcare
has a comprehensive clinical
audit programme
10 | Quality accounts for 2010/11
1
2
Statements from the
Care Quality Commission
St Andrew’s Healthcare is required to
register with the Care Quality
Commission (CQC) and is currently
registered for:
3
The charity ensures that the
information we record, hold and use in
the treatment and care of
our service users:
n
n
n
n
Treatment of disease, disorder
or injury
Assessment or medical treatment of
persons detained under the Mental
Health Act 1983.
St Andrew’s Healthcare has the
following conditions on registration:
n
The Registered Provider must not
provide services for people under
thirteen years of age at the location
St Andrew’s Healthcare,
Adolescence Services, Northampton.
The Care Quality Commission has not
taken enforcement action against St
Andrew’s Healthcare during 1 April
2010 to 31 March 2011.
St Andrew’s Healthcare has not
participated in any special reviews or
investigations by the CQC during the
reporting period.
Data quality
Statement of relevance of Data Quality
and your actions to improve your
Data Quality
Good quality information underpins the
effective delivery of patient care at
St Andrew’s.
n
Is updated and validated in a timely
manner
Is monitored for accuracy and
completeness
Complies with the NHS national
clinical coding ensuring consistency
in reporting information that can be
comparable with other
organisations.
Over the previous 12 months, St
Andrew’s has been following a strategy
to ensure that data quality is improved.
We have achieved an improvement rate
of 80 per cent on our baseline data
from 2009/10.
Our strategy for the year ahead is to
continue with our improvement rate
and to implement an audit schedule
that will monitor and track scheduled
information governance audits. These
will pay particular attention to:
n
Clinical record keeping
through improved clinical
governance procedures
n
Accuracy of data that relates
to Mental Health Minimum
Dataset Submissions
n
Information obtained on admission
n
Consistent use of the NHS number.
1. Our information is monitored for
accuracy and completeness
2. We are registered to assess and treat
people detained under the Mental
Health Act
3. St Andrew’s complies with NHS
national clinical coding
Quality accounts for 2010/11 | 11
NHS Number and General
Medical Practice Code Validity
St Andrew’s Healthcare did not
submit records during 1 April 2010 to
31 March 2011 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
St Andrew’s Healthcare Information
Governance Assessment Report
overall score for 1 April 2010 to 31
March 2011 was graded as:
To achieve a ‘satisfactory’ rating, we
need to comply with level 2 in all
requirements of the toolkit. Following
an internal audit review in October
2010, a series of recommendations
were made and our management
team implemented a change
management strategy. All but four of
these recommendations have now
been either fully resolved, or making
good progress. Action plans are now
in place to make sure we comply
with the remaining requirements by
December 2011.
Current Score
42%
Not Satisfactory
Target Score
65%
Not Satisfactory
Clinical coding error rate
St Andrew’s Healthcare was not
subject to the Payment by Results
clinical coding audit during the
reporting period by the Audit
Commission.
1
2
1. Our team is currently progressing a
change management strategy
2. The charity is making good progress
to measure up to level 2 of the toolkit
12 | Quality accounts for 2010/11
PART THREE TO THE ACCOUNTS
On track with patient safety
Keeping people safe is a top
priority for St Andrew’s. We do
everything we can to provide a
safe and secure environment for
service users, staff and visitors.
There are five key ways that we
do this:
n
n
n
Assessing and managing
risks
Building and maintaining
well-designed hospitals
(page 15)
Recruiting, training and
supporting staff (page 3)
Assessing and managing risks
The charity has grown in recent years
and we now treat more service users
than ever before. Table 1 shows how
many registered beds we have
managed over the past six years.
We now manage 480 more beds
than we did in 2005 - with an
increase of 40 per cent in the last
two years alone.
Table 1: Number of registered beds
1200
1000
800
600
400
200
0
n
n
Delivering effective care and
clinical treatment
programmes (page 20)
Sharing learning and best
practice across the charity
and beyond.
St Andrew’s was the first mental
healthcare provider awarded a full
five-star rating by the British Safety
Council. We’re determined to
maintain this high standard, and
during the year ahead, all of our
national services will be assessed
through an external audit of health
and safety management systems.
Minimising risks
We work hard to minimise risks in our
hospitals and use the safest
equipment. Retractable needles are a
case in point. EU directive
2010/32/EU requires all healthcare
providers to use retractables from 11
May 2013, but we’ve used them
since June 2009.
Whilst they cost a little more, we’ve
found using retractables means less
injuries and less anxiety. Our
needlestick incident reports are
consistently low; just 11 incidents
were reported last year, with no
adverse outcomes.
2005
2006
2007
Number of beds
2008
2009
2010
Year ended 31 December
We are also managing risks better.
The total number of incidents
reported in our hospitals has reduced
by 40 per cent since 2007, even
though we’re supporting more
people. Table 2 shows our
year-on-year performance.
Table 2: Number of reported Incidents
18000
16000
14000
12000
10000
8000
6000
4000
2000
0
2005
2006
2007
Number of incidents
Please note these figures include all
incidents involving staff or patients.
A lot of those things are quite small,
but we report them because it’s the
right thing to do. The number of
serious problems is much lower, and
this figure is also decreasing.
2008
2009
2010
Year ended 31 December
Our Serious Untoward Incident
reporting system helps us collect
information consistently and has clear
guidelines for investigating any
problems that may occur.
Quality accounts for 2010/11 | 13
1
Tackling challenging
behaviours
In 2010, St Andrew’s was the first
secure healthcare provider in the UK to
receive the RAID® Centre of Excellence
Award from the Association of
Psychological Therapies (APT).
RAID® - which stands for Reinforce
Appropriate, Implode Disruptive – is
designed to tackle extremely
challenging behaviours in healthcare
settings. The system involves setting
clear goals to aid individual recovery,
such as working towards
independence, or developing
appropriate social skills.
The process involves rewarding positive
or ‘green’ behaviours in ways that
help patients recognise their
achievements; whilst ‘red’ (negative)
behaviours are safely played down
through the use of strategies such as
distraction techniques.
Chloe’s journey
Chloe, a 28-year-old with Huntington’s
disease, was admitted to St Andrew’s
after a string of unsuccessful
placements elsewhere.
1. We were the first secure provider to
receive the RAID® Centre of
Excellence Award from the
Association of Psychological
Therapies (APT)
2. The process involves reinforcing
positive or ‘green’ behaviours in
ways that help patients recognise
their achievements
On her arrival, Chloe ignored staff and
refused to conform to ward routines.
Due to self-harming risks, we provided
enhanced support; she hid under the
duvet and tried to avoid activities.
She also showed physical and verbal
aggression towards herself and other
people, slammed doors, threw items
of property around and routinely
refused meals.
2
Through RAID®, Chloe’s goal was to
be calm and motivated to engage in
activities. The team did this in many
ways, including:
n
Providing encouragement and
incentives to help her get up
n
Using distraction techniques to
tackle disruptive behaviour
n
Changing the environment to
reduce risks to Chloe and others
n
Creating an activity timetable to
promote positive actions
n
Giving her a designated ‘role’ on
the ward.
Changes in Chloe’s behaviour were
measured through the Overt
Aggression Scale - Modified for
Neurorehabilitation (OAS-MNR). Over
two years, her aggressive behaviours
reduced from more than 50 incidents a
week to less than 10. She has also
progressed to a point where she:
n
Gets out of bed and eats meals
without prompting
n
Is talkative and takes part in groups
n
Is highly motivated to try new
activities, including bowls,
horse-riding and pet therapy
n
Shows high levels of wellbeing
n
Consistently shows high levels of
positive behaviour.
14 | Quality accounts for 2010/11
1
2
Progress against last
year’s priorities
Essen Climate Evaluation
Scale (EssenCES)
St Andrew’s aspires to be a teaching
hospital, leading the way in
healthcare. Research is important
to check that our services are
effective, and prove that we deliver
high-quality treatment.
Lots of research takes place at the
charity. In 2010, members of our
team were published 34 times, and
delivered 39 national and
international presentations. We
also have a Therapeutic Practice
Group that helps us to develop
strong therapies with a built-in
review process.
The Essen Climate Evaluation Scale,
or ‘EssenCES’, is a new measure of
ward atmosphere and personality. It
assesses engagement, patient
motivation and perceived safety.
Evidence suggests that patients
respond better, engage more and
recover more quickly where they feel
safe and comfortable.
St Andrew’s conducted research on
EssenCES last year. We used the scale
to assess ward atmosphere and
identify any patient concerns, then
use interventions to test if they made
an impact.
For example, we found that in some
services, misunderstandings between
service users were leading to
individual friction and apprehension.
So we developed an anti-bullying
policy, ran some theatre workshops
on diversity and bullying and helped
service users to produce an
anti-bullying leaflet. We then used
EssenCES again to test the difference.
We’ve found that patients moving
through medium secure services who
feel supported show fewer needs,
fewer risk behaviours and are more
likely to progress through the care
pathway.
the wider research community
describes as key therapeutic factors.
The work was recently written up by
the charity’s Dr Clive Long.
Linda has gone from strength to
strength, having spoken at national
conferences, presented her own
content and fielded questions from
mental health professionals. The fact
that she has done this whilst unwell
is impressive.
Linda’s journey
Linda had a severe and enduring
mental illness, and was in medium
secure care in St Andrew’s women’s
service. She started attending service
user group meetings, where a
consultant spotted her potential skills
articulating and presenting
information. She showed an obvious
interest in developing her skills
further, so we looked for
opportunities to do this.
Last year, St Andrew’s supported
Linda in developing a piece of
qualitative research. This explored
what patients feel makes a
comfortable therapy setting (such as
attitudes, staff and physical layout).
Linda ran two focus groups, looking
at what patients felt were positive
factors in their treatment and
learning what they value. Her
findings were consistent with what
1. EssenCES assesses engagement,
patient motivation and perceived
safety
2. Patients respond better, engage
more and recover more quickly
where they feel safe and comfortable
Quality accounts for 2010/11 | 15
Priorities for the year ahead
EssenCES
EssenCES remains an important
priority for the year ahead. All
healthcare providers must identify a
service development or improvement,
based on the surveys they did in
2010/11. At St Andrew’s, we intend
to focus on patient perceptions of
the ‘risk status’ system.
2
We are now producing an
implementation plan to make sure
that we achieve service
improvements over the year ahead.
This will be regularly tracked
throughout the year, to make sure
we meet what is required of us.
Building and maintaining
well-designed hospitals
3
With three new hospitals recently
opened and ward refurbishments in
Northampton, Birmingham and
Essex, St Andrew’s is determined to
provide well-designed healthcare
environments. We want to create
homely spaces that people feel
comfortable living in as they recover.
This year, the charity has developed a
design guide which sets standards for
the quality of our hospital
environments. The guide builds on
1
1. A view of St Andrew’s latest
development, William Wake House
2. Plans to upgrade one of the wards
on the charity’s Northampton
campus
3. Our Nottinghamshire facility,
which opened in September 2010
the national regulatory standards,
and includes information to make
sure that any development or
refurbishment meets and (where
appropriate) exceeds those
requirements. It also helps colleagues
to learn from the charity’s experience
and share information about
environments and products for
particular service user groups.
The guide prevents unnecessary risks
and identifies areas that may be
susceptible to problems. This includes
information on products tested, to
minimise risk and encourage shared
learning without stopping creativity.
For example, if buying a new sofa,
we will initially test it in a low-secure
environment, against agreed criteria.
If something works in that
environment, we will consider
whether it’s appropriate to test the
product in a medium-secure setting.
During 2011/12 we will work with
service users to develop the guide
further, and include specifications for
specific room types. We will also be
looking at room layouts and designs
for seclusion areas; the Institute of
Psychiatry has shown an interest in
being involved in this work, possibly
with a view to developing UK
standards for seclusion environments.
16 | Quality accounts for 2010/11
Safe access to technology
Education journeys
Many secure mental healthcare
providers routinely prevent patients
from accessing technology. But St
Andrew’s makes every effort to help
people access technology for work,
social, leisure and education use.
In St Andrew’s College, we’ve
installed eight interactive
whiteboards, linked to individual
student laptops. We can download
thousands of lessons for the national
curriculum using ‘SMART’ software.
Everyone can access some form
of technology, from gaming consoles,
laptops and mobile phones through
to PCs, Wiis and Playstations on
our wards. We focus on managing
access, rather than denying
it altogether.
The technology enhances lesson
planning and student learning, and
we use it all the time. It’s very visual for example, students can look at the
positions of planets in the solar
system – and kinaesthetic, as you can
move words into sentences or shift
body parts for a biology lesson.
Teachers use pens to pick out key
learning points from a lesson, then
click a button to print the
information; the equipment
‘understands’ their handwriting.
As we support vulnerable people, we
must risk assess individuals to ensure
they access technology safely. Last
year team members met with
Nottinghamshire Police for training
around access to information and
the law, and best practice on
disclosing information.
St Andrew’s has a forensic IT security
expert responsible for screening
information and helping to assess
machine capabilities. We share a
technology ‘safe list’ with our
Service User Group. We can also
adapt equipment to patient
needs, such as disabling Playstation
browsers to allow gaming without
Internet access.
This approach has attracted plenty of
interest, including visits from several
NHS providers. In 2011/12, we will
dedicate more resources and support
to service users. This includes risk
management training sessions and
providing regional testing equipment.
We’ve increased screening resources
to track emerging technologies, and
will evaluate video conferencing
options for people whose families
live overseas.
1
2
3
For some service users, such as young
people with autistic spectrum
conditions, it’s a very effective way of
helping them focus into learning
sessions. They can see things
happening, and find this calming.
Wiis are also linked to each machine.
We use these to teach physical
education GCSE, provide warm-ups
to get the body and mind thinking
and as ‘rewards’. There is scope to
link in DVDs, music and sound;
students can even write their
own programs.
1. St Andrew’s College uses ‘SMART’
software to make lessons more
engaging
2. The charity makes every effort to
help people access technology,
including accessing Wiis on wards
3. To maximise safety, a forensic
expert is responsible for screening
information
Quality accounts for 2010/11 | 17
On track with
clinical effectiveness
Physical healthcare checks
St Andrew’s supports patients
to help them achieve optimal
mental health and recovery. Our
focus is on helping people to
move into less secure settings,
and back into the community
wherever possible. Some people
admitted into our care are very
unwell, so it’s important to
support and empower them in
planning and managing
treatment programmes. Their
carers or families may need our
help too.
1
1. St Andrew’s routinely assesses new
patients for physical healthcare
conditions and possible infections
The Department of Health
publication No mental health without
physical health recognises that
people with mental illness need good
physical healthcare. People with
mental illness often don’t access
medical support; some patients
admitted to us haven’t seen a GP for
a long time.
St Andrew’s routinely assesses
everyone admitted to our hospitals
for physical health conditions and
possible infections. We also provide
annual physical healthcare checks,
including monitoring blood pressure,
screening for chronic diseases and
obesity and providing regular
vaccinations. Our vaccination
programme is already set to exceed
the World Health Organisation
influenza targets for the year ahead.
The results are logged on our patient
records system and trigger follow-up
treatment where needed, so relevant
staff can access key information
immediately. For example, people
with diabetes, asthma or heart
disease are referred to clinicians for
reassessment, and development of
an illness-specific care plan.
Alongside our physical health checks,
we monitor service users’ diets and
analyse the nutritional value of the
food they eat. We screen their
nutrition on admission and then
every month; weight data is recorded
on the patient records system, and
Body Mass Index (BMI) figures are
monitored on a graph.
If someone is underweight,
overweight or has had a major
change in weight, the charity
monitors their progress. High BMI
patients usually enter the weight
management care pathway. This
involves a referral to therapists and
access to a ward-based healthy
lifestyle group, with information on
food and activity choices. Interactive
resources, factsheets and
presentations are also available on
our intranet.
Healthcare providers need to
promote healthy lifestyle choices. We
encourage people to make informed
decisions by coding menus and
posting ‘traffic light’ nutritional
content on food. In late 2011, we’re
set to launch some service user
workshops on tackling obesity. These
sessions will use pictures and key
words (such as ‘takeaways’ and
‘portion control’) to prompt debate.
18 | Quality accounts for 2010/11
Progress against
last year’s priorities
Recovery planning
St Andrew’s uses a range of recovery
tools to help people recognise where
they are on their treatment pathway
based on how they feel now, and
where they want to be.
The tools we use include Recovery Star,
Teen Star, Dementia Care Mapping and
Functional Independence Measure and
Functional Assessment Measure
(known as FIM-FAM). We know that
different tools suit different people,
and individual experience is also very
important; after all, our service users
are expert in understanding their life
they have lived so far.
One of our key targets for 2010/11
was to implement a recognised tool for
recovery planning. We promised that
every service user would be offered the
chance to complete a recovery plan
during 2010/11. Our progress towards
this goal is shown in table 3 below.
1
Table 3: Compliance with recovery targets 2010/11
100
90
80
70
60
50
40
30
20
10
0
End of quarter 2
End of quarter 3
This information shows that we have
made steady progress towards our
target for the year. Some people have
declined to take part in a plan; we
will offer them the chance again
End of quarter 4
every so often, in case they change
their minds. Others haven’t
completed a plan yet, that’s usually
because they have been admitted in
the last 12 weeks.
1. The charity uses a range of tools
and information to track performance
Quality accounts for 2010/11 | 19
1
2
Risk management
Secure mental healthcare providers
need clear guidelines in preventing and
managing aggression. St Andrew’s is
determined to provide the most
sensitive support. We train staff in the
prevention and management of
aggression and violence; this helps us
to prevent situations occurring, and
reduce risks of injury to service users
and staff. The charity has also trained
nearly 400 staff to Level One Health
and Safety.
St Andrew’s uses a risk management
tool called HCR-20 to assess service
users and the people around them. This
tool looks at patient history, clinical
symptoms and risk situations. By being
sensitive to risks that may affect people
in our care and carefully managing
potentially difficult situations, we can
keep people safe without imposing
unnecessary restrictions.
Commissioners expect us to conduct
HCR-20 with certain service users when
they’re admitted to hospital, and then
every six months. In 2010/11 we
monitored 97 per cent of these
‘relevant patients’.
Last year, Professor Chris Webster – one
of the people who developed
HCR-20 – ran an in-depth ‘train the
trainers’ session and risk assessment
workshop with clinicians. We produced
a user guide in December 2010,
showing staff how to log information
on our patient records system. And
over the year, we trained 83 staff to use
the tool across our adult services.
For 2011/12, St Andrew’s has
developed an action plan to make sure
we fully implement HCR-20; we have
also set minimum standards to make
sure that all elements of the tool are
completed.
During 2011 we will integrate the tool
into individual care plans for relevant
service users. We will also audit our
standards next year, to check the
quality of this work.
1. By being sensitive to risks and
managing potentially difficult
situations, we keep people safe
2. Training and auditing are key to
managing risk successfully
20 | Quality accounts for 2010/11
Effective care and treatment
Anna’s journey
Delivering effective care and
treatment programmes is very
important to St Andrew’s. We’re
constantly looking for ways to
develop new ideas and improve
services where this will benefit our
service users.
A healthcare professional who had
experienced mental illness for many
years, Anna’s pregnancy increased
her paranoia and she tried to
smother her child, leading to
admission. She repeatedly attempted
self-harming, including setting
herself alight and suffering severe
burns.
In 2010, St Andrew’s women’s
service developed a psychosocial
treatment programme to support
women with complex mental health
needs. Many of these patients have
experienced trauma such as physical,
mental and sexual abuse; they
typically have a history of high levels
of risk to themselves or others, with
challenging behaviours needing
careful management.
The charity has developed individual
and group-based treatments,
including problem solving, emotional
regulation and interpersonal skills.
Sometimes service users attend more
than one group, to maximise
treatment impact and speed recovery.
The team has also developed creative
solutions to help women assume
personal responsibility and make
informed choices. Achievements
include training service users and
staff together to use the Recovery
Star, and piloting a self-assessment
process where patients assess their
own state and decide whether they
should be given leave.
1
2
Anna joined St Andrew’s intensive
programme, where the team helped
her understand her illness and take
responsibility for her own actions and
safety. Initially suspicious, she was
afraid to disclose some symptoms.
Intense psychotherapeutic input
(both through psychosocial groups
and individual support) helped to
change her ways of thinking,
manage anxiety and challenge reality.
A self-monitoring mood checklist
helped Anna check her anxiety levels
and perceptions of safety. Initially
completed several times a day,
Anna’s reliance reduced as her
condition and confidence improved.
Complementary vocational work
boosted Anna’s self-esteem and she
engaged much more effectively with
the ward team, becoming open
about her feelings. She gained
sufficient independence to progress
to a Community Treatment Order.
Discharged in 2010, Anna now lives
in the community and is engaged to
be married. She and her family have
written to the women’s service,
thanking them for their support.
1. Nottinghamshire service users
developed this Recovery Star diagram
2. Anna’s recovery journey has had a
happy ending, with the
announcement of her engagement
Quality accounts for 2010/11 | 21
Priorities for the year ahead
Care Programme Approach
St Andrew’s follows the Care
Programme Approach (CPA), a
national clinical framework for
supporting people with complex
mental health needs.
Every service user has an individual
care plan, and an appointed care
co-ordinator. Some service users have
several plans that are rolled into one.
(For example, if someone has a
chronic physical illness, they may also
have a detailed nursing plan or
weight management plan.) The
charity’s appointed care co-ordinators
meet individual service users at least
weekly to discuss their care plan and
how things are going.
In 2011/12 we will review St
Andrew’s CPA processes, to bring
together clinical practice and
contractual requirements. This work
will include refreshing our policy and
agreeing key roles and
1
responsibilities. It will also involve
reviewing our measures in line with
the charity’s performance
management framework. Service
users’ views will be an important part
of the process too.
Recovery planning
Recovery remains a strong focus for
St Andrew’s. In a 2009 policy paper,
the Centre for Mental Health listed
10 key organisational challenges
facing mental healthcare providers.
To address these challenges and help
healthcare providers improve the way
they work with service users, the
Centre worked with the NHS
Confederation and National Mental
Health Development Unit to launch
the Implementing Recovery,
Organisational Change project
(known as ImROC).
ImROC involves changing service user
treatment from a mainly clinical focus
to one that puts recovery in the
spotlight. Recovery puts service users
at the centre of their care; it helps
them to explore what’s right for
them and live the best life they can,
in the context of their mental illness.
By working in partnership, the
person’s life experiences and
understanding of their own illness is
recognised and valued.
St Andrew’s has been selected as one
of six national ImROC pilots, and the
only independent sector provider.
As a pilot site, we expect to review
and challenge our existing services
and find ways to build on existing
good practice. We will have access to
a two-year support package to help
us. This includes input from expert
consultants and trainers at the
Centre for Mental Health, provision
of training tools and guidance and
attendance at ‘learning sets’ to share
good practice.
2
1. Service users directly influence our
work, as shown on this achievement
wall
2. Dr Shawn Mitchell is the charity’s
lead on the ImROC project
22 | Quality accounts for 2010/11
3
1
2
25 hours of activity
Since 2007, medium secure
healthcare providers have been
required to provide 25 hours of
therapeutic activity to each service
user weekly. The scope of this time
includes:
n
Directed psychological therapies
n
Occupational therapy,
including life skills training
and physiotherapy
n
Creative therapies, such as
drama, art, music and animation
n
Complementary therapies, aimed
at improving self-image
n
Educational and vocational
training - including both
life skills and practical skills
(such as bricklaying)
n
Voluntary placements and
academic development
n
Weight management, exercise
and diet
n
Self-directed activity, including
hobbies and leisure.
St Andrew’s follows the 2007
Offender Partnerships Best Practice
Guidance for Mental Health Services.
Activity and engagement are often
closely linked, so we aim to get
service users fully engaged in
focusing on their recovery. That way,
they understand what is happening
and can sign up to the benefits of
getting involved. For example, if
someone has been in and out of a
psychiatric setting for years and on
medication for a long time, it may
be hard for them to acknowledge an
obesity problem. But until they do,
the success of weight management
activities may be limited; so we
encourage them to think about
where they are now, and what they
need to do to move on.
St Andrew’s routinely sets
challenging targets to exceed the
basic 25 hour figure. For example,
our new men’s service at William
Wake House has set a target of at
least 30 hours of activity in 2011/12.
This unit achieved a ‘top five’
position in the country in a peer
review, less than three months
after opening.
Although we’ve worked hard on the
practical side of things, our current
systems don’t produce clear and
concise information. So in 2011/12,
we will develop a new performance
framework. We’re adapting the
‘community diary’ on our patient
records system to develop a
timetable module, and help us to
record and report activity hours.
The software developer is helping us
to make these changes ready to
launch in late 2011.
Another key action for the year
ahead involves aligning our systems
and treatment programmes with the
new, agreed national definition of
‘meaningful activity’. St Andrew’s
intends to achieve the targets set
nationally. This includes auditing
services using the new sector
benchmarking tool and
implementing a work plan to
address any needs arising from
the audit.
1. Learning woodwork helps patients
to build confidence and practical skills
2. Animation techniques can tell a
strong story, as this example shows
3. Figures developed by service users
in our Northampton creative studio
Quality accounts for 2010/11 | 23
Enhancing physical
healthcare
Physical health is still a key priority
for St Andrew’s. In the year ahead,
we want to help service users
with diabetes manage the
condition themselves.
A high proportion of people referred
to us have diabetes; around 10
per cent of service users are
diabetics, compared to a national
average of four per cent (source:
Diabetes UK, 2009).
In December 2010, we piloted a
structured six-week programme to
help diabetic patients look after
themselves. This included:
n
n
n
Pre- and post-programme blood
pressure, lipids and blood glucose
checks to test the impact on
participating service users
Conversation maps, developed
with Lilly’s diabetes education
section, to train 25 staff in
guiding discussions around topics
such as food, lifestyle and feelings
A ‘takeaway’ resource covering
issues such as blood glucose levels
and self-monitoring.
The pilot is now being evaluated
before we extend it charity-wide later
this year. We will also share its
resources online, to help staff
support service users. We aim to
achieve the National Institute for
Clinical Excellence quality standards
for diabetes in adults by year end.
Bob’s journey
Bob was admitted with paranoid
schizophrenia. On admission, our
routine checks showed that he had
Type 2 diabetes, with an average
blood sugar level of 11.9 per cent
using the ‘HbA1c’ test (which
measures sugar levels over
three-months).
Bob had been diabetic for many
years, but he’d never done anything
to monitor or regulate the diabetes.
This meant he faced other health
risks, such as blindness, heart attack
or stroke.
An important change involved
getting Bob to understand his
relationship with food, and how it
affected his physical and mental
health. We helped him review his
diet, change his eating habits, start a
regular exercise programme and
adjust his diabetic medication. He
started making healthier food
choices, and changed his attitude to
snacking between meals.
Within a month, Bob’s average blood
sugar level reduced to 10.9 per cent.
He now manages his diabetes well.
He keeps a food diary and blood
sugar diary, to monitor what he’s
eating and how it affects his sugar
levels. His glucose level is now an
average of 10.0 per cent, which is a
big improvement.
1
Bob joined our weight management
care pathway as part of his treatment
programme. He worked with a
practice nurse, dietician and ward
nursing staff to get the diabetes
under control.
2
1. Conversation maps guide
discussions around food-related topics
2. Healthy eating education helps
people like Bob to make more
informed choices
24 | Quality accounts for 2010/11
On track with patient
experience
The way that patients experience
our services is critical to any
quality assessment of St
Andrew’s. Almost every service
user at St Andrew’s gets involved
in giving the charity feedback or
ideas. We involve people in their
care and treatment and as many
areas of hospital life as possible
because:
n
They know best what is
right for them
n
It helps us to target services
better and understand which
outcome measures are
most helpful
n
It’s more efficient to listen to
them - and get services right
first time
n
It helps them to feel valued,
important, know their opinion
counts and that the charity
cares about what they have
to say.
Our engaged service users are at all
stages of the recovery journey. Some
can be very unwell, having chronic or
multiple disorders. But anyone can be
involved if they want to and there are
many ways of taking part: from ward
discussions, satisfaction surveys
and minor projects through to work
placements, training, governors’
events, parties and formal groups
such as the service user contributor
scheme. We even involve patients
in recruitment, including interviewing
clinicians, ward and administration
staff.
1. Helping people to build their
confidence and achieve their potential
is core to what we do
Some highlights from our service user
involvement programme are
explained throughout this section.
There are not enough pages to
explain everything we do in detail,
such as involving patients in service
improvements, induction training and
developing a user handbook.
But we can emphasise that helping
people to build their confidence and
achieve their potential is a core part
of what we do. Last year we
supported service users to become
befrienders, train our team on ‘what
it’s like to be a service user’ and
speak about mental health issues at
national conferences. Where people
show an interest and it’s good for
their development, we work hard to
help them grow.
1
Tom’s journey
Tom was admitted to a medium
secure ward at St Andrew’s following
a history of profound drug misuse
and numerous arrests.
During his stay, Tom showed an
interest in learning; we found out
that he had formerly been interested
in studying higher education. With
support and encouragement,
he started to study for a
university degree.
As he recovered, Tom’s motivation
remained strong. When he returned
to community life, he continued
the qualification, and successfully
completed a degree in
business studies.
Quality accounts for 2010/11 | 25
Progress against last year’s
priorities
Diversity
Everyone is unique, with their own
special strengths and qualities. In a
secure mental healthcare setting, this
can be challenging as some people
may not always understand or tolerate
each other’s behaviours and needs.
In 2010, St Andrew’s developed a
diversity questionnaire for staff. Service
users helped to develop questions for
this. The questionnaire was sent to
heads of departments, asking them
to review local practice.
We also helped service users to
construct a patient survey. This asked
questions such as:
n
Do you feel respected?
n
Are your cultural needs being met?
n
Does our dining experience meet
your needs?
n
Would you benefit from diversity
awareness training?
From a population of 667 patients, 227
gave us their views – a 34 per cent
response rate. Most people said their
cultural needs are met; where people
did have unmet needs, these
concerned religion, food, decisionmaking, music or acceptance by other
people. Some 69 per cent of service
users who replied said they can be
1
themselves at St Andrew’s. However,
29 per cent of patients said they had
been bullied and 73 per cent of
patients told us they would benefit
from awareness sessions, to encourage
greater respect for differences among
service users and staff. So we took
urgent action to change this (see
page 14).
Since the survey, St Andrew’s has taken
several steps to help people respect
individual differences. For example,
we developed interactive training to
help people recognise and celebrate
different ideas and cultures – including
elements delivered by service users to
their peers. One tool, a visual training
wheel with ‘true’ and ‘false’ cards, uses
statements based on patient
experiences to challenge why people
think in a certain way.
The charity also developed a spirituality
needs assessment tool last year. We
went to great lengths to identify
spiritual leaders across many faiths;
service users can request support and
input from a leader of their chosen
faith and we will provide access.
We are also considering creating a
series of groups in response to the
survey. These include a lesbian, gay,
bisexual and transgender group, as
well as activity-based groups around
music, film and sport.
2
1. This questionnaire helped us to
explore service users’ views on diversity
2. The anti-bullying leaflet was
developed following our diversity
audit
26 | Quality accounts for 2010/11
1
2
On track with
patient experience
Service user
contributor scheme
St Andrew’s provides a huge range of
voluntary opportunities for service
users to contribute to the charity’s
work. Examples include clerical
support, gardening, helping in our
shop and hairdressing salon,
attending meetings and befriending
other patients.Taking part makes
people feel valued and important,
helps build self-esteem and prepares
them for life back in the community.
Voluntary placements can also turn
negative perceptions of mental
disorder into positive experiences, as
service users contribute their life
experience to improve things. Some
service users have severe mental
illness, learning disabilities or
acquired brain injuries but can still
benefit from learning new skills and
connecting with other people.
1. Gardening is one way in which
service users can contribute to
St Andrew’s work
2. This hairdressing salon is a focal
point in the hospital community
When a patient is admitted to St
Andrew’s, we offer them access to
befrienders and explain what
opportunities are available to them.
When someone contributes their
time, they accrue service hours. As
they build up these hours, service
users are rewarded with a range of
benefits - such as certificates, cards,
presents and invitations to social
events with other charity supporters.
St Andrew’s also has ‘Oscars’ for
people who complete 100 hours of
service, and gifts for people
completing 200 and 300 hours.
By contributing time and energy,
individuals can build up a portfolio of
evidence ready for their future
discharge and potential employment.
So there are many positive reasons
for people to get involved.
John’s journey
John was originally admitted to a
medium secure ward, where he
found it hard not being able to
go shopping and get the things
he wanted.
When he progressed to low secure
care and was able to get out and
about more, John mentioned his
former frustrations and showed an
interest in helping other service users
going through similar experiences.
So John’s occupational therapist
helped him develop a plan to
help him become an unofficial
‘personal shopper’ for medium
secure service users.
There were lots of things to consider
in making this happen, including risk
assessments, training and support.
But St Andrew’s has helped John to
overcome those barriers. He now
enjoys fetching errands for people,
bringing back their receipts and so
on. It’s also good for his peers,
who feel that a friend is doing
them a favour rather than feeling
dependent upon our staff to shop on
their behalf.
Quality accounts for 2010/11 | 27
1
2
Priorities for
the year ahead
“I like it when I’m covered up.”
“Feels good inside, treatment becomes easier, being looked after well.”
“Being looked after properly.”
“To feel like I’m important when staff care for me.”
“Showing me what I feel and think matters.”
“Feels like I’m treated well. Respected. Dignity means private.”
Dignity
Helping vulnerable service users to
retain their dignity is hugely important
to St Andrew’s. We want to make each
patient’s experience of our care as
positive as possible, recognising
individual talents and needs and
supporting people whilst they’re with
us. Some service users are very unwell
and it’s important to do as much as
possible, so people can take pleasure in
the little details of everyday life.
St Andrew’s follows the Department of
Health’s 10-point dignity challenge.
This aims to help people understand
what providers are doing to improve
quality of life for their patients.
Last year the charity conducted a
dignity audit. We asked 122 service
users what they thought being treated
with dignity feels like, and 67 people
responded. Some of their feedback is
shown above.
During 2010/11 St Andrew’s
has introduced several service
improvements to enhance
dignity, including:
n
Introducing a ‘clean face’ policy, to
make sure more vulnerable
residents maintain their dignity after
mealtimes
n
Providing training (using the Royal
College of Nursing’s dignity pack)
to remind staff of the importance of
dignity - this involved staff feeding
each other with blindfolds on, and
being pushed around in a
wheelchair, to show how service
users may feel in certain situations
n
Installing frosted windows on a
ward where people walking past
could previously look in, to improve
service user privacy
n
Developing life story books to help
ward staff and befrienders connect
with patients (for example, they can
see that the service user used to
have a particular car, or support a
sporting team)
n
Launching a ‘hospital passport’
system, which records factors that
are important to service users and
will make them feel comfortable –
such as having a bedside light, or
wearing bright colours.
St Andrew’s is set to review its dignity,
choice and care policy by June 2011.
Through this work, we will identify
actions and key milestones required to
ensure our approach to dignity still
meets the very latest industry practice.
1. We work hard to help people take
pleasure in the little details of everyday life
2. Service directors make sure that our
approach to dignity meets the latest
industry practice
28 | Quality accounts for 2010/11
“Service user satisfaction with our food is consistently
around 80 per cent. We collect feedback at service times,
in meetings between chefs and service users and through
quarterly surveys.”
Dining experience
Dining at St Andrew’s is very
important. It affects our service users’
quality of life, and is a topic they like
to discuss. And of course, diet is an
important factor in improving mental
and physical health.
Since 2009, we have completely
overhauled our catering services to
focus more on local, organic and
ethical produce. A central electronic
ordering system controls the
products staff can buy, so they can
only use healthy options. (For
example, sources of ‘trans fats’ have
been removed from our purchasing
list.) Meals are cooked and served
locally to the wards.
Service user satisfaction with our
food is consistently around 80 per
cent. We collect feedback at service
times, in meetings between chefs
and service users and through
quarterly surveys.
We’re sensitive to people’s needs
and preferences, with eight bespoke
menus catering for different groups.
Following last year’s diversity
survey (page 25), we extended our
dining experience to include halal
and kosher produce. We also
organise themed days linked to
religious festivals and serve
culturally-relevant food.
The charity has analysed and
reviewed its menus for some time,
taking advice from specialist
dieticians. In 2010 we started
formally testing the nutritional value
of our chefs’ recipes using nutrition
analysis software.
Each recipe is tested for 14 nutrients
(including vitamins, fats and salt) and
checked against recommended
dietary allowances. A traffic light
system highlights the nutritional
value of each recipe; this helps us to
assess ways of refining ingredients
and cooking methods to make
options even healthier. The final
recipes are priced according to
agreed portion controls, and shared
on the staff intranet. Our chefs can
analyse a week’s menus in advance,
knowing they’re achieving a
balanced diet.
1
2
The first batch of recipes is online.
Our priorities for 2011/12 are to
complete the analysis of all recipes
and publish the ‘healthiest options’
on the intranet. This will include an
online ‘menu builder’ where chefs
can pick items from a list.
We also aim to maintain high levels
of service user satisfaction. One way
we plan to achieve this is by building
service user awareness of food
production. Work is underway to
develop herb gardens for the
charity’s kitchens. In spring 2011 we
will also support service users in
planting fruit and vegetables on-site,
helping them to see the benefits of
growing healthy produce.
1. Meals are cooked and served locally
to our wards, with service user
satisfaction consistently around
80 per cent
2. Each recipe is tested for 14
nutrients and checked against
recommended dietary allowances
Quality accounts for 2010/11 | 29
Involvement and
personalisation strategy
As this section proves, St Andrew’s is
dedicated to providing a wide range
of opportunities for service users to
get involved in shaping the charity’s
work. People can contribute formally
through work-related tasks,
informally through activities and
feedback, and of course influence
the recovery process.
A strong example of how we
encourage service user input to
develop charity practice and enhance
recovery is shown below.
Care Pathway Star
Service users from all the charity’s
sites and services have been involved
in delivering a new assessment tool,
the Care Pathway Star. This is based
on the Recovery Star, but is intended
for in-patient settings.
There are some key differences
between the two tools. For example,
the top point of the Recovery Star
is self-reliance; on the Care Pathway
Star, it’s moving on (which could
mean moving from medium to
low secure care, or back into
the community).
1
1. St Andrew’s is dedicated to
providing many opportunities for
service users to shape our work
St Andrew’s is one of four secure
organisations developing the Care
Pathway Star, and service users and
staff have collaborated together on
the work. Service users from
Birmingham, Essex and Northampton
developed descriptors for all 10
points of the star and we received
positive feedback from a Mental
Health Providers Forum
representative.
In spring 2011, service users and staff
will join forces to develop the final
tool, ready for publication by
September. We expect the star will
be a huge benefit to service users
in future.
During 2011/12, we will bring our
work into line with the new national
framework. By June 2011 we will
have developed a new service user
involvement strategy for the charity,
linked to the national service user
groups. Throughout the rest of the
year, we will implement the strategy
to make sure that we continue to
support people in developing their
skills, potential and confidence.
Working with service users, we will
also produce a report showing how
the charity can achieve the choices
made by patients for the year.
30 | Quality accounts for 2010/11
Mapping feedback
In producing this document we have
listened to the views of staff, service
users, commissioners and other
partners who have an interest in our
work. Thanks to everyone who has
been kind enough to submit ideas and
comments; we appreciate your views
and know this will help us to keep
improving what we do.
The list of people formally consulted on
these accounts includes:
n
Strategic commisioning managers
n
Service user groups
n
Colleagues at St Andrew's.
The feedback received is shown below.
We are also grateful to our Board of
Trustees for its continued commitment
- providing independent input
through service visits and challenges,
and scrutiny through our
committee structure.
“In principle it looks fine to me, I wouldn’t
suggest any major amendments.”
Mick Burns, Senior Commissioning Manager,
Yorkshire and Humber region
"I have looked through the report and think
that once it is complete it will be a very good
read and extremely informative."
Yvonne Srinivasan, contract lead,
East of England Specialised Commissioning Group
Quality accounts for 2010/11 | 31
Key connections
Partnership working is very important
to St Andrew’s. We work with
hundreds of people and
organisations to support service
users, develop and manage services
and share best practice.
Diagram 1 below outlines some of
the key partners we work with, and
what we achieve together.
Diagram 1: partnership working at St Andrew’s
Networks
Carers
Share best
practice and
influencing
opportunities
Share knowledge and
understanding
to support people
Governors
Communities
Help us to
prepare people
for life
St Andrew’s
Provide an
independent view
of our work
Service users
Researchers
Regulators
Discover and share
information
to improve quality
of care
Check we’re
upholding the law
and meet national
standards
Education
specialists
Partner us to
provide learning
opportunities
Commissioners
Work with us to
provide safe and
suitable
placements
Northampton
Billing Road
Northampton
NN1 5DG
Birmingham
70 Dogpool Lane
Stirchley
Birmingham
B30 2XR
Essex
Pound Lane
North Benfleet
Essex
SS12 9JP
Nottinghamshire
Sherwood Avenue
Sherwood Oaks Business Park
Mansfield
NG18 4GW
T: 01604 616000
T: 0121 432 2100
T: 01268 723800
T: 01623 665280
Registered charity number: 1104951