Quality Account
2010/11
“I would like to extend my appreciation to all staff within Torbay Care
Trust for all their hard work during the past year. Our integrated health
and social care teams, public health services and community hospitals
are able to provide high quality effective care that is recognised as such
by the people of Torbay we serve.
In 2010-11 we have managed to deliver our services within financial
balance demonstrating that our services are effective, efficient and of a
high quality.
Improving quality is the primary focus for the organisation which has
seen an increasing number of quality and safety improvement initiatives
driven by our frontline staff who are directly involved with service users.
Torbay Care Trust aims to embed a culture where we always strive to
improve quality of care and outcomes for the people who use our
services. We will do this by listening to our staff and to those who use
our services to measure our progress.
Anthony Farnsworth
Chief Executive
1
Contents
Part 1: Executive Summary ............................................................................................................................. 4
What is a Quality Account? ................................................................................................................................ 4
Part 2: 2010-11 Commissioning Intentions and Priorities ................................................................................ 7
Our Mission and Objectives ................................................................................................................................ 7
2011-12 Priorities (Regulation 7) ..................................................................................................................... 10
Part 3: Priority Areas Addressed in 2010-11 ................................................................................................ 20
1.
Priority: Keeping our patients safe from infections associated with health care .................................... 21
2.
Priority: Privacy and Dignity- Eliminating Mixed Sex Accommodation (EMSA) ...................................... 23
3.
Priority: Keeping our patients safe from the risk of blood clots............................................................... 24
4.
Priority: Reducing the incidence of pressure ulcers ................................................................................. 26
5.
Priority: Keeping patients safe from the risk and harm associated with falls. ........................................ 27
6.
Priority: Safe management of medicines ................................................................................................. 29
7.
Priority: Safeguarding Children ............................................................................................................... 31
8.
Priority: Safeguarding Adults ................................................................................................................... 33
9.
Priority: Support the health of carers to enable them to care for their loved one when they die .......... 35
10.
Priority: Early Supported Discharge for stroke patients ...................................................................... 37
11.
Priority: Helping people towards a healthier lifestyle ......................................................................... 39
12.
Priority: Supporting recovery from drug and alcohol dependence ...................................................... 42
13.
Priority: Enabling independence re-ablement pilot ............................................................................. 45
14.
Priority: Quality Payments for Care Homes ......................................................................................... 47
15.
Priority: Productive Community Services ............................................................................................. 49
16.
Implementation of National Institute for Health and Clinical Excellence guidance (NICE) ................. 49
17.
Participation in clinical audits ............................................................................................................. 50
18.
Central Alerts System (CAS) and Medical Device Alerts (MDAs) ......................................................... 52
19.
Commissioning for Quality and Innovation (CQUIN) Arrangements for 2011/12 ............................... 53
Patient, Family & Carer Experience ............................................................................................................... 55
20.
Comments and Complaints ................................................................................................................. 55
21.
Public Engagement and Feedback – Domiciliary Care ........................................................................ 56
22.
Patient Feedback Questionnaires – Community Matrons ................................................................... 57
23.
Experts by Experience .......................................................................................................................... 58
24.
Caring for our Staff .............................................................................................................................. 59
25.
Statement provided from Commissioner ............................................................................................ 60
2
26.
Statement provided from LINKs ......................................................................................................... 63
27.
Statement provided from Overview & Scrutiny Committee ............................................................... 64
Appendix 1 – Domiciliary Care Observation Feedback .................................................................................... 1
3
Part 1: Executive Summary
Part 1A
What is a Quality Account?
From April 2011, the Trust is required to produce a Quality Account. This
important document sets out how we continue to improve the quality of
the services we provide.
Quality Accounts are about opening up a dialogue about quality with
service users, the public and others who have a stake in our work. They
cover three key areas:
Patient safety
The effectiveness of our care
Patient experience
Within these areas, Quality Accounts aim to cover the things that matter
most to people who use our services, the public and as part of this
process, make working in the NHS rewarding for staff too.
Part 1B
Torbay and Southern Devon Care Trust is committed to providing
services that provide the best outcomes for our service users. We are
pleased to provide you with this - our first quality account. It will look
back on 2010/11 providing information regarding quality of our services,
explaining both what we did well and where improvement is needed.
Crucially this document looks forward, in part 2, explaining what we
have identified as priorities for improvement over the coming financial
year and how we will achieve and measure these. In part 2 we include
statements relating to quality of NHS services provided (in regulations).
These statements are common to all providers which makes the account
comparable with other organisations and provides assurance that the
Board has reviewed and engaged in cross-cutting initiatives which link
strongly to quality improvement.
The aim of this report is to provide assurances to you, the public, that we
are continually working to improve services.
4
Our achievement as an organisation is dependent upon the
professionalism and commitment of our workforce who strive to provide
high quality, effective care, whilst keeping people safe from harm. We
aim to work with people who use our services to deliver care that is
personalised and addresses their needs. We have listened to our
service users and the public and acted upon feedback received to
improve the quality of care.
We also feel that it is important to be open with people who use our
services when safety incidents occur or services do not meet their
expectations. We strive to learn from these occurrences to prevent
incidents reoccurring and to continuously improve the quality of the care
provided.
In part 3 of this report you will read about the work being undertaken in
this area. You will see a number of examples of where we have
engaged with people who use our services, their families and carers, the
public and our staff to improve quality.
Part 1C
Board statement
Quality is at the very heart of all that we do in Torbay & Southern Devon
Care Trust (TCT). Every member of staff we employ and every General
Practitioner shares in this agenda. Doing the right thing, at the right time,
in the right place for our patients has achieved a health system in
Torbay that is nationally and internationally recognised. This has been
achieved by close integrated working with our patients, GP Practices,
Torbay Council, South Devon Healthcare Foundation Trust (SDHCFT),
South West Ambulance Service, Devon Doctors (the out of hours
service), independent care providers and voluntary sector.
Quality is underpinned by robust governance both in our commissioning
arms (now the GP run Baywide Consortium) and in our provider arm,
which has recently expanded to include Southern and Western Devon.
We have stringent governance committees and procedures to ensure
the TCT Board has evidence of the highest quality of service.
Safeguarding of both adults and children is given the highest priority.
5
The Social Service arm of the TCT is overseen by the Health Overview
and Scrutiny Board of Torbay Council. TCT monitors performance with
SDHCFT by monthly performance reports which are presented at our
senior management team, the Board and in individual Clinician to
Clinician groups.
We have forged links with patient groups and now have representatives
in every general practice within Torbay. We are committed to listening to
what our patients want from their NHS. We are also committed to
empowering patients to take control of their health, giving them the
knowledge to manage their illnesses with our help. We are working
closely with our public health team to ensure that our public understands
how preventing ill health and promoting healthy lifestyles will improve
the overall health of our population and allow us to target our resources
where they are most needed.
We have achieved tight financial control and have delivered our high
quality service whilst remaining within budget for both health and social
care.
We are proud of what has been achieved both internally within Torbay&
Southern Devon Care Trust but also in our wider community by working
collaboratively with our partner organisations and the public we serve.
I confirm that to the best of my knowledge the information contained
within this Quality Account is accurate.
Signed:
Mr Anthony Farnsworth
Chief Executive
Torbay Care Trust
April 2011
6
Part 2: 2010-11 Commissioning Intentions and Priorities
Our Mission and Objectives
In this report we mainly focus upon the services Torbay Care Trust staff
provided in 2010-11. This includes some examples of joint working with
other organisations which has had a positive impact on the services
offered.
Alongside our commissioning colleagues we have set ourselves 10
promises for the next five years. These are our promises to the people
of Torbay:
i)
We will deliver services and target money to reduce health
inequalities
Why? The quality of health is often better for those who have more
money available to them. We believe it is unacceptable for people‟s
health to be compromised by the area in which they are born or by
their social status.
ii)
We will deliver services and target funding to increase life
expectancy
Why? Nationally and locally, life expectancy has been rising
steadily. However, we are still behind the European best, so there is
more we can do to improve the health and wellbeing of our
population so they live longer lives.
iii)
We will provide you with firm foundations for enjoying good
health
Why? Giving our children and young people the best start in life is
essential if they are to go on to become well-rounded, strong and
healthy individuals in their adult lives. It is more important than ever
to deliver services that keep our young people safe and offer them
opportunities to avoid taking risks with their health.
7
iv)
We will deliver services that promote on-going wellbeing
Why? The number of people living in Torbay who are aged over 75
years is expected to increase by around 26,000 by 2024. The
choices made about lifestyle as we grow older have a real impact
upon health, including our chances of getting a long-term disease.
We want to make sure that every person in Torbay has the same
opportunities to live a long and healthy life. This means improving
awareness of conditions and of the support available, and enabling
those who are already living with a long-term condition, such as
diabetes or asthma, to have more control over the way they manage
their illness.
v)
We will remove unnecessary delays for services and treatment
Why? Working with NHS partner organisations we have already
reduced waiting times significantly for patients in Torbay. Our
ultimate goal is to remove completely all unnecessary waiting for
services, thereby improving the experience for every patient.
vi)
You will always have the right to choose
Why? Every patient and service user is different, and local services
need to be varied and flexible enough to respond to the needs of the
individual. We want to improve access and choice from birth to the
end of life.
We want expectant mothers to have more choice about where they
have their babies, and where and how they can access specialist
services.
We want to work more closely with patients and their families when
they are nearing the end of their lives to ensure their wishes and
choices are respected wherever possible.
8
vii)
We will deliver high-quality and safe services
Why? We believe local people have the right to enjoy safe and highquality NHS services. We want to further reduce the numbers of
infections that people contract within a healthcare setting and ensure
the services provided by the NHS in Torbay are based on the best
available evidence, nationally and internationally.
viii)
We will improve care and services for older people
Why? We want to enable as many people as possible to live in their
own homes while still enjoying full and active social lives. This also
means ensuring that we develop services that can provide goodquality care for older people including those living with dementia.
ix)
We will deliver a wide range of care services
Why? We know that one size does not fit all and that local NHS
services need to be flexible enough to meet individual needs. We
want to make sure local people are able to access a range of
services, in a range of different settings and at different times of the
day, providing help and support how, where and when it is needed.
x)
We will improve services for people who need mental health
and learning disability services
Why? Our minds, like our bodies, need looking after.
At any one time, nearly a sixth of adults will experience depression
or anxiety. We want to make it easier to access services such as
counselling and support, advice and care for those with eating
disorders, and carers‟ services.
The number of people with a learning disability increases by one per
cent every year, so it is vitally important that there are excellent local
services to enable people to live long, healthy and independent lives.
9
2011-12 Priorities(Regulation 7)
Our priorities for improvement in 2011-12 are identified below. There
are three fundamental themes underlying all of these areas:
1.
Ensuring the dignity and respect of the service user – making
certain we learn from local patient stories and those highlighted in
other areas of the country in the “Care and Compassion”
Ombudsman‟s Report (2010).
2.
Safeguarding the vulnerable – in particular, working with our
partner agencies to develop the skills of all of our staff in
recognising safeguarding actively work with them to improve care
throughout the organisation.
3.
Recognising the impact of dementia– we will plan and redesign
our services based around not only the needs associated with a
physical illness but also dementia due to the impact of increased
prevalence of dementia. To assist us in this we will implement the
South West Dementia standards across all of our Community
Hospitals.
From this basis we will ensure:
Patient Safety
a) Wecontinue to improve patient safety working with others to
develop the South West Safety Improvement Programme. This
will focus upon:
1. Improving the recognition and treatment of the deteriorating patient
2. Reducing the number of healthcare acquired pressure ulcers
3. Reducing the number of patients who fall whilst in our care
4. Reducing the incidence of healthcare acquired infections, including
catheter acquired urinary tract infections
5. Reducing the incidence
thromboembolism
of
patients
6. Improving the safety surrounding
especially on discharge from hospital
developing
medicines
venous
management,
10
Clinical Effectiveness
b) Torbay and Southern Devon Care Trust are committed to a
programme of clinical effectiveness which:
1. Measures improvement and regularly audits services to identify
areas for improvement
2. Undertakes local and national care audits which will allow us to
share good practice and also to learn from others
3. Implements and informs recognised best practice which will
improve outcomes for people who use our services e.g. those
contained within NICE guidance and National Quality Standards
Creating cross organisational networks that support innovation and
improvement and above all improves the quality of care offered
and celebrates our success.
Patient Experience
We will engage with service users and public to gain feedback.
c) All patients, carers and users in contact with our services are:
1. Treated with dignity and respect
2. Able to access personalised services which meet the needs of
each individual
3. Assured that we learn from incidents and this learning is shared
with others
4. Able to contribute to the development of services that meet the
needs of the local population
As an organisation we are committed to continually improve
patient experience therefore we will also explore ways of
improving how we gain feedback from service users, carers and
the public.
11
Torbay Care Trust is developing capacity and capability to monitor and
deliver these plans by having effective governance reporting
arrangements that ensures the Board and senior managers within the
organisation are aware of the quality, safety and effectiveness of our
services. This allows them to gain assurance from work being
undertaken and then identify areas for strategic improvement. One
essential element of this is the feedback that we receive from the public
and those who have used our services. Examples of this are highlighted
in Section 4 of this report. It is essential that we are able to provide a
service that people recognise as high quality, effective and responsive to
their individual needs. Our aim is to ensure people who use our
services and their carers and families are confident that the care they
receive is safe and effective.
To monitor standards and implement improvement we have a number of
working groups and committees that are responsible for implementing
and monitoring innovation and improvement in quality, safety,
effectiveness, sharing best practice and learning from incidents or near
misses.
All clinicaland care governance is monitored through the monthly Clinical
Quality and Safety Committee which reports to the Integrated
Governance Committee and Trust Board.
The following information complies with Regulation 4 or the National
Health Service (Quality Accounts) Regulations 2010:
1.
During April 2010 and March 2011 the Torbay Care Trust provided
and/or sub-contracted 7 NHS services. (As defined under CQC
registration)
1.1
The Torbay Care Trust has reviewed all the data available to them
on the quality of care in 7 of these NHS services.
1.2
The income generated by the NHS services reviewed in 2010-11
represents 100% percent of the total income generated from the
provision of NHS services by the Torbay Care Trust for 2010-11.
2.
During 2010-11, 2 national clinical audits and 0 national
confidential enquiries covered NHS services that Torbay Care
Trust provides.
12
2.1
During that period Torbay Care Trust participated in 100% of
national clinical audits and there were no national clinical enquiries
which it was eligible to participate in.
2.2
The national clinical audits (NCAs) and national confidential
enquiries that Torbay Care Trust was eligible to participate in
during 2010-11 are as follows:
(As listed by the Department of Health NCAs for inclusion in Quality
Accounts 2011)
Falls and non-hip fractures (National Falls & Bone Health Audit)
2.3
The national clinical audits (NCAs) and national confidential
enquiries that Torbay Care Trust participated in during 2010-11
were as follows:
Falls and non-hip fractures (National Falls & Bone Health Audit)
2.4
The national clinical audits and national confidential enquiries that
Torbay Care Trust participated in, and for which data was
collected 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.
National falls and bone health in older people 2010
Each „site‟ (i.e. an individual healthcare trust or community/acute service
provider) was asked to aim to collect information on a minimum of 20
patients with a hip fracture and 40 patients with a non-hip fragility
fracture. Torbay Care Trust worked with South Devon Healthcare
Foundation Trust in the completion of this audit 100% of the number of
registered cases required by the audit.
2.5
The reports of 1 national clinical audit were reviewed by the
provider in 2010-11 and the Torbay care Trust intends to take the
following actions to improve quality of healthcare provided:
13
The report for Torbay Hospital indicated the rate of patients discharged
from hospital having received a falls assessment was only 7% and so a
standard falls assessment is being devised, and is planned to be piloted
by Torbay Hospital to improve timely and effective communication with
GPs about the assessments and interventions being carried out whilst
their patients are in hospital. This will be rolled out across the hospital
once it is proven to be effective and linked to the community hospitals
and community.
Investment was made to employ 2 Fracture Liaison Nurses to identify,
diagnose, advise GPs on treatment and improve compliance for those
on bone protecting agents. They will also improve reporting of falls and
refer people on for falls assessments. See Priority 5 in part 3 of this
report for more information.
The reports of 14 local clinical audits were reviewed by the provider in
2010-11 and Torbay Care Trust intends to take the following actions to
improve the quality of healthcare provided:
NBThis list includes 2 national audits not contained within the
Department of Health list for inclusion in Quality accounts:
National Audits not contained within the Department of Health
prescribed list of national audits for 2010-11
Actions
Audit
Continence Care
CQC Stroke Pathway
Review
Awaiting results at time of writing this Quality Account
1. Providing Early Supported Discharge Extra support to
help people return home as soon as possible
2. Helping people participate in community life Helping
people take part in family life and leisure activities.
3. Reviewing progress after people have left hospital
Checking how people are doing months / years after
stroke
4. Providing a range of information to people who have
had a stroke
5. Helping people choose the services they want Including
access to advice, training and personalised support
Local Audits
Audit
Privacy and Dignity
(including Delivering Same
Sex Accommodation)
Interruptions at Meal Times
Action
Individual concerns raised were managed by the Hospital
Matron
No actions – fully compliant
14
VTE Risk Assessment within
24 Hours of admission
Cleanliness in Community
Hospitals
Patient and Visitor Comment
Cards/Feedback
Patient Identification
Baypen Nutrition Screening
Week
Nutrition and Dietetics
„MUST‟ score
Missed doses (medication)
Cold Storage of medicines
Care and Clinical
Supervision
Record Keeping (paper)
audit – for all services using
paper records
Electronic Record Keeping –
excluding safeguarding
adults for all services using
electronic patient records
Record Keeping (electronic)
audit for safeguarding adult
records.
Education and awareness raising continued with improved
recording template introduced
Continue to monitor and improve standards
Findings are shared with teams and clinical leaders with local
actions undertaken where indicated
Fully compliant
A Programme of education and training for staff in NHS and
independent sector
Training for staff as above
Education and training for staff as part of their regular training
to ensure that missed doses are recorded appropriately.
Review of standing operating procedure and training for staff
as part of regular updates
Introduction of revised policy and training for staff
Training and updates for staff as part of regular training
programme
Training and updates for staff as part of regular training
programme.
Training and education for staff and revision of supervision
policy to include review of records as part of regular
supervision sessions.
Education and awareness raising of guidance for record
keeping in safeguarding adult meetings.
Training in risk assessment.
3. Research
The number of patients receiving NHS services provided or subcontracted by Torbay Care Trust in 2010-11 that were recruited during
that period to participate in research approved by a research ethics
committee was 0.
15
4.Commissioning for Quality and Innovation Payment
A proportion of Torbay Care Trust income in 2010-11 was conditional on
achieving quality improvement and innovation goals agreed between
Torbay Care Trust and any person or body they entered into a contract,
agreement or arrangement with for the provision of NHS services,
through the Commissioning for Quality and Innovation payment
framework.
A further detail of the national guidance on the framework of CQUIN
goals is available at:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH_091443
5. Care Quality Commission Registration
Torbay Care Trust is required to register and its current registration
status is registered, and therefore licensed to carry out across 7
locations:
Diagnostic and screening procedures
Personal care
Treatment of disease, disorder or injury
5.1 (i) There are no conditions on registration
5.1 (c) The Care Quality Commission has not taken enforcement action
against Torbay Care Trust from 01April 2010 to 31st March 2011.
7.1. Torbay Care Trust has participated in special reviews or
investigations by the Care Quality Commission relating to the following
areas during the reporting period 2010-11:
Review of services for people who have had a stroke and their
carers.
Review of „meeting the healthcare needs of people in care homes‟.
Review of „social services' response to people's first contact with
them.
A part of a joint CQC/Ofsted inspection undertaken in Torbay,
CQC reviewed safeguarding and looked after children with the
Care Trust. The Trust was rated as adequate.
16
The Trust took part in a Temazepam-Controlled Drugs
Surveillance in June 2010 where no further action was required.
Torbay Care Trust has taken the following action to address the
conclusions or requirements reported by the CQC:
CQC/Ofsted inspection undertaken in Torbay, reviewed
safeguarding and looked after children with the Care Trust.
Improve the quality of health assessments for all looked after
children and young people
Improve the timeliness of health assessments for all looked after
children and young people
TCT to ensure formalised arrangements are in place and
implemented for monitoring the quality of health care provided to
looked after children placed out of borough
Improve the capacity of the LAC designated doctor and nurse
roles to enable them to fully meet the health needs of looked after
children and young people and ensure that they report regularly on
progress and outcomes
Ensure that the findings from case file audits across agencies are
regularly collated and are included in performance management
reports to senior managers within the council, elected members
and the Torbay safeguarding Children Board and that immediate
action is taken to resolve and identified practice issues and/or the
underlying reasons for these
Ensure representation from health and education in the Missing
Children‟s Forum and establish clear link, accountability and
reporting mechanisms to senior managers and boards
Ensure that the take up of safeguarding training across all
agencies is carefully monitored and reported on, that gaps are
identified and addressed and that training needs analyses are
completed to inform training plans
Ensure that actions arising from serious case reviews are
implemented within the identified timescales
Implement effective transition arrangements to adult health
services for young people with long term physical conditions
moving towards adulthood
Health partners to ensure that out of hours emergency access to
service provision enabling children in need of forensic medical
examination provision is met appropriately
17
Health partners to ensure that out of hours emergency access to
service provision enabling children in need of forensic medical
examination provision is met appropriately
TCT, SDHFT and DPT to develop and embed performance
management and evaluation systems at strategic and operational
levels to ensure consistent performance monitoring of service
delivery and outcomes for children and young people in order to
identify areas for improvement
TCT to ensure that the performance of looked after children‟s
health is part of its integrated governance system with monitored
outcomes to ensure the effectiveness of the service of health and
well-being of children and young people
TCT to develop its involvement in the Corporate Parenting Board
to make it an effective partner in the multi-agency partnership,
driving the corporate parenting agenda
TCT to ensure independent contractors are offered and undertake
accessible training
TCT provider services to work with partner agencies to develop
robust communication systems to ensure the inclusion and
involvement of GP‟s in communication regarding the needs of
children who required safeguarding
Health partners to develop and embed processes to ensure the
views of children and young people are captured and used to
inform and influence service provision
Health partners to ensure the increased provision and uptake of
equality and diversity training to enable staff to fully understand
and meet the needs of children and young people and their carers
To ensure CAMHS thresholds and service provisions are clear and
accessible to all professionals to enable the needs of young
people to be met in an appropriate and timely manner
Torbay Care Trust has made the following progress by 31st March 2011
in taking such action as monitored and reviewed by the Strategic Health
Authority (SHA) and reported to the Safeguarding Improvement Board.
The individual actions were initially scrutinised within the organisation
with oversight by the SHA. The actions above have been further
subdivided into more specific actions. To date 26 actions are now green
(both from provider and commissioned services); 32 actions are
amber/green as either awaiting scrutiny or requiring further evidence
that embedded into practice; 7 actions are amber as the evidence has
not yet been collected to ensure action complete and 10 are red as the
action has not yet been completed.
18
There has been a delay in taking some of the actions forward due to a
diversion of resources to a significant investigation, additional resource
has now been put in place to address this.
Review of services for people who have had a stroke and their
carers.
Providing Early Supported Discharge Extra support to help people
return home as soon as possible
Helping people participate in community life, helping people take
part in family life and leisure activities.
Reviewing progress after people have left hospital. Checking how
people are doing months/years after stroke
Providing a range of information to people who have had a stroke
Helping people choose the services they want Including access to
advice, training and personalised support
Torbay Care Trust has made the following progress by 31st March 2011
in taking such action:
Additional funding has been allocated to develop an Early Supported
Discharge Service. Long term funding for this will be realised by
reduction in the length of hospital stay for patients, as the service will be
able to support more patient in the community.
8. Torbay Care Trust did not submit records during 2010-11 to the
Secondary Uses Service for inclusion in the Hospital Episode Statistics
which are included in the latest published data.
9. Torbay care Trust Information Governance Assessment Report
overall score for 2010-11 was graded unsatisfactory.
10. Torbay care Trust was not subject to the payment by results clinical
coding audit during 2010-11 by the audit commission.
11. Torbay Care Trust will be following the following actions to improve
data quality:
Roll out mandatory update training to achieve 95% of staff trained
by March 2012;
Develop and implement a rolling corporate records audit to support
the management of information on shared IT systems;
To work with other NHS organisations to ensure corporate records
are retained by the appropriate organisation for the appropriate
period of time during this transition period;
19
To set up a working group with other organisations to review
information sharing protocols in light of recent and on-going
changes to the NHS that affect the way information is used and
shared;
Identify areas that continue to use paper records and ensure that
they have appropriate local procedures in place for tracking,
reporting missing files
Set up and carry out regular audits to gain an understanding of
information governance knowledge of staff and groups and
support the development of action plans to improve information
governance in these areas;
Develop an easy read Fair Processing Notice and publish widely;
Develop a care record keeping training programme for all staff
Part 3: Priority Areas Addressed in 2010-11
Key quality work completed in 2010/2011 in Torbay Care Trust
In this part of our report we aim to demonstrate some of the areas of
work we have engaged in to achieve our organisational objectives,
providing accounts from selected service areas that we think you would
want to know about.
We have also summarised key areas that we will focus on next year to
ensure continuous quality improvement.
Each priority has been reported to identify what it is and why it is a
priority. After providing a brief description of the work undertaken in
2010/11 it will explain the improvement planned next year and how we
will monitor this.
Due to a delay in the directive to provide a quality report for 2010/2011
we were unable to undergo a full consultation of the content and
priorities contained within this report. We do however plan to do this for
2011/2012.
20
1. Priority:Keeping our patients safe from infections associated
with health care
What is the issue?
A health care associated infection (HCAI) is an infection acquired whilst
receiving health care which was not present or incubating when the
patient began their pathway of care.
All cases of Clostridium Difficile and Methicillin Resistant
Staphylococcus Aureus (MRSA blood borne infections are formally
reviewed by the specialist infection control teams.
Why is it a priority?
Both MRSA and Clostridium difficile can cause serious illness.
Evidence shows that reducing the number of healthcare associated
infections is one of the most important factors that patients consider
prior to coming into hospital.
Good hygiene is essential in helping to prevent the spread of infections,
thorough hand-washing and drying between caring for people is
imperative in helping to reduce cross-infection. The standards of
cleaning by hotel services are also a vital part of our plan to keep
infections to a minimum.
We want to do the best we can to keep our patients safe from infection
whilst in our care.
How did we do in 2010/11?
We have worked hard to ensure that our patients are protected from
developing infections whilst in our care. Our current MRSA bloodstream
infections and Clostridium Difficile rates are well below the national
average. We saw a 50% reduction in the number of Clostridium Difficile
cases in 2009-10.
We recognised in 2010/11 that there was still room for improvement,
and we have introduced a number of initiatives to achieve this, including:
4. A renewed focus on further improving hand hygiene – ensuring staff
wash their hands before and after having physical contact with each
patient. Our compliance with best practice is currently an average of
90% across all our hospitals.
5. Routinely screening all patients that come into our community
hospitals for MRSA and treating those identified.
21
6. Improving the appropriate use of antibiotics to reduce the risk of C.
Difficile infections.
7. Learn from all cases where patients do acquire an infection by
understanding the root cause and changing practice accordingly
8. Ensuring our hospitals and other premises are clean and provide an
environment in which we can deliver high-quality, safe care.
9. Improving our buildings to ensure that they maximise clinical
efficiency and help us deliver high-quality healthcare services.
Monthly audits of hospital cleanliness are undertaken and any identified
actions or poor performance areas are addressed by the hospital
Matrons. The audits are monitored through regular infection control
committee meetings.
The annual Patient Environment Action Team assessments look at
environment, food, and privacy and dignity for each of our hospitals. The
PEAT ratings continue to score excellent in all areas in Paignton and
Brixham hospitals.
What will we work on in 2011/12?
10. Continue to improve hand washing compliance acrossTorbay and
Southern Devon Care Trust
11. Continue education and audit of our compliance with MRSA
screening
12. Continue to deliver infection control training for staff, as part of their
mandatory training requirement.
13. Continue monitoring and reduce cases of incidents of hospital
acquired infection outbreaks in line with the Department of Health
requirements
14. Continue to deliver education and support for the efficient
management of viral gastroenteritis (Norovirus)
Monitoring our progress
To ensure that we achieve this priority we will undertake regular audits
and report our progress through the Infection Control Committee, Care
Quality and Safety Committee and Integrated Governance Committee.
22
2. Priority: Privacy and Dignity- Eliminating Mixed Sex
Accommodation (EMSA)
What is the Issue?
There are no exemptions from the need to provide high standards of
privacy and dignity. This applies to all areas, including when admission
is unplanned.
High standards include that men and women do not have to sleep in the
same room, nor use mixed bathing and WC facilities. These
presumptions are intended to protect patients from unwanted exposure,
including casual overlooking and overhearing. Patients should also not
have to pass through opposite sex areas to reach their own facilities.
Why is it a priority?
This supports the NHS commitment to providing every patient with
same-sex accommodation, helping to safeguard their privacy and dignity
when they are often at their most vulnerable. This means providing a
same-sex sleeping area, bathroom and toilet facilities.
How did we do it in 2010/11?
Within both our community hospital sites estates work has taken place
to ensure the requirements set by the Department of Health to EMSA
are successfully achieved.
Although our hospital wards are mixed sex the design of the wards
allows segregation of sexes to ensure privacy & dignity is maintained for
our patients.
A monthly audit is undertaken to identify if any breeches have taken
place we are pleased to report no breaches occurred in 2010/11. On the
first of April 2011 we published our statement of compliance with the
national standards on our Internet website.
A patient questionnaire is also completed to understand if patients in our
care feel their privacy and dignity requirements have been met during
their hospital stay. Paignton Community Hospital results showed that
96% of patients and Brixham Community Hospital reported that 98% of
patients said that they had not had to share accommodation with the
opposite sex when first admitted.
Although we know that none of our patients shared sleeping
accommadation these results indicate that further work needs to be
undertaken in order to ensure that patient perception reflects this.
23
Patients are also asked if they felt they had been treated with respect
during their hospital stay. Of the 248 surveyed one patient reported “No”,
in these such cases where care was not of an acceptable standard the
matron works with the patient and team to ensure appropriate standards
of privacy and dignity are delivered.
Results below show the outcomes from the questionnaires relating to
the patients overall experience of their hospital stay.
Response Unanswered 1
2
3
4
Basic
Number
of
Patients
2
0
5
Excellent
2
16
58
170
Total number
of responses
248
What will we work on in 2011/12?
We will continue to listen and gain feedback from our patients. We are
mindful of the negative findings in the Ombudsman‟s report Care and
Compassion although the findings in this report related to care received
elsewhere in the country and we will strive to ensure we learn from it to
further improve the patient‟s experience here.
Monitoring our progress
We will provide monthly reports to our commissioners on our
performance in this area based on feedback from those who use our
services.
We will report any breeches in delivering same sex accommodation
monthly to the Trust Board and Commissioners of our services.
3. Priority: Keeping our patients safe from the risk of blood clots
What is the issue?
A blood clot, also known as a deep vein thrombosis (DVT) or venous
thromboembolism (VTE), forms within a vein deep in the body. Most
occur in the lower leg or thigh, but they can occur elsewhere. The clot
blocks the normal flow of blood through the veins either partially or
completely, causing swelling and tenderness. If a clot breaks off it
travels to the lung and causes a pulmonary embolism.
24
Why is it a priority?
A blood clot is a potentially-serious condition. Although not all clots can
be prevented, the risk of developing a VTE can be significantly reduced
if we assess each patient for the likely risk of one occurring and then
prescribe preventive treatment.
How did we do it in 2010/11?
Torbay Care Trust has developed practice to ensure that VTE
assessment and appropriate prophylaxis for all patients admitted to our
community hospitalsmeets the National Institute of Clinical Excellence
Guidance (CG92 Reducing the risk of venous thromboembolism in
patients admitted to hospital January 2010)
This work has included the development of a “Drug Prescription &
Administration Record Chart”.
Included within this record are all the essential clinical elements to
support VTE assessment and ensures that preventative measures have
been successfully achieved.
Both community hospital sites have been collecting data for VTE on all
admissions since June 2010.The intention is to continue to ensure best
practice is embedded and improve on these results during 2011/12.
What will we work on in 2011/2012?
Continue to audit the prescription and medication record for
appropriate VTE risk assessment and Prophylaxis that monitors
practice against the NICE recommendations to further improve
quality
Undertake additional education and development work to improve
compliance
Monitoring our progress
To ensure that we achieve this priority we will monitor and report our
progress through the Safety Group and the Care Quality and Safety
Committee. Alongside auditing all admissions to our community
hospitals we will undertake a more in depth audit to ensure if other
parameters stated in the NICE guidance are also being achieved.
25
4. Priority: Reducing the incidence of pressure ulcers
What is the issue?
Pressure damage can be avoided in many patients if early detection of
risk, and best practice care planning strategies to prevent, is
implemented by clinicians. This work was identified as one of the high
impact actions for nurses and midwives (DH 2009)
Why is it a priority?
The cost to the NHS in treating pressure ulcers (about £2 billion a year)
is secondary to the personal cost to the patient in loss of dignity, quality
of life, pain, delayed discharge and possible infection.
How did we do in 2010/11?
Torbay Care Trust is an active participant in the Community Quality
Patient Safety Improvement Programme facilitated by the Strategic
Health Authority. One of the key work streams from the Improvement
Programme focuses around the reduction in the numbers of pressure
ulcers developed in a healthcare setting.
Torbay Care Trust has worked collaboratively with local healthcare
providers including South Devon Health Care Foundation Trust and
more recently with two local Residential / Nursing Homes with the aim of
reducing the number of hospital and community acquired pressure
ulcers.
The primary focus of the improvement work undertaken has been the
„Keep Moving‟ element of the “SKIN bundle” – this includes repositioning
of patients, regular assessment of the risk of developing pressure
damage to the skin, encouraging mobility and providing written advice
for patients and carers.
What will we work on in 2011/12?
We intend to spread the good practice from the pilot sites in achieving
the skin bundle to all community hospitals and community nursing teams
in Torbay and Southern Devon Care Trust
26
We will develop education packages and written advice sheets on
prevention of pressure ulcers and the use of the skin bundle to all
agencies and carers of patients in the community.
Monitoring our progress
We will continue to use risk assessment tools (Waterlow), pressure ulcer
grading and care planning to ensure data is captured effectively. All
grade 3 and 4 pressures ulcers are reviewed using Root Cause
Analysis, resultant action plans are reported to the Safety Group with the
intention of sharing the lessons learnt and to identify common themes to
improve practice across all service areas.
We will monitor and report our progress through the Safety Group, which
reports into the Care Quality and Safety Committee.
5. Priority: Keeping patients safe from the risk and harm
associatedwith falls.
What is the issue?
With the ageing population nationally, falls prevention remains a major
issue. Falls lead to increased dependency, morbidity and mortality,
causing reduced confidence, in some cases before a fall has occurred.
Why is it a priority?
In many patients suffering a hip fracture there is often a history of
increasing loss of mobility, falls and fragility fractures. Earlier evidence
based interventions could help to improve mobility, (in particular strength
and balance) improve confidence, prevent falls, reduce injury from falls
and prevent fractures.
How did we do in 2010/11?
Investment was made to employ 2 Fracture Liaison Nurses to identify,
diagnose, advise GPs on treatment and improve compliance for those
on bone protecting agents. They will also improve reporting of falls and
refer people on for falls assessments.
27
We currently receive reports of around third of those people who fall
expected statistically and work continues within community teams to
carry out assessments for those who fall and improving reporting of falls
in the community.
The Trust remains committed to an annual public event supported by
Age UK to promote older people‟s awareness of falls prevention with a
very successful day with over 280 people attending in 2010 and a similar
event is planned in 2011.
For the first time the Trust took part in the National Falls, Fracture and
bone health Royal College of Physician audit jointly with SDHFT, the
results of which are awaited.
In collaboration with the private sector, the Trust is able to offer postural
stability courses for patients to maintain their exercise plan once they
have completed their rehabilitation and community classes. These
exercise programmes continue to be well received and can demonstrate
improvements in patients‟ strength, balance and confidence.
Paignton hospital has been involved with the South West improvement
programme to reduce injury following patient falls. Following a number
of small scale changes there has been a steady reduction in the
numbers of patients who fall during 2010.
Four elements of a six part advanced falls training programme for staff
were initiated in 2010-11 and build on the regular falls awareness
training that has been run throughout the year for staff across the
country hospitals and independent sectors attending.
What will we work on in 2011/12?
The SW improvement programme continues and we look to maintain the
improvement in falls reduction we have made across Torbay and
Southern Devon Care Trust.
Bed and chair exit sensors have been purchased for use in community
hospitals in Torbay and this should impact on both the numbers of falls
and the severity of injury from falls.
More postural stability classes will be available through the “Invest to
Save” monies for greater numbers of less active older people to improve
their mobility, specifically their strength and balance.
28
Work will continue in the development of a revised multi-factorial falls
assessment form to improve information for GPs about the assessments
and interventions being carried out with patients and staff in the
community.
The first National Hip Fracture Database report for Torbay hospital
indicated the rate of patients discharged from hospital having received a
falls assessment was only 7% and so a standard falls assessment is
being devised and is planned to be piloted by Torbay Hospital to
improve timely and effective communication with GPs about the
assessments and interventions being carried out whilst their patients are
in hospital. This will be rolled out across the hospital once it is proven to
be effective and linked to the community hospitals and community.
There will be another public event aimed to promote healthy ageing in
the older population and falls prevention.
The final two elements of the advanced falls training will be delivered
with the complete programme available to staff during the year.
Monitoring our progress
The Trust will continue to improve the reporting of falls and to
demonstrate how many people are receiving falls assessments.
The Fracture Liaison service will be evaluated as it develops with
numbers of patients receiving treatment for bone health, compliance, as
well as numbers of fractures being monitored.
The National Falls Fracture and Bone Health audit results will be key in
shaping any further work over 2011-12 and will be a baseline to monitor
our progress in this area.
6. Priority: Safe management of medicines
What is the issue?
The national agenda for Safer Medicines Management has increased
significantly. The local Medicines Management Team (MMT) has
continued to build relationships with GPs and staff within the community
teamstoprovide a proactive service that ensures high quality, evidencebased and cost- effective prescribing.
29
It is reported nationally that up to 10% of emergency admissions to
hospital are medication related. Our goal is to raise awareness and
embed medicines management in all areas of every day practice to
reduce this.
Why is it a priority?
To improve patient care and safety regardless of setting
To improve communication regarding medicine management
within all settings
Public Health demographics show that Torbay has a higher than
average elderly population. Medication reviews need to be an
integral part of all care pathways for the elderly.
We need to have safe robust processes for any effective
delegation of medication management to non registered staff.
We need to ensure cost effective quality prescribing
How did we do in 2010-11?
Practical advice on legal, ethical and clinical medicines management
issues have been provided to community nurses, physiotherapists,
occupational therapists and social workers.
The MMT has supported the public health team with a number of public
health initiatives. A high risk area in this department is the Drug, Alcohol
and Sexual Health Team (DASHt) where the requirement for medicines
governance is high.
The MMT has worked with all providers to facilitate change to improve
the safety use of medicines, providing training and education for all staff.
We have also worked to ensure compliance with and implementation of
the Health Act 2006 with regards to controlled drugs (CDs)
What we will work on in 2011-12?
Build a firm infrastructure with the merger of Southern Devon and
Torbay Care Trust to deliver an effective MMT service
Provide strong governance support to implement best practice
identified by national guidelines (e.g.National Patient Safety Alerts)
30
Continue to deliver training and education to staff to ensure best
practice in medicines management, controlled drugs.
Continue to raise awareness of the safe use of medicines within
the organisation and to the wider population
Build on the work carried out in 10/11
Monitoring our progress
Reports will be received by the Care Quality and Safety
Committee, Controlled Drugs Management Group,Safety
Group,Medicines Governance Committee.
Progress will be monitored at quality review meetings with the
commissioner.
7. Priority: Safeguarding Children
What is the issue?
Child protection numbers and the numbers of Looked After Children
continue to rise.
Why is it a priority?
In September 2010 there was a joint inspection of Safeguarding
Children and Looked After Children services with Ofsted and Care
Quality Commission. From this inspection a comprehensive action plan
was developed that is currently being monitored by the Strategic Health
Authority and Torbay‟s Safeguarding Improvement Board. In 18 months
there have been 3 Serious Case Reviews and the learning from these
will be embedded into practice. In February 2011 an investigation into
sexual exploitation in Torbay was launched. This complex situation has
meant that additional resources have needed to be committed
31
How did we do in 2010/11?
In 2010-2011a large amount of work was placed on formulating the
Inspection action plan and ensuring that work was progressing on these
actions. The complex investigation into sexual exploitation has meant
that the Trust has been working as part of an integrated team with the
police, Torbay Council children‟s services, education and voluntary
organisations. Alongside this has been the planning to launch a MultiAgency Safeguarding Hub (MASH). This hub will provide a coordinated
response to safeguarding alerts raised by agencies and the public.
Agencies involved in this development include Torbay Care Trust,
Torbay Council and the police.
What we will work on in 2011-12
In April 2011 the Multi-Agency Safeguarding Hub (MASH)
becomesoperational,a very welcomed development for Torbay.
Due to the amount of work that is on-going within Children‟s
Safeguarding, it has been agreed to provide additional resources to
concentrate on Safeguarding Children improvement work and to ensure
that there are processes in place to embed the learning from the
inspection, Serious Case Reviews, the sexual exploitation investigation
and development of the Multi Agency Safeguarding Hub (MASH).
We will further the collaborative approach to safeguarding children with
partner agencies within the Multi Agency Safeguarding Hub (MASH).
Monitoring our progress
This will be monitored by Torbay Care Trust‟s Children‟s Safeguarding
Executive and Torbay Safeguarding Children‟s Board.
32
8. Priority: Safeguarding Adults
What is the issue?
The Trust is the lead agency for Safeguarding Adults in Torbay which
advocates that all persons have the right to live their lives free from
violence and abuse. The Trust works to the No-secrets guidance (DH
2000) to support any adult at risk of abuse or neglect to enable them to
live a life free of violence and abuse.
"Abuse is a violation of an individual‟s human and civil rights by any
other person or persons." „No Secrets‟ (DH 2000)
Why is it a priority?
As public awareness grows the demand for this service is increasing
with the expectation that the quality and outcomes are effective for those
that use them, the Trust is committed to achieving this for the people of
Torbay.
It is a priority due to several factors:
The need to expedite safeguarding adults cases in timescales that
comply with best practice guidelines.
The need to ensure that outcomes for our service users are the
best that can be achieved.
The need to increase resources to clear any backlog in
Safeguarding meetings and ensure that capacity and demand is in
balance for the future.
To improve the awareness, understanding, quality and cultural
approach to Safeguarding Adults work.
To ensure that a sustainable position is maintained, that our
commissioners and those who use our services will be satisfied
with.
In response to clear direction from both Chief Executive Officers of
Torbay Care Trust and Torbay Council.
33
How did we do in 2010-11?
The Trust commissioned an independent report into the effectiveness of
the Safeguarding Adults Service in Oct. 2009, this made a number of
recommendations which were included within our improvement
programme for 2010. A Single Point of Contact for all safeguarding adult
alerts was developed. Four sub-groups were developed to support the
work of the Torbay Safeguarding Adults Board and a review of policies
and procedures undertaken to align them to the redesigned service.
Whilst these significant improvements delivered key benefits, highlighted
in a re-audit undertaken in October 2010, there was still an issue –
unreported at the time – of capacity to undertake Case Conferences,
withon-going issues regarding practice, recording and reporting (via the
Trust IT system)with new key performance indicators being developed
reported in a Safeguarding Adults Dashboard, it was obvious that more
capacity was required.
A Safeguarding Improvement Programme was embarked upon, with
specific attention paid to the issues outlined above. Subsequent
feedback from Kate Ogilvie has indicated that our progress is very good
and on track. Regular review and reporting from the safeguarding team
and project manager has provided assurance with regards to progress
and reduction of the backlog, allied to a significant improvement in
performance.
What we will work on in 2011-12?
Continuation of the action plan objectives, clearance of the backlog of
case conferences by the end of June 2011, continued training and
development of staff, review of policies standard operation procedures
and improved reporting functions are all key outcomes for 2011-12
Monitoring our progress
Regular progress reports are presented to Torbay Safeguarding Adults
Board (TSAB); Torbay Council Chief Officers Group (COG); Torbay
Council Health Overview and Scrutiny Committee; Torbay Care Trust
Board, Integrated Governance Committee and Audit and Assurance
Committee.
34
The development of a performance dashboard will allow scrutiny of key
targets that will indicate improvement.
Regular audits to measure improvement.
9. Priority: Support the health of carers to enable them to care for
their loved one when they die
What is the issue?
Nationally between 56% and 74% of people expressed a preference to
die at home, but only 35% of people actually achieved this (Audit
Commission 2009).
Locally, only 22% of patients within the South Devon Health Community
die at home. (Specified Place of Care StudyRowcroft Hospice, 2010).
The aim of the End of Life Care (EOLC) Strategy (2008) is to enable the
people to live as well as they are able until they die; to die in the place of
their choice: and for themselves and their families to receive high quality
co-ordinated care and support.
The SPOC study highlights the inability of carers to cope with the role
they find themselves in to be an influencing factor in patients not
achieving their wish to die at home.
The study identified reasons for carers becoming overwhelmed as:
Facing complex situations or symptoms
Feelings of anxiety and insecurity, fearing the unknown
Facing unpredictable and distressing symptoms
Having poor understanding or loss of confidence in the care
system
Knowing where to get help when they need it
Receiving poor or conflicting information
Effective symptom control, good general health of the primary carer, and
support, were seen as major influences in achieving a home death.
35
Why is it a priority?
The Trust wishes to support people to die in the place of their choice
and for themselves and their families to receive high quality co-ordinated
care and support.
Approximately 1400 expected deaths take place in Torbay Care Trust
each year. As this number grows, it is vital that we have services to
support carers in maintaining their physical and mental health to enable
them to continue in their caring role at home.
How did we do in 2010/2011
To address the needs of the carers, and to enable them to care for their
terminally ill loved one within the home environment, if that is their wish,
a 4 week structured training programme provided by Torbay Care Trust
was commenced. This is in partnership with Rowcroft Hospice entitled
“Caring for Someone with a Life Limiting Illness” and provides education,
information, support, and reassurance. It is delivered bi-monthly on a
rolling programme.
Between September 2009 and January 2011, 8 courses took place. 59
carers were enrolled, with 40 completing the course.
All participants indicated the course had met their needs and increased
their confidence. 100% of the participants indicated they would
recommend the programme to others.
Examples from some programme evaluations:
“I was somewhat sceptical about what I would gain from this
course at this point in my caring role but was pleasantly surprised
to find it very helpful at so many levels. I just wish I had the chance
to attend 6 months ago, as I am sure it would have made life a
great deal easier for our family‟‟.
„‟I found it very helpful, made me make time for myself even if only
a little, even wearing perfume again. Was able to go in the
direction I needed to and I would recommend it definitely. I found it
has been a good release.‟‟
„‟It has been very helpful to be able to talk. I how feel much more at
ease. It was very helpful to talk to people with the same problems.
36
Helpful and very good to have questions and answers to things
that needed to be discussed‟‟
Apart from the good practical information, it helped me realise that
there may not be a single answer, my efforts may not be perfect,
but it is the best I can do, and that is all that can be asked of me.
What we will work on in 2011/2012
It is planned for the sessions to continueonce funding has been secured.
Following completion of the programme the carers reported feelings of
isolation and expressed a need for ongoing support therefore a bimonthly 2 hour drop in session commenced in December 2010. 9 carers
attended with 7 attending the February session. One carer had not been
out of the house on her own since attending the November session. She
recognised meeting with other carers was very helpful.
Monitoring our progress
Reports will be received by the Care Quality and Safety Committee,
Southern Devon Clinical Commissioning Group and the Trust Board.
Audit and evaluation will be undertaken to monitor the effectiveness of
the service by receiving feedback from those that have participated and
patients achieving their preferred place of care at the end of life.
10.
Priority: Early Supported Discharge for stroke patients
What is the issue?
Developing an early supported discharge service for stroke patients in
Torbay and Southern Devon that enables patients to leave hospital
earlier.
Why is it a priority?
37
Research has shown that Early Supported Discharge (ESD) enabled 30
to 40% stroke patients to be discharged from hospital earlier and receive
specialist services in their own home. The Stroke Strategy (2007) found
that discharge to a comprehensive stroke specialist and multidisciplinary
team in the community can reduce long term mortality and
institutionalisation for up to 50% of patients.
The evidence base for early supported discharge includes:
Cochrane Systematic review on Early Supported discharge in
2005
National stroke strategy 2007
NICE standard 10 (2010) recommends that “All patients
discharged from hospital who have residual stroke related
problems are followed up within 72 hours by specialist stroke
rehabilitation services”
How did we do in 2010/11?
We merged Torbay Care Trust Acquired Brain Injury and Stroke
Occupational Therapy Teams. This made a larger team of staff
with similar and transferable skills giving greater flexibility of
response. This involved co-locating Torbay Community Stroke
Occupational Therapists, management/leadership and
administrative support at Paignton Hospital.
We were also able to support joint Physiotherapists and Assistant
Practitioner, together with working between Devon Provider
Service staff, South Devon Healthcare staff and Torbay Care Trust
provider and commissioners to develop a service specification for
Community Stroke and Early Supported Discharge in South
Devon.
Funding has been identified to develop the service. This initial
funding will reduce over several years and the service will
thereafter be funded from saving the cost of inpatient care
including secondary care (acute) and community services
(inpatient rehabilitation) through reduced lengths of stay.
What we will work on in 2011 -12
38
Finalise staffing for new Early Supported Discharge service in
Torbay. Advertise and recruit to additional posts.
Determine level of service which can be provided within the initial
funding levels and aspire to 7 days per week service.
The implementation date for Torbay Early Supported Discharge
service is likely to be June/July 2011.
Enable systems to support staff so that referrals and discharge
summaries can be provided from the acute ward to the community
teams electronically to reduce any treatment delays.
Rationalise supervision arrangements for staff so they are
employed and managed within local teams (zones or clusters).
Consider the possibility of expanding a specialist stroke and Early
Supported Discharge service to other parts of the care trust i.e.
South Hams and Tavistock.
Monitoring our progress
Analysis of statistics to identify numbers of patients seen, to obtain
patient feedback outcomes and efficiency savings.
Develop an electronic system of recording activity so savings can
be identified and evidenced to the commissioners. If possible this
will link to the PARIS system.
Monitor complaints and compliments and develop a means of
customer satisfaction survey.
11.
Priority: Helping people towards a healthier lifestyle
What is the issue?
The Public Health White paper “Healthy Lives Healthy People” set out
the vision for delivery of Public health included in this is the Public
Health Outcomes framework
Why is it a priority?
39
Health improvement – helping people towards a healthier lifestyle by
making healthy choices and reduce health inequalities is one of the five
domains in this Public Health Outcome framework.
Examples of this include:
Supporting and encouraging the adoption of a healthy, nutritious
diet will support the prevention of long term health conditions e.g.
diabetes reducing the likelihood of premature health conditions
e.g. CHD, stroke, and cancer.
Encouraging people to be more active by undertaking regular
exercise either through local programmes such as bay walks, fit
bay GP referral, running, swimming etc.
Reducing levels of overweight or obesity in our local community
and deliver education programmes to support self-management
e.g. diabetes education programme.
Smoking Prevalence
Smoking is the biggest single cause of premature death & preventable
illness in the UK. 1 in 2 smokers will die prematurely with average lifeloss of 12 years. Overall the estimated burden in the UK of tobacco use
is estimated to be £13.74 billion per year. Locally the prevalence of
smoking is 18.3% in 2009/10 (source integrated household survey) with
a national average of 21 % (General Household survey 2009 / 2010).
However, prevalence in routine and manual workers is likely to be higher
and figures for smoking during pregnancy have been consistently higher
than both regional and National levels.
How did we do in 2010-11?
The final 4 week quit target of 873 will not be signed off until after
the quarter 4 submission date on the 17th June but currently well
on track to exceed this target.
Smoking during pregnancy target (local Indicator) is set at 20%
and we currently have achieved 19.8%.
Progress with referrals from midwives for women smoking during
pregnancy was implemented.
A voucher incentive scheme and drop in for pregnant smokers.
Some development of stop smoking service within secondary care
40
We have delivered assist Peer led prevention of smoking
programme in first school.
Deliver a range of training e.g. Mental Health first aid, cook4life
Torbay (train the trainer cooking skills), RSPH Level 2
Understanding health improvement.
The on-going delivery of type 2 diabetes education programme,
with some improvements.
We have supported the pilot of the NHS health checks in GP
practices.
We have introduced combined weight management and physical
activity programme.
Continued to deliver cardiac rehabilitation programmes and
postural stability (falls prevention).
Training for pharmacy staff in health promotion champion
programme
What we will work on in 2011-12?
Delivering the 4 week quit target (vital signs) for year. This will be
supporting at least 1031 individuals to stop smoking sustained for
at least 4 weeks.
To continue to reduce numbers of women smoking during
pregnancy.
To routine monitor of all pregnant women for elevated Carbon
Monoxide levels at their 12 week scan. (Carbon Monoxide is the
poisonous & harmful gas found in smoke)
To develop referral pathway and stop smoking service in
secondary care
In collaboration with Devon Health continue to provide support for
obesity management programmes.
To continue the integrated delivery of Public health service from
high street shop
To broaden volunteering opportunities to support the work of the
lifestyle services
To develop obesity services for children / young people (&
families)
41
Improve data collection for all lifestyle services including level 2,
stop smoking and health trainer service, to enable effective
performance management.
Monitoring our progress
All Public health activity will be commissioned under a contract and
performance / quality managed with the public health commissioners.
12. Priority: Supporting recovery from drug and alcohol
dependence
What are the issues?
The government launched its new drug strategy, 'Reducing demand,
restricting supply, building recovery: supporting people to live a drugfree life' in December 2010. This publication indicated a major change to
government policy. The 2010 strategy sets out a fundamentally different
approach to supporting recovery from drug and alcohol dependence.
The strategy has recovery at its heart and it puts more responsibility on
individuals to seek help and overcome dependency. It places an
emphasis on providing a more holistic approach to treatment offering
support to people dependent on drugs or alcohol such as employment
and housing. Alcohol related harm continues to be a major public health
problem. During 2010-2011 NICE issued 3 sets of guidance related to
addressing drug and alcohol-related problems (PH24, CG100 and
CG115).
42
Why is it a priority?
Torbay has the second highest rates for alcohol related hospital
admissions in the South West (NI39). Considerable work has been
undertaken over the past three years in relation to improving the access
and availability of alcohol treatment to support the reduction of
admissions. This work needs to continue in order to support a continued
reduction in the admission rate to hospital for alcohol related harm as
well as that associated with drug and alcohol misuse such as poor
health, poverty, crime and family breakdown. The new drug strategy
means that we need to adopt a change of approach in how we work with
drug and alcohol service users not only within treatment providers but
also with partner agencies and the wider community. Ensuring those
experiencing harm associated with their drug or alcohol use can access
support, advice and treatment promptly is key in supporting them in their
journey of recovery.
How did we do in 2010-2011?
The targets for waiting times (all service users to be seen within 3
weeks) were met by both the drug and alcohol team.
All service users had care plans and general healthcare assessments.
There was a significant increase in numbers being screened and
vaccinated for Blood borne Viruses as highlighted below.
Percentage of new presentations YTD offered (or assessed as not requiring) HBV vaccinations
89%
Percentage of new presentations YTD who accepted offer commencing HBV vaccinations
73%
Percentage of new presentations YTD (current or ever injectors) offered (or assessed as not requiring) a hepatitis C test
100%
Percentage of individuals in treatment previously or currently injecting who have received a HCV test
90%
Outcomes for those completing a primary care alcohol intervention were
good with reductions in drinking days, drinking amounts, GP visits and
hospital admissions.
43
Current initiatives:
We have established the „Walnut Lodge Care Forum‟ – which is a
joint group of service users, ex-service users and staff and is used
to communicate opportunities for involvement with services,
provide a forum for consultation on the development of services, to
provide an equal voice for staff and people who use services, to
provide an opportunity for generating new ideas about service
provision
We have commenced a three tier training programme for frontline
staff with Level 1 focusing on basic drug & alcohol awareness,
Level 2 on Screening and providing brief advice for drug & alcohol
problems and Level 3 on training supervisors of staff who have
contact with people who use drugs or alcohol
We have engaged in a review of the alcohol treatment system to
look at new ways of working to improve efficiency and service user
outcomes.
We have worked with ex-service users to help them set up their
own mutual aid recovery group – SMART which complements
local existing mutual aid groups such as Alcoholics Anonymous
and Narcotics Anonymous
We have established referral pathways between treatment
services and Job Centre Plus to support those in treatment and
those trying to access employment in accessing the support they
need to help them achieve their goals
We have completed the pilot of the alcohol targeted case worker,
demonstrating a reduction in hospital admissions (including
attendance at A&E and ambulance call outs) for those provided
with an outreach style intervention over an extended period of
time. (A reduction in cost terms of £42,793 in 2008-2009 to
£11,657 in 2009-2010 for the groups receiving an intervention).
We have recruited an additional hospital alcohol worker to focus
on the development of screening and brief interventions with A&E
at Torbay Hospital
What will we work on in 2011-12?
We will continue with the roll out of the training programme to front
line staff
44
We will implement an alcohol service redesign plan with other local
service providers
We will work closely with service users and ex-service users on
the development of recovery services provided and led by service
users themselves to support the recovery agenda
Focus of the hospital alcohol team to develop pathways and
policies to support the implementation of screening and brief
advice programmes within A&E and the wider hospital.
Developing a new group work programme to support the recovery
agenda focusing on „Recovery Capital‟, which is a model that helps
an individual look at all of the resources available to them in
assisting with their recovery from addiction (i.e. medical
interventions, psycho-social interventions family, friends,
employment, activity, life skills, volunteering, education) and
increasing individual responsibility for developing personal
recovery plans.
Implementing a newevidence based practice intervention
programme for non-prescribed drug users.
Maintaining progress achieved in relation to Blood Borne Virus
testing and immunisation.
Monitoring our progress
To ensure that we achieve our priorities, we will monitor and report on
our progress through the Drug & Alcohol Treatment Development subgroup and the Public Health Provider Team. It will also form part of our
quarterly quality and performance review meetings with the Torbay
Drug, Alcohol and Sexual Health Team which commissions these
services for our local population.
13.
Priority: Enabling independence re-ablement pilot
What is the issue?
With such a significant proportion of both health service and social care
funding spent on the over 65 population, we are acutely aware of the
need to work differently if we are to continue providing high quality
services within the funding constraints expected during the forthcoming
years.
45
Why is it a priority?
Our health community is therefore keen to adopt a system wide
approach to promoting and prolonging independence for our elderly
population which changes the focus of care from support and
rehabilitation to one of prevention and re-ablement. In doing so, we
acknowledge care home and domiciliary care providers have a key
contribution to make and so strengthening relationships with them is
vital.
How did we do in 2010/11?
During 2010/11 we commenced a re-ablement pilot. Our Intermediate
Care Lead produced and delivered (with the help of other lead
professionals) a bespoke training package for falls re-ablement
techniques. Staff from 2 care homes and 2 domiciliary care agencies
took part in the training and we are now in the process of identifying
suitable patients/clients who are willing to participate.
The pilot covers patients who have fallen or are at risk of falling and who
will benefit from up to 12 weeks of dedicated re-ablement support. It
aims to increase their mobility and confidence. Whilst they will be
initially assessed and work with a member of Torbay‟s Intermediate
Care Team, given time, joint working will commence between this team
and the care home/domiciliary care agency of staff trained as part of the
pilot. Doing so will allow more frequent patient contact and ensure
repetition of desired exercises.
What will we work on in 2011/12?
More intensive re-ablement is seen as a way of prolonging
independence and reducing the reliance on long-term care. Whilst
SWICs (Support Workers in Intermediate Care) are already trained and
employed by the Trust, we want to work closely with care home and
domiciliary care providers in an attempt to:
Change the ethos of contracted care provision to secure a reablement focussed service rather than one which creates client
dependency.
To better meet the needs of patients once their regular care has
transferred from TCT and Southern Devon staff.
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Provide care in an appropriate setting that delays the need for
permanent admission to residential or nursing homes.
Secure closer working arrangements between TCT front-line staff
and domiciliary care staff and which will seem less delay of care.
Secure financial savings for our social care budget which can be
re-deployed to meet the increasing number of elderly residents
requiring help and support.
In conjunction with the personalisation agenda, enable this to
become one strand in our market development strategy.
Monitoring our progress
During 11/12 a full evaluation of the pilot will be undertaken which
includes quantitative and qualitative aspects for patients and the staff
involved (both Care Trust and our 3rd sector organisation partners).
Other areas that could benefit from joint working shall also be identified
thereby ensuring the pilot is mainstreamed, as appropriate.
14.
Priority: Quality Payments for Care Homes
What is the issue?
As the Care Quality Commission is undergoing a substantial
reorganisation and changing their inspection regime. It is essential to
keep care homes focussed on quality provision. Additionally, the impact
of homes on the acute sector is often underestimated and the previously
highly successful joint working of the hospital and homes on infection
control is reflected in the results for MRSA and CDiff within the
community.
Avoiding admissions and supporting early discharge is a significant
opportunity with the homes. To this end, engaging them in being part of
the health system and having that recognised was the foundation to
introducing CQUIN (commissioning for quality and innovation).
The system worked by awarding homes with additional funding in return
for improved quality outcomes ensured that their viability was increased,
their quality was improved and the system overall benefited from cost
avoidance through achieving the key driver - the improved health and
wellbeing of residents
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Why is it a priority?
The demands on the care homes sector are high and costs are
increasing. It would be challenging to obtain engagement and require
substantial extra PCT resource to implement further inspection or quality
demands in isolation and likely to achieve a lesser result. The homes
are a key resource in improved care of the elderly.
How did we do in 2010/11?
We received excellent engagement across the Trust with colleagues
designing,
interacting,
supporting
homes
and
evaluating
results. Feedback from the homes has been highly positive and CQUIN
payments are now able to be made. The quality of submissions has
been impressive and where gaps have been identified the opportunity
has been taken to
a) discuss with the homes and establish further evidence
b) address the gap with an agreed action plan
Homes have seen this as a really positive step which creates firm
foundations for further initiatives and quality care improvements in the
future.
What will we work on in 2011/12?
We will be working with the Care Homes forum to review the
scheme. We will investigate different options such as continuing to offer
a further individual CQUIN or, as suggested by some homes
themselves, pool the CQUIN for the development of a bay-wide training
resource for nursing and intermediate care.
Monitoring our progress
The homes have been invited to submit their CQUIN at the earliest
opportunity and many have come in during the course of the year. The
CQUIN has provided a focus for on-going dialogue and training which
has been appreciated on all sides.
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15.
Priority: Productive Community Services
In October 2010 Torbay Care Trust launched the “Institute For
Innovation and Improvement Productive Community Services –
Releasing Time to Care “ series. This is a modular programme that is
currently being undertaken by the community nursing teams in all the
zones to consider how we can increase the amount of patient facing
time. A present the teams are working through the first module “Well
Organised Working Environment” which aims to identify the waste within
the system and improve systems and processes that support nursing
teams.
Since the launch the teams have reorganised their store cupboards to
ensure ease of access of stock and consumables, to review the stock
control methods that improve cost efficiencies.
Time has also been saved by purchasing supplies which contain all the
essential items to undertake a procedure reducing time and improving
efficiency.
Further work continues to improve efficiencies in how we manage the
supply of some specialist equipment to nursing teams.
16. Implementation of National Institute for Health and Clinical
Excellence guidance (NICE)
On publication, all NICE documentation is available on the Trust‟s
intranet site for staff access. A summary document is produced which
includes a synopsis of the guidance including any cost implications.
This document is reported at the Care Quality & Safety Committee for
review and relevance to the organisation and nomination of a clinical or
specialist lead to drive the implementation forward. The committee is
then responsible for the on-going monitoring of work undertaken. In
cases where NICE guidance crosses multiple organisations,
implementation occurs via Clinical Commissioning Groups as part of the
care pathway redesign process.
From the period 1st April 2010 to 31st March 2011 a total of 123 NICE
publications were reviewed:
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24 Clinical Guidelines
34 Technology Appraisals
50 Interventional Procedures
11 Public Health Guidelines
1 Cancer Service Guidelines
3 Medical Technologies
17.
Participation in clinical audits
The Trust is committed to a programme of audit in order to ensure that it
is able to monitor services and measure performance accurately in order
to focus core training, to improve the quality and to provide a foundation
for a programme of monitoring and improvement.
In addition to these national audits Paignton and Brixham Community
Hospitals received a top rating of excellent in the Patient Environmental
Action Team audits (PEAT) assessment for the second year in a row.
The community hospitals are two of only 40 sites out of the 1,242 sites
that were assessed nationally to score excellent in all three of the main
standards: environment, food and privacy and dignity. The assessment
includes team of nurses, matrons, doctors, catering staff, domestic
service managers, and patients. It aims to review key areas from a
patient perspective and awards a score of excellent, good, acceptable,
poor or unacceptable across a range of patient services within the three
main categories.
The process for the selection of audit criteria and the registration of
audits across the Care Trust demonstrates that a systematic approach
to audit topic selection, taking into account organisational priorities and
new government initiatives together with local needs. The Trust‟s audit
plan is determined and monitored by the Care Quality & Safety Group,
this is also the forum for the review and evaluation of action plans.
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Audit results are key drivers for the changing of practice and confirming
adherence to national guidelines and best practice. The results of audits
from the monthly Eliminating Mixed Sex Accommodation audit, which is
undertaken by the Community Hospitals, is essential to ensure that
comments received from patients, service users and their families and
carers are taken into consideration in the service delivery and planning
processes.
The development and introduction of a new electronic record keeping
audit tool in late 2010 has provided Torbay Care Trust with the
opportunity to audit the care records of patients and service users that
are held electronically and ensure that high standards of record keeping
are adhered to in electronic format as well as in paper care records. The
results of this audit are currently being analysed and the audit has been
undertaken across the Care Trust.
Peer review audits have been used by clinical teams, followed by direct
feedback to the teams with the aim to inform and improve practice. This
is a powerful tool, and has been used to improve quality and patient
safety at individual service level.
Clinical Audit in 2011-12
The development of a clinical audit plan for 2011-12 is underway, this
will aim at ensuring that regular audits are undertaken in community
settings as well as within speciality services. It will be essential to
implement a uniform approach to audit that extends across the whole
organisation, work has commenced to unify these audit arrangements.
The use of data gathering electronically via the Torbay Care Trust
intranet site, iCare, has assisted with the ability of community services to
supply audit data and for the timeliness of data collection and analysis to
be improved. The aim is for this to be extended to streamline the audit
data flow processes.
Action plans created throughout the 2010-11 period will be reviewed and
acted upon to improve service provision and benchmark again for the
2011-12 period. The clinical audit improvement programme is currently
being reviewed with a view to setting new priorities for the next year, and
will include the following core areas, with additional service specific
audits to be agreed:
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Record keeping, as this is a fundamental element of the
Information Governance Toolkit and is essential to ensure the
safety and security of patient/service user information.
Monitoring of levels of healthcare acquired infections and the best
practice guidance relating to the reduction of these risks.
Ensuring that the environment for providing healthcare is suitable,
clean and well maintained.
Reviewing of services, increasing feedback and the involvement of
patients‟ and service users views.
Auditing against service specific guidance, for example, the
completion of Venous Thromboembolism risk assessments within
24 hours of admission.
Nutrition needs are being addressed across the health community
Audit relating to new and existing NICE guidance
18. Central Alerts System (CAS) and Medical Device Alerts
(MDAs)
The Central Alerts System (CAS) was designed to rapidly disseminate
important safety and device alerts to nominated leads in NHS Trusts in a
consistent and streamlined way for onward transmission to those who
need to take action.
Alerts originate from the following organisations:
Medicines and Healthcare products Regulatory Agency (MHRA)
National Patient Safety Agency (NPSA)
Department of Health Estates and Facilities Division (DHEF)
Department of Health (DH)
Local Alerts
Any alert requiring a detailed action plan, such as NPSA alerts will have
an identified lead to progress work; these alerts usually have an
extended timescale.
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The commissioning team have been responsible for the dissemination of
alerts during 2010/11 but as of 1 April 2011 this will now be carried out
by the Professional Practice Team with the addition of the nine extra
hospitals following our amalgamation with South Devon.
The process is monitored by a monthly report being provided to the
Safety Group, where decisions are made on, if the alert is relevant and
also whether the alert can be formally closed. This procedure ensures
we have a robust system for providing assurance.
During the period 1 April 2010 and the 31 March 2011, there were 191
alerts of which the following information is provided:
191 alerts = 100% - were acknowledged within two days
191 alerts = 100% - had action underway within prescribed time
scales
19. Commissioning for Quality and Innovation (CQUIN)
Arrangements for 2011/12
The following CQUIN schemes have been agreed for 2011/12 with our
commissioners, some of the key areas include:
a) VTE Prevention - Reduce avoidable death, disability and
chronic ill health from Venous-thromboembolism (VTE)
Indicator - VTE risk assessment on admission
Indicator - VTE prophylaxis
b) Patient Experience - Improve responsiveness to personal
needs of patients
Indicator - Care and compassion of older people
Indicator - Composite indicator on responsiveness to
personal needs
Indicator - Development of PROMs for ESD and falls service
c) Support Planning Summaries - Improve the timeliness and
quality care planning summaries
Indicator - Timeliness of support plans
Indicator – Quality of support plans (including outcomes)
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d) End of Life care - Improve the management of patients on the
end of life rapid discharge pathway
Indicator – reducing care home admissions
Indicator - End of life discharge pathway (links with SDHFT)
e) Intentional Rounding - Improve the management of high risk
patients with a focus on those at risk of falling, pressure sores
and malnutrition
Indicator – Management of pressure sores
Indicator – Reducing falls
f) Learning Disability - Improve the quality of care for people with
a learning disability and their carers
g) Dementia - Improve the quality of care for people with dementia
and their carers
h) Management of Complex Patients - Improve the quality of
community based care for people with complex needs
Indicator - Implement predictive modelling of complex pts
Indicator - Greater integration across community teams
i) Productive Community Services - Implementation of the PCS
initiative
Continue implementation of the first four modules for the DN
service
Roll out PCS initiative to two other services – completing
modules 1 & 2 by March ‘12
Many of the schemes rely on collaborative working with other
organisations – in particular South Devon NHS Foundation Trust. They
represent “stretch targets” for the specific areas of care we aspire to
achieve.
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Patient, Family & Carer Experience
This section includes how we ensure patients, their families and carers
have the best possible experience when using our services. It explains
how we:
Address, manage and learn from comments and complaints
Engage the public and seek their feedback along with the
outcomes from two recent engagement exercises
20.
Comments and Complaints
What is the issue?
To ensure that people who use our services and those acting on their
behalf can be confident that their comments and complaints are listened
to and dealt with effectively, that they will not be discriminated against
for making a complaint, and that lessons will be learned and
improvements made as a result of the feedback given.
Why is it a priority?
We constantly strive to improve our services; feedback from service
users and their friends/families is extremely valuable in identifying areas
requiring improvement and also areas where we are doing well so that
we can share best practice. This issue is also a priority in order to
comply with Regulation 19, Outcome 17 of the CQC Essential
Standards.
How did we do in 2010-11?
In June 2010 we merged the Patient Advice and Liaison Service (PALS)
and Complaints Team into one service and looked at all new complaints
to see where it was appropriate for an informal PALS approach to be
taken rather than a formal investigation. This has given quicker results
and greater customer satisfaction, and the number of formal complaints
as a percentage of total contacts received has fallen from 25% in 09/10
to 18% in 10/11. The service has handled792 contacts of which 146
were formal complaints during 2010-11.
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What we will work on in 2011-12?
Look at the Learning and Outcomes process and ensure that this
feeds into the whole organisation.
Review our leaflets to improve access to the service and look at
other ways to improve access to service.
Review our complaints handling questionnaires to get further
feedback about how people feel about the new PALS approach of
handling complaints and concerns is working.
Training for investigators to improve quality of investigations and
responses.
Monitoring our progress
Regular reporting to Care Quality and Safety Committee and Integrated
Governance Committee.
21.
Public Engagement and Feedback – Domiciliary Care
What is the Issue?
To understand from a customer‟s perspective the quality of domiciliary
care services commissioned by Torbay Care Trust. We will explore
alternative methods of accessing information about complaints and
incidents to provide the organisation with a holistic reflection of service
quality.
Why is it a priority?
Gives clients an opportunity to comment on the quality and their
experience of services outside of our normal formal processes and
assists the organisation‟s understanding for future discussions and
negotiations with potential providers. It will inform our commissioning
procedures – tenders and contractual arrangements. Ensure services
are designed to meet client‟s needs, are person centred, holistic and fit
for purpose.
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How did we do it in 2010/11?
We began the process with discovery interviews with clients receiving
commissioned domiciliary care. Overarching messages from these will
form a basis in future negotiations, see Appendix 1.
What will we work on in 2011/12?
Continue follow up interviews to establish any differences,
improvements or concerns. In addition, extend the work to include new
services or areas, including:
Dunboyne extra care – pre and post clients taking up residence
Personal Health Budgets - in order to establish a more pro-active
approach in auditing and understanding quality and effectiveness
of the services provided
It will also enable us to have more informed discussions with our
partners and ensure the effectiveness of contract monitoring and quality
assurance arrangements.
Monitoring our progress
We will monitor client experience, the effectiveness of the service and
the financial impact and report the findings to the Trust Board. We also
need to design a system for collating and learning from informal
customer feedback e.g. the internet, formal and informal comments, etc.
As part of this process we will provide regular reports to the Board and
our commissioners and those we commission services from.
22.
Patient Feedback Questionnaires – Community Matrons
In February almost 240 questionnaires were circulated to the individual
patients and carers on Community Matrons‟ caseloads. 60% of patients
and 78% of carers returned their questionnaires for evaluation. The key
findings were:
35% of patients are under 75; 31% are 75 – 85; and 34% are over
85
89% of patients “definitely” feel listened to and the same
percentage have confidence and trust in their community matron
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95% felt they were treated with dignity and respect “all of the time”
61% of patients the community matron service as excellent and a
further 24% as very good
43% believe their overall quality of life is “a lot better” since starting
to receive care from a community matron and a further 24% say it
is “a little better”
The responses received from carers replicate the above findings
A full report will be submitted to Commissioners in May 2011 and a
similar survey is underway for patients in contact with our Specialist
Nurses.
23.
Experts by Experience
The Experts by Experience group are a reference group made up of
citizens from across Torbay. This is in line with the Care Quality
Commission recommendation to engage with service users, providing a
regular and systematic approach to listening and acting on the views of
people who use services. The group meets on a monthly basis.
This group has diverse membership from people who have experienced
the Trust from many perspectives. The group consists entirely of people
across the bay that use the services of the Care Trust, excluding the
facilitator and the Non- Executive Director of the Trust who chairs the
group.
The group also act as a sub group of the Safeguarding Adults Board and
Personalisation steering group,with the members of the group
participating in the recruitment to key Trust vacancies.
The citizens in the Experts by Experience Group debate within the group
and collate views on pieces of work, passing relevant information to
other groups / organisations as necessary.The members of the group
provide peer support to each other and other groups and has been sited
as an area of good practice within the South West Region.
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24.
Caring for our Staff
The Trust participants in a national staff survey that allows us to
compare results with other NHS organisation to measure how we are
doing.
The following table shows where the Trust was in the best 20% of PCT‟s
in England for the 2010 survey. Where the scores are not percentage
based they are on a range from 1 to 5.
Key Finding
Trust
Score
PCT
Average
Staff job satisfaction
3.67
3.60
Staff motivation at work
3.95
3.82
Staff recommendation of the trust as a place to work
or receive treatment
Staff intention to leave jobs
3.72
3.47
2.39
2.71
Support from immediate managers
3.87
3.76
Percentage of staff agreeing that their role makes a
difference to patients
Percentage of staff receiving job-relevant training,
learning or development in last 12 months
Percentage of staff suffering work-related injury in
last 12 months
Perceptions of effective action from employer
towards violence and harassment
91%
88%
83%
79%
8%
10%
3.76
3.61
These results provide evidence that in general most staff are satisfied
and motivated in their work at the Trust and would recommend the Trust
as a place to work or receive treatment.
To provide a balance to this excellent feedback there are some areas
where numbers of staff who have concerns about aspects of the Trust
including:
Percentage of staff experiencing harassment, bullying or abuse
from patients, relatives or the public in last 12 months
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Percentage of staff experiencing harassment, bullying or abuse
from patients, relatives or the public in last 12 months
Impact of health and well-being on ability to perform work or daily
activities
Percentage of staff reporting errors, near misses or incidents
witnessed in the last month
The Care Trust Board has reviewed the results of the staff survey and
the Trust is committed to work over the next year to address areas
where we did not perform so well. Further analysis of the staff survey
and an action plan is being developed. These issues will be included in
our priorities for quality improvement in 2011-12.
25.
Statement provided from Commissioner
Regulation 5
Statements provided from:
CommissioningPCT:
Feedback: from initial feedback from our commissioning PCT
Torbay Care Trust has amended the content in Part 2 of the report
to included statements in accordance with The National Health
Service (Quality Accounts) Regulations (www.legislation.gov.uk).
Torbay Care Trust Commissioning Quality Team is pleased to provide a
statement for inclusion in this Quality Account. Torbay Care Trust as
commissioners has taken reasonable steps to corroborate the accuracy
of data provided within this Quality Account and considers it contains
accurate information in relation to the services provided.
Torbay Care Trust (TCT) is the lead commissioner for Torbay Care Trust
as a provider of Community Services. In the future TCT will work with
NHS Devon to jointly commission care from the new provider
organisation, Torbay and South Devon Care Trust.
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Information contained accords with data provided throughout the year in
question by internal reporting mechanisms. Due to the internal
governance arrangements within the Care Trust there have been no
formal Quality Review Meetings as monitoring of quality in the provider
arm has been effected through a clinical governance committee
reporting into an Integrated Governance Committee. However, the
Quality Team has received regular reports on incident reporting and on
complaints management and does oversee the investigation of Serious
Incidents. We have worked very closely with the Provider part of the
organisation on issues such as Dignity and Privacy (e.g. Eliminating
Mixed Sex Accommodation), Infection control in Community Hospitals
and the reporting of Healthcare Associated Infections. We recognise
and congratulate the Provider for their constant focus on improving
health care for the residents of Torbay and we are sure they will
continue this focus for the wider population of Southern Devon and
Torbay in their future provider role.
Review of 2010/11
There have been no Never Events reported and there have been very
few Serious Incidents. The Trust signed up to the National Patient
Safety Agency Framework for Serious Incidents Requiring Investigation
(SIRI‟s) and as a result are now reporting Serious Pressure Ulceration
as SIRI‟s. As this involves undertaking a full analysis of the root causes
of the incident, the commissioners are assured that learning is being
taken from all such incidents.
The renewed focus on hand hygiene in the community hospitals is
welcome as the NHS continues to work to reduce the incidence of
infection in care. There is now routine screening for MRSA for all
patients admitted to the community hospitals and this allows appropriate
treatment for those affected. It is also assuring to note the monthly
audits of hospital cleanliness and the actions that are taken to rectify any
issues.
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The Quality Team is pleased to confirm that the focus on Dignity and
Privacy has ensured that there have been no breaches of the national
standards for Eliminating Mixed Sex Accommodation in the past year,
and that the results of patient experience surveys strongly suggest that
patients feel that their privacy and dignity has been well protected whilst
they have been inpatient in the community hospitals.
The Quality Team is also aware that the Provider part of TCT is fully
engaged in the regional work to improve patient safety by a relentless
focus on reducing the incidence of pressure ulceration, reducing harm
associated with falls, protecting patients from Venous Thromboembolism and ensuring that Medicines are managed safely wherever
care is provided.
Looking Forward 2011/12
NHS Devon and TCT as commissioners will be working very closely
over the next year to monitor the new contract with the new
organisation, Torbay and Southern Devon Care Trust. The contract
contains various locally determined quality requirements and Operating
Principles and the commissioners will work closely with the providers
during 2011/12 to ensure that the quality and safety of care continues to
be the main focus for the Care Trust.
The Commissioners look forward to supporting the Care Trust in several
areas including Safeguarding Children, and End of Life Care, and fully
support the areas of focus that are described in the CQUIN initiatives
agreed for this year.
There will be a renewed commissioning emphasis on the quality of
community services and the quality team very much look forward to
being more involved in receiving assurance of the work being
undertaken within community hospitals across the Southern Devon
locality. The quality team will meet with quality leads from the Care Trust
on a very regular basis to discuss issues of quality of care and together
we will ensure that the focus on care and compassion, patient safety
and good patient experience continues over the years to come.
Gill Gant
Assistant Director of Commissioning Quality Torbay Care Trust
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26.
Statement provided from LINKs
LINKS Statement:
19th May 2011
Dear Anthony,
Thank you for your copy of the Quality Accounts for 2010- 2011. The Link would like to
praise Torbay care Trust in achieving improvements in many areas through this difficult
period.
Following consultation with Link members and other participating groups, we would like to
comment as follows:
Main Points to raise:
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The report is well presented and various issues raised within the report are explained
well.
Good index with priorities listed clearly
Report is very Health orientated rather than being equally divided between Health
and Social Care.
Concerns raised regarding the capacity within Safeguarding team to support
vulnerable people in difficult circumstances, as apparently there is a backlog in case
conferences due to lack of resources.
Link has not been involved in the development of the report and would like to
increase their involvement throughout the year through possible patient engagement.
In your executive summary you have mentioned that you have forges links with
patient group and now have representative within every practice in Torbay. Query
raised regarding individuals contact details and role within the surgeries.
No mention within the report of work to engage a wider range of views from the local
community with Torbay Link and Torbay Care Trust.
Concern raised regarding the effect the Trust change of name to „Torbay and South
Devon Care Trust‟ will have and how this change will be cascaded within the wider
community.
Hope you find the above information constructive andlook forward to working closely with
Torbay Care Trust in the coming year.
Yours sincerely
Anne Matttock
Chair of LINk Torbay
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27.
Statement provided from Overview & Scrutiny Committee
„Due to Council elections and the timing of its submission for
comment, Torbay Health Scrutiny Board has not been able to
consider Torbay Care Trust‟s Quality Account for 2010/11.
Overview and Scrutiny Committees are well placed to ensure the
local priorities and concerns of constituents are reflected in a
provider‟s Quality Account. Torbay Overview and Scrutiny would
welcome an engagement process in relation to the production of
Torbay Care Trust‟s Quality Account that includes stakeholders,
particularly in the identification of priorities for improvement. In
accordance with Department of Health guidance, Torbay Overview
and Scrutiny would welcome early discussions around the
proposed content of a Quality Account and an opportunity to
review early drafts.‟
Councillor Jeanette Richards (Torbay Health Scrutiny Board Chair)
Councillor Christine Carter (Torbay Health Scrutiny Board Vice-Chair)
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Appendix 1
Appendix 1 – Domiciliary Care Observation Feedback
Treat me as an individual
Listen to me
Be courteous
Be conscientious
Re assure me
Encourage me
You are supporting me
Support my routine
Ask me, don‟t wait to be asked
Talk to me, communicate
Don‟t expect my “main carer” to pick up behind you
Make me feel at ease
Help me feel good
Stay calm
Be considerate to me & other members of my household
Show compassion
Give me your full attention
Treat me gently, don‟t manhandle me
Adapt – some days I am more able than others
Don‟t talk down or patronise me
Attitude
Office Communication /
Administration
Let me know what is happening
Tell me when things change
Let me know if you are going to be late
Give me sufficient notice
Ensure I have most up to date information
Tell me who to expect and when
Listen to me
Ask me, include me in care arrangements
Treat me as an individual
Give me choice (age, gender etc).
Give me an opportunity to appraise/ feedback (not paperwork)
Care about the service you provide
Don‟t dismiss my worries / concerns
Don‟t make empty promises
Be polite
Help and support me to live in my community
Make a difference
Professialism
Dress appropriately (uniform)
Have the right tools (aprons and gloves)
Know your stuff
Keep me safe
Have meaningful paperwork (support plans that describe me and my needs)
Give me a dedicated regular team of carers – people I know and have a rapport with
Give me appropriately trained staff for my needs
Give me the same standard of care 7 days per week
Make sure my carers know what is required
Know my limitations
Have company standards
Arrive when I expect you
Complete the tasks
Know what to do
My care should not dictate my life, it‟s to support me
Don‟t keep varying the times
Organise the care around me and my schedule not fit me into your business schedule
Provide some consistency
Allow for travelling time
Give me the full allocated amount of time
Give me someone I can understand
Efficiency
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