Warrington Community
Services Unit
Quality Account 2010/11
Page 1
Contents
Statement of Chief Operating Officer
3
Warrington Community Services Unit Services
4
Regulatory Bodies and Management of Risk
6
Leadership and Development
8
Transforming Community Services
10
Quality Innovation Productivity Prevention (QIPP)
11
Partnership Working
13
Patient Safety
15
Effectiveness and Productivity
18
Patient Experience
23
Clinical Audit and Research
26
Performance Framework
30
Organisational Lessons Learnt
33
Quality Improvement for 2011/12
35
Comments on Our Quality Account
38
Page 2
Statement of Chief Operating Officer
I am pleased to introduce our first Quality Account. In it we have described how we monitor the
quality of the care our staff provides to the population of Warrington.
Warrington CSU places quality at the centre of everything it does. This is reflected in our vision
statement “To provide safe effective and responsive services in partnership with local people
and communities”.
As a Community Provider we successfully gained full registration with the Care Quality Commission
without any conditions being applied from 1st April 2010.
Effectiveness and productivity are crucial to us delivering safe care whilst achieving best value. In
the account, we have described two recent regional benchmarking exercises which have given us
positive feedback about the quality and cost of some of our services.
The CSU over the last year has made it a priority to ensure that the data we collect is correct and
accurately reflects the quality of the services we deliver. As such we have invested in equipment to
collect real time patient feedback. The data has demonstrated that our patients report their overall
experience of our services as improving from 87% in 2009 to 92% in March 2011. We will continue
to strive to further improve this to our stretch target of 95%.
Care has been taken to present a balanced view of both our achievements in improving the quality
of our services and the learning of lessons from adverse events when the care we provided was not
as we would have wished. Ensuring that lessons are learnt is an important part of the safety and
improvement culture we have been building.
The CSU have operated autonomously from the PCT during 2010/11 and during this time we have
prepared for the transition to a new organisation. From the 1st April 2011 we joined four other
community providers to form an aspiring Community Foundation Trust. We believe this will give us
the best opportunity to continue to transform our services to deliver higher quality care closer to
home for the people of Warrington.
Numerous members of staff have contributed to the development of this Quality Account and it is
with warm wishes that I thank all staff for their individual and collective contributions. The account
has been reviewed and the content agreed by the board.
To the best of my knowledge the information in this Quality Account is accurate and it correctly
reflects the performance of the organisation and sets out our aspirations for the care we will deliver
in the future.
Carole Hugall
Chief Operating Officer
Warrington CSU
Helen Bellairs
CEO
NHS Warrington
Page 3
Dr Kate Fallon
CEO
Ashton Leigh and Wigan
Community Healthcare NHS Trust
Warrington CSU Services
Introduction
Warrington Community Services Unit provides
a range of health services in the community –
from district nursing in people’s homes to stop
smoking advice in GP practices and speech
and language therapy for children in specialist
community clinics.
We provide healthcare services for both
adults and children. We aim to provide high
quality, safe, effective and responsive
community healthcare by working with local
people and communities.
Our services are currently organised into
five operational business units.
Business Units:
¾ Home Based Services
¾ Adult Clinic Based Services
¾ Child Development Services
¾ Child and Family Nursing and Public
¾ Healthcare Services Offender Health
Services
Home Based services include:
¾ Community Matrons
¾ IV Therapy Team
¾ Catheter Care
¾ Wheelchair Service
¾ Continence
¾ Stoma Care
¾ Palliative Care
¾ Care Home Support
¾ Access All Areas for vulnerable
adults
¾ Falls and Rehabilitation Team
¾ Intermediate Care
¾ Community Neuro and
Rehabilitation
¾ Parkinson’s Disease Nurse
¾ Acquired Brain Injury
¾ Single Point of Access
¾ Discharge Facilitation
¾ Cardiac Service
¾ Respiratory Service
Clinic Based Services
We provide services from clinics based in
Birchwood, Culcheth, Grappenhall, Orford,
Penketh, Westbrook, Woolston, Meadowside
and the town centre on Sankey Street and at
Home Based Services
the Warrington Wolves Rugby Stadium. Not
The Home Based Services deliver patient
all of the services below are delivered from all
care within the patients own home and care
of our clinic bases.
homes.
People who are house bound or who have a
Clinic Based Services include:
¾ Dermatology
¾ Dental
¾ Out of Hours Service
¾ Orthopaedic Clinical Assessment
and Treatment Service
¾ Community Surgery
¾ Podiatry
¾ Lifestyles Team
¾ Adult Speech and Language
Therapy
long term condition that means that they may
be at risk of hospital admission or high users
of healthcare services can access home
based services.
Home Based Services include;
¾ District Nursing Services
Page 4
Child Development Services
The Sexual health team provide a clinic based
service which includes provision of
Some children need to access Specialist
contraceptive advice and a targeted service
Children’s Services to ensure they reach their
for young people through the Youth Advice
full potential. Children may be seen in the
Shop.
Child Development Centre, local
clinics, schools / nurseries or at home
Child and Family Nursing & Public
Healthcare include:
¾ Children’s Long Term Conditions
¾ Health Visiting
¾ Child Protection – Safeguarding
Children
¾ School Health Advisers
¾ Sexual Health
according to what best meets the child’s
needs.
Child Development Services include:
¾ Paediatric Speech and Language
Therapy
¾ Paediatric Continence
¾ Paediatric Physiotherapy
¾ Paediatric Audiology
¾ Paediatric Occupational Therapy
¾ Specialist Learning Disability
Nursing
Offender Health Services
The aim of the Offender Health Service is to
provide a primary care health service in HMP
Risley or HMYOI Thorn Cross.
Services include GP services, a Dental clinic,
Child and Family Nursing and Public
Nurse led clinics, Mental Health services and
Healthcare Services
Sexual Health services. Dermatology,
The children’s nursing service offers clinic
Physiotherapy, Podiatry and Ophthalmology
based and home visiting services. The health
services are also available at HMP Risley.
visiting and school health teams provide
In December 2010 we were also successful in
advice, support and treatment for children and
becoming responsible for provision of dental
families. We work in partnership with
services in HMP Hindley.
children’s centres and schools. Specialist
services include nursing for children with long
term conditions and children with complex
health needs to support parents to care for
their child at home and help prevent hospital
admissions.
The safeguarding children service is a highly
specialised team, providing expert advice and
support, training and supervision.
Page 5
Offender Health Services include:
¾ Offender Health at HMP Risley and
HMYOI Thorn Cross
¾ Dental Health at HMP Hindley
Regulatory Bodies and Management of Risk
Registration with the Care Quality
Information Governance (IG) Toolkit
Commission (CQC)
Attainment Level
Warrington CSU was required to register with
The IG Toolkit is a framework for assessing
the CQC from April 2010 and its current
whether the necessary safeguards for the
registration status is full and unconditional
appropriate use of patient and personal
registration.
information are in place.
The CQC has not taken enforcement action
Warrington CSU Information Governance
against Warrington CSU during 2010 – 2011.
Assessment Report overall score for 2010 -
Warrington CSU has participated in one
2011 was 45% and was graded as Red.
special review by the CQC during 2010/11.
A robust action plan is in place to address
This was a review into Services for People
these issues and achieve level 2 compliance
who have had a Stroke and their Carers. The
by 31st March 2012.
review was conducted throughout 2010 and
The identified shortfalls relate to our corporate
focused on care from the point where people
rather than our clinical information systems.
prepared to leave hospital, to the ongoing
This means that patient identifiable data is
care and support in their homes. Health and
kept safely and confidentially by the CSU.
adult social care, as well as other relevant
services were also reviewed.
National Patient Safety Agency (NPSA)
For Warrington CSU the review highlighted
The NPSA receives monthly submissions
that the Early Supported Discharge Pathway
from all NHS organisations on patient safety
was working well although enhancing speech
incidents. We record around 8-10 patient
and language therapy and access to neuro-
safety incidents on average each month,
psychology services would further improve the
which accounts for 30% of all incidents.
service.
On the basis of incidents from across
Warrington CSU intends to take the following
England, the NPSA develop national
actions to address the conclusions or
initiatives and training programmes to reduce
requirements reported by the CQC and had
these incidents and encourage safer practice.
made the following progress by 31st March
We receive alerts which are assessed within
2011. A scoping exercise was started to
the required timescales and action plans for
understand the specific neuro-psychology
improvement put in place where they are
needs of people who have had a stroke. This
applicable to Community Healthcare. We are
will inform how we work to meet these needs
currently fully compliant with all but one alert.
in the future.
We are currently partially compliant with the
Page 6
alert that relates to the assessment of all
potential ligature points that might pose a
danger to vulnerable people.
NHS Litigation Authority (NHSLA)
The NHSLA is like an insurance scheme for
the NHS to support claims made against it for
compensation. All NHS organisations
contribute to this scheme and are
independently audited to ensure that they
have good systems in place to manage risks
and incidents. We self-assessed against the
national risk management standards, and
achieved the required level of compliance but,
as part of a PCT in 2010/11; we were not
required to have an independent assessment.
Page 7
Leadership and Development
We employ over 754 staff across a range of
our Lead Nurse and it seeks to improve
professions, who on a daily basis work to
the way in which we deliver patient care.
¾ A Continuing Professional Development
ensure that they deliver effective care and an
excellent patient experience.
Lead works closely with the Lead
As an organisation, we believe that to provide
Professionals and their managers to
high quality, safe community health care, we
ensure that the financial resources
need to ensure that our staff are trained and
allocated to Learning & Professional
supported to develop. This provides our staff
Development are utilised to their maximum
with the skills, competence and flexibility to
effect.
¾ All our healthcare professionals are
deliver the healthcare agenda.
We provide a range of training opportunities
required to undertake Clinical Supervision
which are both classroom and internet based.
which is an essential part of their on-going
The introduction of online training has freed
professional development and helps them
up more time for staff to see patients and we
to reflect on ways they can improve patient
are proud to be in the top 20 users of the e-
care.
¾ We also actively support trainee nurses
learning system.
Effective Clinical Leadership is an important
and healthcare professionals by reviewing
component in ensuring the on-going delivery
and assessing the suitability and quality of
of safe and effective care.
our educational placements. We are
The following are just a few examples of the
committed to ensuring the workforce of the
new ways in which we have achieved this:
future receives the best training possible.
¾ There are formally appointed Professional
To this end we support students in practice
Leads for each of our Healthcare
through trained mentors, who work in
Professional Disciplines. These
partnership with our dedicated
Professional Leads make up our
Professional Education Facilitator and the
Professional Leadership Forum, which
Universities.
meets to advise on a wide range of issues
¾ All of our staff are required to undergo an
that impact upon professional practice and
annual Performance Development Review
standards of care.
(PDR), where their objectives, skills and
¾ As the largest Healthcare Professional
competencies for the coming year are
group within our organisation, the nursing
reviewed and agreed. The organisation is
workforce has its own forum that is open to
committed to ensuring that all staff clearly
all practitioners. The forum is chaired by
understands how their personal
contribution supports the achievement of
Page 8
the wider objectives of the organisation. In
Accredited Training Centre for Doctors
2010/11, 61% of our staff had a
Our Lead Doctors have Specialist Status in
performance development review. We
their area of expertise and are accredited to
recognise that this is an area in which we
provide training to doctors who are studying
need to improve and in 2011/12 we aim for
for professional qualifications.
all staff to have had a review by June
Our doctors are accredited to provide training
2011.
in the following specialties:
¾ Sexual and Reproductive Health.
¾ We know that staff and managers
experience stress both at work and at
¾ Community Paediatrics.
home. To support them in dealing with
¾ Out of Hours care.
stress we offer Personal Resilience
Training to encourage managers to
CSU Star Awards
recognise the early warning signs and
The dedication of more than seven hundred
symptoms of stress so they can support
community healthcare staff was celebrated on
the people that they manage.
31st March 2011 as Warrington Community
¾ Externally, the organisation has links to all
Services Unit held its Star Awards.
of the local Universities and Higher
Winners included district nurses, podiatrists
Education institutions. We regularly
and the dental team who provide a wide range
collaborate with them in developing
of healthcare services to local people at home
learning opportunities that enhance the
and at clinics all over Warrington.
skills of our workforce and the quality of
the care that they deliver. Equally, we
access accredited programmes run by the
North West Leadership Academy and the
Institute of Leadership Management.
¾ All of this activity is underpinned by our
annual Organisational Development Plan
which identifies all of the development
activities required to support the
achievement of the organisations aims and
objectives.
Page 9
Transforming Community Services
Transforming Community Services
We continue to take part in a national initiative
Programme (TCS)
called the Productive Community Services
Since April 2009, Primary Care Trusts (PCT)
series which aims to release more time for
have been required to have separate
front line clinicians to spend providing direct
commissioning and provider arms and to have
care to patients. This programme recognises
adopted a contractual relationship with
that front line staff are experts in community
provider organisations.
health care and it equips them with the tools
Following an extensive assessment and
to address the productivity challenge. Extra
consultation process, Warrington Community
time to care for patients is found by staff
Services Unit formally separated from
looking at the way they work and staff having
st
Warrington PCT on 31 March 2011.
the permission to test out and find new ways
The decision was made to align the majority
of working.
of our community services with Ashton Leigh
We have selected a District Nursing and
and Wigan Community Healthcare Trust.
Health Visiting team to get things started and
This reflects the recognition that the
then we will roll out the programme across all
combining of skills and experience and the
our services. Recognising that sustaining
mutual understanding of community-based
change requires enormous energy and
services would have a positive impact on the
commitment, we are taking a long term view
care we provide to the population of
on this project and aim for all our services to
Warrington. The remaining services will be
have completed the 9 elements of the toolkit
managed by Warrington and Halton Hospital
over the next 12-18 months.
Foundation Trust, but continue to be located
The Productive Community Services
in the community.
Framework.
For community services to be genuinely
transformed to deliver care closer to home,
we will continue to work in partnership with
our colleagues in the acute and social care
settings.
Productive Community Services
An example of our approach to transforming
community services is the implementation of
the Productive Community Services.
Page 10
Quality Innovation Productivity Prevention (QIPP)
During 2010/11 we have worked to redesign
method of support is the facility for GPs to
our operational structure to get the basics
request advice and guidance about a patient’s
right and ensure that services are configured
skin condition by providing a digital
in a way that works for patients. To underpin
photograph of the skin condition. This allows
the delivery of services within our redesigned
diagnosis and treatment planning for
structure we embraced the QIPP and TCS
appropriate patients to have their condition
agenda to truly transform, and demonstrate to
managed by their own GP without the need to
our commissioners and patients:-
attend for a face to face assessment with a
¾ Quality of provision - “providing
dermatologist.
consistently good care for every patient
The NHS Operating Framework
first time, every time”.
The NHS Operating Framework (DH 2009),
¾ Innovation in current and future delivery -
which was updated in June 2010, set out
“being able to think differently about what
many challenges, in particular the implications
we do, how we do it today, and what we
of a restricted economic climate. Retaining
need to do beyond tomorrow”.
quality as its organising principle; the
¾ Productivity – “delivering the right care to
emphasis of the Operating Framework is
as many patients as is safely possible with
clearly placed on improving productivity to
the same or less resource”.
deliver best value quality care.
¾ Prevention – “preventing harm to patients
Quality and Patient Safety Strategy
and staff, at all times, whilst avoiding
2010/11
unnecessary acute admissions for
We always strive to improve the quality of our
patients”.
services and the care we provide. At the same
Community based integrated Dermatology
time we aim to demonstrate best value for
Service
money.
We successfully transferred the Dermatology
Using Lord Darzi’s definition as a framework;
Service from the hospital into the community
this Strategy set out the CSU’s commitment to
in 2009. In 2010, this service was further
quality in terms of:
enhanced with the provision of care for
¾ patient safety
patients with suspected skin cancer. This
¾ patient experience
means that Warrington patients do not have to
¾ the effectiveness of care
visit a hospital for assessment or treatment of
The aim was to deliver demonstrably higher
their skin condition.
standards of quality and patient safety year on
This Consultant led service established
year and to eliminate all preventable patient
innovative ways to directly support GPs. One
harm.
Page 11
This Strategy was underpinned by a range of
Twenty four quality and safety indicators were
local and national policy drivers, including:
developed to monitor progress towards the
¾ Quality Innovation Productivity and
achievement of the priorities, all of which were
monitored quarterly.
Prevention (QIPP).
¾ The NHS Warrington Quality, Innovation,
Prevention and Productivity (QIPP)
Achievement against the priorities was varied
Strategy 2009 -2014.
¾ Care Quality Commission Regulatory
with success in some areas and areas for
improvement in others for example;
Outcomes.
¾ 92% of patients reported that they
¾ High Quality Care for All (2008).
received the care that mattered to them
¾ 91% of patients showed no deterioration in
Informed by a review of national and local
priorities, the CSU Management Board
grade of pressure ulcer whilst in the care
identified the following quality and patient
of CSU services
¾ 62% of patients >65 years were offered a
safety priorities:
¾ Development of a proactive patient safety
falls assessment.
¾ The average rate for 2010/11 was 4.4%.
culture.
¾ Establish a safeguarding infrastructure that
meets the needs of children and adults.
¾ Reduce the incidence of falls.
¾ Reduce the incidence and severity of
ulcers.
¾ Reduce the incidence of catheter related
Urinary Tract Infections.
¾ Maximise clinical audit activity and
findings.
¾ Reduce inappropriate hospital attendance
of patients with long term conditions.
¾ Achieve a positive patient satisfaction rate
of 95%.
¾ Maximise staff wellbeing and reduce
absence to an average rate of
3%.
Page 12
The National average was 4.47%.
Partnership Working
We understand that patients often require
Intermediate Care
care that involves a number of different
In collaboration with the local authority, we
organisations. The co-ordination of this care
have launched a new integrated intermediate
is critical to ensure that patients receive
care service to support more people to have
appropriate care and have a positive
rehabilitation either at home or closer to
experience. We also realise that relationships
home. By combining our shared philosophy of
with our partner agencies e.g. the local
offering alternatives to hospital based
hospital, social care services and other
rehabilitation, this ambitious change has been
providers of health and social care will
realised. Health and social care staff are now
become increasingly important in the shaping
working together in multi-disciplinary teams to
of the new NHS.
support people’s health and social care needs
This year we have worked with our partners in
in the community.
various ways and below are some examples
of improvements we have achieved together.
Emergency GP Out of Hours
This service has recently re-located to work
Winter 2010 Planning
alongside the Urgent Care Centre and
Winter is often the time of year when patients
Accident and Emergency departments at
need the support of health and social care
Warrington Hospital. This relocation helps
services more than ever. Through weekly
these services work together and flexibly to
meetings and daily contact with hospital and
best meet the needs of patients and avoid an
social care colleagues, we implemented the
unnecessary hospital stay where possible.
following community initiatives to help people
stay at home or return home sooner after a
Breast Feeding
hospital stay:
In partnership with our Warrington Hospital
¾ 7 day access to community matrons.
and Sure Start Centre Colleagues, 5 Bosom
¾ 7 day access to specialist respiratory
Buddy Breastfeeding Support groups have
been set up across Warrington. The aim of
support.
¾ 7 day access to specialist care home
these groups is to provide support,
encouragement and advice to mothers who
support.
¾ Easy access to independent living aids
choose to breast feed. We have been going
through a process to be accredited UNICEF
from the hospital.
We also recognise how hard staff across the
Baby Friendly and have already passed stage
organisation worked particularly during the
1 of the 3 stages. We hope to complete stage
snow and ice experienced in the winter.
2 by the summer of 2011.
Page 13
Children and Young People’s Partnership
case review to be undertaken.
The Children and Young People’s
Children are of course not the only vulnerable
Partnership, of which the CSU is a member
group within our town. Adults may also be
brings together health, local authority services
vulnerable to abuse for different reasons at
such as social care and education and third
different times in their lives. The CSU is a
sector partners together to make strategic
member of the Warrington Adult Safeguarding
plans that address the needs of children and
Executive Board and the underpinning
young people within Warrington. The ethos of
Partnership Board. These arrangements are
the partnership is that there are a number of
not at present statutory, but there is a firm
issues that can only be addressed
belief within Warrington that partnership
successfully if we all work together around the
working is the only way in which we can
needs of the child or young person. The
successfully minimise harm to vulnerable
action plan is structured around 5 key
adults. The arrangements for safeguarding
outcomes for children and young people
vulnerable adults were reviewed in 2010 and
(Staying Safe, Enjoying and Achieving, Being
there is now a safeguarding structure similar
healthy, Economic Wellbeing and Making a
to that which is in place for children and young
positive contribution) and the partnership aims
people.
to ensure that it makes a difference in the
lives of Warrington’s youngest residents.
Transforming Community Services
As previously stated, the government
Safeguarding Vulnerable People
announced that there should be a formal
The most fundamental of the 5 outcomes for
separation of community services provider
children and young people is arguably
arms from the PCTs. This meant that a
‘Staying Safe’ and Warrington fulfils its
rigorous review of community health services
statutory duties in this area through the
in Warrington was undertaken to ensure the
Warrington Safeguarding Children Board.
final ‘destination’ of each service represented
This Board brings together statutory and non-
a best fit in terms of developing services in the
statutory agencies to oversee the policy and
future. The Service Review Panels consisted
practice around safeguarding and the training
of GPs, patient representatives through LINKs
provided to staff in all partner agencies to
and commissioners of services, from both the
safeguard children. It also carries out a
PCT and the local authority. A key outcome
performance monitoring and quality
from the service review panels was to set out
assurance function, and in the event of a
how we should work together in the future to
serious event, it may commission a serious
deliver services that best meet patient needs.
Page 14
Patient Safety
Infection Control and Prevention
* Survey equipment not available
The prevention and control of Health Care
There was also a rolling programme of
Associated Infections (HCAIs) continues to be
infection control audits undertaken. The team
a top priority for Warrington CSU. The
audited hand hygiene, sharps management,
Infection Control teams work focuses on
clinical waste, vaccine storage, transfer of
implementing systems that embed Infection
patients, and use of gloves and protective
prevention and control into everyday practice,
clothing. Any issues or shortfalls identified
making prevention of HCAIs “everyone’s
were acted upon to either maintain or improve
business”. During the year, significant
our standards.
progress was made to ensure that patients
An announced and an unannounced visit took
were cared for in a safe and clean
place at each of our clinics. All clinics
environment, where the risk of HCAIs was
achieved the minimum recommended score of
kept as low as possible.
85% with 5 of the clinics scoring over 95%.
Clinic users were asked as part of our Patient
Experience surveys “How would you rate the
cleanliness in this building”? There was a
Community
Clinics
Announced
Visits
Unannounced
Visits
choice of rating from “excellent” to “poor”.
Birchwood
96%
91.5%
Improvements were made over the past year
98%
Child
Development
Centre
in many of our clinics to ensure our clinics
were clean, comfortable, fit for purpose and
the risk of infection was low.
Q1
10/11
Q2
10/11
Q3
10/11
Q4
10/11
*
96%
100%
*
Birchwood
Garven
Place
93%
99%
100%
100%
84%
82%
80%
81%
Orford Clinic
80%
87%
90%
90%
Woolston
89%
100%
88%
Wolves
95%
93%
Penketh
90%
Grappenhall
Average
Performance
CDC
99%
Garven
Place
89.5%
88%
Grappenhall
86%
88.5%
Orford Clinic
97%
97.5%
Penketh
Clinic
94%
96.5%
Healthcare at 91.5%
Wolves
89.5%
Woolston
Clinic
97.5%
99.5%
100%
HMP Risley
90.5%
*
97%
98%
HMYOI
Thorn Cross
91.5%
*
100%
93%
95%
95.5%
99%
94%
93%
94%
97%
Wheelchairs
Service
89%
94%
92%
93%
* Not possible to make unannounced visit
to prisons
Page 15
The Infection Control Team used every
The Clostridium Difficile figures in Warrington
opportunity to promote effective hand hygiene
reduced from 124 cases in April 2009/10 to 72
and they will continue to implement the
cases in April 2010/11 i.e. a reduction of 58%.
national Good Hand Hygiene Awareness
The MRSA figures in Warrington reduced
Campaign.
from 8 cases in April 2009/10 to 7 cases in
The main elements of this campaign include;
April 2010/11.
Following any reported incidents of
¾ Promoting the use of alcohol hand gel
Clostridium Difficile infection or MRSA in the
which has been shown to significantly
blood stream, the Infection Control Nurses
improve compliance as they are quick
carried out a detailed look at the patient’s
and easy to use.
journey to see if they could identify any
¾ Hand hygiene road shows utilising the
reasons why the person may have caught the
glow box. Staff apply an ultraviolet
infection. Where necessary, action was taken
hand gel which becomes invisible to
to reduce the risk of further infections.
the eye. They then wash their hands
The following reflects some of the actions
and put them under the ultraviolet light
taken:
(glow box). It shows up any areas they
¾ written guidance produced on swabbing of
wounds.
may have missed when washing their
¾ staff reminded to complete infection risk
hands.
¾ Hand hygiene audits using the
assessments for all wounds.
Department of Health “Essential Steps”
¾ where necessary GPs and Non-Medical
Prescribers were reminded of correct
to safe clean care audit tool.
¾ Training all clinical and non clinical staff
antibiotic prescribing.
¾ information booklets for patients on MRSA
in Hand hygiene.
¾ Participation in the National Patient
and Clostridium Difficile were reviewed
and updated.
Safety Agency (NPSA) “Clean your
hands” campaign.
¾ Upgrading hand washing facilities in
We continue to improve standards around
infection prevention and control and ensure
many of our clinics.
we are fully compliant with the Hygiene Code
The number of Meticillin Resistant
and the requirements of the Care Quality
Staphylococcus Aureus (MRSA)
Commission.
Bacteraemias and Clostridium Difficile
infections continues to reduce year on year.
Page 16
Patient Safety and Risk
These walkabouts have resulted in the
The organisation introduced web-based online
following improvements:
incident reporting during 2010/11 to capture
¾ Improved communication with patients
patient safety incidents faster and more
using feedback, access to PALS, posters
comprehensively than before. It is our policy
and diagrams in literature.
to investigate all incidents to ascertain the
¾ Increased staff first aid training.
cause and make changes to avoid recurrence.
¾ Using pro-forma’s to standardise clinical
record.
The key types of patient safety incidents
monitored over the year and reported to the
¾ Better communication between staff.
Management Board were:
The organisation regularly receives national
¾ There were 47 reported incidents of
patient safety alerts and alerts regarding faulty
patient delays being treated or accessing
devices, medicines, or estates issues. Even
services. This equates to 0.006% of
though many of these national alerts are not
overall patient contacts.
applicable to community healthcare, all our
¾ Poor and incomplete discharges into
services scrutinise each alert and put in place
community healthcare 28 (0.004% of
actions where needed.
overall patient contacts).
Service leads meet together on a monthly
¾ Patient falls or accidents 27 (0.003% of
basis to discuss all outstanding incidents,
risks, service improvements and other patient
overall patient contacts).
The Management Board conducts ‘patient
safety issues. All services contribute to a
safety walk around’ sessions in clinical areas
central register of risks across the
to understand and discuss patient safety
organisation in order that these can be
issues with patients and staff. These were
monitored by specialist sub-groups, sub-
implemented in October 2010 and to date
committees and the Management Board. The
have been undertaken in:
risk management systems are independently
¾ Prison Healthcare
audited and the findings are reported to the
¾ Sexual Health
Management Board and the Audit Committee.
¾ Dermatology
This provides assurance that these systems
¾ Podiatry
are robust and that the Board is suitably
¾ Community Paediatrics.
aware of patient safety issues. This year our
internal auditors evaluated our risk
management systems and they were
“significantly assured” that we had effective
processes in place.
Page 17
Effectiveness and Productivity
Statement on Relevance of Data Quality
Clinical Coding Error Rate
and Our Actions to Improve Our Data
Warrington CSU was not subject to the
Quality
Payment by Results clinical coding audit
Mersey Internal Audit Agency undertook a
during 2010/11 by the Audit Commission.
data quality audit in 2010. The audit identified
Quality and Patient Safety Strategy
a total of 3 risks, 2 high and 1 low risk, that
Our 2010/11 Quality and Patient Safety
needed to be addressed.
Strategy identified the following 4 priorities in
Warrington CSU will be taking the following
relation to effectiveness of care.
actions to improve data quality:
Quality Dimension: Effectiveness of care
¾ A comprehensive training package will be
Objective: Right first time
developed to ensure the accurate
What?
Why?
collection of data and to prevent duplicate
Implement a
To reduce the
records being created.
programme of falls
number and impact of
risk screening for
falls on this
any patient record anomalies such as
adults over 65.
population.
missing NHS numbers or suspected
Implement a model of
To reduce the
duplicate records.
pressure ulcer
incidence and
NHS Number and General Medical Practice
assessment and
severity of pressure
Code Validity
management.
ulcers.
Warrington CSU submitted records during
Implement urinary
To reduce incidence
2010/11 to the Secondary Uses service for
catheter care bundles
of catheter-related
inclusion in the Hospital Episode Statistics
and provide education Urinary Tract
which are included in the latest published
to professionals.
Infections.
data. The percentage of records in the
Integrate clinical audit
To ensure that clinical
published data which included the patient’s
findings into the CSU
audit results in
valid NHS number was:
Service Improvement
practice development
¾ 99.9% for out patient care
Programme.
and improvement.
¾ Regular reports will be produced to identify
The percentage of records in the published
data which included the patient’s valid
A key member of staff was assigned to each
General Medical Practice Code was:
priority that was responsible for developing a
¾ 100% for out patient care.
detailed action plan.
Progress towards the achievement of each
priority is described below.
Page 18
¾ Implement a programme of falls risk
A urinary catheter assessment and monitoring
form has been developed which requires a
screening for adults over 65
A lot of work has been undertaken to reduce
daily assessment of need for continuation of a
the risk of patients falling. A Falls Team was
catheter and prompts daily cleansing. This
established and a Community Falls clinic has
has resulted in the more timely removal of
been set up. An audit of the use of the Falls
catheters and has led to greater patient
Risk Assessment Tool (FRAT) indicated that
comfort and reduced the risk of infection.
62% of patients over the age 65 years were
Following removal of a catheter scans are
offered a falls assessment. This was the first
preformed to ensure the bladder is working
time the use of the FRAT had been audited
properly. Training has also been provided to
and we are working to improve this figure
care home staff regarding correct sample
during 2011/12. Completion of the
taking techniques and appropriate antibiotic
assessment will ensure early identification of
prescribing.
patients that are at risk of falling and will result
¾ Integrate clinical audit findings into the
in falls prevention actions being taken.
CSU Service Improvement Programme
¾ Implement a model of pressure ulcer
Compared to 2009/10 we saw an increase in
the number of audit reports and action plans
assessment and management
NICE guidance recommends that patients at
submitted during 2010/11. Work commenced
risk of developing a pressure ulcer should
on identifying audit champions within each
have a Waterlow assessment completed. In
service who will be responsible for
order to check that this assessment is being
encouraging more clinical audit across the
completed the Record Keeping audit has
organisation. This project also resulted in the
been amended. Completion of the
more effective development of the 2011/12
assessment ensures that an appropriate care
Audit Programme. We have prioritised the
plan is put in place and that suitable pressure
participation in relevant national clinical audits
relieving equipment is provided. A recent
and the undertaking of the agreed
benchmarking exercise within community
organisation wide audits e.g. record keeping
nursing across the North West indicated that
and consent audits.
we had the lowest reported incidence of grade
Compliance with National Institute for
3 and 4 pressure ulcers.
Clinical Excellence (NICE) Guidance
¾ Implement urinary catheter care
We ensure that all guidelines issued by NICE
bundles and provide education to
are assessed to find out if they are applicable
professionals
to the services we provide. If they are
Page 19
applicable, guidelines are further assessed to
¾ The team are able to focus upon patient
understand if we are compliant.
facing activities and devote 80% of their
Of the guidance that is currently applicable we
time directly with patients.
are fully complaint with 72, partially compliant
¾ Reference costs submitted for 2009/10
with 23 and non-complaint with 0 guidelines.
average £33 per contact with a lowest cost
Action plans are developed when gaps in
of £20 per contact and a highest cost of
compliance are identified. These are
£44 per contact. Reference costs for the
monitored by the Adult & Prisons and Children
Warrington Podiatry service are extremely
& Young People Governance Groups on a bi-
competitive at £26.28.
monthly basis to ensure that where possible
full compliance is achieved. Further to this the
Via the Patient Satisfaction survey our
Management Board is kept informed about
podiatry patients have told us that overall they
compliance with NICE Guidelines on a
99% satisfied with the service they receive.
monthly basis.
The report did however suggest that we could
improve some areas of our service. For
NW Podiatry Benchmarking Exercise
example the service has set up working
The North West Podiatry Benchmarking
groups to identify appropriate clinical and
Exercise was completed in October 2010.
quality patient outcome measures.
The benchmarking report presented a
comprehensive analysis and comparison of
NW Community Nursing Benchmarking
25 community based Podiatry services and
Exercise
covered:
Following the successful completion of the
¾ Population and demographics
Podiatry services benchmarking project, a
¾ Service models
similar exercise was undertaken within
¾ Access (Referral to Treatment times and
Community Nursing services. The exercise
return times for non-urgent patients)
took place from February 2011, covered 15
¾ Workforce and skill-mix
North West providers and presents a
¾ Activity and Caseload analysis
comprehensive analysis and comparison of
¾ Financials and Reference costs
community nursing services.
¾ Clinical outcomes and quality
The Warrington Podiatry Service compared
favourably in terms of productivity and value
for money:
Page 20
The report findings for Warrington CSU are as
which is 16% above the national average
follows:
of 44 WTEs.
¾ Skill Mix - Warrington CSU has slightly
Clinical outcomes and quality
¾ Warrington had the lowest reported
higher numbers of band 3 and band 5 staff
complaints and one of the highest number
than the NW average.
¾ The NW average sickness absence total
of compliments.
¾ Warrington were able to report on the
stands at 6% which is higher than the
percentage of deaths in preferred place of
national average of 5%. However
care and of those able to report, achieved
Warrington reported the lowest sickness
the average of 80%.
absence of 4%.
¾ Warrington reported the lowest number of
Cost
¾ The DoH national reference cost for
clients with grade 3 and 4 pressure sores
2009/10 was £38.60 per contact. The NW
(please see page 18).
Referrals
average is less at £36.94. Warrington
¾ Referrals per 100,000 population averaged
having the lowest reported at £24.94.
4,862 with Warrington reporting the
highest at 10,600.
Out of Hours Quality Requirements
Activity
From 1st January 2005, all providers of out-of-
¾ The average number of face to face
hours (OOH) services have been required to
contacts per 100,000 weighted population
comply with the national OOH Quality
in 2009/10 was 63,542. We reported
Requirements, first published in October
80,000 in 2009/10. In 2010/11 we reported
2004. The Quality Requirements provide a
110,000 face to face contacts. This
clear and consistent way of assessing
represents a 37% growth.
performance. Regular and accurate reporting
¾ This is further supplemented by 30,000
of the precise levels of compliance with each
non-face-to-face contacts.
Requirement enables us and our
¾ Analysis of activity revealed a higher
commissioners together to identify what action
proportion of time allocated to wound
is needed in those areas where performance
dressings and end of life care.
falls short of the standard that service users
should expect.
Workforce
¾ Warrington has slightly higher than the
average number of WTEs per 100,000
population in the NW with 51 WTE’s,
Page 21
We are currently reporting on the following
reviewed by the PCF indicated that the
standards:
service had made significant progress since
Quality Requirements Monitored
the last benchmarking report in 2009/10.
QR1 - Regularly reporting of Quality
Highlights included:
Standards
¾ Significant improvement in achievement of
QR2 - Supply clinical data GP
Quality Requirement 9 – time to first
QR3 - Patient with defined needs
definitive assessment
¾ A 3% reduction in the level of home visits
QR4 - Clinical audit
(reduced from 9% to 6%)
QR9b - Urgent calls definitive clinical
assessment within 20mins
The OOH service is currently working with the
QR9c - Routine calls definitive clinical
PCF benchmarking organisation in order to
assessment within 60mins
further improve the quality and productivity of
QR12a - Emergency appointments within
the service. A detailed action plan has been
60mins
produced and is progressing well.
QR12b - Urgent appointment within
Examples of actions undertaken include:
120mins
¾ Capacity and demand tools are now in
place to ensure appropriate staffing levels
QR12c - Routine appointments within
¾ The system for screening for emergency
360mins
QR13 - Providing access to interpreter
conditions has been improved to ensure
services
appropriate and timely care is provided
¾ Reducing variation in working practices
within staff groups.
The Primary Care Foundation (PCF) utilise
the above data and is responsible for
benchmarking over one hundred GP OOH
An independent audit of performance will be
services. The next national benchmarking
carried out by the PCF during summer 2011 in
report will review four weeks of data from the
order to demonstrate the on-going service
service – two from 2010 and two weeks from
improvements.
2011.
In the most recent Benchmarking Patient
The PCF were invited to visit the Warrington
experience survey for 2010/11, Warrington
OOH service on 6th April 2011 in order to
Emergency
assist the management team in a service
performed consistently above the national
review. In preparation for the visit, the PCF
average
carried out a review of recent data from
satisfaction and were in the top 25% of the
January and February 2011. The data
country.
Page 22
on
GP
all
Out
of
Hours
measures
of
service
patient
Patient Experience
¾ they are a valuable source of information,
Warrington CSU introduced a real time patient
satisfaction survey in September 2009.
to enable the Management Board and staff
The surveys have been completed using
to understand patient perception of the
either hand held or stand alone electronic
quality of services provided.
¾ they enable service development and
devices.
Patients are guided through a range of
improvement in direct response to patient
questions relating to cleanliness, dignity &
feedback.
respect, confidentiality and information
provided. A final summary question asks
What Our Patients Have Told Us
patients to assess their overall experience of
During 2010/11, 2,057 surveys were
the services received.
completed and all services undertook an in
The survey devices are currently located at
depth service specific survey.
the following sites:
Since the introduction of the survey overall
¾
Child Development Centre
experience across our clinic sites has
¾
Birchwood Clinic
improved from 87% at the start of the
¾
Garven Place
programme in September 2009 to 92% at the
¾
Orford Clinic
end of March 2011 indicating that the changes
¾
Health Services at Wolves
we made following patients feedback had a
¾
Woolston Clinic
positive affect on there experience.
¾
Grappenhall Clinic
Patients have indicated that our performance
¾
Penketh
in relation to cleanliness, confidentiality and
These clinics offer a variety of services
the provision of information has improved.
including podiatry, dermatology, district
However patients have also indicated that our
nursing, sexual health, health visiting,
performance in relation to dignity and respect
paediatric audiology, paediatric speech &
has deteriorated and remains at 3% below
language therapy and community
target. This has been attributed to poor
paediatricians.
experiences of patients particularly at our
In addition, patient surveys are carried out
Garven Place and Orford clinics. Our Out of
regularly within specific adult and children’s
Hours service that was located in Garven
services.
Place has since been relocated to the urgent
The key benefits of the survey are:
care centre at Warrington and Halton Hospital
¾ they enable patients and carers to give
Foundation Trust. After investigation of the
poor experience being reported at our Orford
direct feedback on the services provided,
at the point of delivery.
Page 23
¾
clinic, we found that the rating was being
“No improvement is required. The care I
affected by services that we do not provide.
received was first rate. Thank you for an
We continue to work with both staff and
excellent service”.
patients to improve the experience of all of our
¾
class, we are so very grateful”.
patients across all services.
The table below summarises patient response
¾
Jan –
Mar 11
Oct –
Dec 10
July –
Sept 10
April –
June 10
Child
Development
¾
Garven
Place
“Thought staff were fantastic”.
Here is a selection of some of the comments
from patients on things that they felt we
needed to improve:
*
94%
*
100%
¾
Centre
Birchwood
“I have nothing to add I receive excellent
service and treatment”.
to their overall experience of our services.
Site
“Care is absolutely superb, excellent, first
“Appointments on time, always kept
waiting”.
100%
98%
96%
89%
91%
77%
85%
79%
¾
“An idea of waiting time”.
¾
“More car parking”.
¾
“Parking is terrible everything else
Orford Clinic
91%
91%
93%
92%
Woolston
100%
100%
100%
83%
¾
“More information”.
Wolves
99%
93%
96%
97%
¾
“More doctors”.
Penketh
94%
100%
100%
100%
In response to these comments we have
Grappenhall
89%
94%
94%
100%
provided:
¾
Average
across the
CSU
excellent”.
93%
93%
93%
an information board at each location
detailing clinics in operation, clinicians in
92%
attendance and any significant waiting
times.
* Survey equipment not available
¾
Here is a selection of some of the positive
posters and wallet sized cards with local
PALS information
comments that we have received from
¾
clinicians and reception staff are also
patients:
asking patients directly,” Has everything
¾
“I am pleased with the care I receive.
been alright for you today?”. This gives
Staff are always pleasant and friendly”.
us an opportunity to provide any
“Excellent service and pleasant staff”.
information that they may require.
¾
On reviewing the performance for service
specific and clinic based surveys, overall
Page 24
performance has been better across all areas
Lessons learned from complaints this year
when carrying out a survey within an
include:
individual service.
¾ Ensuring care plans are always discussed
Our priorities over the coming year are to
with parents and a single point of contact
build on the learning from our first year of
in school agreed in order to ensure
measuring patient experience and work with
effective communication.
¾ Where there are unavoidable delays or
our staff to increase survey uptake and
improve performance particularly with regard
changes, patients will be advised of this
to dignity and respect.
and offered the choice of waiting or
We also wish to ensure that we develop a
booking another appointment.
meaningful way to feedback to our patients
¾ Patient letters amended to show that we
the actions and developments that we have
can provide a chaperone or interpreter if
started in direct response to their feedback. In
requested by the patient.
addition we looking to develop patient forums
to further enhance the way we communicate
Patient Stories
with our patients.
Listening to a patient story is a powerful
experience. Therefore, in 2010 we started to
PALS and Complaints
present patient stories to the Management
During 2010/11 we responded to 240 PALS
Board. The aim of this was to always have our
queries and 42 complaints. PALS issues
patients at the heart of everything we do.
range from providing contact information,
arranging the collection of a wheelchair which
Compliments
was no longer required and liaison regarding
During 2010/11 we received 1204
a cancelled appointment. As a result of this
compliments.
last issue, processes have changed in order
Compliments received include:
¾ “Grateful thanks for all your help and
that patients are advised in good time by
support during my sister’s illness. Your
gentle care and professionalism was
much appreciated”.
¾ “It was amazing to see the difference the
8 weeks course made to other members
of the group and I know it has improved
my mobility”.
telephone of cancelled appointments
wherever possible.
Although we compare favourably in the
number of complaints we receive we are
always concerned when we receive a
complaint about one of our services, we value
the feedback so that we can improve our
services for future patients.
Page 25
¾ “My husband saw Steve last week, he
was very impressed by him. He must
have been good because my husband
is never impressed with anyone”.
Clinical Audit and Research
Clinical Audit
The national clinical audits and national
During 2010/11, 4 national clinical audits and
confidential enquiries that Warrington CSU
0 national confidential enquiries covered NHS
participated in during 2010/1 are as follows:
services that Warrington CSU provided.
¾ National Audit for Cardiac Rehabilitation
During that period Warrington CSU
(NACR)
participated in 100% of national clinical audits
¾ National Sentinel Stoke Audit
and 0% (non applicable) national confidential
¾ National Falls and Bone Health Audit
enquiries of the national clinical audits and
¾ RCP Continence Audit
national confidential enquiries which it was
eligible to participate in.
The national clinical audits and national
The national clinical audits and national
confidential enquiries that Warrington CSU
confidential enquiries that Warrington CSU
participated in, and for which data collection
was eligible to participate in during 2010/11
was completed during 2010/11, are listed
are as follows:
below alongside the number of cases
¾ National Audit for Cardiac Rehabilitation
submitted to each audit or enquiry as a
percentage of the number of registered cases
(NACR).
¾ National Sentinel Stoke Audit – the Acute
required by the terms of that audit or enquiry.
¾ National Audit for Cardiac Rehabilitation
Trust led on this audit and Warrington
(NACR) - 100%
CSU has contributed towards the audit.
¾ National Falls and Bone Health Audit - the
¾ National Sentinel Stoke Audit - This audit
Acute Trust led on this audit and
is lead by Warrington & Halton Hospitals
Warrington CSU has contributed towards
NHS Foundation Trust. Warrington CSU
the audit.
contributed to this audit by providing the
¾ Royal College of Physicians (RCP)
Stroke Care Co-ordinator with information
Continence Audit.
relating to service provision for stroke
patients in the community.
¾ National Falls and Bone Health Audit –
This audit is lead by Warrington & Halton
Hospitals NHS Foundation Trust.
Warrington CSU contributed to this audit
by completing the organisational audit.
¾ RCP Continence Audit – 100%
Page 26
The reports of 2 national clinical audits were
The reports of 248 local clinical audits were
reviewed by the provider in 2010/11 and
reviewed by the provider in 2010/11 and
Warrington CSU intends to take the following
Warrington CSU intends to take the following
actions to improve the quality of healthcare
actions to improve the quality of healthcare
provided:
provided:
¾ National Audit for Cardiac Rehabilitation –
¾ Record keeping audit tools will be
this is an ongoing audit. Warrington CSU
reviewed to ensure robust capture of data
is helping to revise the audit tool to enable
and information relating to record keeping
future actions to be taken on more reliable
principles. In particular, the tool will be
information.
updated to more fully capture data relating
¾ RCP Continence Audit - An action plan is
to recording of NHS numbers and consent
being drawn up in conjunction with the
¾ Following an evaluation of Speech and
Warrington PCT to improve practice in
Language Therapy cases needing long
relation to GP’s assessment and treatment
term intervention in mainstream schools,
of continence issues.
16 % of the caseload was recommended
for discharge. This freed up capacity for us
to take on more new cases.
For the remaining 2 National Audits the
¾ As a result of the Goal Attainment Scale
following has occurred;
¾ National Sentinel Stoke Audit – this is an
Audit conducted within the Neurological
ongoing audit and actions that need to be
Rehabilitation Team, agreed goals are
taken will be led by Warrington & Halton
reviewed regularly with patients, and new
Hospitals NHS Foundation Trust. To date
goals are set to help patients achieve the
there have been no actions identified for
things that are important to them.
¾ As a result of the Six Month Post-
Warrington CSU to complete.
¾ National Falls and Bone Health Audit –
Discharge Telephone Follow up audit
results of this audit will be made available
conducted within the Stoma Care Team,
at the end of April 2011. A regional
patients now have the opportunity to
workshop is planned for June 2011 where
discuss any issues they may have with
results will be discussed and a local action
their stoma.
¾ As a result of the audit of Failure to Attend
plan developed to facilitate service
Rates for Sedation Sessions within the
improvements.
Dental Service, information sheets have
been produced for the receptionists on
how to deal with appointment
Page 27
cancellations. Patients are also telephoned
safety of the care that patients received from
at least 48 hours prior to the appointment
Warrington CSU.
to remind them about their appointment. If
the appointment is then cancelled the
The Record Keeping Audit showed that 65%
appointment slot can be offered to another
of audit criteria were compliant with local
patient.
policy and national best evidence and
practice. We recognise that we need to
At the beginning of 2010/11 an Annual Clinical
improve these results. Each service has an
Audit Programme was developed. The
action plan in place to increase compliance.
Programme ensured that audit projects
reflected our priorities in the delivery of
effective health care.
The Programme was implemented throughout
the year, and progress was monitored by the
Adult & Prisons and Children & Young People
Governance Groups on a bi-monthly basis.
These Governance Groups also monitored
and reviewed the audit reports and action
plans resulting from audit findings.
This year we completed 94% of the audits we
set out to undertake. The Clinical Audit
91% of the Essential Steps to Safe Clean
Care Audits indicated compliance with best
Programme included a cycle of corporate
practice, demonstrating effective infection
audits. Completion of these audits was
control.
mandatory and facilitated benchmarking
across all of our services. The audit criteria
The Patient Identification audit results showed
reflected national standards and Warrington
CSU’s local procedures. The corporate audits
included, record keeping, infection control,
that our staff were not complying with the
Patient Identification Policy. Although we at
times have fallen short of best practice no
patient identification, consent to treatment,
patients have been harmed as a result.
audit of resuscitation equipment and safe &
Following on from the audit, the Patient
secure handling of medication. These audits
were central to ensuring the effectiveness and
Identification Policy has been reviewed and
the audit tool for 2011/12 will be revised to
monitor compliance with this policy.
Page 28
The Consent to Treatment Audit was
Warrington CSU was involved in conducting
conducted to check if the Department of
16 (portfolio and non-portfolio) clinical
Health consent forms were being used
research studies in community nursing,
correctly. The audit showed on average good
physiotherapy and mental health during
compliance with 88% of criteria audited being
2010/11.
compliant.
Portfolio studies are funded by the Clinical
The Resuscitation Equipment Audit showed
Leadership Research Network for example
that most of the stipulated resuscitation
research into a new drug. Non-portfolio
equipment was available. At 1 site, it was
studies are those that are being undertaken
identified that there was insufficient equipment
as part of an academic qualification e.g. a
available although this posed no immediate
Masters degree.
risk the equipment has now been made
available.
The Safe Secure Handling of Medication Audit
showed that on average there was good
compliance with agreed standards. The
overall average compliance score across
services was 90%.
Participation in clinical research
We are committed to and understand the
value of undertaking research. However, the
opportunities for undertaking research within a
community healthcare setting are much more
limited than within a hospital setting.
The number of patients receiving NHS
services provided or sub-contracted by
Warrington CSU in 2010/11 that were
recruited during that period to participate in
research approved by a research ethics
committee was 25.
Page 29
Performance Framework
Review of Services
NHS National Staff Survey Results for 2010
During 2010/11 Warrington CSU provided
To achieve high quality care we must ensure
and/ or sub-contracted 44 NHS services.
that we have a high quality workforce who are
Warrington CSU has reviewed all the data
committed, engaged, trained and supported.
available to them on the quality of care in 44
One of the ways of measuring this is through
of these NHS services.
the annual NHS staff survey. The results from
The income generated by the NHS services
the 2010 survey were analysed and key areas
reviewed in 2010/11 represents 6% of the
for development identified.
total income generated from the provision of
NHS services by Warrington CSU for
Innovation (CQUIN) Payment Framework
A proportion of Warrington CSU income in
2010 - 11 was conditional on achieving quality
improvement and innovation goals agreed
between Warrington CSU and any person or
body they entered into a contract, agreement
or arrangement with for the provision of NHS
services, through the Commissioning for
Quality and Innovation payment framework.
Further details of the agreed goals for 2010 11 and for the following 12 month period are
available electronically at:
http://www.warringtonpct.nhs.uk/publicinfo/publications.html
The 2010 -11 total contract value included an
element for CQUIN which was supported with
an agreed CQUIN scheme. The PCT agreed
not to penalise unfairly due to the late timing
of the final agreement for the scheme. An
action plan is in place to ensure the
achievement of any areas where full
compliance was not delivered in year.
Page 30
% feeling satisfied with
the quality of work and
patient care they are
able to deliver
% receiving job relevant
training, learning or
development in last 12
months
% appraised in last 12
months
% reporting good
communication between
senior management and
staff
% able to contribute
towards improvement at
work
Staff job satisfaction
Staff recommendation of
the trust as a place to
work or receive
treatment
Warrington
CSU score
Lowest score
attained
Use of the Commissioning for Quality and
Highest score
attained
2010/11.
59% 82%
64%
69% 86%
81%
60% 94%
82%
21% 47%
30%
55% 79%
66%
3.45
3.09
3.52
3.47
3.78
3.81
patient and by service)
Monitoring Quality
¾ Compliance with 18 week Referral to
Throughout 2010/11 we utilised a quality
Treatment target
dashboard to monitor the quality of care
provided.
This includes data on the following:
The CSU Management Board reviewed the
¾ Incidents
dashboard on a monthly basis and it provided
¾ Infection control (MRSA and C. Difficile)
an overview of the performance of CSU
¾ Patient survey results
services. Any areas of poor performance were
¾ Complaints and PALs data
targeted to ensure shortfalls were addressed.
¾ Compliance with NICE guidance
For example we implemented a text
¾ Compliance with Information Governance
messaging system to remind patients about
their appointments to reduce the number of
Toolkit
¾ Compliance with the Annual Clinical Audit
DNA’s.
Programme
The CSU Management Board reviewed the
dashboard on a monthly basis and it provided
an holistic picture of the quality of CSU
services. This monthly focus on quality
ensured that any areas of poor performance
were targeted to ensure shortfalls were
addressed in a timely manner.
For example we reviewed and revised the
Annual Clinical Audit Programme as we were
failing to comply with the agreed version.
Service Level Dashboards
This year all of our services were provided for
Performance Dashboard
the first time with data relating to Key
We also utilised a dashboard to monitor the
Performance Indicators via a service line
performance/activity data across all of our
dashboard. They contained the same kind of
services. It included data on the following;
data as the performance dashboard; however
¾ Number of referrals
this was represented in more detail to enable
¾ Waiting list data
staff within each service to understand how
¾ Number of attendances
their individual service performs.
¾ Number of “Did Not Attends” (DNAs)
¾ Number of appointments cancelled (by
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The following are some of the actions that
have been undertaken:
¾ Pilot bowel cancer screening programme
in place
¾ Older persons exercise regime developed
¾ Dedicated Hepatitis C Specialist Nurse
now provides a weekly clinic.
Prison Health Indicators
We provide the health and dental care in both
HMP Risley and HMYOI Thorn Cross. Both
establishments under went independent
assessments against the Prison Healthcare
Performance and Quality Indicators in May
2010.
39 indicators were used to assess the quality
of services provided. 21 were rated as green
i.e. fully compliant. Of the remaining indicators
6 were rated as red and 9 as amber with 3
indicators being not applicable. An action plan
was developed to address the areas requiring
improvement and most actions have now
been completed.
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Organisational Lessons Learnt
In order to continually improve the care we
Failure to Adequately Control a Patients
provide it is imperative that we learn from
Pain
when the care we have provided is not as we
In response to a relative’s complaint, our
would wish.
processes regarding the use of syringe drivers
were reviewed. As a result, additional
By analysing:
¾ incident reports
¾ complaints
¾ patient experience survey results
¾ clinical audit results
¾ staff survey results
¾ staff concerns
measures have been put in place in the form
of a supportive training framework. The
training programme has four levels to
accommodate novice to expert practitioners. It
incorporates instruction on specific devices
and training on our Continuous Sub-
we can identify areas for improvement.
Cutaneous Infusion procedure guidelines.
Below are some examples of where we have
This will ensure that patients receive effective
learnt from when things have not gone as we
pain relief.
would wish.
Health and Safety Inspections
Insulin Administration Error
During a routine local Health and Safety
Following an insulin administration error a
Inspection at the Community Equipment Store
though investigation was carried out by our
it was identified that there was poor
Lead Nurse. The investigation found that the
adherence to regulations.
prescription sheet was written using the
As a result of the inspection the service
abbreviation ‘u’ instead of written fully as
changed practice to facilitate ongoing training
‘units’. This failed to comply with the National
each month throughout the year thus
Patient Safety Agency recommendations and
improving patient and staff safety.
led to the misinterpretation by a District Nurse
and subsequent medication error. The District
Nurse quickly identified the error and the
patient was admitted to hospital. The patient
was discharged safe and well the next day.
As a result of this incident the drug
administration sheets have been reviewed to
ensure that they are pre-printed with the
words units written in full, to prevent future
risk of misinterpretation.
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Access Doors and Reception Desk at
Safeguarding Children
Healthcare at Wolves
Following an incident where information about
As a result of incident reports regarding the
a child was sent to the birth parent’s address
entrance doors and also a complaint about
rather than the carer’s address, files of all
long queues at the reception desk changes
Looked after Children have identification
have been made. An electronic door opening
labels on to alert staff to check that
system was installed along with a bigger
information is being sent to the correct
reception desk. The number of receptionists
address.
was also increased during busy periods to
support the demands of our clinical activity.
Whilst the electronic doors are a benefit to
patients, there were 2 incidents whereby the
electronic doors closed before a patient with
mobility issues was able to leave the building
safely, resulting in the patient being knocked
over by the doors. Fortunately no injuries
were sustained. The type of door has now
been altered to allow more time to enter and
exit the building. This situation continues to
be monitored.
Patient Information on Immunisations
The patient experience survey carried out with
young people in schools identified that young
people did not feel sufficiently informed about
what to expect following immunisation. An
information leaflet was developed in
conjunction with young people and school
health staff and it is given out at all school
immunisation sessions.
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Quality Improvement for 2011/12
Although we pleased with our performance
the coming year. It identifies our top 10 quality
this year, we would like to improve further in
improvement initiatives.
2011/12 and are committed to this goal. This
Clinical Governance Development Plan
will be achieved through working with our
A Clinical Governance Development plan has
staff, partners and patients.
been written which identifies areas for
improvement related to maintaining and
; framework underpinning our
The
strengthening ongoing compliance with the
improvement activities includes:
CQC Registration Requirements.
¾ Commissioning for Quality and
Contractual Quality Requirements
Innovation Scheme (CQUIN)
We agreed a list of over 40 Quality Indicators
¾ Quality Improvement Plan 2011/12
as part of our contract with the
¾ Clinical Governance Development
Commissioners. They cover a wide range of
Plan
topics from achieving national waiting time
¾ Contractual Quality Requirements
targets to reporting the number of people
¾ Transforming Community Services
getting pressure ulcers whilst in our care.
and Quality Innovation Productivity
Embracing the TCS and QIPP Agendas
Agendas
Given increasing demand, the reduction in
funding, rising expectations and our
CQUIN Payment Framework
commitment to providing “leading edge
The CQUIN Scheme is a national initiative
services that are of the highest safety and
designed to improve the care we provide to
quality”, the achievement of our aims will not
our patients. As part of our contract with the
be possible without large scale transformation
Commissioners for 2011/12 we have
of our services.
negotiated 3 CQUIN quality indicators that
Clinical, patient and public engagement is at
reflect key priorities locally. These relate to
the heart of delivering this vision and will be
patient experience in children’s services,
dementia care and rehabilitation at home. The
CQUIN Scheme is a national initiative
critical in determining the programme of
transformation. Our approach will improve the
utilisation of NHS resources, develop effective
designed to improve the care we provide to
partnerships and utilisation of best practice
our patients.
by:
Quality Improvement Plan
¾ Improving quality whilst improving
The Quality Improvement Plan has been
productivity
designed to give structure, direction and
¾ Acting now for the long term
vision to the work of our clinical teams over
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¾ Harness the potential in technological
Clinical Effectiveness Initiatives
advances in support of new and more
PE 1: End of Life Care
efficient ways of working.
Aim: To offer all patients and those caring for
¾ Rolling out our Productive Community
people at the end of life the choice of their
Services Programme to release more time
preferred place of care.
for front line clinicians to care for patients
Measures of success:
¾ 10% improvement on current baseline
within the 2011/12 financial year.
Priorities for Quality Improvements in
2011/2012
PE 2: Children & Young Peoples
From the above quality improvement plans
Experience
we have identified the following 10
Aim To understand the experience of children
priorities.
and young people.
Patient Safety Initiatives
Measures of success:
PSI 1: Children’s Assessment
¾ Submission of report to commissioner and
receipt of CQUIN related payment.
Aim: To strengthen our assessment of
children in care.
Patient Experience Initiatives
Measures of success:
Eff 1: Allied Health Professional
¾ >90% of children (age 0-4) in care receive
Interventions
a comprehensive health assessment every
Aim: To demonstrate improvement following
6 months.
therapy interventions.
¾ >90% children (age 4-16) in care receive a
Measures of success:
¾ Identify appropriate therapy outcome
comprehensive health assessment every
measures at service level.
12 months.
PSI 1: Falls
¾ Establish baseline data.
Aim: To reduce the incidence of falls and
¾ 10% improvement on baseline date by the
end of the 2011/12 financial year.
prevention of harm from falls.
Measures of success:
Eff 2: Pressure Ulcers
¾ >90% of patient contacts >65 years
Aim: To improve the management of pressure
offered assessment evidenced by
ulcers.
documentation.
Measures of success:
¾ >95% of grade 2 or above pressure ulcers
¾ >90% of patients with a score of 3 or
more on the FRAT offered a multi-
show no deterioration whilst in the care of
factorial assessment.
CSU services.
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¾ Establish baseline ratio of patients
Eff 6: Community Rehabilitation
acquiring a pressure ulcer whilst in the
Aim: To support people to live independently
care of CSU services.
in the community.
¾ Reduce the incidence of acquired pressure
Measures of success:
¾ Percentage of patients with mobility
ulcers whilst in the care of CSU services.
Eff 3: Catheter Management
fractures recovering to their previous
Aim: To improve in-dwelling catheter
levels of mobility/walking ability at (i) 30
management.
days and (ii) 120 days.
¾ Percentage of older people (>65) who are
Measures of success:
¾ >90% patients with in-dwelling urinary
still at home 91+ days after discharge from
catheters have had a full catheter
hospital into rehabilitation services
assessment including consideration of a
(intermediate care and neuro rehab
trial without catheter.
service).
¾ Improvement on baseline measure.
¾ Establish baseline number of patients
acquiring a urinary tract infection whilst in
¾ Receipt of CQUIN payment.
the care of CSU services.
Monitoring and Reporting
Eff 4: Long Term Neurological Disease
Each of our quality improvement prioritises
Aim: To improve the co-ordination of care for
will be proactively monitored utilising the
people with neurological disease.
identified measures for success.
Measures of success:
Progress reports will be submitted on a
¾ > 95% of people on a rehabilitation
monthly basis to the Clinical Quality Review
pathway have in place an integrated care
meetings. These meetings are held with our
plan.
Commissioners and are accountable for
Eff 5: Dementia
monitoring compliance with our contractual
Aim: To contribute to the holistic management
requirements.
of Dementia.
Progress reports will also be submitted to
Measures of success:
the Governance and Risk meetings. These
¾ Screening tool implemented across home
meetings are chaired by our Divisional
Director (previously known as the Chief
based services.
¾ Onward referral pathway in place.
Operating Officer) and attended by the
¾ > 80% of people with dementia have Care
senior management team.
We will share our progress with staff
plans in place.
¾ Receipt of CQUIN payment.
through regular features in our CSU
newsletter.
Page 37
Comments on Our Quality Account
Opportunity to Shape the Content of our
Comment made by Helen Bellairs CEO
Quality Account
NHS Warrington
Prior to our quality account being drafted our
The community provider unit has made some
Chief Operating Officer wrote to the;
excellent progress this year in some
¾ Chair of the Overview and Scrutiny
exceptionally challenging circumstances.
They have put patient safety and quality at the
Committee
¾ CEO of NHS Warrington
forefront of everything they have done and at
¾ CEO of Warrington and Halton Hospital
the same time met challenging financial
Foundation Trust
targets.
¾ CEO of the Local Authority
I am confident that the Community Services
¾ Chair of Warrington Health Consortium
Unit will continue to develop and improve their
high quality care to the residents of
Board
¾ LINKs Manager
Warrington and I wish the Community
inviting them to provide suggestions regarding
Services Unit continued success now that
the information they would like to see
they have made the transition into the new
included. We received no suggestions
community Trust.
following this letter.
Comment made by Warrington LINk
Comments by NHS Warrington, Warrington
Local Involvement Network (LINk) and
LINk Involvement
The Warrington LINk has a good relationship
Overview and Scrutiny Committee (Health
and Well-Being)
with the CSU PALS Officer. When comments,
issues and enquires are received by the LINk
Comments made by PCT’s, LINk and
the PALS Officer responds in a timely manner
Overview and Scrutiny Committees are seen
as key to the Quality Accounts assurance
with an appropriate response.
Transforming Community Services
process. Assurance is required to ensure that
the information in our Quality Account is
The LINk have been involved in transforming
community services by way of membership of
accurate and fairly interpreted.
NHS Warrington/ Community Services
Prior to its publication a copy of our Quality
Committee, planning for the future
Account was sent to the above organisations
on 9/5/11.
management of community services in
Warrington. Further involvement is reviewing
the service specifications for individual
services and discussions regarding the future
management of individual services.
Page 38
Comments Received
As a result of this complaint changes have
The main comment received regarding the
been made as follows:
CSU regards Wolves Healthcare Centre. The
¾ Patients contact details are extracted
main issues were:
from a national database thus ensuring
¾ Poor communication from 1st appointment,
we have accurate contact details.
¾ Improved recording of discussions
biopsy to the sharing of information.
¾ No discussions around a future care
following Multidisciplinary Team
pathway.
Meetings to ensure clear
¾ Slow in acting upon information
understanding of agreed actions.
¾ Causing unavoidable worry and confusion
¾ Very poor in house referral system
¾ Improved provision of cover for the
Clinical Nurse Specialist.
¾ Because of mistakes lengthy unnecessary
A full apology was given to the patient as part
time scale to referral to specialist.
¾ Continuous clerical mistakes and lack of
of the response to the complaint. However,
onward referral to secondary care remained
communication.
¾ Breaches of patient confidentiality (letters
within agreed national timescales.
going to wrong addresses)
A formal complaint was made and investigated.
Comment made by Overview and Scrutiny
Committee (Health and Well-Being)
Our Response to the Comment made by
We received no comments from the
Warrington LINk
Warrington Overview and Scrutiny Committee
In response to the issues raised by LINks we
(Health and Well-Being).
acknowledge that administrative errors were
made in relation to a patient attending our
dermatology service based at Health Services
at Wolves.
These errors resulted in letters being sent to
the wrong address and also a breakdown in
communication following a Multidisciplinary
Team Meeting. Subsequently the patient was
sent an appointment for the wrong clinic and
as a result the patients’ consultation was
rushed and not of the standard we expect
from our services.
Page 39
Would You Like to Make a Comment on
Our Quality Account?
We would very much appreciate feedback on
the content of our first quality account so that
we can improve the next edition.
¾ Did you find the information provided
useful?
¾ Was it written in a way that you could
understand what was being said?
¾ Is there anything that you would like to
see included in our next quality
account?
You can provide your comments by contacting
Andrea Melbourne on 01925 867726 or via email at:
Andrea.Melbourne@warrington-pct.nhs.uk
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