Provider Services Quality Account 2010/11
Provider Services Quality Account 2010/11
1
Provider Services Quality Account 2010/11
Contents
5
Introduction
6Statement from the Director of Provider
Services
Section 1 - Priorities for
Improvement for next year
9
Priorities for Improvement for Next Year
10Priority 1 - Transition from Child and
Adolescent Mental Health Services to
Adult Mental Health Services
11
Priority 2 - Recovery
12
Priority 3 - Dementia
13
Priority 4 - Nutrition
Section 2 - Statement of
Assurance from the Board
16
Review of Services
19
Participation in Clinical Audit
20
Participation in Clinical Research
21
Goals Agreed with Commissioners
24
Statement from the CQC
26Data Quality and Clinical Coding Error
Rate
27Information Governance Toolkit
Attainment Levels
Section 3 - Review of Quality
Performance from Last Year
Patient Safety:
29
Clinical Incidents
33
Infection Control
34
Safeguarding
2
Patient Experience:
35
Introduction
36
Patient Environment Action Team (PEAT)
37
NHS Choices
37 Patient Surveys
40
Complaints and Compliments
45Health Service Ombudsman Care and
Compassion Report: Our Response
46
Equalities
Clinical Effectiveness:
47
Local Clinical Audit
49The West Midlands Quality Review Service
(WMQRS)
50Quality Conference - Recognising Good
Quality Care and Learning from Each
Other
Staff Experience:
51
In Brief
52
Staff Survey
53Staff Annual Development Review (SADR)
Rate
54
Staff Awards Evening
Section 4 - Statements
55Statement from Local Involvement
Networks (LINks)
57Statement from Health Overview and
Scrutiny Committee (HOSC)
58
Statement from NHS Worcestershire
Section 5 - How to Contact Us
Provider Services Quality Account 2010/11
3
Provider Services Quality Account 2010/11
Introduction
Welcome to Worcestershire Primary Care Trust Provider Services quality
accounts for 2010/11. This account sets a measure of the quality of
care we have delivered to patients and service users over the past year,
illustrating where we have performed well and where we need to improve.
Worcestershire Primary Care Trust Provider
Services aims to provide the highest possible
quality of community health services in
Worcestershire at all times.
• Wheelchair and Equipment Loans
• School Health Nursing
Worcestershire Primary Care Trust has a
population of around 553,000 and WPCT
Provider Services is by far the largest provider of
healthcare in the County.
• Children’s Community Nursing and Home Care
Support
The wide range of services we provided
across Worcestershire over the last year
include:
• Community Hospitals in Malvern, Pershore,
Evesham, Bromsgrove, Tenbury, and Wyre
Forest GP Unit
• Prison Healthcare in HMP Hewell and HMP
Long Lartin
• Sexual Healthcare and Genito-urinary Medicine
• Palliative Care Services
• Stroke Care Services
• Dental Services including 6 Dental Access
Centres across the county
• District Nursing
• Community Matrons
• Intermediate Care
• Physiotherapy
• Podiatry
• Occupational Therapy
• Breast Screening
• Continence Service
• Nurse Advisors for older people
• Specialist Nurses for conditions such as
diabeties, tuberculosis, chest diseases
• Speech and Language Therapy
4
• Children’s Development and Assessment
Centres
• Children’s Respite
• Children and Young Peoples Mental Health
Service
• Community Paediatricians
• Health Visiting
• Children’s Audiology
• Young Persons Substance Misuse Services.
We would welcome your views on our quality
accounts. There is a tear-off section on the last
page that you can send in to let us know how we
could make next year’s account better.
Provider Services Quality Account 2010/11
Statement from the Director of
Provider Services
The quality of patient care and improving that quality for the benefit of
our patients and for the public we serve is fundamental to us and is at
the heart of everything we do.
only through being transparent about the quality
of care we provide and listening to feedback
from the people we serve that we can ensure
the continuous improvement of the services we
provide.
The organisation achieved notable successes
during 2010/11. The organisation was
shortlisted for no less than three awards
at the Health and Social Care Awards 2010
(West Midlands), more than any other
organisation in the West Midlands. We were
shortlisted for three categories:
• Success in partnership working
• Support for independence
• Offender health care award.
Teresa French - Director of Provider Services
In this, our organisation’s final year, our results
have been outstanding in every area; finance,
performance and most importantly quality- as
I hope will be demonstrated in the following
pages. This is the first year we have been
required to publish a Quality Account and we
welcome this opportunity to demonstrate our
commitment to delivering the highest possible
quality of care to our patients. We have engaged
widely with patients, staff, partner organisations
and the public to help us understand how we can
best provide the highest quality of services in the
future, and of course importantly to ensure that
we learn from our experiences. We have strived
to create an open culture that values knowing
where we are in terms of the quality of care we
provide, learning from events when things go
wrong and rewarding high performing teams
who demonstrate continuous improvement. It is
I am delighted that we won the offender health
care award.
External reviews of our stroke services and breast
screening service highlighted the excellent
quality of both of these services with the CQC
review confirming that our stroke services were
in the best performing category and in relation
to breast screening services the overall uptake
rate was the best in England. This recognition
highlights the innovative way we are promoting
and embedding best practice into the everyday
working life of the organisation.
We recognise that the provision of high quality
care requires investment in buildings and
equipment to ensure that patients received
services in a clean and well kept environment
delivering benefits to both patients and staff.
This has been an area of particular focus during
the last year. The annual Patient Environment
Action Team (PEAT) inspections assess each
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Provider Services Quality Account 2010/11
hospital in areas including cleanliness, hygiene,
privacy and dignity, access, signage, patient
information, food quality and service. This year
results were outstanding. Each hospital is scored
in each of five categories, five of the six hospitals
received excellent in every category with Tenbury
Community Hospital scoring excellent in every
category except environment which was rated
as good. We expect Tenbury too will receive an
excellent rating with the opening of the new
extension in August 2011.
I am delighted that such exceptionally high
standards were recorded in all areas. We cannot
rest on our laurels though and are planning to
roll out PEAT inspections into other community
services in order to further improve patient
experience.
We were also subject to unannounced inspection
visits to four of our community hospitals earlier
in the year by the Care Quality Commission. The
robust and rigorous inspection culminated in a
report confirming that the hospitals were rated
with no concerns in 13 of the 14 measures. We
were delighted with the overall results of the
report but as always with these inspections there
is learning to be gained and an action plan has
been agreed to ensure that the single area of
minor concern is rectified.
The new Malvern Hospital was formally opened
by HRH The Princess Royal in February 2011
and has provided the people of Malvern with
a hospital for the 21st Century of the highest
quality providing more improved patient privacy
and dignity. I am delighted to say that the
hospital has been nominated for two national
design awards whilst the organisations work in
relation to same sex accommodation throughout
all of our community hospitals has been cited as
an area of good practice by the West Midlands
Strategic Health Authority.
The provision of high quality care relies heavily
6
on having well trained, highly qualified
and motivated staff with staff training and
development being the key to success. There
have been a number of initiatives designed to
support the training and development of our
staff, including a new training facility opened on
the Evesham Hospital site and the establishment
of an apprenticeship programme which was
recognised for its excellence at the Annual
Chamber of Commerce Awards.
To support our commitment to improving
the quality of patient care our governance
structures have undergone a strengthening
process over the past year. We have developed
our own Patient Quality and Safety Committee
chaired by a Non-executive Director. We also
hold performance reviews for each of the
Business Units every quarter. These reviews are
an essential way of assuring the Trust Board
that high quality care is being delivered by our
services and to ensure that any risks to quality
are brought to the attention of the Trust Board.
1st July will see the majority of our services
transferred to the newly established
Worcestershire Health & Care NHS Trust. I am
confident that the establishment of the new
organisation is the best way forward for staff,
patients and the public in Worcestershire. The
exceptionally high standard of care delivered
by this organisation has set the benchmark for
the future. I am confident that staff in the new
organisation will continue to deliver an even
better quality of care and I wish them and the
new organisation all the best for the future.
I confirm to the best of my knowledge and
belief that the information in this document is
accurate.
Teresa French
Director of Provider Services
Provider Services Quality Account 2010/11
Section 1
Priorities for Improvement
for Next Year
77
Provider Services Quality Account 2010/11
Section 1 - Priorities for Improvement for Next Year
A number of engagement events have been held
where patients/service users, carers, staff, service
commissioners and members of the public have
been consulted on proposed quality priorities for
the new organisation for 2011/12. The priorities
chosen include two key areas- transition and
dementia care - where we believe we could
enhance care and treatment to patients/service
users as a consequence of bringing these services
together, whilst also ensuring that existing
commitments are honoured.
The four areas that have been jointly
selected as priorities for improvement for
the new Trust in 2011/12 are:
• Transition from Child and Adolescent Mental
Health Services to Adult Mental Health Services
• Dementia care
• Recovery and
• Nutrition
We will monitor our performance against these
priorities and share our progress with you in
early 2012. We hope that over the coming years
the Quality Account will become a key public
document which confirms our commitment
to the quality of care and our delivery of key
priorities. I also hope it will encourage open
dialogue about how we can constantly improve
the quality of the care and support we provide
to improve outcomes for our patients and service
users.
Sarah Dugan
Chief Executive Designate
Worcestershire Health and Care Aspirant NHS
Trust
The table below shows the groups, organisations and mechanisms we have involved in
producing this Quality Account:
Stakeholders
Group/Mechanism
Service Users, Patients, Carers and local voluntary
organisations
Partnership Forum
Carers’ Forum
Local Involvement Network
Transforming Community Services events
Staff
Monthly Staff Briefings
Emailed notices to staff
Senior Management Team meetings
Business Unit Quality Meetings
Quality Conferences
Commissioners (NHS Worcestershire)
Monthly review meetings between NHS Worcestershire
and the providers
Invitation to comment on accounts
Non-Executive Directors, Governors and Members
Membership Matters
Board Meetings
Quality Meetings
Other Partners
HOSC
West Midlands QI
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Provider Services Quality Account 2010/11
Priority 1: Transition from Child and Adolescent Mental Health
Services to Adult Mental Health Services
Domain:
What we want to
achieve:
How we are going to do
it:
What success will look
like:
Clinical
Effectiveness
Ensure the clinical protocol
for transition from Child &
Adolescent Mental Health
Services (CAMHS) to Adult
Mental Health Services is
embedded
Establish a database to
record transition
arrangements for all 17-year
olds in CAMHS
All young people who will
transfer to Adult Mental
Health Services will have
appropriate transition
arrangements in place
Patient Safety
Transition to Adult Mental
Health Services will be well
planned in order to ensure
consistently safe and
appropriate clinical care to
achieve the best outcomes
Increase the proportion of
Young people transferring
young people aged 17½ to to Adult Mental Health
18-years, receiving CAMHS Services will do so safely
support who have a
transition care plan (or exit
strategy plan as appropriate)
as a result of a transfer
meeting
Patient Experience
Continuous service
improvement
The processes involved in
transition will be audited
and action plans will be fed
into the review of the
transition from CAMHS to
Adult Mental Health
Services policy
Report monthly to CAMHS
and Adult Mental Health
Service commissioners on
the current and likely mental
health and care needs of
each person
Young people transferring
to Adult Mental Health
Services from CAMHS will
experience an improved
level of service delivery
9
Provider Services Quality Account 2010/11
Priority 2: Recovery
Domain:
What we are going to do: How we are going to do
it:
What success will look
like:
Clinical
Effectiveness
Roll-out outcome measures
such as Recovery Star and
the Carers’ and Users’
Expectations of Services
(CUES) tool
Train appropriate staff to
use outcome measures
Service users and key
workers will be able to
monitor progress towards
goals
Complete outcome
measures within 6-months
of starting to receive mental
health services
New service users will have
completed an outcome
measure within 6-months of
starting to receive mental
health care
Demonstrate improved
outcomes
Complete outcome
measures on a regular basis
(no less than annually) and
on discharge from services
10
Provider Services Quality Account 2010/11
Priority 3: Dementia
Domain:
What we want to
achieve:
How we are going to do
it:
What success will look
like:
Patient Experience
Build staff skills and
confidence in working with
service users who have a
dementia
Train staff in line with the
projections from the Health
Economy Training Needs
Analysis undertaken in
2010/11
Service users will have a
better experience by us
ensuring safe and effective
care is given
Work with and support
General Practitioners (GPs)
in assessing for early signs
of dementia
GP’s will be better able and
more confident in assessing
for early signs of dementia
using a cognitive
behavioural tool
Clinical
Effectiveness
Ensure referrals to the Early
Intervention in dementia
service are appropriate and
timely
Introduce a standard
cognitive behavioural tool
that GP’s can use to assess
people prior to referral
Clinical
Effectiveness
Reduce the inappropriate
prescribing of antipsychotic
medication in service users
with dementia as detailed in
‘Time for Action’ 2009
More health professionals
will be able to communicate
clearly and effectively with
service users and their carers
regarding dementia.
Fewer inappropriate referrals
will be made to the Early
Intervention in Dementia
service
Review and audit the
More appropriate
prescribing of antipsychotics prescribing of antipsychotic
for service users with
medication
dementia
11
Provider Services Quality Account 2010/11
Priority 4: Nutrition
• This was a popular choice when we consulted the public, patients and staff on which priorities we
should choose
• Food and water are essential elements of care - as vital as medication and other types of treatment
• One of the Department of Health’s ‘High Impact Actions’ is to stop inappropriate weight loss and
dehydration in NHS provided care
• The body’s immune system is highly dependent on nutritional status. Research shows malnourished
patients experience longer stays in hospital
• Nutrition Now is a national clinical campaign launched by the Royal College of Nursing to raise
standards of nutrition and hydration in hospitals and the community. This campaign gives nurses
the practical tools, support and evidence they need to make nutrition a priority in the area where
they work
• There is widespread public concern regarding patients who are unable to feed themselves when
they are in hospital.
Domain:
What we want to
achieve:
How we are going to do
it:
What success will look
like:
Patient Safety and Patient
Experience
All staff will know the
process for anticipating,
minimising, recording and
reporting nutritional risks to
patients, clients and service
users
Develop and implement a
trust wide Nutrition Policy
and monitor its
implementation
Patients, clients, service
users, carers and staff will
have agreed standards,
principles and practices to
work with
Clinical Effectiveness
To monitor patients weight
during their hospital stay
and identify weight loss
early on
Make sure all patients are
weighed when they are
admitted to hospital and are
weighed at least once a
week whilst they are in
hospital
100% of inpatients are
weighed on admission to
hospital
All patients to have a
nutrition assessment
undertaken when they are
admitted to hospital
100% of patients will have
a nutritional assessment
completed on admission to
hospital
This will include establishing
patients like and dislikes
Patients will be able to have
the kind of food they like
To prevent malnutrition for
those patients who have
been identified as at risk
Develop and implement a
trust-wide nutrition care
plan for those patients who
are identified as at risk of
malnutrition
100% of patients who have
been identified as at risk of
malnutrition will have an
agreed plan in place to
prevent malnutrition
Increase the number of
referrals to the Health
Trainers from the
community for help with
managing weight
Patients, clients or service
An increase in the number
users who would like to lose of referrals to the Health
weight receive support and Trainers
help to do so
Clinical Effectiveness and
Patient Experience
To be able to detect those
patients who need extra
nutritional support and care
To ensure that all aspects of
nutrition are taken into
account and acted upon in
the context of the person’s
individual needs and wants
Clinical Effectiveness
12
100% of patients are
weighed once a week during
their hospital stay
Provider Services Quality Account 2010/11
Patient Experience
Patients to enjoy mealtimes
and food
Ensure that the Protected
Mealtime Policy is
implemented in all wards
Clear signs in every ward
setting out the Protected
Mealtimes principles
Promote awareness of policy Patient representatives to
to staff and visitors
audit wards to check for
uninterrupted meal times
Involve carers in helping us
to ensure that patients have Regular patient feedback
access to food they enjoy
regarding the quality and
variety of food on offer
Respond to patient
feedback regarding
the quality of meals by
liaising with the catering
department
Introduce red tray and red
Vulnerable patients will
jug system on wards,
receive help to eat and
whereby those patients who drink
are most vulnerable are
easily identified as needing
extra help
Red trays and jugs apparent
on wards are used
appropriately
13
Provider Services Quality Account 2010/11
Section 2
Statement of Assurance
from the Board
14
14
Provider Services Quality Account 2010/11
Section 2 - Statement of Assurance from the Board
Review of Services
During 2010/11 Worcestershire PCT Provider Services have provided
and/or sub-contracted five NHS Services. These are:
• Children’s Services
• Community Therapy Services
• Community Hospitals
• Adult Community Services
• Prison Health Services.
Provider Services’ Quality and Safety Committee
provides assurance to Worcestershire PCT
Provider Board on the quality and safety of
services delivered.
The income generated by the NHS Services
reviewed in 2010/11 represents 100% of the total
income generated from the provision of NHS
Services by Worcestershire PCT Provider Services
for 2010/11.
Worcestershire PCT has reviewed all the data
available to them on the quality of care in all of
these services.
The Lead Nurse Provider Services / Associate
Director of Nursing and Therapies is responsible
for ongoing monitoring of a quality dashboard
with indicators taken from the Safety,
Effectiveness and Patient Experience domains,
which is presented to the Provider Board each
quarter. The dashboard covering the four
quarters for 2010/11 is presented on the next two
pages.
Key to the dashboard:


Full compliance
Partial compliance against some
indicators


Insufficient assurance
Not applicable or other reason
stated
Definitions/further information
Never Events are serious but largely preventable
patient safety incidents that should not occur if
preventative measures have been implemented.
The list of Never Events is:
• wrong site surgery
• retained surgical instruments
• wrong-site chemotherapy
• misplaced naso-gastric tube
• inpatient suicide with non collapsible rails
• escape from secure mental health services
• in hospital maternal death from post-partum
haemorrhage
• intravenous administration of mis-selected
Potassium Chloride.
High Impact Actions- these are 8 measures
promoted by the Chief Nursing Officer for
England that nurses and midwives have agreed
that if fully implemented could substantially
transform care and help reduce costs. They are:
• Skin Matters (reduction in pressure ulcers)
• Staying Safe (preventing falls)
• Keeping Nourished (preventing malnutrition in
hospital)
• Promoting normal birth
• End of Life Choices (where to die when the end
comes)
• Reducing sickness absence among nurses and
midwives
• Ready to Go (more effective patient discharge)
• Protection from Infection.
15
16
Clostridium difficile: within set targets
Compliance with Hygiene Code
All Serious Incidents (SI) are reported to SHA, Provider Board, Risk
Committee and to commissioners including investigation reports
and where appropriate, Root Cause Analysis reports
All Serious Incidents are subject to investigation or Root Cause
Analysis and taken for discussion to the Risk Committee prior to
closure and further reported to Provider Board
Evidence to show that process in place to prevent Never Events
from occurring (description of never events below)
Reports on clinical incidents and SIs, including categories, trends,
evidence of actions taken to business units, Provider Quality &
Safety Committee (PQS) and other relevant committees
Lessons to be learned form SIs and Clinical Incidents are shared
with all clinical staff
Process in place to disseminate NPSA/SABS alerts and evidence
that actions are taken as required
Provider Services Risk Register is populated, maintained and
reviewed bi-monthly
Safeguarding processes in place to support agreed countywide
policies and procedures.
Standard operating procedures are in place for prescribing,
administration, storage, procurement and disposal of medicines
2
3
4
5
6
7
8
9
10
11
12
Patient/carer surveys undertaken in line with local and national
initiatives
Process in place to manage complaints/PALS including
classification and compliance, actions taken, and evidence to
show that lessons are being learnt and service changes
13
14
Domain 2- PATIENT EXPERIENCE
MRSA bacteraemia within set targets
1
Domain 1- PATIENT SAFETY
QUALITY INDICATOR
Q2
Q3
Q4
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

Identified need for more detailed analysis of compliments in future
NPSA- National Patient Safety Agency









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Process for cascade to be evidenced at PQS and senior managers
monitoring visits needs to assess the level of knowledge / learning across
the frontline staff
‘Safety Matters’ newsletter recently introduced on bi-monthly basis
Regular alert notices go out to all provider services staff via the Safety
Alert Bulletin (SAB) distribution process
No Never Events have occurred in Provider Services. We are currently
assessing relevance of newly published Never Events for new
organisation
A robust action plan was implemented to address the ‘Minor Concern’
judgement following CQC unannounced visit in May 2010 to ensure
continued improvement and compliance with the Hygiene Code. The
action plan was submitted to the CQC as requested
COMMENTS
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Q1
Provider Services Quality Account 2010/11
Demonstrate active application of 8 High Impact Actions (HIAs)
16
Provide assurance regarding compliance with single sex
accommodation
Public/patient engagement in decision making processes which
effect delivery of services
Measures in place to promote equality and diversity (E&D) across
the organisation
18
19
20
Care Quality Commission (CQC) registration compliance subject to
regular monitoring and reviewed.
Assessment of and implementation of NICE Guidance and
Technology Appraisals
Process in place to provide assurance that all staff are aware of
how to access clinical policies relevant to their clinical practice
Process in place to demonstrate attendance at mandatory training
programmes and a process for management of non-attendance
Annual Training Plan in place reflecting training requirements of
non-medical and dental staff and evidence to show that training
is being delivered as per plan
Continuous Professional Development Plan for Medical and
Dental staff in place and evidence to show that training is being
delivered as per plan
Workforce plan in place and reported to the commissioners on
annual basis with periodic review
Outcomes of staff surveys have associated actions plans in place
Evidence that a clinical audit plan is in place and that monitoring
of audits being undertaken in all services as per plan
21
22
23
24
25
26
27
28
29
Domain 3- CLINICAL EFFECTIVENESS
Process in place to carry out PEAT inspections and evidence of
action plans for improvements
17
Description of High Impact Actions below
Process in place to evidence that lessons are being learned
and service changes affected where required resulting from
complaints/PALS
15
QUALITY INDICATOR
COMMENTS
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
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Compliance group set up and audits undertaken
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
Information on individuals personal development plans for medical and
dental staff is currently being collated
OLM System linked to Electronic Staff Record (ESR) now in use to record
all attendance at mandatory training
Mandatory training list produced for staff and opportunities for
e-learning maximised
‘Outcome Owners’ now established in each clinical service who declare
their level of compliance on web-based dashboard every 3 months. All
have compliance templates
Check visits and audits also undertaken to scrutinise assurance
Identified area that needs improving. Opportunities to be maximised
from new organisation
PPI representation at Provider Board, PQS, Clinical Policies group, Area
Prescribing Committee and Community Hospitals Committees, but room
for enhancing public involvement
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HIA workshop held on 8 October 2010 in which there was representation
from clinical specialists, finance, information, clinicians to agree a way
forward and action plan
HIA Champions now identified and groups formed to take work forward
Q4

Q3
Need to assess the level of knowledge / learning from complaints/PALS
across the frontline staff
Q2

Q1
Provider Services Quality Account 2010/11
17
Provider Services Quality Account 2010/11
Participation in Clinical Audits
During 2010/11 four national clinical audits and no national
confidential enquiries covered NHS services that Worcestershire Primary
Care Trust Provider Services provides.
During that period Worcestershire Primary Care
Trust Provider Services participated in 100% of
national clinical audits which it was eligible to
participate in.
It should be noted that national clinical audits
currently focus on areas of Acute Health
Care and very few are relevant to community
providers. Worcestershire Primary Care Trust
Provider Services however recognises the
importance of participation in national audits
and endeavours to support our Acute Trust
partners in collecting primary care data wherever
we can.
We have our own internal annual clinical audit
plan whereby each service must undertake at
least one clinical audit each year that is relevant
to their area of practice. Further details are given
in section 4 of these accounts.
The national clinical audit that
Worcestershire Primary Care Trust Provider
Services was eligible to participate in
during 2010/11 is as follows:
National Falls and Bone Health Audit
The national clinical audits that Worcestershire
Primary Care Trust Provider Services participated
in, and for which data collection was completed
during 2010/11, are listed below alongside the
number of cases submitted to each audit as a
percentage of the number of registered cases
required by the terms of that audit or enquiry.
National Falls and Bone Health Audit
We supported Worcestershire Acute Hospital
18
Trust in identifying interventions in Primary Care
in their 120 cases from this audit.
The report of one national clinical audit was
reviewed by the provider in 2010/11 and
Worcestershire Primary Care Trust Provider
Services intends to take the following
actions to improve the quality of healthcare
provided:
As a result of taking part in last year’s national
Continence Audit and reviewing the findings
from the reports, the Continence Service has
reviewed the pathway documentation, reviewed
the content of the current training package and
included High Impact Actions to re-examine
specific quality indicators.
The reports of 80 local clinical audits were
reviewed by the provider in 2010/11 and
Worcestershire Primary Care Trust Provider
Services intends to take the following
actions to improve the quality of healthcare
provided:
We intend to further enhance our monitoring
of the implementation of action plans arising
from all clinical audits by increasing the
level of scrutiny into the evidence of change
management. This will be monitored through
performance reports, re-audit and analysis of
patient feedback.
Further detail regarding local clinical audit can
be found in Section 3 of these accounts.
Provider Services Quality Account 2010/11
Participation in Clinical Research
During 2010/11 support for all research and development in
Worcestershire PCT Provider Services was co-ordinated through a
Service Level Agreement with the Comprehensive Local Research
Network (CLRN). CLRN ensures compliance with the Department of
Health’s Research Governance Framework.
Whilst the Chief Executives remains accountable
for research governance, this management
arrangement allows the Trust to benefit from a
single system for overseeing research projects,
enabling us to approve projects quickly, reduce
delays and encourage clinicians to engage in
research.
A Research Group chaired by NHS Worcestershire
(the commissioning side of our organisation)
held responsibility for approving all research
projects initiated by staff in Primary Care and
Provider Services.
All assurance processes for research are
completed by the team at the CLRN in advance
of seeking approval with NHS Worcestershire.
The number of patients receiving NHS services
provided or sub-contracted by Worcestershire
PCT Provider Services from April 2010 to March
2011 that were recruited during that period to
participate in research approved by a Research
Ethics Committee was 508 (source: CLRN).
19
Provider Services Quality Account 2010/11
Goals Agreed with Commissioners
Over 2010/11 we were actively involved with NHS Worcestershire in
setting local goals for improving the quality of our services through
the CQUIN (Commissioning for Quality and Innovation) Payment
Framework.
The agreed targets, which are set out in the
table below, were chosen for a number of
reasons:
the schemes that were agreed with NHS
Worcestershire for 2010/11, the targets that were
set and our end of year results.
• To address the areas where we have the highest
number of patient safety incidents reported
(falls, medication errors and pressure ulcers)
• To address priorities for health improvement
across the wider local economy (use of tobacco)
• To address areas that are known to concern the
public (nutrition)
• To find out from patients what they think of
our services (patient survey)
• To link in with national quality improvement
initiatives such as ‘High Impact Actions’ and
‘Essence of Care’.
For most of the CQUINs we undertook a baseline
audit in the first part of the year to establish
our starting base. We then introduced changes
in clinical practice to improve the quality of
our services such as awareness raising, training,
improvement of documentation, and then
re-measured during the year to see if the
changes we were implementing were producing
improvements in quality. We were required to
report our progress to our commissioners at the
end of every 3 months during the year. Although
we are proud of our achievements, we recognise
that the good work that has been done must
continue and further improvement is still
needed. We aim to have all of our achievement
scores at 100% all of the time.
A proportion of Worcestershire Primary Care
Trust Provider Services income in 2010/11 was
conditional on achieving quality improvement
and innovation goals agreed between Provider
Services and Worcestershire NHS which
were 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 www.institute.nhs.uk/
world_class_commissioning/pct_portal/cquin.html
The table on the page opposite shows
20
Further details of the audits that were
undertaken as part of the CQUIN programme
are given in the Clinical Audit and Patient Safety
sections of these accounts. Further details of the
CQUINs will also be available on our website.
A patient experience survey was also undertaken
in 2010/11 as part of the CQUINs. A separate
report setting out the findings is provided in the
Patient Experience of these accounts in section 5.
Provider Services Quality Account 2010/11
No
CQUIN Goal description
Target for
year end
Achievement at
year end
1
Smoking Cessation
Percentage of patients attending selected outpatient clinics recorded as smokers /
users of tobacco products who receive a brief intervention to reduce their tobacco
use
75%
90%
2
Tissue Viability
Percentage of inpatients in Community Hospitals with documented assessment of
risk of developing a pressure ulcer
95%
95%
3
Tissue Viability
Percentage of inpatients in Community Hospitals identified as being at risk of
ulceration who have an action plan to prevent or treat the ulcer
90%
94%
4
Tissue Viability
Percentage of patients under the care of District Nurses with documented
assessment of risk of developing a pressure ulcer
90%
99%
5
Tissue Viability
Percentage of patients under the care of District Nurses identified as being at risk of
ulceration who have an action plan to prevent or treat the ulcer
98%
100%
6
Tissue Viability
Percentage of ulcerations of Grade 2, 3 or 4 recorded as an incident on the
appropriate system- Community Hospitals
90%
100%
7
Tissue Viability
Percentage of ulcerations of Grade 2, 3 or 4 recorded as an incident on the
appropriate system - District Nursing
90%
96%
8
Tissue Viability
Percentage of patients with pressure sore where there is a deterioration in the
grading of the sore and this is recorded on the appropriate system- Community
Hospitals
90%
100%
(relates to
one ulcer)
9
Tissue Viability
Percentage of patients with pressure sore where there is a deterioration in the
grading of the sore and this is recorded on the appropriate system- District Nursing
90%
100%
(relates to
4 pressure
ulcers)
10
Reduction of Falls
Percentage of patients who have a falls assessment completed on admission to
community hospital using a nationally recognised tool
90%
91%
11
Reduction of Falls
Percentage of in-patients identified at risk of falls having an individualised falls care
plan implemented
90%
90%
12
Reduction of Falls
Percentage of patients referred to the Nurse Advisors for Older People who have a
‘level 2’ falls assessment initiated through a face to face contact within 10 working
days of referral. The measure for this CQUIN was only required for the time period
during February and March 2011
25%
35%
13
Nutrition
Percentage of patients have a nutrition assessment completed on admission to
community hospital
95%
99%
14
Nutrition
Percentage of in-patients identified as at risk who have an individualised nutrition
care plan in place
90%
91%
15
Nutrition
Percentage of patients who have a nutrition assessment completed on initial contact
with District Nurse team
90%
99%
21
Provider Services Quality Account 2010/11
No
CQUIN Goal description
Target for
year end
Achievement at
year end
16
Nutrition
Percentage of District Nurse patients indentified as at risk who have an individualised
nutrition care plan in place
50%
100%
17*
Medicines Management- Missed Doses
Percentage of number of instances where there was failure to administer prescribed
medicines as a result of non-availability of the medicine
17%
24%
18
Reducing the Prevalence of Smoking in Families with Young Children
Percentage of new families in contact with the Health Visiting service where the
smoking/tobacco use of the mother (and father where present in the household) is
recorded
95%
97%
19
Reducing the Prevalence of Smoking in Families with Young Children
Percentage of smokers/tobacco users in contact with the Health Visiting service
receiving a brief intervention (as per NICE guidance) to reduce tobacco use including
being given written advice
75%
98%
*Medicines Management - Missed Dose CQUIN explained:
The National Patient Safety Agency (NPSA) highlighted incidents where delays in obtaining, and
therefore administering medicines when patients are in hospital could cause harm to the patients.
The NPSA suggested a list of drugs where it is critical to avoid delays in dosing particularly for longer
than 24 hours.
The CQUIN target unfortunately only measured the percentage of patients with a delayed dose and
did not take into account for how long the dose was delayed and whether the drugs were critical.
The audit undertaken however did measure this and 6 out of every 100 patients in the community
hospitals at the time of the audit experienced a delayed dose of a critical drug; less than 2 in every
100 patients experienced a delay of a critical drug for more than 24 hours. Despite there not being a
pharmacy on site in the community hospitals, the organisation is continuing to work hard to ensure
such critical drugs are never delayed.
22
Provider Services Quality Account 2010/11
Statement from the CQC
The Care Quality Commission (CQC) is the health and social care
‘watchdog’ in England. It is a powerful organisation that has the right
to inspect any service at any time without warning. The CQC can
enforce significant penalties if it finds that services do not measure up
to legal standards of quality and safety.
Worcestershire Primary Care Trust Provider
Services is required to register with the Care
Quality Commission and its current registration
status is full registration without conditions.
The Care Quality Commission has not taken
enforcement action against Provider Services
during 2010/11.
Provider Services has participated in
special reviews or investigations by the
Care Quality Commission relating to the
following areas during 2010/11:
• Unannounced inspection of the Community
Hospitals under Regulation 12 (Prevention and
Control of Infections)
• Review of Stroke Services
Community Hospital Inspection
The CQC state on their website (CQC.org.uk):
“We performed an unannounced inspection on
25th May 2010 to assess whether Worcestershire
Primary Care Trust is adequately protecting
patients, workers and others from healthcareassociated infection.
Our overall judgement
On inspection, we found evidence giving us a
minor concern about the provider’s compliance
with the regulation on cleanliness and infection
control. When we followed up, the trust
provided assurance that it had addressed the
areas for improvement.”
23
Provider Services Quality Account 2010/11
These are some of the actions that Provider
Services took to address the conclusions or
requirements reported by the CQC:
Provider Services has made the following
progress by 31st March 2011 intaking such
action:
• Bed cleaning schedules are now displayed
above each bed in every ward
• Ward cleaning schedules are displayed at the
entrance to all wards for patients and the
public to read
• Commode cleaning schedules displayed in all
sluice areas recording commode inspections
at mid-day and a full and thorough clean
including dismantling of commodes at night
• Agency staff issued with sample hand gel
sachets for use during their shift
• Each ward issued with an Infection Control
Log Folder. Infection Control Link Nurses are
responsible for keeping folder up to date
• Infection and prevention standards monitoring
form implemented for Link Nurses to complete
on a quarterly basis. Results and actions
associated with this monitoring will be held in
the log as evidence
• Directors, Matrons and the Infection Control
Team undertake random spot-checks and
inspections, including checks during the night
• Provision of detailed posters relating to
cleaning schedules for commodes and
results of the first audit to indicate levels of
decontamination have now been distributed.
We have purchased the DBO (Design Bugs Out)
Department of Health commissioned commode
to enhance decontamination practices.
The action plan that came out of the findings
from the inspection has now been fully
implemented and new ways of working adopted.
To increase the availability and visibility of
cleaning schedules, as requested by the CQC,
‘Think Clean’ posters have been distributed to
all inpatient settings and entrances detailing the
cleaning schedules for that area.
24
Further inspections from the Peat Environment
Action Team (PEAT) and unannounced
inspections (one at 3am in the morning) by the
management team provide assurance that these
actions continue to be implemented, and indeed
have been embedded as new ways of working.
CQC Stroke Review 2010
This CQC review looked at the care experienced
by people who have had a stroke including the
views of their carers. The review focused on
discharge arrangements from hospital and the
longer term care and support services for strokerelated disabilities in the community. Our community hospitals and community stroke team
were fully involved in the review.
We were very pleased when the CQC stated in
their assessment that WPCT were the best performing area in the region. Further details about
the review can be found at
http://cqc.org.uk/stroke.
We welcome working in partnership with the
CQC; we recognise the value of learning that
comes from external scrutiny and the end result
of an improvement in our services to patients.
Provider Services Quality Account 2010/11
Data Quality and Clinical Coding
Error Rate
The quality of the information we collect about our services and how
we analyse it has a direct impact on helping us to measure the quality
of our patient care.
When we look at our performance statistics
that we take from our data analysis, we make
comparisons with other information such as
incidents, complaints, staffing and sickness levels
so that we have a rounded picture of how our
services are working for patients, and where
any risk areas might be. Our data also helps us
determine if we are providing services that are
good value for money.
Our information tells us, for example:
• How long patients are waiting to see clinicians
and whether urgent referrals are seen more
quickly than routine appointments. During
2010/11 we know that we achieved our target
of no one having to wait longer than 18 weeks
for most of our services. The information
also helped to us to refine the access criteria
in therapy services to ensure that urgent
appointments are prioritised
• Whether any patients who were going to be
discharged home from our hospitals had delays
to their discharge dates. We understand that
patients can find any delays distressing. This
data helps us identify such cases and examine
why delays happen. We know the number of
delayed discharges in the community hospitals
for 2010/11 were below the threshold set by
our commissioners.
Worcestershire Primary Care Trust Provider
Services will be taking the following actions to
improve data quality:
• We will continue to work with clinical teams to
ensure everyone understands the importance
25
Provider Services Quality Account 2010/11
of recording data in a timely and accurate
manner
• We will continue to liaise with clinical teams to
make sure the codes and systems make sense
• We will work to refine our reporting in order
that we make the most of the information we
hold.
NHS Number and General
Medical Practice Code Validity
Worcestershire Primary Care Trust Provider
Services submitted records during 2010/11 to
the Secondary Uses service for inclusion in the
Hospital Episode Statistics which are included in
the latest published data.
The percentage of records in the published
data which included the patient’s valid NHS
number was:
The percentage of records in the published
data which included the patient’s valid
General Medical Practice Code was:
99.82% for admitted patient care;
99.82% for out patient care; and
99.5% for accident and emergency care.
Worcestershire Primary Care Trust Provider
Services was subject to the Payment by
Results clinical coding audit during 2010/11
by the Audit commission and error rates
reported in the latest published audit for
that period for diagnoses and treatment
coding (clinical coding) were:
Admitted Patient Care
Primary Diagnoses Incorrect
Secondary Diagnoses Incorrect
Primary Procedures Incorrect
Secondary Procedures Incorrect:
13.29%
41.96%
37.06%
69.02%
99.86% for admitted patient care;
96.64% for out patient care; and
38.1% for accident and emergency care.
Information Governance Toolkit
Attainment Levels
What is Information Governance?
Information Governance (IG) is the way in which
the NHS handles information about patients
and employees, particularly personal and
sensitive information. It allows Worcestershire
PCT Provider Services and its staff to ensure
that personal information is dealt with legally,
securely, efficiently and effectively, in order to
deliver the best possible high quality care.
IG helps Worcestershire PCT Provider Services to
ensure that it fulfils its obligations to maintain
secure, complete, accurate and up-to-date
records of the care provided to patients or
clients. It also helps to inform Worcestershire
PCT Provider Services of the actual processes and
26
procedures that need to be in place, for example,
IG training is mandatory for all members of staff.
The IG Toolkit
The mechanism by which Worcestershire PCT
Provider Services measures IG compliance against
the law and central guidance and to see whether
information is handled correctly and protected
from unauthorised access, loss, damage and
destruction is through the submission of an
annual mandatory on-line return. The NHS
evidence-based return is made at the end of
March each year against 41 Requirements and
Worcestershire PCT Provider Services overall score
for 2010/11 was 72% and was graded Green.
Provider Services Quality Account 2010/11
Section 3
Review of Quality
Performance from Last Year
27
Provider Services Quality Account 2010/11
Section 3 - Review of Quality Performance from Last Year
Patient Safety:
Clinical Incidents
Providing feedback about clinical incidents, both within our organisation
and externally, is a crucial part of our quality improvement initiatives. We
understand that a culture of openness will lead to increased reporting
of clinical incidents; this in turn leads to a better understanding of the
safety of our services and where improvements in patient care need to be
focussed.
Anonymised information regarding clinical
incident trends, patterns and improvements to
patient safety is disseminated throughout the
organisation via service and team meetings and
is reinforced through regular newsletters, staff
meetings, group emails and the intranet.
800
Total number of incidents reported
2010 - 2011
700
600
500
PCT staff record all patient safety incidents and
near misses on an electronic reporting system
called Sentinel. The system is able to produce
tailored reports for individual services or across
the organisation to help with, for example, trend
analysis.
400
300
200
100
In 2010/11, there were 2,267 incidents reported
through Sentinel. 84% of the incidents related to
patient safety. The rise in Q4 can be attributed to
an increase in the reporting of incidents rather
than a rise in the occurrence of incidents. It was
during this period that we undertook extensive
checks in clinical areas to ensure incidents were
being correctly recorded on Sentinel.
0
April - June
2010
July - Sept
2010
Oct - Dec
2010
Jan - Mar
2010
The graph above shows the number of incidents
that occurred in each quarter from April 2010 to
March 2011.
The incidents are categorized using
definitions from the National Patient Safety
Agency into:
• No harm
• Low harm
• Moderate harm
• Severe harm
• Death.
96% of incidents reported in 2010/11, resulted in
no or low harm.
28
Provider Services Quality Account 2010/11
The following is a short analysis of the main
learning points from 2010/11 incident reports.
Falls
Slips, trips and falls in the community hospitals
are the most frequently reported incident,
accounting for 29% of all incidents reported in
2010/11. The graph below shows the number of
falls that occurred in each quarter of the year.
We think the reason for the sharp rise in Q4
may be due to increased compliance with the
reporting of falls as incidents. It was during Q4
that the percentage of reported falls of the total
number of patient safety incidents actually fellwhich tells that there was increased reporting of
all incidents.
200
Total number of falls reported
2010 - 2011
150
Pathway’. The pathway aims to identify people
who are at high risk of falling in their own
homes. A variety of assessments are carried out in
the patient’s home, such as blood pressure checks
and medication reviews in order to ensure the
falls risk factors are reduced to a minimum.
Increasing the number and timeliness of falls
assessments was included in our ‘CQUIN’ targets
(see section 3) for 2010/11. We were pleased to
achieve all of our targets for this CQUIN and
have identified slips, trips and falls as one of our
priority quality improvements to be reported on
in next year’s Quality Accounts, as we know there
is much more work to be done.
Pressure Ulcers
The second most frequently reported patient
safety incident, which amounted to 16% of the
total number of incidents, was pressure ulcers/
tissue damage. All pressure ulcers are graded
for their severity- grade 1 being the least severe
up to grade 4, the most severe. We are required
to report any pressure ulcer which is grade 2 or
above onto our Sentinel system, regardless of
where the ulcer developed.
100
50
0
April - June
2010
July - Sept
2010
Oct - Dec
2010
Jan - Mar
2010
A number of initiatives have been implemented
to try and reduce the number of falls over the
past year, and we remain resolute in ensuring
that we continue to address this prominent
patient safety issue. Our Falls Policy expects
nurses to assess all patients within 12 hours of
admission to the community hospitals for their
risk of falling. Any patients who are assessed as
being at high risk of falls have extra measures
put in place to try and prevent falls occurring
whilst they are in the unfamiliar environment of
a hospital ward.
Our community staff are involved in
implementing a countywide strategy for
reducing falls in the home - the ‘Falls Care
The graph below shows the number of pressure
sores reported in each quarter over the last year.
In the third and fourth quarters of the year,
District Nurses and Community Hospital nurses
were given a performance target as part of the
CQUIN framework (see section 3) to improve
their reporting of pressure ulcers onto the
Sentinel system.
200
Number of pressure sores (Grade 2 or above)
2010 - 2011
150
100
50
0
April - June
2010
July - Sept
2010
Oct - Dec
2010
Jan - Mar
2010
29
Provider Services Quality Account 2010/11
As a result, we have assurance that the rise in the
number of pressure ulcers recorded in quarters 3
and 4 illustrates an increase in the reporting of
existing pressure ulcers rather than a rise in the
occurrence of pressure ulcers.
Any Grade 3 or 4 pressure ulcers must also be
reported to the Strategic Health Authority as
these are classed as a serious incident. A ‘Root
Cause Analysis’ which determines how the
pressure ulcer developed, and crucially whether
any lessons should be learned, is undertaken on
all grade 3 and 4 pressure ulcers. The Root
Cause Analysis is reviewed by the Consultant
Tissue Viability Nurse to ensure a thorough
investigation has been carried out and also to
identify warning signs or ‘hotspots’ for further
action.
During 2010/11, as a result of our learning from
incidents, we found that some nurses were not
grading pressure sores correctly. As a result,
all nurses are now required to complete extra
training on grading pressure sores to ensure we
have consistency of reporting. The Consultant
Tissue Viability Nurse is also visiting wards and
reviewing individual patients who have pressure
ulcers.
The breakdown of grade 3 and 4 pressure ulcers
reported on Sentinel during 2010/11 is presented
Number of pressure ulcers
10
Pressure ulcers (grade 3 and 4) reported on
Sentinel in 2010 - 2011
8
We are committed to ensuring that all pressure
ulcers are recorded on our incident reporting
system. This will enhance our understanding
of where and why ulcers are occurring in
our services, and will help us make informed
decisions about how we need to improve practice
to prevent as many pressure ulcers as possible
occurring.
Medication Errors
After falls and tissue viability, the third most
reported patient safety incidents are medication
errors. These amount to 7% of the total number
of reported incidents.
We have a Medicines Policy which sets out
clear steps for staff to take when administering
medicines. Frequent audits are undertaken to
measure staff’s compliance with the policy and
any necessary changes are made as a result.
Community hospital wards are visited at least
once a week by a clinical pharmacist who
checks prescribing and clarifies prescriptions.
The pharmacist liaises with the wards nurses
and doctors and is available to answer queries.
Adherence to the Medicine Policy is observed
and audited and staff are reminded of the
recommendations in the policy whenever
required at visits. The Head of Medicine
Management attends the hospital matrons’
meetings to report on medicine management
issues and to answer queries and follow up
In our healthcare service in the two prisons in
Worcestershire, the most frequently recorded
incidents are medication errors. However this can
be put into context in that over a 6 month period
there were 6 drug errors involving one drug out
of over 29,000 doses being administered.
6
4
2
0
April - June
2010
July - Sept
2010
Oct - Dec
2010
Number of pressure ulcers (Grade 3)
Number of pressure ulcers (Grade 4)
30
below. Again, we have assurance that the rise in
numbers is due to improved reporting by nurses,
rather than a rise in actual pressure ulcers.
Jan - Mar
2010
National Patient Safety Agency alerts and
National Institute for Clinical Excellence (NICE)
guidance are acted upon and following the
recent alert highlighting missed medication
doses, a new medication delivery run from
the Acute Trust pharmacy was introduced and
guidance for staff on how to obtain drugs in a
timely manner was produced.
Provider Services Quality Account 2010/11
Incidents Relating to Patient
Information
of incidents, the most frequently occurring being
‘Breach of Confidentiality’ accounting for 31
such incidents over the year.
Incidents relating to potential or actual loss,
destruction or unauthorised access to patient
data accounted for just 4% of the total number
All such instances are thoroughly investigated to
determine steps that can be taken to prevent any
recurrences.
31
Provider Services Quality Account 2010/11
Infection Control
Minimising healthcare associated infections is a priority within PCT
Provider Services and we are committed to ensuring that the risks of
infections are kept to an absolute minimum.
During 2010/11 we maintained excellent
performance on the control of infection across
our services. Only 12 cases of C-diff in Provider
Services were reported against a target limit of
28 cases and only one case of MRSA Bacteraemia
occurred during the year.
Within the Trust, it is widely acknowledged that
infection prevention and control is everyone’s
responsibility. We have an Infection Prevention
and Control team who provide specific advice
and guidance to staff.
The team of nurses and doctors ensure that
appropriate guidelines are in place, practices and
clinical environments are audited, staff can access
training and that levels of infection in both the
community and inpatient settings are monitored
and acted on.
32
Across the Trust there have been a number
of ongoing specific initiatives to reduce
infection during 2010/11:
• Ongoing promotion of hand hygiene and ‘bare
below the elbows’. This includes the use of
posters and floor stickers to remind staff, visitors
and patients to wash their hands or use the hand
rub. Promotion of cleaning standards through
ongoing education and audit
• Participating in government initiatives to reduce
infection including the “cleanyourhands”
campaign and Infection Control Week
• An infection control charter for both patients,
service users, visitors and staff has been
implemented. This is available in each ward area
and provides information on standards and what
can be done to minimise the risk of infection
• Ensuring that, wherever possible, infection is
designed out of new buildings which means that
the physical environment helps to minimise the
risk of infection.
Provider Services Quality Account 2010/11
Safeguarding
Adult Safeguarding
Safeguarding Children
Adult Safeguarding continues to have a raised
profile due to a number of high profile national
cases. We continue to be an active member of
the Worcestershire Safeguarding Adults Board,
and with our constituent partners work hard to
ensure a strong response to the management of
safeguarding.
Safeguarding Children remains a high priority for
the Primary Care Trust in relation to its statutory
duties under the Children Act 1989 and 2004.
Safeguarding children continues to have a high
profile for health organisations due to a number
of national and regional cases where children
have died from abuse or neglect.
In Worcestershire as a whole there continues
to be an increase in safeguarding referrals and
much of this is related to increased awareness and
reporting, and supportive work from members
of the safeguarding board. Within the PCT
provider services, increased levels of attendance
at Adult Safeguarding training has helped raise
awareness and provided staff with the confidence
to make referrals where necessary. All new staff
receive adult safeguarding awareness at the Trust
induction and all service areas have access to a
Referral Checklist.
We have a Nominated Director for Safeguarding
Children within the Primary Care Trust who works
closely with the Designated Doctor and Nurse to
provide advice and support to health professionals
where concerns are raised in relation to the safety
and welfare of children in Worcestershire.
We have robust procedures in place to record
and administer applications made under the
Mental Capacity Act Deprivation of Liberty
Safeguards (DoLS) and statutory notifications
to the Care Quality Commission are actioned
in line with regulations. In the year ending
March 2011, a total of seven applications under
the Deprivation of Liberty Safeguards were
submitted from our Community Hospitals. Of
those, two were granted, four were not granted
and one application was withdrawn.
We continue to be active members on
Worcestershire Safeguarding Children Board
working with partner agencies to ensure a strong
response across the county to safeguard children. In
line with the recent Ofsted/Care Quality Commission
Inspection for Safeguarding Children in October
2010, we have worked with our partner agencies
to action improvements and requested changes to
safeguarding children processes and practice.
As an organisation we follow Worcestershire
Safeguarding Children Board Procedures which
are available to all staff. Safeguarding Children
education and training is provided to staff across
all services to increase awareness, recognition
and confidence to share information and make
appropriate referrals.
33
Provider Services Quality Account 2010/11
Patient Experience:
Introduction
There are huge benefits to be gained for the organisation from public and
patient participation. We are committed to proactively seeking the views of
patients and their carers who have used our services so that we can understand
from the patient’s perspective what we do well and where we need to improve.
We have a constructive relationship with the
Local Involvement Network (LINks) who are
an integral part of our participation agenda.
Alongside LINks we are fortunate to have a
broad range of other mechanisms in place
for the local population to make their views
known. Individual involvement groups such as
neighbourhood forums, friends leagues in the
hospital, young people’s groups or the voluntary
34
and community sector often allow us to gain a
specialised or focused input into projects. We
have patient representatives in many of our
committee meetings who make an invaluable
contribution to the scrutiny of our services. We
are immensely grateful for the time and care
that people take in getting involved and we
intend to ensure that we foster and develop
these relationships in the new organisation.
Provider Services Quality Account 2010/11
Patient Environment Action Team
(PEAT)
We are pleased to report our Community Hospitals received top marks in
the PEAT inspections for 2010/11. The PEAT inspections involve a team of
health professionals and an independent patient representative assessing
each hospital in areas including cleanliness, hygiene, privacy, dignity, access,
signage, patient information and food quality and service.
Evesham, Pershore, Malvern, Princess of Wales in
Bromsgrove community hospitals and the Wyre
Forest GP Community Unit, scored excellent in all
areas of the annual inspections.
“Over the last five years the scores have
continued to improve and thanks go to all staff
involved in maintaining the high standards in our
community hospitals.”
Tenbury Community Hospital, which is currently
undergoing partial refurbishment, was awarded
‘good’ in privacy and dignity, and environment.
Its score in these areas is set to improve once the
work has been completed.
Patient representative, Stella Baldwin, who
is part of PEAT, said: “All aspects of patient
environment, including cleanliness, hygiene,
food, privacy and dignity, are at a very high
standard in all the community hospitals and the
Wyre Forest GP Community Unit.
Lisa Levy, PCT associate director of provider
services, said: “We are delighted with this year’s
inspection results and the fact that exceptionally
high standards were noted and recorded in all
areas.
“The matrons and staff at all these facilities
should be rightly proud to have attained these
excellent scores, which are very reassuring for
patients and their families.”
Princess
of Wales
Hospital,
Bromsgrove
Evesham
Community
Hospital
Malvern
Community
Hospital
Pershore
Hospital
Tenbury
Community
Hospital
Wyre Forest
GP Unit
Environment
2011
Excellent
Excellent
Excellent
Excellent
Excellent
Excellent
Environment
2010
Good
Good
Excellent
Excellent
Good
Excellent
Food 2011
Excellent
Excellent
Excellent
Excellent
Excellent
Excellent
Food 2010
Excellent
Excellent
Excellent
Excellent
Excellent
Excellent
Privacy and
Dignity 2011
Excellent
Excellent
Excellent
Excellent
Good
Excellent
Privacy and
Dignity 2010
Excellent
Excellent
Good
Excellent
Good
Excellent
35
Provider Services Quality Account 2010/11
NHS Choices
Real-time patient feedback is an evolving area that provides a tangible
guide to public and patient opinion. NHS Choices is a website where
anyone can leave a comment about a health service they have used.
The address is www.nhs.uk/choices
We regularly check the NHS Choices website for
comments about our services to see what we can
learn from people’s experiences in our services.
The comments are also reviewed by the CQC
and commissioners to determine if there are any
areas for concern.
Of the comments that are currently on the
website, 7 out of the 9 people would recommend
our community hospitals. There are many
associated positive comments such as “cheerful
and pleasant staff in the dental department” and
“the nursing staff were excellent”.
The negative comments mainly concern the
quality of information on our website, which
will be addressed with the new organisation,
and issues regarding the facilities in the older
hospitals. All issues that were raised have now
been reviewed and addressed with the staff in
the services. Positive feedback is as important as
negative feedback to us, and we ensure staff are
made of aware of all such comments.
We will continue to monitor and respond to the
comments on NHS Choices and welcome this
opportunity of being able to receive real time
feedback.
Patient Surveys
As well as clinical teams sometimes undertaking their own small
scale patient surveys, as part of the Commissioning for Quality and
Innovation (CQUIN) programme for 2010/11 we have undertaken two
large patient surveys, one in June 2010 with a follow up survey using
the same questions in March 2011.
For the large scale survey, questionnaires were
posted to 1,000 patients who had recently used
community services, in addition to over 740
patients who had recently been discharged from
the community hospitals.
We achieved a 36% return rate for the
community services questionnaires, and 42%
return rate from the community hospital
questionnaires.
36
Survey Results
We are very pleased to be able to report that
97% of patients in community services felt that
they had been treated with dignity and respect,
although we aim for this figure to be 100%.
The following table sets out the question asked
and the percentage response to each question
for the first survey (Q1) and the follow up survey
later in the year (Q4).
Provider Services Quality Account 2010/11
Community Services
Question
Yes responses
Q1
Yes responses
Q4
1.
Have you been involved as much as you wanted in decisions about your
treatment?
92%
90%
2.
Were you given enough time to discuss your condition with healthcare
professionals?
92%
91%
3.
Did staff clearly explain the purpose of any treatments and/or medication and
the side effects in a way that you could understand?
94%
94%
4.
Do you know what number/who to contact if you need support out of hours
(after 5pm)?
50%
54%
5.
Overall, have staff treated you with dignity and respect?
97%
97%
Following the disappointing response to question
4 in Q1, we introduced small cards for clinical
staff to give to patients setting out the numbers
and contacts for out of hours services. Although
we were pleased to see a slight increase in the
positive response to the question in Q4, we
clearly need to continue to look at other ways of
improving the way we give this information out
to patients.
At the end of the survey patients were asked
to add any further comment about care and
services. 46% of respondents made a final
comment, 54% of which were positive, most of
which were in praise of individual staff member
or teams.
10% of comments were negative, the majority
relating to waiting times between appointments
or the amount of time staff spend with patients.
The remaining comments were suggestions
relating to such issues as parking or staff wearing
uniforms outside of the work place.
37
Provider Services Quality Account 2010/11
Community Hospitals
Question
Yes responses
Q1
Yes responses
Q4
1.
On your arrival were you welcomed, introduced to people on the ward and
given information about your stay?
82%
80%
2.
Were you given enough time to discuss your condition, worries and fears
with healthcare professionals?
81%
81%
3.
Did staff clearly explain the purpose of any medication and side effects in a
way that you could understand?
84%
84%
4.
As far as you know, did hospital staff take your family or home situation into
account when planning your discharge from hospital?
88%
90%
5.
Did hospital staff tell you who to contact if you were worried about your
condition or treatment after you left hospital?
78%
77%
At the end of the survey patients were asked
to add any further comment about care and
services. 56% of respondents wrote an additional
comment, 65% of which were positive, most of
which were in praise of individual staff members
or wards.
All of the responses from the survey are
circulated to the Matrons and wards, to our
commissioners and to our Board. Action plans
are drawn up to ensure that we can measure
which actions we have put in place have been
successful.
Food was a common theme in the additional
responses; some respondents saying food was
excellent while another who stayed in the same
hospital thought it was ‘horrible’.
In future we will compare the results of patients
surveys with information that we have from
complaints, clinical incidents and clinical audit to
produce a fuller overall picture of the quality of
care in each of the services.
38
Provider Services Quality Account 2010/11
Complaints and Compliments
Since the 1st April 2009, there has been a single national approach to
dealing with complaints about the NHS and adult social care services
as part of Regulation 18 of the Local Authority Social Services and NHS
Complaints (England) Regulations 2009.
In April 2010 the PCT’s former Patient Advice
and Liaison Service (PALS) joined up with the
Complaints Service to form the Patient Relations
Service. The Patient Relations Service has produced
a form with a Freepost address to make it easier
for people to send in their concerns. General
enquiries and signposting services are recorded
as ‘comments/concerns’, with complaints listed
separately. This helps us to respond to issues more
effectively and to make the most of learning
points.
Since 1st April 2009, there has been a single
national approach to dealing with complaints
about the NHS and adult social care services as
part of Regulation 18 of the Local Authority Social
Services and NHS Complaints (England) Regulations
2009.
We take all complaints seriously and seek to ensure
that we listen and learn from patients and their
families’ experiences of our services; patients, their
families and carers are actively encouraged to raise
any concerns, complaints and compliments about
services. Complaints can be made either directly to
the individual service or to the Patient Relations
team as a central contact point.
This year we acknowledged all complaints within 3
working days and responded to all complainants in
line with the “Listening, Responding, Improving, A
Guide to Better Customer Care” guidance from the
Department of Health.
All complaints and their responses are reviewed by
the senior manager of the service and the Director
of Provider Services. Quarterly reports are produced
to try and identify any trends or ‘hotspots’.
Complaints are anonymised and reviewed in team
meetings to identify learning points.
The following tables give an overview of the
complaints and concerns that we have received
regarding in 2010/2011 in comparison to 2009/10.
Community Provider Services
Total 2010/11
Comparison with 2009/10
Complaints
150
190
Comments/Concerns
673
563
To put these figures into context, over 705,000
patient contact episodes were recorded in total
for Provider Services during 2010/11.
The figures in the above table show a 21%
decrease in the number of complaints in 2010/11
compared with the previous with a 35% increase
in the number of comments/concerns received.
This indicates a significant decrease in the
number of complaints received by the Trust.
39
Provider Services Quality Account 2010/11
Complaints
100
Services receiving complaints during
2010 - 2011
150
120
90
60
30
0
0
Br
ea
st
sc
re
Ch
en
ild
Co re CA ing
m n
M
Co m 's S H
m uni erv S
m ty ic
un D es
Di ity ent
st Ho al
ric s
He t N pita
al urs l
th in
Vi g
sit
Po ing
Sp
d
Sp ec
ia
e ial
P try
W ech ised riso
he an N n
e
u s
O lch d La rsin
cc ai n g
up r/E gu
at qu ag
io ip e
na m
Ph l Th ent
ys er
io ap
th y
er
ap
y
20
cr
ee
Ch
n
ild
Co re CA ing
m n's M
Co m S H
m uni erv S
m ty ic
un D es
Di ity ent
st Ho al
ric s
He t N pita
al urs l
t h in
Vi g
sit
Po ing
di
a
Sc
ho Pr try
ol iso
Sp Se Nu ns
Sp ec xua rsi
e ial l ng
W ech ised Hea
he an N lth
el d ur
ch L si
ai an ng
r/E gu
qu ag
ip e
m
en
t
Br
ea
Number of complaints
40
st
s
Number of complaints
80
60
Services receiving complaints during
2009 - 2010
When considering all other community services
there has been a 17.5% increase in the number
of complaints received with complaints received
rising from 51 to 60. There has been a rise in
complaints in five services but with a more
significant rise in both District Nursing and
Podiatry. The District Nurse Service has over
360,000 patient contact episodes recorded for
2010/11 with 8 complaints recorded. Podiatry has
over 9,600 episodes recorded for the year with 8
recorded complaints.
the needs of the current patients on the
caseload, some of whom have been receiving
care for many years. Those patients who no
longer meet the criteria for the service, have
been discharged with advice as to where they
may obtain podiatric care to meet their needs.
Often the alternative low level care is charged
for and unfortunately this has caused an increase
in the number of complaints from former
Podiatry patients because they are no longer
able to access the NHS Podiatry Service.
The podiatry service is contracted to deliver
treatment to those with high risk foot conditions
such as ulceration. The demand for the service
from patients who meet this criteria is growing
year on year. In order to meet the needs of
this high risk client group and maintain the
waiting list to below eighteen weeks, we are
undertaking a review of the service, including
There has been a 22% fall in complaints
regarding the Community Hospitals. This could
be due to an overall increased focus on customer
service including the introduction of Welcome
Packs, better communication as a result of
implementing action plans following patient
surveys and a greater emphasis on discharge
planning.
40
Provider Services Quality Account 2010/11
Number of comments and concerns per
service
Community Service
Breast Screening
CAMH
Childrens Community
Community Dental
Community Hospitals
Continence
District Nursing
Health Visiting
Occupational Therapy
Physiotherapy
Podiatry
School Nursing
Sexual Health
Specialised Nursing
Speech and Language
Wheelchair/Equipment
Number of
concerns
5
13
13
3
51
5
13
0
7
14
31
2
9
12
5
9
Over 47% of the contacts received by the Patient
Relations Team were related to general advice
and appointment issues.
Community hospitals increase in comments/
concerns coincides with the introduction of the
Patient Relations Team taking calls regarding
the ‘Choose & Book’ system which has increased
queries regarding appointments.
Over the last year the Podiatry Service have
ensured that the criteria for accessing the service
has been adhered to in that patients who are
most in need receive priority appointments. This
The categories for comments/concerns for
the community services in 2010/11
Categories
Admission/transfer
Advice and Information
Aids/appliances
Appointments, delay/
cancellation
Clinical treatment
Communication/information
Complaints Handling
FOI
Personal records
Privacy and Dignity
Personal property and expenses
Staff Attitude
Transport
Number of
concerns
10
53
25
38
23
18
1
1
2
1
6
15
1
has increased the number of comments/concerns
from patients who do not receive priority
appointments. As a result the podiatry service are
reviewing the appointments system.
Physiotherapy experienced high volumes of
patient contact and therefore appointments
were delayed for those who were not identified
as having priority clinical needs.
We have responded to the concerns by changing
the way of accessing physiotherapy in some areas
and we are monitoring whether this leads to an
improvement.
41
Provider Services Quality Account 2010/11
Categories of complaints - 2010 - 11
Categories
Admission/transfer
Aids/appliances
Appointments, delay/
cancellation
Clinical treatment
Communication/information
Complaints Handling
Medication Issue
Personal records
Staff Attitude
Number of
complaints
2
9
29
39
28
1
28
4
10
The information above indicates that there
has been a significant falls in the number of
complaints received relating to:
• Clinical aspects of care - 30% reduction
• Medication issues - 24% reduction
Categories of complaints - 2009 - 10
Categories
Admission/transfer
Aids/appliances
Appointments, delay/
cancellation
Clinical treatment
Communication/information
Hotel Services
Medication Issue
Personal records
Privacy and Dignity
Staff Attitude
Number of
complaints
2
16
19
56
27
11
37
7
3
15
written response is passed directly back to the
prisoner within 3 working days for a simple
concern. If the prisoner remains dissatisfied then
he can request a member of the healthcare
management team to investigate further and
receives respond within 10 working days. Each
stage of this process is recorded as a separate
concern.
• Staff attitude- 33% reduction.
There has been a 35% increase in the number of
complaints relating to appointment issues which
is related to both the prison setting and the
community hospitals, with 15 of the complaints
relating to appointments having been received
from the prison settings.
Comments and Concerns
Over the year 673 comments and concerns have
been dealt with by both the Patient Relations
Team and the prison healthcare staff.
Of these, 481 contacts have been in the prison
setting and are dealt with by the prison
healthcare staff. This does indicate a 10%
increase in concerns raised in this setting but this
also needs to be considered with the substantial
reduction in the number of complaints received.
A further contributory factor is the introduction
of improved methods of recording and
responding to concerns the prison settings. A
42
The comments and concerns received regarding
all other community services have risen during
this period from 128 contacts to 192. This is a
33% increase but there are a number factors
that can be attributed to the rise in concerns
received:
• Publicity campaign regarding the Patient
Relations Service and how patients/families/
carers can voice concerns
• Welcome packs introduced for all Community
Hospital in patients (which were developed
following the learning from a complaint) which
include Patient Relations Teams contact details
• Expansion of the way in which patients/carers/
relatives can make their concerns known
including the re-design of the Trust’s website to
make it easier for patients to log a complaint
via email to a generic Patient Relations email
account.
Provider Services Quality Account 2010/11
Compliments
Compliments
Total 2010/11
757
Learning from compliments is as important as
learning from complaints; we could gain an
understanding of how things have gone well and
how this could be replicated in other services.
In addition to recorded compliments, many
departments and wards receive gifts such as
boxes of chocolates and tins of sweets as a thank
you. These are very much appreciated.
Comparison 2009/10:
1,458
Staff are always notified if any compliments
are received by the Patient Relations Service.
The Staff Awards Event (see section 3 of the
accounts) aims to acknowledge those members
of who repeatedly receive compliments from
patients.
A breakdown of the compliments for 2010/11:
Top 3 Services Compliments
Received
Community Hospitals
Continence Services
Podiatry
2010-11
241
102
96
We do not record the category for the
compliment, only the service the compliment
was received for. We recognise that we need
to change this in the future as we should be
learning more from analysis of compliments.
Parliamentary and Health Service
Ombudsman
If the complainant is not satisfied with the
response at local resolution then they have
the right to take their complaint to the
Parliamentary and Health Service Ombudsman
(PHSO). The PHSO are independent of the NHS
and, if they investigate a complaint, they can
then make recommendations back to the Trust
which the complainant has raised concerns
over. If the PHSO choose not to investigate the
complaint then the complainant cannot take
their concerns any higher. The complainant must
first seek local resolution before the PHSO will
look at the case.
Parliamentary and Health Service Ombudsman Contacts
Provider Services
2010/11
2009/10
Complaints Sent to PHSO
7
2
Cases Investigated by PHSO
0
1
Cases Rejected by PHSO
6 (1 case awaiting decision)
1
Of those referred to the PHSO this year, 4 have been from prison residents.
43
Provider Services Quality Account 2010/11
Health Service Ombudsman Care
and Compassion Report: Our
Response
The principles and values of the NHS, as embodied in the NHS
Constitution, promotes the NHS as an organisation which provides care to
all within a framework of respect and dignity, in which everyone is valued
and treated with care and compassion.
However, the national ‘Care and Compassion’
report published in February 2011 provides a
summary of ten investigations into complaints
made to and upheld by the office of the Health
Service Ombudsman. It should be noted that these
ten ‘stories’ were selected from approximately
9,000 complaints submitted to the Health Service
Ombudsman during 2009/10, of which 226 (2.5%)
relating to the care of older people met the
criteria and were accepted for investigation.
The report focuses on the standard of care
provided to older people, illustrating a failure of
NHS provision to respond to the needs of older
people with care and compassion and to provide
the basic standards of care. It describes how the
NHS failed to ensure the patients had adequate
food, drink and basic sanitary care and how poor
pain control, inadequate discharge arrangements
and poor communication caused enormous
distress and suffering to the individuals and
families concerned.
Visits have been undertaken to all of the
community hospital sites, attended by Teresa
French, Director of Provider Services, Sandra
Brennan, Director of Clinical Development and
Lead Nurse, Karen Hunter, Head of Quality and
Patient Safety, a Non-Executive Director and
a patient representative. During these visits
patients were asked about their care and if there
were any things that could be done differently or
better, using the key topics as identified within
the report as a basis for the review. A review of
the nursing care plans was also undertaken.
44
Overall the response of the patients to their care
was very positive and there were no examples
of care that gave cause for significant concern.
There was however some indication that a
majority of patients were not involved in their
discharge planning with little clarity on when
they might be going home. The documentation
review indicated a variety of documentation in
use across the PCT and also examples of care
plans not in place for some patients identified
at risk of falls and/or pressure ulcers. Provider
Services have developed and implemented an
action plan in response to the feedback to the
visits to address the issues raised.
Provider Services Quality Account 2010/11
Equalities
Worcestershire is a rural county with a wide spread of population. It is
essential that people can access our services, regardless of where they
live in the county, their race, gender, disability, age, sexual orientation,
religion, belief or socio-economic status.
Putting individual needs at the heart of the way
our services are run makes better services for
everyone. Patient and staff experiences should
reflect the core values of fairness, respect,
equality, and dignity.
We know that the black and ethnic population
in Worcestershire is approximately 2%, with
a growing population of people of Eastern
European background, often arriving as migrant
workers. Although migrant workers on the whole
tend to be young and healthy some may, for
example, experience difficulties due to language
barriers and lack of familiarity with local systems.
We need to be able to respond with practical
support and help for everyone’s individual needs.
Our collection and use of ethnic group data on
patients, service users, and staff is the foundation
on which we can assess and address existing
health inequalities. We closely monitor patient
and staff records for completion of the ethnicity
recording fields. A service that performs
45
particularly well in this is prison healthcare where
98% of patients/service users have their ethnicity
recorded against a whole service average of 87%.
During 2010/11 as part of their induction, all new
staff received an initial session in equalities and
human rights where the values and attitudes
expected by the Trust in relation to patient
care are made explicit. There is further detailed
mandatory training for all staff which includes
disability awareness sessions. In addition,
information on a wide range of equalities issues
is available to staff on our staff website. We hold
contracts with external organisations who deliver
our language and interpreting services; over 150
languages can be accessed by any of our staff
within 24 hours.
Patient Story
The Intravenous Therapy team received a
referral for a patient to have a 10 day course of
intravenous antibiotics, three times a day. During
the initial assessment, the patient explained he
was a practicing Muslim who prayed 5 to 6 times
a day. The nurses found an easy solution and
arranged to visit and administer the antibiotics
at times that enabled the patient to continue to
attend for prayers.
45
Provider Services Quality Account 2010/11
Clinical Effectiveness:
Local Clinical Audit
2010/11 was a productive year for clinical audit in Provider Services,
with a particular focus on improving the number and quality of audits
undertaken.
We work to ensure clinical representatives from
all of our services are engaged in the audit
programme. The progress of individual audits is
tracked through a strong governance framework
directed by an audit committee to ensure that
action plans for improvement are followed
through.
During the year a total of 78 audit topics were
registered. Some of these audits are complete
and others are still going through the audit
or change management phase at the time
of writing this report, but all will be tracked
through to completion.
Audits are conducted on a wide variety of topics,
with some monitored by our Commissioners
as part of the CQUIN programme. Clinicians
are required to audit practice against any NICE
or national best practice guidelines that are
relevant to their service to ensure that patients
Subject of Audit
Standard Where Audit
Identified Need for
Improvement
Compliance with NICE Head All head injuries to be
Injury Guidelines in the
assessed and potential
Minor Injury Units
trauma injuries identified
Compliance with NICE
Guidelines in Podiatry
46
receive the most up to date, effective clinical
treatment. Where we do not comply with NICE
guidelines, an action plan is implemented to
bring us up to compliance.
We also audit whether staff are working to PCT
clinical policies and guidelines to make sure
agreed best practice is being implemented.
We provide regular clinical audit training sessions
to staff and offer specialised support for data
collection, analysis and change management.
During 2010/11 over 100 members of staff
attended the audit training. We also provided
specialised bespoke training to individual services
as the need arose. The feedback from staff who
have attended the clinical training from staff is
extremely positive.
The following are some examples of
improvements as a result of clinical audits:
Actions that have been
put in place since Audit
Outcome
All patients now have
NICE head injury proforma
completed to ensure any
warning signs are identified
Patients with possible
signs of deterioration
are identified quickly
and receive swift clinical
treatment
Patients to be given written All Team Leads now have
as well as verbal information address of ordering point
for leaflets
Patients receive clear
information that they
can refer to at later
point, and have increased
understanding of treatment
options
Provider Services Quality Account 2010/11
Subject of Audit
Standard Where Audit
Identified Need for
Improvement
Actions that have been
put in place since Audit
Outcome
Compliance with
cardiovascular aspects of
ADHD in Paediatrics
Clinicians will measure and
record blood pressure, heart
rate and family history
New proformas in use
providing clinical prompts
for measuring and recording
blood pressure, heart rate,
family history
All patients with ADHD will
be assessed in line with
national guidance and have
findings recorded
Compliance with Protected
Mealtimes Policy in
Community Hospitals
Patients identified at risk
List of patients who need
need a red tray at mealtimes a red tray now on menu
board for ward staff and
also on board in the kitchen
Compliance with the Falls
Policy for the Community
Hospitals
All staff are trained to carry
out falls risk assessments
Training delivered to Falls
Patients who are at greater
Link Nurses and cascaded to risk of falling are identified
ward staff
so that actions can be taken
to minimise the risk of
falling whilst in hospital
Compliance with NICE
Guidelines for reducing
smoking in patients who
attend Outpatients Clinics
Patients who have been
identified as smokers are
given verbal and written
information regarding how
to quite smoking
Staff have been trained in
delivering smoking cessation
advice and now have
sufficient supplies of Quit
Smoking leaflets to hand
out to patients who are
smokers
Patients who need help
have their meals on a red
tray to flag that extra help
and/or time is needed
Patients who identify
themselves as smokers are
given support in trying to
reduce or stop their use of
tobacco. This will bring
considerable health benefits
47
Provider Services Quality Account 2010/11
The West Midlands Quality Review
Service (WMQRS)
The West Midlands Quality Review Service (WMQRS) is supported by
local PCTs and the Strategic Health Authority and sets out to improve
the quality of health services by comparing local service provision with
recognised national quality standards.
The overall aim is to reduce variation in the
quality of services by raising standards to the
best.
The Minor Injuries Units (MIUs) in the community
hospitals Evesham, Malvern, Tenbury and
Bromsgrove community hospitals were included
in a review of urgent care services in the West
Midlands between May and October 2010.
Following a visit to the MIUs and
interviewing members of staff, the WMQRS
stated in their report:
“Excellent services were available throughout
Worcestershire. There was good liaison between
48
MIUs and good links with local population. The
computer software “Patient First” links all MIUs
and the Emergency Departments. This helps the
identification and care of frequent attenders and
particularly vulnerable patients. Most registered
nursing staff are Emergency Nurse Practitioners
and there were good plans for extending this to
all registered nursing staff.
The networking between MIUs was excellent,
allowing the sharing of protocols and procedures
and providing mutual support for staff.”
Provider Services Quality Account 2010/11
Quality Conference- Recognising
Good Quality Care and Learning
from Each Other
On 3rd March 2011 we held a Quality Conference
for staff at the Training and Development
Centre in Evesham. The aim of the conference
was to celebrate the successes of the past year,
acknowledge the hard work of staff in our
services and to share examples of good practice.
The event was a great success with very good
feedback from everyone who attended. All of
the business units were represented and staff
took the opportunity to showcase their services.
The key note speaker was Jill Fraser (pictured
below) from the ‘Kissing it Better’ campaign
(more details about the campaign at
www.kissingitbetter.co.uk). Jill gave an inspiring
and thought provoking session when she talked
about the importance of little things that can
make such a difference to people’s experiences
of healthcare. She gave many examples of how
good communication and simple kindness can
make people feel better, even in the worst of
times.
We had previously filmed patients and young
people (with their consent) and asked them
to talk about their experiences of using our
services so that we could share their views with
our staff. The films were shown at intervals
during the conference. They were very moving ,
especially with one or two patients who shared
their difficulties in coming to terms with some
of the consequences of ill health. A couple of
patients had some humorous anecdotes which
were received with much laughter from the
conference audience. All of the films were
uplifting and we are very grateful to the patients
who took part.
There was wide agreement following the
conference that, although we must continue to
learn from instances when things go wrong, we
can learn just as much from instances when we
get it right.
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Provider Services Quality Account 2010/11
Staff Experience:
In Brief
Apprenticeship Scheme
A PCT initiative which offers local people
valuable experience and qualifications to
start their career within our organisation was
shortlisted for a top business award in 2010. The
PCT’s Apprenticeship Programme was one of the
three finalists in the Apprenticeship Employer
of the Year category at the Annual Chamber of
Commerce Awards.
Fast-track physiotherapy for staff
One of our most reported reasons for sickness is
musculoskeletal problems. From 1 July 2010, fast
track physiotherapy appointments have been
introduced for employees reporting sick due to
these conditions, and since 1 August 2010 these
appointments have been offered to employees
still at work but with musculoskeletal problems
in order to try and prevent them going off sick.
There has been excellent feedback about the
scheme from staff who have used it.
Although the PCT has access to training facilities
at Charles Hastings Centre and other NHS
training facilities across the county, it has not had
its own dedicated training facility until the new
centre opened. It provides a bright and pleasant
training environment to enable us to offer a full
range of training programmes including practical
training such as Manual Handling.
It provides a large training room with up to date
projector facilities which can be split into two
training rooms and a smaller break-out room
which house a number of PC workstations for
access to E-Learning.
Article published
In 2008 the PCT, in conjunction with the
University of Worcester, developed a bespoke
educational programme for nurses working in
prison healthcare.
As part of the development and delivery of the
Prison Nursing Development Programme, we
agreed to support an action research approach
which would include a pre and post intervention
questionnaire and focus group work with course
participants. This would gauge the impact the
programme had on the nurses’ confidence,
assertiveness, clinical expertise and approach to
change.
We are pleased that the British Journal of
Nursing accepted an article for publication which
was published recently in Vol 19, Number 12 (247 July 2010).
New Training and Development
Centre
A new Training and Development Centre on the
site of Evesham Community Hospital is now open
and available to staff.
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The article describes how prison nurses are key
to achieving the goal of equality of healthcare
services for offenders. The results of the study
suggest that the partnership and action research
approach was instrumental in facilitating
cultural change and advancement of care within
Worcestershire PCT’s Prison Healthcare Service.
Provider Services Quality Account 2010/11
Staff Survey
WPCT Provider Services employs over 2,800 staff. Each year staff in the
PCT are asked to participate in the annual national NHS staff survey. In
2010 we achieved a 57% response rate to the survey, compared with
61% in 2009 and 69% in 2008. Although this year’s survey response
rate was lower than the last two years, it was still higher than the
national average response rate of 55%.
Following some disappointing results from the
2009 survey, staff focus groups were set up
around the county to address issues that had
been raised. The meetings were well attended
and contributed to shaping the Health and Wellbeing Strategy for the PCT.
Over the year we also improved communication
between senior managers and staff by introducing
a staff newsletter - ‘The Loop’, formalising
monthly Team Brief sessions for all staff and
having open forums where staff could ask Teresa
French, the Director of Provider Services, any
questions or raise any issues that they might have.
Despite the above measures there was only a 1%
increase in the score for communication in the
2010 survey. Communication with staff remains
therefore one of the key workforce priorities for
2011/12.
Summary of the Responses to the
2010 Staff Survey
There are over 90 questions in the survey. The
following is a summary of key responses. A full
copy of the Staff Survey can be found at cqc.org.uk.
• The percentage of negative responses for 2009
decreased in comparison with the previous
two years. In other words, fewer staff reported
negative views
• Average response scores showed an increase
from the previous two years. In other words
more staff than last year reported an ‘average’
view
• Positive response scores decreased from last
year, but increased compared to 2008. In other
words, fewer staff reported a positive view this
year compared to last year.
To summarise, in the 2010 survey staff had fewer
positive and negative views, but tended to score
more answers in the middle ground. It is difficult
to establish a definitive reason as to why the
responses were less polarised.
In 2010, staff reporting a positive response for
enthusiasm for their work was equal to the
national figure of 40%.
In comparison to the results from last year
there were some areas of improvement.
These included:
• The number of staff who reported they have
had a development review has gone up from
80% in 2009 to 91% in 2010 (our year-end
statistics show that 100% of staff have received
an appraisal and development review in the
last year)
• 59% of staff felt that they were able to make
improvements happen in their area of work
compared to 56% in 2009
• Staff or one of their colleagues reporting an
error, near miss or incident which could have
hurt patients/service users has risen from 88%
in 2009 to 95% in 2010
• 62% of staff felt that their immediate line
manager took a positive interest in their health
and well-being compared to 56% in 2009.
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Provider Services Quality Account 2010/11
Areas where the responses were more
negative were:
2011 Priorities
• Only 35% of staff agreed that they get clear
feedback about how well the are doing their
job
Priorities have been drafted as we go in to the
new organization and are being shared with
staff to see if the priorities are right, and if so
how we can address the them.
• Only 27% thought that senior managers try to
involve staff in important decisions.
The priorities include:
• Ensure we have good channels of
communication between senior managers and
staff
• Ensure that every member of staff has a wellstructured appraisal.
Staff Annual Development Review
(SADR) Rate
The annual appraisal process is a cycle of review, planning,
development, implementation and evaluation for staff against the
demands of their job. It is an important channel for staff support and
for managing performance.
We are very pleased to report that during
2010/11 100% of our staff received an Appraisal
and Development Review.
The appraisal gives the member of staff and
their manager an opportunity to get together,
review achievements in the previous year and set
objectives for the coming year.
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Over the coming year it is our intention that
again, all staff undergo an annual appraisal.
We will review the appraisal paperwork to
ensure that its design and layout supports staff
in delivering and receiving good quality and
effective appraisals.
Provider Services Quality Account 2010/11
Staff Awards Evening
More than 200 people turned out to help congratulate our colleagues
at the annual Long Service and Staff Achievement Awards held on
Wednesday 2nd March 2011 at the Worcester Rugby Club.
The ceremony, hosted by BBC Hereford and
Worcester’s Breakfast Show presenter Howard
Bentham, began in style with Worcester Warriors
Jake Abbott handing out long service awards to
staff who have worked for the NHS for 25 years
or more.
The Patient’s Choice award, which is nominated
by patients, was picked up by hospital porter,
David Dougan who works at the Princess of
Wales Hospital in Bromsgrove and the winner
of the award for outstanding performance
was scooped by Malvern Community Hospital’s
Matron, Lin Ingles (pictured).
NHS Worcestershire Chairman, Bryan Smith, said:
“The long service and staff achievement awards
is a chance for us to show our appreciation to
our dedicated, conscientious and loyal staff
who ensure that the people of Worcestershire
have access to the best possible healthcare.
We received nearly 100 nominations this year,
from both within and outside the organisation,
proving how highly our staff are regarded.
He added, “While the winners should feel
immensely proud of themselves, I would like to
congratulate all of our staff and volunteers who
were nominated for an award. It is thanks to the
hard work and dedication of all our staff that we
can be so proud of the NHS in Worcestershire.”
There were over 40 staff or teams shortlisted
across eight categories. The award categories
were:
• Patients’ Choice Award
• Volunteer of the Year
• Excellence in Improving Patient Care
• Clinical Team of the Year
• Non-clinical Team of the Year
• Unsung Hero or Heroine Award
• Leader of the Year Award
• Outstanding Performance Award.
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Provider
Provider Services
Services Quality
Quality Account
Account 2010/11
2010/11
Section 4
Statements
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Provider Services Quality Account 2010/11
Statement from Local Involvement
Networks (LINks)
Worcestershire LINk is pleased to note the high levels of achievement
that the Trust made during last year.
Transition from Child and Adolescent Mental
Health Services to Adult Mental Health Services:
we are aware that these transitions are of
concern to parents. They worry that the services
that their child uses may not be available as their
child moves to adolescence then adulthood. We
are delighted that this is a priority for this year.
The planning for improvement in dementia care
is timely, particularly with an aging population.
We are pleased to see the range and scope of
the project and look forward to seeing firm data
on improvements in service provision in the next
Quality Account.
Recovery: this is an essential part of the work of
the Trust. However, there does not appear to be
any monitoring and evaluation processes in place
from what is given in the Quality Account. We
strongly urge the Trust to monitor and evaluate
for effectiveness of this part of the service to
ensure that service users and their families
and carers find the service fit for purpose and
effective in what it offers.
Nutrition: this is an essential priority for the
Trust. All of the issues identified in the chart are
key to ensuring that service users do not suffer
from malnutrition and that those who recognise
they are overweight and wish to address this
will receive help. We note that the red tray and
jug system is to be introduced and are surprised
that it is not already in place in the community
hospitals for those patients who need support
with eating and drinking.
Review of services 2010-2011: the Provider
Services have achieved high standards and
Worcestershire LINk is delighted to see what
has been achieved. Learning from complaints
and PALs is key for staff to continue to improve
the service that they offer, and we hope that
this aspect will continue to improve during the
coming year. We do believe that much more
could be done to include patients and the
public input within the committee structure, as
they bring an objective, and, often, different
viewpoint, which will help the committee to
focus upon what is important to those who
use the service. We welcome the improvement
made in the uptake of mandatory training, and
similarly the continuous professional training for
dental and medical staff, and trust that these
improvements will continue within the new trust.
We offer our congratulations for the
achievements for CQUINs. However, it is difficult
to judge the size of the achievements when no
raw data of patient numbers is offered, and
results are portrayed as percentages. We are also
pleased that there is more reporting of clinical
incidents, and that 96% result in no or low harm.
It would be helpful to know the categorization
of the remaining 4% and especially how many of
these were reported as SUIs.
Good work is being done to help reduce falls
at home. As more patients will be nursed at
home in the future this is a very important
piece of work. We welcome the identification
of nursing needs with classification of pressure
ulcers and trust that all patients are now assessed
correctly, treated according to need and that
this will be reflected in future outcomes. We
are reassured to note that medication errors are
taken seriously and the level of input in place to
improve medication safety.
31 incidents with regard to Patient information
were for ‘Breach of Confidentiality’. No
explanation has been included to explain what
measures are now in place to minimize this risk.
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Provider Services Quality Account 2010/11
On the other hand the achievements in both
infection control and safeguarding are to be
welcomed.
We note that Patient Survey results are taken
seriously and that staff worked on issues that
arose in order to provide an improved service.
We recognise the improvements made which
may well account for the fall in complaints.
However, compliments fell by 50% compared
with the previous year. We suggest that the
compliments are analysed for both years in order
to identify what in particular so pleased patients
so that these matters can be rolled out across the
services in order to improve patient satisfaction
further.
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We note the results of the local clinical audit
and are pleased with the improvements to
services identified. However, the staff survey
results, especially the drop in the number of staff
completing the survey, is of concern. We suggest
that as part of performance review staff are
given the opportunity to discuss why they do or
do not complete this survey as the evidence from
the survey must help to shape working practices.
We wish the staff and service users every success
as the Provider Services become part of the new
Worcestershire Health and Care Trust, and look
forward to working together in the coming
months in order to help to identify issues for the
newTrust which arise from service users’ and the
public’s comments and concerns.
Provider Services Quality Account 2010/11
Statement from Health Overview
and Scrutiny Committee (HOSC)
Worcestershire County Council’s Health Overview and Scrutiny
Committee’s comments on the draft Quality Account of Worcestershire
Primary Care Trust Provider Services.
The Health Overview and Scrutiny Committee
(HOSC) welcomed that the Trust and
Worcestershire Mental Health Partnership NHS
Trust had worked together to identify the 4
priorities for 2011/12 as they would form one
organisation from July 2011, Worcestershire
Health and Care NHS Trust.
HOSC Members were aware that concern had
been expressed by services users of mental health
services that, under the new Worcestershire
Health and Care NHS Trust, their needs would
not be looked at to the same extent as by
the current Worcestershire Mental Health
Partnership NHS Trust, with physical disease
possibly taking priority over mental health needs.
The inclusion of nutrition as a priority for 2011/12
was welcomed by the HOSC, acknowledging that
nutrition was a basic requirement to get people
well and could impact on general health and
particularly dementia.
The HOSC noted that there had been a lot
of complaints about prison healthcare and
welcomed that such complaints were monitored
and acknowledged that the Trust had drilled
down into these and done something to
address the issues. The Trust advised that
often a significant issue for prisoners accessing
healthcare appointments was the availability of
prison officers to escort them.
The inclusion of the transition from child and
adolescent mental health services to adult
mental health services within the Trust’s 4
priorities for 2011/12 was welcomed by the
HOSC. The Committee questioned why the
waiting time in CAMHS was 18 weeks whereas
within adult mental health services it was
negligible, being 24/48 hours. The Trust advised
that it was working with commissioners
on this and it was a key area all wished to
improve. It was highlighted that the service was
experiencing an increase in referrals and this was
actively being looked at to understand what was
happening, recognising its impact on waiting
times. The Trust acknowledged that children and
young people and adults should not experience
any significantly different waiting times for
services.
The HOSC expressed concern that there was no
reference within the Quality Account to speech
and language therapies for children and it was
suggested that this should be a priority issue
for the Trust and should be taken on-board by
the new Worcestershire Health and Care NHS
Trust. The HOSC was advised that there were
waits within the service and improvements were
needed and the views expressed would be taken
on-board. The HOSC was assured that work was
already underway to address the service’s issues
and it was already possible to demonstrate
improvements.
The HOSC welcomed the work done by the
Trust to address slips, trips and falls within its
community hospitals.
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Provider Services Quality Account 2010/11
Statement from NHS Worcestershire
NHS Worcestershire welcomes the opportunity to comment on the
2010/11 Quality Account for WPCT Provider Services. Based on the ongoing assurance processes adopted with the Trust and the information
available to us we believe this provides a representative and balanced
perspective of the quality of healthcare provided.
As this is the first report produced by the Trust
there have been no specific priorities for action
to report against but it is encouraging to see
the breadth of work and achievement against
existing quality standards and initiatives across
the three domains of patient safety, patient
experience and clinical effectiveness. The
sustained performance against the majority
of the quality indicators as monitored both
internally and by NHS Worcestershire as the lead
commissioner is recognised and commended.
The high achievement against the majority of
indicators within the CQUIN scheme for 2010/11
is also indicative of a commitment to delivering
high quality and safe care for patients.
There is also clear demonstration of learning
from incidents, reports and audits which
have all supported further work to enhance
the quality and safety of services delivered.
Encouraging the reporting of incidents, for
example as demonstrated by the increase in the
number of pressure ulcers being documented,
has enabled the staff to learn for this and take
action to reduce the risks and improve practice.
There is also recognition of areas in which
the Trust needed to improve with evidence of
actions taken to achieve those standards. The
unannounced CQC visit in May 2010 found some
minor concerns with compliance against the
regulations related to infection control which
resulted in positive action being taken to resolve
the issues and subsequent internal and external
assurance visits have demonstrated this has been
sustained.
58
Seeking and responding to patient feedback on
their experiences of care is to be encouraged and
it is hoped this will be enhanced and expanded
further by the new Trust. This will ensure
that the on-going development of services
incorporates the views and experiences of
patients and service users which is vital to ensure
that care services are responsive to their needs.
Commissioners will continue to hold the Trust to
account for performance against the priorities
and improvement targets detailed in this
Quality Account during 2011/12 through the
quality assurance processes established with the
Trust. The information in the account provides
evidence of achievements, challenges and future
aspirations.
The priorities for improvement for 2011/12 will
further contribute to enhancing quality of care
for patients across a diverse range of services. It
is encouraging to note the involvement of staff,
patients and service users in the identification of
and development of the actions to address these
priorities. It is acknowledged that this work will
be taken forward by the new Worcestershire
Health and Care NHS Trust has clearly stated
its commitment to maintaining and further
enhancing the focus on the quality of services
provided for the people of Worcestershire.
Provider Services Quality Account 2010/11
Section 5: How to Contact Us
If you would like to talk to anyone about any concerns you have
regarding your care or treatment, please contact:
Patient Relations Team
Worcestershire Primary Care NHS Trust
Free-phone: 0800 917 7919
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Provider Services Quality Account 2010/11
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