Barchester Healthcare’s
Independent Hospital Services
Quality Account
2012–2013
Barchester Healthcare’s Independent Hospital Services, Quality Account 2012–2013
Introduction
Barchester Healthcare is pleased to report back on the 2011 to 2012 Quality
Account from our independent hospital services, and to set new targets for
2012 to 2013. This document provides a basis for all stakeholders involved
with our hospitals to look back over and reflect upon the quality
improvements we have made over the past year, and to plan actions for the
improvements we have set ourselves going forward into next year.
I founded Barchester Healthcare as a member of a family with caring responsibilities
myself, because I was so dissatisfied with the care facilities available at the time.
I have always wanted to ensure that Barchester delivers the very best in quality
care. Our independent hospital’s Quality Account for 2011 to 2012 was an
important contribution to positive change. Though we did not meet all our
targets we made significant progress in all areas – and we now know what we
need to do to deliver on areas where more work is needed. Much of the value of
a Quality Account is the help they offer services in measuring progress objectively,
identifying problems, thinking through and planning new approaches.
Moving forward to the Quality Account for 2012 to 2013, we have identified five
areas of improvement that we believe will improve quality within our services,
based on consultation with the individuals we support, their families and carers,
our staff and other stakeholders. These initiatives are chosen from within the
domains of Patient Safety, Clinical Effectiveness and Patient Experience, areas for
improvement across England overall, identified by the Department of Health.
Barchester Healthcare’s Independent Hospital Services, Quality Account 2012–2013
We are committed to open and transparent working practices, reporting on
what we do, and on where we need to improve. Quality is always evolving,
responding to changes in values, expectations and perceptions. We are
committed to measuring and reviewing our planned outcomes regularly, to
adapting them wherever necessary, and ensuring that the service given to our
patients, staff and other stakeholders is based on best practice. As a result,
planning for improvements on the basis of working with a Quality Account is
a useful and natural approach for our organisation.
I would like to take this opportunity to thank all those involved in providing
feedback, ideas or actions for our Quality Account. This includes the
individuals we support, relatives, friends, our staff and internal and external
stakeholders, particularly commissioners and visiting care professionals.
Without their input the progress we have made towards our aims and
objectives would not have been possible.
I can confirm that the content of this report has been reviewed by the Barchester
Operations Board in June 2012 and to the best of our knowledge the information
contained in it is accurate.
Mike Parsons
Founder and CEO, Barchester Healthcare, on behalf of the Operations Board.
I am very pleased to see that the Quality Account initiative is actively owned
by the individuals we help support, and by relatives, friends and care
professionals involved in that support.
There has been genuine eagerness and enthusiasm for the consultations setting
this year’s quality initiatives throughout our stakeholder forums, linked to the
Five Outcomes for Health, which are described in Part Two of the report.
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Barchester Healthcare’s Independent Hospital Services, Quality Account 2012–2013
Statement of Accuracy of our Quality Account
Directors of organisations providing hospital services have an obligation under
the 2009 Health Act, National Health Service (Quality Accounts) Regulations
2010 and the National Health Service (Quality Accounts) Amendment
Regulation 2011 to prepare a Quality Account for each financial year. Guidance
has been issued by the Department of Health setting out these legal requirements.
In that context we need to formally record that over the period covered
by the Quality Account for 2011 to 2012 Barchester Healthcare provided NHS
mental health services within its six independent hospital sites. 100% of the total
income generated by these services was procured through Barchester providing
care and treatment to those in need on behalf of the NHS.
Monitoring and reporting progress
The Barchester Executive team meets monthly. It regularly reviews the quality
and risk profiles covering all service provision, including mental health service
provision. The Executive identifies any areas of care practice that need
improvement. It links with the Mental Health Clinical Governance
Committee to make sure that action plans are put in place to improve service
delivery and maintain safety. The Executive also reviews reports on progress
and challenges to these action plans.
As the Care and Quality Director for Barchester I am the Chairman of the
Mental Health Clinical Governance Committee and I am responsible for its
link to the Executive. The Mental Health Clinical Governance Committee is
the key body for driving quality improvements across all our independent
hospitals. We meet every two months to monitor, manage and improve the
process, planning and governance structures designed to ensure safe and
effective service delivery. Our strategy is based on national policy initiatives,
internal regulatory compliance and Quality Account priorities. Our committee
reviews and plans its performance to meet the requirements of NHS
commissioning bodies. Plans are shaped by Commissioning for Quality and
Innovation (CQUIN) standards and its agreed priorities.
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Barchester Healthcare’s Independent Hospital Services, Quality Account 2012–2013
Barchester’s independent hospitals work hard to continually improve patient
experience through monthly clinical governance meetings, patient forums,
input from clinical review teams and quality improvement initiatives. As with
Barchester’s corporate clinical governance more generally, local governance
committees are made up by multi-disciplinary representatives.
Throughout 2011 to 2012 the Independent Hospitals ran monthly clinical
audits as part of quality checks based on our Quality Account.
We have six small independent hospitals based primarily in the north of England
(in Hull, Billingham and Stockport) and one in Waltham Abbey in Essex.
Our hospital services are commissioned by the NHS, either through PCTs or
through special commissioning bodies acting on behalf of PCTs. We have
consolidated these relationships through joint venture partnerships with local
PCTs and NHS trusts, commissioning and supporting innovative hospital
services based on meeting local needs.
We value our shared working relationships with our partners in the NHS and
appreciate the contribution that accurate reporting through our Quality Account
makes to it, and to the quality of the services we offer.
Jim Marr
Director of Care and Quality, Barchester Healthcare
on behalf of the Operations Board.
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Barchester Healthcare’s Independent Hospital Services, Quality Account 2012–2013
Part one: How we performed last year (2011 to 2012)
This section of the Quality Account for Barchester's independent hospitals
reviews our performance over the last year, running from March 2011 to March
2012 but reported on in June, following Department of Health guidelines.
Overall, we worked hard to meet the targets we set ourselves. One or two key
people working within the independent hospitals changed roles at the beginning of
the action planning process and it took time for new managers to pick up on how
a Quality Account works. Our established hospitals were able to achieve most of
their goals. One of the newer ones could not get started on action planning for the
Quality Account process until very late in the year. That meant that progress was
not universally as strong as it could have been. On the other hand, we have learned
lessons from this year of work on the Quality Account. We have developed
important measurement systems that will tell us what we are doing well and what
we are doing less well. We have also appointed managers to key roles and made
sure that action plans for 2012 to 2013 will be implemented by named staff
members in all hospitals, accountable through manager's local governance
meetings and to Barchester’s Mental Health Clinical Governance Group.
We achieved some important successes, too. Some of our key achievements against
the action plans in our Quality Account for 2011 to 2012 are detailed below:
1. Personalised Care Pathways
New care plans have been designed to be used by each person we support.
They are written in easily understandable language, and make sure that care
planning is clearly based on what the people we support and their friends and
relatives would like to achieve. The care plan says what each individual we
support can expect to receive, and when it will be delivered. We have linked
this to a system that regularly asks people using care plans about how much the
care plans have helped and where they can be improved. We will keep records
of what they tell us and review them to make sure they deliver what is required.
We have designed our new care plans so that they are driven by the views of the
people we support and their families. We will work with the people we support to
continue to improve our care plans so that they are easy as possible to understand,
helping people to choose what they want to achieve and how they will achieve it.
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Barchester Healthcare’s Independent Hospital Services, Quality Account 2012–2013
Care pathways provide the details of one-to-one sessions with a named nurse
and key workers, members of the multi disciplinary team and others involved
in care planning. Regular reviews and assessments take place to check progress
towards goals. These reviews include information and advice from The Care
Programme Approach, Hospital Manager's Meetings, Mental Health Review
Tribunals, and Second Opinion Approved Doctors. To make sure that care
plans are working well we use tools such as The Health of the Nation Outcome
Scales (HONOS), Recovery Stars (looking at individual recovery), The
National Institute for Health and Clinical Excellence (NICE) Clinical
Guidance and The Essence of Care system.
Did we achieve our targets?
All of our independent hospitals are using personalised care plans. However,
documentation to support new care plans has been agreed and ratified only
recently. In our targets for 2012 to 2013 we will consolidate progress to ensure
that 100% of the people we support are covered by the newly designed and
standardised care planning process by September 2012.
Every individual we support will have a care plan in the new format in place
within 72 hours of admission. Multi-disciplinary team members will agree
what support is needed with each person we support and their families.
We will make sure we achieve these goals by checking progress through local
and national clinical governance reporting mechanisms.
Our target was partially achieved last year and will be achieved this year.
2. Ensure that everyone is able to return to the community as quickly
as possible, with all agreed outcomes achieved.
From the first moment of admission to our service, our plan of care and
treatment is based on a pathway to solutions to problems and discharge to the
community. Goals are set and plans made in order to support freedom and
independence in the least restrictive environment. We track and record
progress through local clinical governance, Barchester’s Mental Health Clinical
Governance Group meetings and the Care Programme Approach, all of which
ensure we are focused on appropriate discharge pathways, and that the people
we support move through our services back into the community.
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Barchester Healthcare’s Independent Hospital Services, Quality Account 2012–2013
Did we achieve our targets?
We set up the systems we needed to ensure that we could monitor and support
care planning focused on discharge to the community but there were delays in
introducing the new care plans. All hospitals will begin using the new
documentation and reporting systems from June 2012. We will complete care
plans in the new format for 100% of the people we support by September 2012.
Our target was partially achieved last year and will be fully achieved this year.
3. Demonstrate a minimum of 25 hours a week structured therapeutic
activity for each patient.
A new database and monitoring systems have been designed and will be
introduced in June. They make sure every person we support under the age
of 65 will be offered a minimum of 25 hours of therapeutic activities each week.
Activities will be chosen on a personalised basis, agreed with the individual we
support, their family (where that is appropriate), and the multi-disciplinary
team. The database will record activities for each individual and show how their
activities are based on their care plans. This information will be used to measure
our progress towards our targets through The Care Programme Approach,
Clinical Reviews and Audits.
Did we achieve our targets?
The basis for monitoring and recording of therapeutic activities within our hospitals
has been agreed. Our new electronic database will be introduced in June 2012.
We know through CPA and commissioner reviews that we are able to evidence
achievement of this target for many individuals but we need to introduce the data
base for everyone this year, so we can review progress for each individual. The next
step will be to keep reviewing our care planning process so that we know (and can
demonstrate) that activities are matched to personal choices.
Our target was partially met last year. We will achieve our formal target for
2011 to 2012 in June of 2012 but we will set more ambitious targets for
personalised therapeutic activities over 2012–2013.
4. We will review our current clinical information systems to ensure that the
data we need to routinely monitor this Quality Account is provided through
our centralised information systems.
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Barchester Healthcare’s Independent Hospital Services, Quality Account 2012–2013
A database that collects the required clinical information has been developed.
This system was designed through consultation between the Mental Health Act
Administrators, professional representatives and Barchester's IT department.
In trials it is working well and is supporting better care. It flags up information
and creates a chain of reactions and alerts. These include reminders of renewal
of sections, sending out alert emails to the named nurse to produce reports for
clinical review meetings. The system also produces information for external
data collection, such as the Commissioning for Quality Initiatives (CQUIN),
and Mental Health Act monitoring. It will be rolled out across all our
independent hospitals from June of 2012.
We have internal Clinical Governance forums, quality review panels and best
practice monitoring systems that will help us achieve the targets we set out in
our Quality Account. Action plans have been developed. The system will allow
us to monitor our progress, to demonstrate our progress to commissioners, the
people we support and other stakeholders. We will also be able to check how
well we are doing by comparing our performance with other hospitals
producing information for national data sets.
Did we achieve our targets?
A new data system to support clinical information has been developed.
All hospitals will be able to use this system by June 2012.
Our initial target will be met by that date but refinements may be necessary.
5. Each hospital will be audited on a quarterly basis to ensure its ethical
practice continues to develop across the 12-month period.
We have worked on the development and implementation of quality reviews
based on ethical issues emphasised by local and national clinical governance.
The associated audits give information on:
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The rights of individuals detained under the Mental Health Act
The utilisation of the Mental Capacity Act
Deprivation of Liberty Safeguards
Safeguarding of Vulnerable Adults referrals
Access to advocacy services
The Human Rights Act
The Equality Act 2010
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Barchester Healthcare’s Independent Hospital Services, Quality Account 2012–2013
‘The Managers Clinical Audit Tool’ is a review that has been developed and
introduced into the clinical areas. It is the responsibility of the Hospital Manager to
complete. It allows us to look at how many of the people we support are affected by
restrictions to their rights and what their experience is like. This means that we can
discuss how well we are doing with the people we support and other stakeholders,
compare our work with similar hospitals and look at how we might improve services.
When the audit tool is completed the Hospital Manager shares their findings
with the local clinical governance meeting, and plans any improvements needed.
The resulting action plan is a working document for change. It is discussed and
reviewed regularly at forums for staff and the people we support, and at local
and national clinical governance meetings. This helps make sure that actions are
followed up and that they lead to the agreed outcomes.
Did we achieve our targets?
A comprehensive audit tool has been put in place, which will generate objective
information. We will use this information to develop reports and action plans to
deliver positive change. It will be monitored by the Mental Health Clinical
Governance Group on a bi-monthly basis.
Our initial target has been achieved. It gives a firm basis to reviews to
deliver change. Over the coming year we will report back to the people we
support, their relatives, friends and other stakeholders on our progress
and on new targets to be set.
6. Each hospital will evidence two service improvements that have been made
as a direct result of direct consultation with people who use the service.
All our hospitals have regular meetings for the people we support, where the views
and wishes of those experiencing the service can be discussed and improvements
can be planned. We know that some people we support can find it difficult to put
their thoughts and views into words, so we have begun to use the Star Wards
system. Star Wards documentation helps us identify areas where the people we
support would like to see change. Three areas that were picked by many people were:
• Spending more meaningful time with staff members
• More contact within the community
• More activity sessions
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Barchester Healthcare’s Independent Hospital Services, Quality Account 2012–2013
We have worked on and improved on all these areas and reported back to the
people we support. We are also monitoring satisfaction levels.
Menus and choice of food was another area where a need for change was
identified. People spoke about wanting ‘something different’. Staff explored
this further, with the people we support and a ‘something different’ menu was
introduced. This is in addition to the daily planned menus, and offers a wider
and different selection of food and snacks.
Did we achieve our targets?
Each hospital discussed at least two areas where the people we support wanted
changes and took actions to improve services on that basis. The only exception
was a new hospital, which opened too recently to implement the action plan.
Our target was partially met.
7. There will be a review of medication on admission and at monthly
intervals for all the people we support.
Monthly reviews of medication have been undertaken in all hospitals.
In one hospital which supports people with dementia the drug Memantine has
been used as an alternative to prescription of anti-psychotic drugs, on the basis
of careful medical review. Memantine treats the symptoms of Alzheimer's
disease, helping people living with Alzheimer's disease to think more clearly
and perform daily activities more easily. It has been specifically used by our
psychiatrist as an alternative to anti-psychotic medications where they have
been prescribed for ‘challenging’ behaviours. The trial was successful.
Did we achieve our targets?
In the hospital that took part in the trial, there was 100% success. Everyone
taking anti-psychotic medication for ‘challenging’ behaviours is now prescribed
Memantine as a less harmful alternative.
Over the coming year we will review the use of anti-psychotic drugs for all the
people we support who are living with dementia.
Our target was partially met.
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Barchester Healthcare’s Independent Hospital Services, Quality Account 2012–2013
Overall review of Quality Account targets for 2011 to 2012
Over the course of 2011 to 2012 two hospitals had particular challenges in
implementing the Quality Account targets. In response to this we have reviewed
our support structures for independent hospitals and established new peer review
and quality development forums.
Our Quality Account targets for 2011 to 2012 were partially met. However,
in the process of striving to meet them we have discovered and addressed
important issues. We have established strong monitoring systems and
improved systems for leadership, planning and delivering change. Taking
these together with strengthened links with local NHS trusts and their expert
clinical staff we will be much better placed to address issues and deliver
positive change through 2012 to 2013, continuing to involve the people we
support and other stakeholders and reporting to them on progress.
Over the next year we will concentrate on ensuring consistency of quality and
approach across all hospital sites, while acknowledging that they support
different people with different needs in local communities with widely differing
capacities for support. Our Quality Account will recognise local needs – but
within a nationally determined framework for monitoring and improvement.
For 2012 to 2013 we will focus on meeting the new national guidelines based
on the five outcomes for health. However, we have linked our new targets to
consolidating the targets we set last year, which we will continue to report on to
the people we support. We will report on progress towards our targets to the
Mental Health Clinical Governance group, making our work accountable to
them. Through them we will be accountable to the Barchester Executive and
Board. We will make sure that we deliver on areas where we did not meet last
year’s targets. We will use our progress as the basis for further development.
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Barchester Healthcare’s Independent Hospital Services, Quality Account 2012–2013
Part Two: Identified Priorities for Clinical Improvements
in 2012 – 2013
The Department of Health’s Quality Account guidance requires that we identify
at least three priorities for improvement from the Department of Health’s Five
Outcomes for Health. This is a list of priority areas for improvement, which for
2012 to 2013 are:
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Preventing people from dying prematurely
Enhancing quality of life for people with long term conditions
Helping people to recover from episodes of ill health or following injury
Ensuring people have a positive experience of care
Treating and caring for people in a safe environment and protecting
them from avoidable harm
Having consulted with the people we support, relatives, staff and other
stakeholders, the independent hospitals’ Managers Forum and Barchester’s
Mental Health Clinical Governance Group have agreed on five priority areas
for improvement. However, our initial priority for 2012 to 2013 is to ensure
that we consolidate the targets we set ourselves last year.
By June 2012 the new mental health database will be in place in all hospitals.
By September 2012 all individuals will be supported by the new and consistent
care planning process, using the Star Ward model where appropriate. We will
report on progress each month and evidence we have met our targets through
the governance structures discussed throughout the Quality Account.
This will also support 2012 to 2013 plans as the database and new care planning
format will supply a platform for providing the evidence base to demonstrate
achievement of our priorities for this year.
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Barchester Healthcare’s Independent Hospital Services, Quality Account 2012–2013
Based on health outcome 5 – Treating and caring for people in a safe
environment and protecting them from avoidable harm:
1. To ensure each hospital has a robust framework to support appropriate
physical interventions when managing challenging behaviours, reflecting
evidence-based best practice.
Barchester’s independent hospitals are currently using internal and external
trainers to teach practical techniques for minimising and safely managing
violence and aggression. Course content varies from hospital to hospital. We want
to establish a model of practice that best supports the people we look after. The
model must minimise the need for intervention, support our staff and ensure the
use of the least restrictive techniques possible where they are necessary. We will
agree and introduce a best practice approach and accompanying documentation
for supporting, recording and reviewing incidents of violence and aggression.
Its effectiveness will be reviewed with the people we support, their relatives,
staff and other stakeholders.
How are we going to achieve this?
We will:
• audit the current training models
• review the current training content and its delivery, ensuring it is in keeping with
the safe practice guidelines, evidence-based best practice and the requirements
of the service
• review the audit processes and documentation for incident management
• review our training methods and set a consistent standard across the service
• review and revise our approach and documentation where necessary,
through feedback and direction from forums for the people we support
and their relatives, audits, staff meetings and Clinical Governance meetings
• integrate the new approach and documentation into our new
clinical database.
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Barchester Healthcare’s Independent Hospital Services, Quality Account 2012–2013
Our targets
• By three months we will have reviewed the appropriateness of the various
models already in use within our service
• By six months we will have agreed and identified the appropriate model
for our services
• By nine months we will have reviewed the documentation to support
the models
• By twelve months all services will have an agreed model with appropriate
documentation to support it
• By twelve months 100% of care plans will have been discussed and staff will be
familiar with appropriate techniques for minimising violent and aggressive incidents
Based on health outcome 4 – Ensuring people have a positive experience of care:
2. Introduce non-invasive complementary therapies as a choice within all the
hospital settings
As part of last year’s Quality Account initiatives we introduced a system to ensure
that all of our patients received a minimum of 25 hours therapeutic activity each
week. We reviewed activities with the people we support.
In one of our services, people were offered Reiki and Indian head massage.
This proved very popular, and feedback suggested these therapies contributed to
a sense of well-being. Given this positive response and feedback from other people
in other hospitals we want to make sure all the people we support are offered
these and other complementary therapies across all our services.
How are we going to achieve this?
We will:
• Audit complementary therapies currently used within our services
• Ask the people we support about complementary therapies and establish a
baseline for what we should offer
• Ensure that care plans identify where individuals would like or might
benefit from complementary therapies
• Identify internal and external capacity to provide complementary therapies
• Measure self-rated well-being with the people we support and review
the effectiveness of complementary therapies
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Barchester Healthcare’s Independent Hospital Services, Quality Account 2012–2013
Our targets
• By three months we will review the current complementary services
within our services
• By six months personal care plans will establish what complementary
therapies individuals would like to be offered
• By nine months we will identify internal and external therapists and provide
complementary therapies requested
• By twelve months we will review the benefits of complementary therapies with
the people we support including people accessing complementary therapies
away from the hospital environment
Based on health outcome 4 – Ensure people have a positive experience of care:
3. Introduce a training package for staff, which will facilitate a better
understanding of personal needs, culture and diversity, eliminating
stigmatising language or practices.
We have identified a need to review and refresh the knowledge and
understanding of personal needs, diversity, culture and avoiding stigmatising
language and practises across our services.
While we have in place a clear policy and appropriate training relating to
diversity we want to develop a system more specific to the current hospital
environment and develop a more in-depth training package that facilitates
knowledge and understanding in these areas. We believe this will help staff teams
better serve, support and respect the personal and diverse multi-cultural needs of
the people we support and their families.
Barchester Healthcare’s Independent Hospital Services, Quality Account 2012–2013
• Undertake a needs analysis among our staff group to ascertain their
current knowledge and understanding of personal needs
• Review current research and practices with our learning and development
team, review current training packages and refresh and develop them
where appropriate
• Review the effectiveness of our training and the care plans based upon it
with the people we support, their relatives, staff and other stakeholders
Our targets
• By three months we will have audited staff interactions and communications
with the people we support to identify negative or potentially stigmatising
language or behaviours. We will achieve this through the use of
observational tools.
• By six months we will have devised a training package that supports
understanding and best practices in personalising care, diversity,
cultural awareness and avoiding stigmatisation
• By nine months we will have introduced and made available the new
training package for all staff to access
• By twelve months all care plans will reflect best practice and reviews will take
place with the people we support and their families
• By twelve months we will ensure that 100% of our staff undergo training
• By twelve months we will ensure that 100% of our care plans better
reflect personal, cultural and spiritual needs
How are we going to achieve this?
We will:
• Audit staff interaction and communications with the people we support
through the use of observational tools to identify positive, negative or
potentially stigmatising language or behaviours
• Review how we currently meet personal, cultural and spiritual needs for
the individuals we support
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Barchester Healthcare’s Independent Hospital Services, Quality Account 2012–2013
Barchester Healthcare’s Independent Hospital Services, Quality Account 2012–2013
Based on health outcome 4 – Ensuring people have a positive experience of care:
Based on health outcome 4 – Ensuring people have a positive experience of care:
4. Develop and introduce improved communication systems for those
individuals we support who currently experience barriers to their ability
to communicate.
We have identified that some of the people we support in our hospitals experience
barriers to communication as the result of conditions such as dementia,
Huntington’s Disease or other organic illnesses. Our community learning disability
services are currently using My Say as a tool that supports communication and
choice. This tool and others will be reviewed, adapted and introduced to individuals
who need help in making their needs and choices known.
5. Continue to work on developing regular Quality Review Panels across any
independent hospitals where they do not yet exist as forums for improving
services through input from the people we support, their relatives, staff and
other stakeholders, ensuring that all Quality Account targets are met.
How will we do this?
We will:
• Audit and evaluate the communication tools already in use across our services.
This information will come through forums, clinical reviews, etc
• Research the availability and success of alternative methods of communication
• Identify communication tools to be piloted within our services
• Identify individuals who will benefit from using particular
communications tools and implement their usage through care plans
• Review the effectiveness of communications tools on an individual basis, through
Clinical Governance meetings and Barchester’s Mental Health Clinical
Governance Group, revising approaches where appropriate
• Review the effectiveness of communications tools on an individual basis,
through Clinical Governance meetings and Barchester’s Mental Health
Clinical Governance Group, revising approaches where appropriate
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How will we do this?
We will:
• Establish Quality Review Panel meetings in all independent hospitals to
which the people we support, relatives, carers and other stakeholders will
be invited on a quarterly basis
• Report back and review progress on all targets at minuted quarterly Quality
Review Panels
• Report Quality Review Panel views to Barchester’s Mental Health Clinical
Governance Group
Our targets
• By four months we will have held Quality Review Panel meetings in all
independent hospitals, with minutes going to Barchester’s Mental Health
Clinical Governance Group
• By twelve months we will have held three Quality Review Panel meetings in all
independent hospitals, with minutes going to Barchester’s Mental Health
Clinical Governance Group
• By twelve months progress will be complete on all Quality Account targets
from 2011 to 2013
• By twelve months Quality Review Panels will be able to help shape Quality
Account targets for 2013 to 2014
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Barchester Healthcare’s Independent Hospital Services, Quality Account 2012–2013
Part Three: About Barchester Healthcare – Funding, Registration, Research,
Staffing and Commissioner’s Comments
Funding: Barchester Healthcare provides services to more than 10,500 people
in more than 200 service sites. Our commissioners are the individuals we
support, who fund their choices through personal budgets or private income
and resources from local authorities and Primary Care Trusts (PCTs). We are
also starting to make connections with the new commissioning bodies that are
emerging. That means our health income fluctuates on a daily basis because
most of it comes through individual nursing or continuing healthcare funding.
In developing this account we have specifically reviewed the quality of six small,
independent hospitals. Their income represents 4% of the total income for
Barchester generated from the provision of NHS services over 2011 to 2012.
Over the course of 2011 to 2012 we have met requirements for being an
approved provider for 'locked and unlocked' rehabilitation services for
Yorkshire and Humber strategic health authority, which included an element of
Commissioning for Quality and Innovation (CQUIN) payment.1 Patients in our
hospitals are funded through individual contracts. Some commissioners have set
broad targets to be achieved in relation to CQUIN, which is now part of the
standard mental health contract.
Barchester Healthcare was not subject to the Payment by Results clinical coding
audit during 2011 to 2012 overseen by the Audit Commission. However, we are
now involved in the work that is being undertaken looking at including mental
health services in systems of payment by results.
Registration: Barchester Healthcare is required to register with the Care Quality
Commission (CQC). Across the services Barchester provides our services are subject
to different registration for different regulated activities. For our independent
hospitals our current registration status is in respect of: ‘Regulated Activity:
Accommodation for persons who require nursing or personal care’. This covers
assessment of medical treatment for persons detained under the MHA 1983;
treatment of disease, disorder or injury; diagnostic and screening procedures.
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‘The Commissioning for Quality and Innovation (CQUIN) payment framework enables commissioners to reward
excellence by linking a proportion of providers’ income to the achievement of local quality improvement goals.’,
Department of Health website, 2008, http://www.dh.gov.uk
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Barchester Healthcare’s Independent Hospital Services, Quality Account 2012–2013
Barchester Healthcare has not participated in any special reviews or
investigations by CQC during the reporting period.
CQC have issued warning notices of action against Barchester Healthcare
during 2011 to 2012 (all of which have been complied within the required
timeframe) but have not done so in any of our registered hospital services.
Research: We are a pilot site for the 'Think Local, Act Personal' initiative.
We have participated in national audit work, though not directly connected to
delivery of mental health hospital services.
Barchester Healthcare did not submit records during 2011 to 2012 to the
Secondary Uses service for inclusion in the Hospital Episode Statistics.
Staffing: Barchester Healthcare’s innovative work in the area of recruitment
and training was recognised through the award of the ‘The Egoli Trophy for
Outstanding Learning Enterprise Globally’ for its learning and development
programmes in 2011. In the previous year Barchester won the National
employer service award and the Macro Apprentice Employer of the Year
award. This award celebrates large employers who genuinely commit to
developing people within the apprentice framework and who successfully
integrate this approach into their culture. Barchester won three awards out of
five categories at the National Workforce Development Awards.
In addition Barchester won in the category for Integrating Employment and
Skills, which was awarded for excellent retention rates and a high success rate
in developing and encouraging staff who begin work with no qualifications.
Barchester also won the award for Supporting Young Talent for our record of
attracting young people to the sector, supporting them through apprenticeships
and work placement schemes.
Barchester Healthcare regularly features in The Sunday Times Top 25 Best
Companies/Organisations to work for, the only care organisation to feature in
this list. The list is based on confidentially researched employee recommendations.
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Barchester Healthcare’s Independent Hospital Services, Quality Account 2012–2013
Commissioner’s Comments: Here are some views expressed by primary care
commissioners and mental health foundation trusts with whom we work
collaboratively. They were requested from PCTs where we have hospital sites
and commissioners who support large numbers of the individuals we support
on our previous Quality Account.
Comments included:
‘I felt positive about the direction of travel and look forward to a positive
relationship with Barchester.’
PCT commissioner
'Thank you for sight of your Quality Account. The governance arrangements you
have in place to oversee the development of quality approaches appears robust. You
also report on excellent plans to drive up quality although it is surprising that not
everyone already has a personalised care-plan. The Primary Care Trust has seen
other Quality Accounts in which an important component of the account has been
past performance on key quality indicators. In further accounts more detail about
actual performance would be welcome.'
PCT commissioner
Barchester Healthcare’s Independent Hospital Services, Quality Account 2012–2013
This Quality Account was sent to local commissioners for comment.
At the time of completion we have received helpful comments from one
commissioner, and altered our original draft to include more detail on
hospitals. A further useful comment was made on producing graphs and
data to support national benchmarking and trend analysis. Our new
database is due to be fully implemented in June of this year and we will
then be able to produce statistical information in the best form for
benchmarking purposes.
The comments were very helpful and reflect our priorities for the year.
Barchester Healthcare would like to thank all commissioners and others
for their contribution to this Quality Account. We look forward to
working with all stakeholders over the coming year to deliver the
improvements to which we are committed.
'This looks really impressive.’
Partner, NHS mental health trust
‘The layout and content are easy to the eye and easy to read – well done!’
PCT commissioner
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