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. 2 3 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. 4 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. 5 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. 6 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. 7 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. 8 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: • • • • • • • 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 9 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 10 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. 11 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. 12 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: • • • • • 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. 13 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. 14 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 15 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 16 17 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 18 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 19 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. 1 ‘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 20 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. 21 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 22 23