Quality Account
2011/12
1
Contents
Quality Narrative
3
NHS Stockport Statement
4
Review of 2010/2011
Stockport Clinical Commissioning for Quality
5
Care Quality Commission
Data Quality
6
Information Governance
7
Review of Services
Service Reviews
8
Patient Safety
9
Patient Experience
14
Clinical Effectiveness
18
Continuous Quality Improvement and Innovation
20
Workforce
22
Stockport LINKs Statement
Contact Us
27
2
Statement of Quality
In 2008, former Health Minister Lord Darzi published the ‘High Quality Care for All’ report. The aim of the
report was to ensure the NHS provided high quality and effective patient care by making it publicly
accountable for the services it delivers.
The report also proposed that all organisations providing services for the NHS should be required to
publish annual ‘Quality Accounts’ - a yearly report to the public about the
quality of services delivered.
Community Health Stockport (CHS) is an NHS organisation which delivers
healthcare, early intervention and health improvement outside of hospital
and within the communities of Stockport.
Legally, we are part of NHS Stockport but we operate as an Autonomous
Provider Organisation. This enables us to concentrate on providing high
quality services to patients, while the commissioners of NHS Stockport focus on securing the best healthcare for the population of Stockport.
We have made our commitment to the population of Stockport through:
 Improving health and providing services no matter who you are or
where you live in Stockport;
 Organising our services to reduce the length of time you have to wait,
involve you, your family and carers in your care, and include other Laura Foster
services when needed;
Interim Director of
 Improving and providing high quality services that meet or exceed NHS
Community Health
standards;
 Ensuring that we keep you safe by making sure the environment in Stockport
which we provide care is clean and safe, that our staff are well trained,
that we use the available evidence to provide the best care and that we continuously monitor standards and look for areas to improve;
 Listening to people who use our services so that we can continuously improve them and develop the
services based on their needs.
Community Health Stockport provides a comprehensive range of services to care for everyone in our
communities throughout their lives. Services like Health Visiting and Children’s Therapy support children,
young people and their families including those with disabilities. Services like District Nursing, Palliative
Care and Rehabilitation provide care for adults and older people including those with a long term illnesses, those requiring ongoing treatment or rehabilitation following a hospital admission, those requiring
short term treatment for an injury or illness and those requiring support and care at the end of life.
The health inequalities between Stockport’s most and least deprived neighbourhoods present us with a
real challenge with the gap in life expectancy between these communities being 12 years for men and 9
for women. It is vital we continue to work with our partners to redress the balance whilst continuing to
offer high quality care to all of Stockport’s 285,000 residents.
Community Health Stockport has a good track record of working well with our partners like the Local
Authority, Stepping Hill Hospital and General Practitioners to ensure that the care we provide is ‘joined
up’ and we are able to deliver the right care, in the right way and in the right place. From April 2012, Community Health Stockport will be merging with Stockport Foundation Trust (Stepping Hill Hospital) to form
one health care provider for the Stockport population.
3
NHS Stockport Statement
NHS Stockport believes that the Annual Quality Account of Community Health Stockport is a true and balanced reflection of its achievements in the year 2011-12 and that it meets the requirements of such a
document. It is also reflective of the commitment to service quality and continual improvement evident
across the service and required by the commissioner. This continued focus on quality during a difficult
year of preparation for transition to a new organisation on April 1 st 2012 is commendable.
NHS Stockport receives a detailed quality report, serious untoward incident reports and patient complaints data quarterly and other reports on quality issues throughout the year. It reviews these with CHS
at its quarterly contract meetings where discussion of service quality is always an agenda item. We also
have frequent one-to-one discussions on specific issues as the need arises. As a consequence we believe
the facts and evidence submitted are correct.
We would particularly highlight the following four areas of successful work. CHS achieved nearly all the
quality targets (CQUIN) that the commissioner set for it despite the focus of its senior management of
service transfer. This was an excellent result and demonstrates that quality whilst led from the top is seen
as a high priority across the organisation.
To achieve this it is necessary that staff at all levels feel empowered to make improvements in quality.
The staff survey results indicating a greater than average ability to contribute to improvements and sense
of feeling value by colleagues are significant in this respect. The work done on training and development
is also of a high standard.
CHS gives a number of examples of working with other agencies and not being unduly inwardly focussed.
So for example inter-professional learning and the QIPP safe care recognition reward indicate a desire to
work across service and professional boundaries essential for real quality improvement.
Fourthly, CHS continues to look in detail at its own services through service reviews and walk-about’s by
senior managers. This visible focus on service quality and willingness to publish findings is indicative of
quality improvement being understood as a priority at the top.
Going forward the challenge for CHS will be to maintain this focus on quality as it joins a much larger organisation with differing approaches in some areas. In particular as commissioners we would wish to see a
continued focus on those areas highlighted above in delivery of CQUIN, staff empowerment to lead quality improvement, multi-agency working and a top team understanding of local service quality.
In addition we would like to see CHS services improve further in three specific areas:
Firstly, build on their patient satisfaction monitoring to broaden it to understand their other “customers”
better. Secondly, make much more headway on pressure ulcer reduction. And finally despite scoring reasonably well on the IG toolkit score there remain too many instances of data loss and the commissioners
would expect specific reference to this issue in any future account.
4
NHS Stockport Commissioning for Quality
NHS Stockport (Stockport PCT) buys Community Health Stockport’s services on behalf of the people of
Stockport. A proportion of Community Health Stockport income in 2011-12 was conditional on achieving
quality improvement and innovation goals which were agreed between Community Health Stockport and
NHS Stockport (the PCT Commissioner) through the Commissioning for Quality and Innovation (CQUIN)
element of the NHS contract.
The use of CQUIN reflects the discussions between the PCT Commissioners and Community Health Stockport in striving to continually improve the quality of care and services we provide. The 19 CQUIN quality
indicators for 2011-12 were in 7 goal areas
Area
Achieved
Improving the quality of our data
Delivering the Health Child Programme
Reducing waiting times for clinics
End of life care
Measuring the healing rates of wounds
Infection prevention and control
Staff Immunisation Rates








17 out of the 19 indicators were achieved. The two
indicators that were not achieved were:

One relating to end of life care. There is an action plan
in place to bring about improvement.

One relating to reducing the number of pressure
ulcers in the community. There is on-going work to
ensure we reduce the number.
Each year, new CQUIN indicators will be negotiated and will reflect the aim continuously to improve our
services and the outcomes for the people we work with.
Further details of the agreed goals for 2011-12 and for the following 12 month period are available by
writing to our Quality Team email address QualityTeam@stockport.nhs.uk, also see contact details at
the rear of this publication.
5
Care Quality Commission
The Care Quality Commission (CQC) regulates all health and
adult social care services in England, the NHS, Local Authorities,
private companies and voluntary organisations. The CQC makes
sure that essential common standards are being met where care is
provided. Community Health Stockport is required to register with
the Care Quality Commission and our application for registration
was approved with no additional conditions required.
The Care Quality Commission has not taken any enforcement action against Community Health Stockport,
or been involved in any investigations by the CQC during 2011-12.
However , Community Health Stockport were asked by the Care Quality Commission to provide evidence
to show compliance to outcome 16 : Assessing and monitoring the quality of service provision . The organisation also took part in a joint Ofsted and CQC inspection for Safeguarding Children and Looked After
Children.
Further information about registration is available from www.cqc.org.uk as well as published reports.
Data Quality
Community Health Stockport’s continuing commitment is to improve patient care by taking a proactive
approach in improving the quality of data that is recorded on our electronic systems.
Since the implementation of Lorenzo (an Electronic Patient Record) in 2008 this has enabled us to obtain
daily information about the types of contacts and the completeness of those records.
During 2011/12 not only has there been further development of our reporting system which was implemented in 2010, but we have also implemented a scheduling system, which has greatly improved capacity
and recording of detailed information.
The reporting system provides managers and directors with daily up to date information about their service, this enables a high quality of clinical care which is cost effective and identifies where efficiencies can
be made without hindering patients’ safety.
For 2011/12, we set a key business objective of making sure that all services are in a position to record,
report and analyse their activity and performance data. This will enable them to manage capacity and
demand, ensure delivery of contractual requirements, increase quality of services and measure the outcomes from service improvement initiatives.
The chart shows some of our key data quality indicators. We are instigating an action plan to start to
improve the collection of information about ethnicity throughout 2012/13:
6
Key data quality indicators
Information Governance
Information governance is the term used to describe the set of standards that the NHS must follow to
make sure that it carries out its duty to:
·
maintain full and accurate records of the care provided to
service users
· keep records about service users confidential, secure and
accurate.
The NHS take the confidential nature of our work very seriously and
each year we undertake an audit of our performance through the Department of Health’s Information Governance Toolkit, which includes
a staff training package.
In 2011-12, NHS Stockport reached the required level on 39/41 requirements, resulting in an overall score
of 66% on the Information Governance Toolkit - an improvement of 36% on last year’s submission.
94.2% of staff successfully completed their mandatory IG training in 2011/12 – 93.07% among the community services team. This showed major progress on last year’s pass rate of 46%.
An action plan has been developed to reach level two on the remaining two requirements, through increased training for staff responsible for maintaining Information Asset Registers.
The Internal Audit department has approved our action plan for 2011/12 and are satisfied that we will
meet all requirements by early 2012/13.
With senior management support we will continue to raise the importance of Information Governance
training and ensure the engagement of key staff members.
7
Review of Services
During 2011-12, Community Health Stockport provided 31 NHS services. Community Health Stockport has
reviewed all the data available to them on the quality of care of these 31 NHS services. This report will
focus on our quality measure of ‘Service Reviews’, followed by the three areas within the national
definition of quality in the NHS:



Patient Safety
Patient Experience
Clinical Effectiveness
Service Reviews
The Service review process focuses on each individual service provided by Community Health Stockport
and measures it against the national quality standards. Each service has to present it’s evidence about
how it meets the quality standards and the process has been updated to reflect the 16 Essential standards
of quality and safety produced by the Care Quality Commission (CQC) in 2010.
In deciding which of the 16 CQC outcomes services needed to provide evidence for, the following criteria
were used:
 Number of patient safety incidents
 Number of complaints
 Number of risks
This was completed so that the outcomes allocated to each service were the most appropriate. The services which had not previously undertaken a service review or had scored below 80 per cent in a previous service review, are required to produce evidence for all 16 of the outcomes. During 2011-2012 7 services have been reviewed and all services scored above 90 per cent. The results can be seen in the table
below.
Service Review Results 2011-12
100
Percentage
80
60
40
Score
20
0
Intermediate
Care
Score
100
Specialist
Community
Palliative
Continence
Development
Care
100
92
100
District
Nursing
93
Nutrition and
Adults Physio
Dietetics
100
100
8
Review of Services
Mini Inspections
During 2011-12 we also introduced mini inspections following the format of the Care Quality Commission
(CQC) inspections. The main purpose was to mirror the Care Quality Commission inspection process, prepare staff for future inspections, to assure the board that we are compliant with regulations, to improve
staff knowledge of the CQC and regulation process, to identify areas for action and to provide evidence to
the CQC of proactive monitoring.
The inspections include:
 Observation of care being delivered
 A staff Interview and
 A patient Survey
All elements were scored giving an overall percentage
CQC Mini Inspection Project 2011-2012
90%
80%
Percentage
70%
60%
50%
40%
30%
20%
10%
0%
Score
Community
Rehab
CASH
Children's
Therapy
Smoking
Cessation
Health
Visiting
94%
97%
96%
96%
97%
9
Patient Safety
Patient safety remains a priority for Community Health Stockport (CHS). Staff are encouraged to report
incidents, and near misses, so that we can learn from them and improve practice for the future. CHS continues to report patient safety incidents to the National Reporting and Learning System (NRLS) on a regular basis.
Benchmark Incidents National Patient Safety Agency Report
The NRLS is a central database of patient safety incident reports. The following report shows the latest
published incidents submitted by Community Health Stockport between April 2011 and September 2011
and is a benchmark with other organisations. The report shows that:
 As an organisation we report incidents in a timely way
showing effective reporting systems
 As an organisation we report incidents on a regular basis
showing a positive patient safety culture
 As an organisation, we are better than average in 9 out of
the 11 reporting categories
 The 2 categories that require further work in order to
improve safety of patients are:
 Medication Errors
 Pressure Ulcers
Volume of Reporting
Between April and September 2011 we reported incidents in 6 out of 6 months
CHS sits just above the average in terms of volume of reporting - higher reporting rates being seen as a
positive measure of the safety culture in an organisation
50% of all CHS incidents are submitted to NRLS just above 7 days of them being reported
What do we report?
Incidents that have been reported fall into a number of different categories, as shown below. As an organisation, we are better than average in 9 out of the 11 reporting categories
10
The top 2 categories that we report on are:
1.
Medication Errors: Improving safety for patients and learning from incidents is a priority for the
organisation. Considerable work has been done over the year focusing on reducing the number of
medication errors. This has included a project that looked at the whole process of medication administration. Following this project, there has been close analysis of medication errors within the
district nursing service. Another area now in development is the electronic patient index which will
reduce patients being accidentally missed off visiting lists.
2.
Pressure Ulcers: The Implementation of Care Category includes the reporting of pressure ulcers.
Stockport reports 3 different categories of pressure ulcers whereas some areas only report 2 categories, therefore Stockport figures will generally show higher than average. However, each pressure
ulcer incidents is individually investigated in order to learn lessons and to continuously improve patient care. As part of the Safety Express initiative, developed by the Advancing Quality Alliance
(AQuA), CHS IS looking to reduce pressure ulcer numbers by 30% (of the 2010/11 total) during the
next 2 years.
Safety Express
Community Health Stockport is currently taking part in the Safety Express programme as the host
organisation. This means that we are the lead organisation for the programme working in partnership
with Stockport NHS Foundation Trust and a number of care homes. This work is across the whole
health economy. Safety Express is a national improvement programme which aims to achieve significant reductions in four avoidable harms: pressure ulcers, serious harm from falls, catheter acquired
urinary tract infections and Venous Thrombo Embolism (VTE). It also supports improvements in efficiency.
The specific aims for the programme are:





Category III & IV pressure ulcers reduced by 80% in hospital
Category III & IV pressure ulcers reduced by 30% in community
Catheter acquired urinary tract infection reduced by 50%
Serious injury from falls reduced by 50%
Venous Thrombo Embolism reduced by 50%
11
Achievements so far
Leadership walk rounds
As an organisation we are registered with the Patient Safety First Campaign to show our commitment to
patient safety. Community Health Stockport continues the leadership walk rounds which are led by either
the Director or an Associate Director accompanied by a patient safety lead. It is an opportunity for staff to
voice any patient safety concerns they may have, directly to senior staff.
During 2011/12, Leadership walk rounds have been occurred at the following community bases:
North Reddish
 Heald Green
Beckwith House
Kingsgate
Regent House
Hazel Grove
The visits have been embraced positively by front line staff. Action plans are developed from each visit
and this has encouraged staff to share their innovative ideas. This is an important point as and how to reduce the spread of infection as well as informing staff about policies that are available to support them
and who to contact if necessary.
Infection Prevention and Control
Provision of safe care involves good infection prevention and control and a
number of practices help to demonstrate our commitment to promoting this.
The practices described below help to demonstrate compliance with the
Health and Social Care Act (2008) and the Care Quality Commission’s Essential
Standards of Quality and Safety
Training
All staff receives infection prevention and control training on commencement of employment and clinical
staff receive update training on a regular basis. Training includes the principles of infection prevention
and control, and understanding of how infections are transmitted .
12
Hand Hygiene
Good hand hygiene is the single most important measure to
avoid the transmission of harmful germs and prevent the spread
of infections. The Clean your hands campaign, aimed at
improving hand hygiene nationally, was launched in community
settings in 2008. Community Health Stockport has been a part of
the campaign since it was launched. Posters and information
leaflets are available in all of our clinics. We have 21 staff who
champion hand hygiene in the workplace and who meet
regularly to ensure hand hygiene remains a priority in maintaining patient and staff safety. CHS takes
hand hygiene very seriously and in the last 12 months 95 staff have had their hand hygiene practice audited. This involves staff demonstrating their hand washing technique and awareness of the hand decontamination policy.
Essential Steps to Safe, Clean Care
The Department of Health introduced Essential
Steps in 2006 with the aim of reducing infections.
When caring for patients, staff use the best practice
and national guidance Essential Steps recommends.
They are assessed regularly to ensure they are
competent to deliver safe care.
Clinics and Health Centres
Clinics and health centres are assessed annually to ensure that healthcare environments meet cleanliness
and infection prevention and control standards. There has been a joint effort with the assessments this
year with staff from Stockport Clinical Commissioning Group’s Health Protection and Control of Infection
Unit undertaking environmental assessments and CHS staff assessing clinical practice elements. The environmental assessments take into account the fabric of the
buildings, fixtures and fittings. Scores ranged between 58 to 90%, demonstrating
that some work is required in the older clinics which were not built with today’s
modern purposes in mind. The clinical practice elements include hand hygiene technique, safe disposal of sharp instruments and waste, effective stock rotation, safe
storage of vaccines and general environmental tidiness. Scores for clinical practice
ranged between 76 and 100%. There has been some work undertaken to improve
the safe storage of vaccines to ensure national standards are met and a review of
waste practices was undertaken as a requirement to ensure compliance with national guidance.
Advancing Quality Alliance (AQuA)
Community Health Stockport is involved in a national programme aimed at improving patient safety. We
have a collaborative working group looking at reducing harm for patients with urinary catheters who may
be at risk of developing urinary tract infections. The group includes nurses and representatives from
Community Health Stockport, NHS Stockport, Stockport NHS Foundation Trust and Borough Care.
Specialist input from the microbiology team at Stepping Hill Hospital, pharmacists and GP’s is available
when required. The group is looking at standardising information and care related to urinary catheters
across Stockport in order to improve patient safety. This programme is ongoing until December 2012.
Further information is available from www.advancingqualityalliance.nhs.uk
13
Patient Experience
Customer Care
Community Health Stockport (CHS) is committed to;

Putting patients and service users at the heart of all we do,

Listening to local people,

Making sure our services meet their needs and preferences,

Actively encouraging them to express their views and experiences of our services,

Improving the way we deliver services as a direct result of feedback,

Informing them how their feedback has been used,

Giving people a say on how services are planned, delivered and evaluated.
We are working hard to achieve these progressive aims
through the introduction of a number of initiatives:
People’s Champions
All CHS services have a nominated Champion who is the link person for Customer Care. Their role
involves:

Planning patient experience surveys for the service,

Disseminating customer care information to colleagues and

Ensuring that patient experience is considered at all team meetings.
Dignity in care Champions
CHS supports the Dignity in care agenda and is committed to
providing high quality services that respect people’s dignity.
This has been achieved by;

People’s Champions working within their teams
to promote the dignity challenge and encouraging
colleagues to sign-up

Presentations to groups of staff including Clinic
Administrators and students on placement in
Stockport

CHS Director and Associate Directors registering
themselves and wearing the Dignity pin-badge

We currently have approximately sixty staff registered
on the national data-base. Our target is to continue to
increase the numbers over the next year.
14
% Satisfaction (Good/Excellent)
Patient Experience Surveys
Capturing the experiences of the patients and public who use CHS services is very important. Our
Customer Care Strategy sets out the direction for the engagement work.
During the past year CHS has undertaken Patient Experience Surveys in a number of services. In the
second half of the year, electronic touch-screen devices have been used which has made collecting
patient experience much easier.
Twelve services used the devices during 2011/12 and all have produced individual reports and actions/
recommendations.
Patient Satisfaction by Survey
100
80
60
40
20
Some of the points raised by those surveyed were:
 CFS/ME – The survey highlighted service users concerns with the duration of the course and meetings
and also that they would like their family/carers to be more involved in the care they receive.
 Health Visitors Baby clinic- Service users were asked if they would like having the option to weigh
their own baby. The results were not conclusive and approximately a third of those surveyed were unsure.
 Podiatry- the results showed that patients had concerns around the frequency and availability of appointments
CHS has also used the Net-promoter Score in all surveys. This asks the person to rate how likely it is that
they would recommend the service to a friend, relative or neighbour. It captures what people say in
terms of ‘word of mouth’ locally and tells us if they are talking positively about the service.
Levels of satisfaction are generally very high.
A Net-promoter score above 50% is classed as a good score as there will be more promoters than
critics.
15
Patient Written Information
The quality of our patient written information has been addressed. A Patient
Written Information Group operates as a virtual group to review and quality
check all leaflets, resulting in faster use in practice (usually within one month).
We have also standardised our service information leaflets to comply with the
Care Quality Commission (CQC) recommendations and ensure the
information is relevant, accurate and consistent.
How do we let you know how we are doing?
This has been achieved through local radio broadcasts as well as newspaper releases, via the website and
clinic notice boards. All survey results are shared with LINks and there is a patient representative on the
Patient Safety & Experience Governance Committee. In addition, LINk’s have a representative on Community Health Stockport’s Committee.
Staff are informed of customer care work through their People’s Champion, via Team Brief and the quarterly Customer Care Newsletter.
Complaints
There has been a decrease of 21 in the number of Community Health Stockport complaints this year. A
total of 26 complaints were recorded from 1st April 2011 to 31st March 2012 compared to 47 complaints
received for the previous year. Each year, Community Health Stockport staff have almost 500,000 contacts with patients and service users.
The table below shows all complaints received by quarter during 20010/11 and 2011/12:
Some complaints are very complicated and can involve other services such as General Practitioners or
Stockport Foundation Trust, therefore investigating across a number of organisations can take additional
time. However, it is recognised that we do need to improve on reporting back to complainants within
timeframes.
Complaints
18
16
14
12
10
2010/11
8
2011/12
6
4
All complaints by quarter
2010/2011 compared to
2011/2012
2
0
1st Quarter 2nd Quarter 3rd Quarter
4th Quarter
16
The chart below shows the number of complaints against each category, the two highest being Clinical
treatment and Access to service & waiting times.
Number
Number of complaints against category type
2011-2012
14
12
10
8
6
4
2
0
Series1
Series1
Access to
Services
and waiting
times
Administrati
on
Aids and
Applinaces
Clinical
Treatment
Staff
Attitude
6
2
1
13
4
Responding to and resolving complaints
During 2011/12 there were four requests for an Independent Review which were then not upheld by the
Health Service Ombudsman.
Learning from complaints and improving services
We are keen to learn how we can do better when we receive a complaint. Most people do not complain
lightly so when they do, it not only gives us a chance to apologise but it also enables us to review the
service to see where improvements can be achieved. As a result of the complaints received by
Community Health Stockport, the following examples of service improvements have been made.
District Nursing ( DN)


Treatment Room Service continues to be developed to ensure adequate number of
appointments are available for ear syringing.
Texting system introduced to remind patients of their treatment room appointments.
CASH

Monitoring sessions arranged to help with communication skills.
Health Visiting

Development of the Health Visitor role discussed at team meetings
Podiatry

Staff reminded to record all details in patient’s notes and to include all observations
and conversations especially for high risk patients with wounds.

Administration changes to avoid delays in seeing urgent patients.

Door notices in clinics checked for politeness and staff encouraged to try to be
flexible if a patient arrives late.
SALT


Staff reminded to send onward referrals immediately to avoid unnecessary delays
Staff to leave messages on voicemails where possible and appropriate, and then to
continue to try and contact until contact made.
17
Clinical Effectiveness
Community Health Stockport is committed to ensuring that everything we do is safe, effective and provides the best possible outcomes for our patients and clients. This involves using the best possible evidence to shape all that we do and opening our practice to scrutiny by reviewing and assessing all that we
do and, where possible, comparing our practice with similar healthcare providers. These activities come
under the umbrella term of Clinical Effectiveness.
NICE Guidance
The National Institute for Health and Clinical Excellence (NICE)
is an independent organisation set up to ensure everyone has
equal access to medical treatments and high quality care from
the NHS, regardless of where they live in England and Wales.
NICE guidance provides advice to NHS clinical staff, commissioners and patients regarding treatments that are clinically and
cost effective. The NICE website is a source of information to
inform practice, measure practice and assess the cost of implementing guidance. Why not register to receive updates from
NICE? www.nice.org.uk
NICE is committed to involving patients, carers and the public in the development of its guidance. Patients
can get involved with their work on www.nice.org.uk/getinvolved/patientsandpublic
Community Health Stockport is committed to the implementation of NICE guidance and works closely
with Commissioners to ensure that the healthcare we provide is in line with the NICE recommendations.
New NICE guidance is reviewed by each service. Where current practice is not in line with guidance the
service develops a plan to ensure that where possible, the guidance is implemented within a specific time
frame. Our commissioners are involved in discussions where services may not be able to fully meet the
guidance without additional resources.
In 2011/12, 16 new or revised Clinical Guidelines issued by NICE which were of relevance to services provided by Community Health Stockport. Examples include:
 CG 124 Hip Fracture
 CG 126 Stable Angina
 CG 128 Autism Spectrum Disorders in children and young people
 CG 132 Caesarean Section
Community Health Stockport supports the implementation of NICE
guidance and will audit services on two areas of compliance in
2012/13.
Further information about NICE guidance can be obtained from
www.nice.org.uk
18
Audit
Community Health Stockport aim to deliver high quality care which is measured through Clinical
Audit. This includes Community Health Stockport audits which we devise and implement ourselves and
internal audits where we are audited by independent auditors.
The purpose of an audit is to check whether we are actually doing what guidance says we should be
doing. This covers every aspect of being a healthcare provider and can range from how we manage
patient information and records to how we carry out a clinical procedure.
In 2011/12 Community Health Stockport completed 19 audits. These were a combination of National
and local audits
The National Audits included a review of falls practice and continence care. Locally we covered areas of practice as diverse as
record keeping, leg ulcers and medication induced constipation.
Following each audit, services are required to produce a Service
Improvement Action Plan in order to guide and demonstrate
continuous quality improvement.
What we have learnt through audit:
Community Health Stockport has 130 nurse, school nurse, health visitor prescribers and a podiatrist
prescriber termed Non Medical Prescribers (NMPs). We participated in the North West Non Medical
Prescribing (NMP) Clinicians Audit “To demonstrate how NMP impacts on the delivery of patient care
through Quality, Innovation, Prevention and Productivity (QIPP). The QIPP model illustrates many positive patient outcomes including patient satisfaction, effective use of a highly skilled workforce, improved outcomes and overall quality of care. Prevention of GP surgery appointment was reported as
being the highest impact of a consultation by a CHS NMP`s (24%). This demonstrates the positive outcome of NMP`s in cost efficiencies and seamless care.
We have learned that 78% of patients with lower leg wounds, in the care of district nurses, were treated in line with best practice guidance for the management of leg ulcers. Services are required to implement an action plan for practice development when an audit demonstrates that there is scope to improve the care our patients receive. Such action plans often include extra training for staff and closer
monitoring of practice.
We have learned through a baseline audit of defibrillators in
community clinics that they all have in date electrode pads and
clear instructions for staff in line with the Resuscitation council
standards.
2012/13
The audit plan for the coming year is now in development and
will include National Audits, Regional and local audits as prioritised by the leaders of each service. From 1st April 2012, all audit
activity will be led by NHS Stockport Foundation Trust.
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Continuous Quality Improvement & Innovation
Making Every Contact Count - Public Health in Action
The Future Forum recommendation on ‘every contact counts’ (DH 2012) sets out the new responsibility
for healthcare professionals to promote healthy living through their daily contact with patients and
recommends
“Every healthcare professional should “make every contact count”: use every contact with an individual to maintain or improve their mental & physical health and wellbeing where possible, in particular
targeting the four main lifestyle risk factors: diet, physical activity, alcohol and tobacco – whatever
their specialty or the purpose of the contact”
It has been widely acknowledged that there must be a collective systematic approach to improving the
poor health outcomes of the Stockport population. Collectively the public and voluntary sector workforce
are the greatest resource in achieving this. Over 1000 staff across the local health economy have now
received training. The ‘Essential Public Health’ training package has been acknowledged as an exemplar
model by NICE, Kings Fund and the RCN. It has also been acknowledged an commended in a recent research publications and a national strategy for nurses. During 2011/12 £38,000 with of income was generated following the sale of the training.
Electronic Master Patient Index (eMPI) :
District Nursing Patient Allocation System
The eMPI is a patient focused scheduling tool developed by Districts Nurses
to enhance patient experience and patient safety in Stockport. The Cheadle Heath DN team successfully
piloted the project which was sponsored by the Queens Nursing Institute. Following this success a full
scale version has been developed and rolled out to 6 DN teams. This has improved the efficiency of allocation times and has improved collection of data surrounding patient demand. The roll out across Stockport is ongoing and it is anticipated teams will be using the system by July 2012.
QIPP Safe Care Recognition Award
Community Health Stockport’s collaborative work with Stockport NHS FT and local care homes on patient
safety has been recognised with a prestigious national award. CHS received the QIPP Safe Care National
Recognition Award for whole health economy engagement, which is part of the Department of Health’s
Safety Express programme which is committed to improving patient safety by the delivery of harm free
care. The aim is to reduce harm in four areas - pressure ulcers, falls, catheter acquired urinary tract infections and blood clots (VTEs) – so that by the end of next year these problems are absent in 95% of our patients.
Locally the programme has led to the introduction of changes, extra education events for staff from all
three organisations and the collation of data using the NHS Safety Thermometer tool. As well as improving care for patients, it has helped promote effective working partnerships across the local health economy.
Team leader for the programme Julie Wragg said “It is an honour to receive
this award – it recognises the hard work put in by the whole team to improve
care for patients. ….It is a complement to us that we are now seen as national
leaders in this area of work and others will be looking to learn from us. Well
done to everyone involved.”
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Early Days Workshops for parents and carers of babies
A new range of post natal education was delivered during 2011/12. This followed a full review of
previous post natal groups, including the effectiveness of the groups and the views of parents. The
new Workshops are delivered to parents in a group setting and are designed to provide a link between the parent education sessions offered in the ante natal period and parenting programmes
designed for parents with older children.
A leaders guide was developed along with resources which included the DVD “The Wonder Years”
and top tip leaflets to give to parents at the end of each session. The sessions are led by the Health
Visitors and delivered by the Health Visitor teams, Children and Family Workers and Children’s Centre Development Workers.
The outcomes of the new workshops for parents have been identified as
More confident
as a parent
Get my partner
involved





How to interpret different
cries and moods
Improved
bedtime routine
Be patient and
give praise
Making time to play
Reduced social isolation,
Increased parent confidence
Increased understanding of baby development and promotion of sensitive attuned parenting,
Promotion of parent-child attachment and positive relationships
Improved home learning environment.
When asked what changes you have made in looking after your baby, parents stated:
“Be patient and give praise” , “More confident as a parent”, “Baby massage for relaxation and for
colic”, “Using turn taking more”, “Making time to play”, “Get my partner involved”, “How to interpret different cries and moods”, “Taught to self settle”, “I take time out for myself”, “Improved
bedtime routine”, “Reading stories even though 5 months old”
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Workforce Factors
Student Placements
At Community Health Stockport we are committed to
providing high quality care
for all our
patients and service users,
and greatly value the important contribution that
students bring to this.
At CHS we strongly value student learning and work in close partnership with NHS North West and
local universities, to provide high quality placements for all students.
Since April 2011, we have supported over 200 pre-registration student placements within our services.
During these placements, students are invited to nominate an individual or team for a “Certificate of Excellence”, for those staff who have provided particularly excellent learning experiences. Since April 2011,
96 teams or individuals were nominated for this award.
In Stockport we offer student nurses the opportunity to spend time with the Specialist Palliative Care
Team. This has shown to help the student gain an understanding of the needs of people complex palliative care needs and also helps gain understanding of the Macmillan Nurse role.
We are very keen to ensure all our health and social care students are equipped with the relevant skills
needed to work effectively with all other disciplines in future, in order to provide excellent, ‘joined-up’,
quality care to patients and services users. Inter-professional Learning (IPL) involves encouraging
students from all professions to learn with and about each other, in order to deliver quality care to their
patients. In Stockport, we are keen to ensure that every single health and social care student will have
this as a strong focus of each placement.
‘Stockport IPL Champion’s Forum’ was therefore established in 2008, and over the last 4 years we have
worked in close partnership with Stockport SMBC, Stockport NHS Foundation Trust, Pennine Care NHS
Foundation Trust, to develop a more strategic and standardised approach to inter-professional learning
(IPL) in practice. One of our recent initiatives has been to develop an ‘IPL Toolkit’, which is now used
across all health and social care placements in Stockport. In February 2012, we were also excited to hold
our 1st joint IPL Conference at Stockport, and aim for this to be an annual event for our educators and
mentors. This was excellently evaluated by staff, and here is some feedback from some of the 60
delegates:-
“Excellent approach to facilitating
collaboration from bottom up and
top down”
“Useful to consider collaborative working, and how we could develop this further to benefit our
services and students”
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“Excellent morning.. this is
flagship work!”
“Great morning thank you very energising. Be proud
of the work you are doing
and continue to celebrate
and share!”
Enthusiastic speakers, an
excellent conference!”
We are also keen to promote Primary Care as a future career choice for students, and since 2004 have
now recruited over 40 newly qualified staff into our organisation. We regularly evaluate our student
placements, and below is some feedback from our recent students:-
“Amazing, professional, caring,
clever, understanding and
supportive – I was a very lucky
student!”
““Excellent, very supportive and
approachable. Sees your learning
needs as very important and wants
to help you achieve your outcomes.
“This is the first placement in 3
years, where every member of
staff has been warm and
welcoming to students… the
staff make the placement!”
“A very well-educated
mentor who was keen to
teach students!”
“Very welcoming and friendly,
always wanting me to
experience new roles, skills,
provided me with training
sessions”
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Staff Survey Results 2011
The results of the latest NHS National Staff Survey demonstrated our commitment to good staff engagement and staff experience at work:





71% of CHS staff felt that they were able to contribute towards improvements at work (compared to
a national average of 68%)
On a scale of 1- 5, a score of 3.43 was achieved in relation to staff recommending the Trust as a
place to work or receive treatment (compared to a national average score of 3.35)
On a scale of 1 – 5, a score of 3.67 was achieved in relation to the Trust being seen as demonstrating
good commitment to work life balance
82% of CHS staff reported using flexible working options (compared to 77% nationally)
82% of CHS staff reported feeling valued by their colleagues (compared to 78% nationally)
Health and Wellbeing
The organisation has once again focused on ensuring that it continues to actively support the health and
wellbeing of all staff.
To ensure that staff are equipped to undertake their role in a safe and professional manner a high number of training and development programmes have been implemented. The number of staff having had
an annual appraisal with development plans is higher than the national average. In the latest staff survey,
staff reported a higher than average score in relation to the support they receive from their immediate
line manager.
Considerable work has been undertaken to understand more clearly the reason why staff are reporting to
be feeling stressed at work. This has resulted in the implementation of a series of workshops aimed at
helping staff to develop their personal resilience to enable them to be better equipped both in and out of
work. These have proved very successful.
Over the course of the year Line Managers, who are trained to use the organisation’s staff attendance
framework, have continued to ensure that all staff who are experiencing health difficulties are managed
consistently, fairly and supportively to facilitate a timely return
to
work wherever possible. Throughout the year, the organisation’s absence rate has been lower than that reported across the
North West region.
The organisation continues to ensure that the range of polices
that it has in place to support health and wellbeing at work are
used effectively.
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Leadership
Dynamic, professional and skilled clinical leaders are essential in being able to provide high quality services. CHS staff have a range of leadership opportunities depending on an individuals needs as shown below.
Local leadership
programs
Aspiring Directors
Clinical leaders
Degree and
Masters
360 degree
assessments
Action Learning
sets
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The direct link between leadership capability and sustained high performance is now widely
acknowledged. No amount of infrastructure and financial investment are guarantees of success if there is
a lack of talent and leadership within the organisation. Community Health Stockport is committed to
facing the challenge of continuing to provide healthcare services within budget and at the same time,
increase productivity, improve quality and achieve greater patient satisfaction. This aspirational goal can
not be achieved without robust and effective leadership at all levels throughout the organisation.
By supporting leadership opportunities, Community Health Stockport want to encourage a culture of creativity and innovation at all levels within the organisation which recognises, values and develops leadership and talent.
Education and Training
In addition, central funding from NHS North West allowed us to support 42 staff in accessing clinical
education updates, conferences or courses and for us to buy-in training for larger groups of staff, for
example, Root Cause Analysis, basic life support for training for all front line workers and Motivational
Interviewing training for Health Visitors.
We will continue to actively support staff development and learning opportunities to ensure both the
quality and effectiveness of care we provide. It is vital for staff to remain up to date with developments in
clinical healthcare, as research knowledge about healthcare is expanding constantly.
Community Health Stockport continues to support staff in their
professional and academic development. Clinical staff can use
opportunities to extend and develop their clinical knowledge at
different academic levels and CHS supports additional study and
learning in order to keep providing up to date, research based and
clinically effective practice. During 2011/12, CHS supported a
range of clinicians (nurse and therapists) to study at the following
levels
Degree
Masters
15 workers attended
6 workers attended
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LINks Statement
Community Health Stockport Quality Account 2011/12 – LINk Statement
The Stockport LINk would like to thank Community Health Stockport for
the opportunity to comment on its 2011/12 Quality Account.
Over the last 12 months the LINk wishes to state that it has had excellent
co-operation, prompt feedback and acknowledgements at a time when
they were under great pressures and going through substantial change and
restructure as they transferred to Stockport NHS Foundation Trust.
The Stockport LINk congratulates Community Health Stockport on its improvements made in information
governance and on the importance placed on patient safety and complaints. The workshops held for parents and carers of babies were read with great interest and the LINk would like to support these to continue.
End of Life care and pressure ulcers appear to be an issue for many health care providers and the LINk will
wish to see and monitor the results of the action plans put in place relating to End of Life Care and pressure ulcers in the community.
The LINk looks forward to working with the staff and managers of Community Health Stockport after they
have transferred to NHS Stockport Trust and hopes the Trust will ensure a continued effective working
relationship that has been built between the LINk and Community Health Stockport.
John Leach
Chair, Stockport LINk
On behalf of the Stockport LINk
Feedback on QA
We hope you have found this publication useful and that it has given you an understanding of some of
our mechanisms for measuring quality care and how we engage service users in measuring the quality of
the care they receive. If you have any comments or suggestions to make about this Quality Account,
please find contact details below:
www.stockport.nhs.uk/members-and-public/
Telephone number 0161 419 5166
Future Plan.
As part of the government policy ‘Transforming Community Services’ NHS Stockport will merge with Stockport Foundation Trust on 1st April 2012. Guidance on Quality Accounts suggests that once community providers have integrated, only one Quality Account will need to be produced, with the community provider
element as a sub section of the main report. Further guidance is awaited for the format for the Quality Account in coming years.
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