Quality Account 2011/12
Providing care that we and
our families would want to use
Contents
»
PART ONE
If you would like a summary of this document in your own language, please call 020 8973 3143 and
state clearly in English the language you need and we will arrange an interpreter to speak to you.
Chief Executive’s statement
4
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PART TWO
Our quality improvements 2011/12
6
How we performed against our ‘priority for improvement’ areas in 2011/12
How we did against our 2011/12 CQUIN targets
How we did against the quality indicators we selected in 2011/12
Our quality improvements for 2012/13
Quality indicators chosen for 2012/13
Our CQUINs for 2012/13
13
22
28
29
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PART FOUR
Statements from our stakeholders
• Hounslow LINk
• Richmond upon Thames LINk • London Borough of Richmond upon Thames
• NHS Richmond
• NHS Hounslow
Equality and Diversity
2
11
20
Our priority for improvement areas for 2012/13
Feedback
8
»
PART THREE
Cover picture: Sushila Koirala, Healthcare Assistant
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3
PART ONE
Providing care that we and our families would want to use
Chief Executive’s statement
I am pleased to present our Quality Account for 2011/12 which outlines our continuing
commitment to improve the quality and safety of the care we provide for our patients.
Everyone has the right to safe and effective care and we want you to feel happy with the care
you receive from us so that, should you need to do so, you will be confident to return to us in
the future.
Community based services are at the heart of a modern and flexible NHS. As the main
provider of community healthcare across Hounslow and Richmond, we are committed to
ensuring continuous improvements in the quality of services we provide.
Our core services include community nursing, health visiting, therapists, the walk-in centre
at Teddington Memorial Hospital, sexual health services and the newly opened Hounslow
Urgent Care Centre. We also provide specialist health services ranging from specialist
community nursing, wheelchair service, to therapy services such as podiatry, dietetics,
speech and language, physiotherapy and occupational therapy.
The Trust aims to provide high quality care out of hospital and closer to home. With
more than 1,000 members of staff, we deliver over 39 health services from a variety of
community locations.
The Quality Account summarises what we have done over the last year to ensure quality
of care and it also describes our priorities for the next 12 months. Our priorities have
been influenced by feedback from our patients, carers, staff and stakeholders, and by the
requirements of our regulatory bodies.
As an independent NHS organisation since 1 April 2011, we are registered with the
Care Quality Commission and are compliant with all standards. This provides a level of
assurance that we must maintain, but it is not the end point in itself.
During 2011/12 we can point to many achievements that demonstrate our commitment
to high quality clinical care. The achievement of our Commissioning for Quality and
Innovation (CQUIN) schemes in areas such as the creation of rapid response and early
discharge support programmes for patients with long term conditions and end of life
care, have demonstrated the commitment of our staff and the organisation to delivering
high quality, safe and effective care within a variety of settings.
Set out in this report are our priorities for improving patient safety, effectiveness and
experience in 2012/13. We have set ourselves high ambitions and have every expectation
of meeting these and building on them in future years.
Looking forward to the year ahead, quality is at the heart of our agenda. For example,
we have an established Integrated Governance Committee of the Trust Board, which is
chaired by a non executive director, who in partnership with the Director of Quality and
Clinical Excellence has the specific aim of driving quality improvement throughout all our
services.
Our mission is to provide care and services that we and our families would want to use.
We hope you will agree that our Quality Account provides many examples of where
we are already providing the highest quality clinical care. We are confident that during
4 QUALITY ACCOUNT 2011/12
2012/13 we will continue to work with our patients, staff and commissioners to ensure
continuous improvement across all services.
I would like to thank all of our staff who have contributed to what has been a successful
year improving quality across all services. This report highlights the commitment of our
staff at all levels of the organisation to providing high quality care to service users on a
daily basis and the pride they take in doing the very best for each and every person they
meet.
Finally, I can confirm on behalf of the Trust’s Board that to the best of my knowledge and
belief the information contained in this Quality Account is accurate and represents our
performance in 2011/12 and our priorities for continuously improving quality in 2012/13.
Richard Tyler
Chief Executive
Photographed above: Trust board members at Heart of Hounslow Centre for Health.
Front: Richard Tyler, Chief Executive and Stephen Swords, Chairman. Middle row: Judith Rutherford, Non
Executive Director; Jo Manley, Director of Operations; Siobhan Gregory, Director of Quality and Clinical
Excellence, David Hawkins, Director of Finance, Pablo Lloyd, Non-Executive Director. Back row: Ajay Mehta,
5
PART TWO
Our quality improvements in 2011-2012
Non-Executive Director; Rachael Moench, Director of Human Resources and Organisational Development;
Dr Rosalind Ranson, Medical Director; Heather Mitchell, Commercial Director; Carol Cole, Non-Executive
Director; Swarnjit Singh, Board Secretary. Absent: Dr Bobby Basra, Non-executive Director
Part 2 – Our quality improvements 2011/12
Putting quality first
Hounslow and Richmond Community Healthcare NHS Trust provides a combination of specialist and
local healthcare services, across Hounslow and Richmond in a wide variety of settings including health
centres and clinics, schools, hospitals and in patients’ homes. We also provide services at Teddington
Memorial Hospital and were chosen to pilot the Hounslow Urgent Care Centre at West Middlesex
University Hospital which opened in March 2012.
Looking back – 2011/12 at a glance
as we chose:
The priority for improvement are
community
ence of pressure ulcers acquired in the
Patient safety - to reduce the incid
in National Clinical Audit
Clinical effectiveness - participation
patients
evidence of obtaining consent from
Patient experience - to improve our
The quality in
dicators we c
hose to
We have a number of services that are integrated
with Richmond Council to provide a seamless service
to patients, which include our community nursing
teams and our intermediate care team. In 2012
we took on the management of the Integrated
Community Response Service. This is an integrated
team with Hounslow Council social services, primary
care, West London Mental Health Trust and the
voluntary sector.
Patient safety
• Incidence of MR
SA bacteraemia
• Patient safety in
cident reportin
g
• Staff sickness ab
se
nce rate
Clinical effect
iveness
• New birth visits
carried out bet
ween 10 - 14
• Clinical audit par
days
ticipation
• Human Papillom
av
For more information about our services visit
www.hrch.nhs.uk/services
Our mission, vision and values
Our mission is simple – we want to provide care
that we and our families would want to use.
Our vision is to be recognised as a high performing,
integrated care organisation delivering quality
services which enable people to live healthier and
more independent lives.
Dr Suman Gupta is one of the GPs in the new Hounslow
Urgent Care Centre which we are operating in partnership
with Greenbrook Healthcare.
Our clinical strategy places the individual at the
centre of service delivery and supports our values of
being patient focused, clinically-led, quality driven,
innovative, productive and responsive.
The NHS identifies three fundamental elements of quality care:
Safety Patient safety – patients are safe and free from harm
EffectivenessClinical effectiveness – the treatment and care we deliver
is the best available
ExperiencePatient Experience – service users have a positive experience
that meets or exceeds their expectations
These fundamental elements of quality are utilised as a framework for our Integrated Governance
Committee and for all quality reporting to the committee and Trust Board.
6 QUALITY ACCOUNT 2011/12
measure:
Patient exper
ience
irus (HPV) imm
unisation rates
• Walk-in centre w
aiting times
• Improving patient
experience thro
ugh respect fo
• Single-sex accom
r privacy and di
m
odation
gnity (PEAT)
commissioners
r
u
o
y
b
t
se
ts
e
ment targ
Quality improve
through CQUINs*
c
t failure and Chroni
ith hear
stem for patients w
sy
g
in
ck
tra
st
bu
• To develop a ro
)
ary Disease (COPD
itions
Obstructive Pulmon
ith respiratory cond
w
n
re
ild
ch
r
fo
bust tracking system
ibers
• To develop a ro
nded nurse prescr
te
ex
of
r
be
m
nu
e
inuing Care Team
• To increase th
nts under the Cont
tie
pa
r
fo
ts
en
m
ss
cklog of asse
• To clear the ba
harge processes
onse and early disc
sp
re
d
end of life care.
pi
ra
p
lo
ve
ectronic record in
• To de
el
re
Ca
y
M
te
na
e use of the Coordi
• To promote th
an
*See page 11 for
INs
explanation of CQ
7
How we performed against our
‘priority for improvement’ areas in 2011/ 12
• We have provided health training and advice sessions at the Richmond Nursing and Care Home Care
Forum. The first session concentrated on nutrition and tissue viability and provided information to the
homes on NICE guidance on pressure ulcers.
• An audit of action plans following root-cause analysis investigations of grade 3 and 4 reported
Patient safety
pressure ulcers has been undertaken to identify trends and ensure learning is being embedded and
actions completed. This work is ongoing and being led by the taskforce with support from the Quality
and Clinical Excellence Team.
PRIORITY 1
To reduce the incidence of pressure ulcers acquired in the community
We wanted to reduce the incidence of pressure ulcers acquired in the community. Pressure ulceration
(previously known as bed sores), causes significant pain and distress for patients when they occur.
Pressure ulcers are graded at grades 2, 3 and 4, which relates to the severity and level of damage to the
skin, with a grade 4 pressure ulcer being the most severe grade.
• We significantly increased staff awareness
of the need to report pressure ulcers as an
incident, achieving an increase in reporting in
2011/12 of 82%, compared to the previous
year. This was particularly relevant for grade 2
pressure ulcers, with an increase in reporting
of 109%, which is important as it allows
for the right care to be provided preventing
deterioration of the ulcer (see chart 1 and 2
below for figures).
• We have developed a pressure ulcer taskforce
with membership from clinicians representing
teams across the organisation, including
specialist tissue viability nurses. The taskforce
has begun the process of clinically reviewing
all pressure ulcer incidents, identifying trends,
undertaking a thematic analysis and developing
a robust action plan to reduce the incidence
of pressure ulcers and improve practice in the
community. This work is ongoing and has led
to our decision to continue this area of work as
a priority for 2012/13.
• We undertook an audit to review pressure
ulcer incidences reported per locality and to
highlight key trends, to inform the work of the
taskforce.
• The pressure ulcer taskforce have begun
developing evidenced-based pressure ulcer
guidelines that will be launched across the
organisation, alongside training in skin and
wound care to achieve our aim to reduce the
incidence of pressure ulcers in 2012/13.
8 QUALITY ACCOUNT 2011/12
Chart 1 Comparison of pressure ulcer
reporting 2010/11 and 2011/12
2011/11
2011/12
PRIORITY 2
Participation in National Clinical Audit
We wanted to improve our participation in National Clinical Audit (NCA) activity, with the aim to
incorporate recommendations arising from direct NCA participation and systematic review of published
NCA and confidential enquiries into our service delivery.
Clinical audit involves systematically improving the quality, effectiveness, and outcome of patient care by
looking at and measuring the gaps between best and current practice and making improvements where
necessary. There is a Department of Health requirement for NHS organisations to participate in NCA, but
we also take part in regional audits and undertake local clinical audits to continually improve standards
across the services we deliver.
250
200
150
The outcomes we achieved
100
• We have developed our mandatory clinical audit training program to include guidance and
information on Quality Accounts (QA) and NCA. This training has been accredited by the Royal
College of Physicians.
50
0
GRADE 2
98
204
GRADE 3
45
64
GRADE 4
17
23
Chart 1 Pressure ulcer reporting 2011/12
Number of pressure ulcers reported
The outcomes we achieved
Clinical effectiveness
25
• We have developed a database which records local, regional and NCA participation by local services.
Learning and outcomes from these audits and from confidential national enquiries are monitored
through the Clinical Effectiveness and Audit Group, who are responsible for sharing the learning
across the Trust.
• We have created a Trust wide Clinical Audit Programme (TCAP) which includes NCA and regional
audits to plan and track participation. The programme is approved and signed off through the
Clinical Effectiveness and Audit Group, who monitor progress throughout the year.
• There are only a small number of national clinical audits that are relevant for community Trust
participation, however we participated in the following National Clinical Audit this year:
20
–– The national audit of services for people with multiple sclerosis – undertaken by the Royal College
15
of Physicians. All audits are reviewed by the Clinical Effectiveness and Audit Group, who also
monitor completion of any actions required.
10
• We have exceeded our target for 2011/12 of completing 80 local clinical audits across the Trust. Next
year through the development of our TCAP we will ensure every service completes two clinical audits
and one service evaluation to continually inform practice and improve quality across all services.
5
0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Pressure ulcer - Grade 2
Pressure ulcer - Grade 4
Pressure ulcer - Grade 4
9
PART TWO
Our quality improvements in 2011-2012
PART TWO
Our quality improvements in 2011-2012
Patient experience
PRIORITY 3
To improve our evidence of obtaining consent from patients
Respect for a person’s right to determine what happens to their own body is a fundamental part of
good practice. It is also a legal requirement. We wanted to improve our evidence that consent had been
obtained appropriately by our clinicians consistently across all of the services we provide. We wanted
to ensure that treatment options were explained in a manner sensitive to our patients’ background,
culture, religion or nationality.
How we did against our 2011/12 CQUIN targets
What is a CQUIN?
CQUINs (Commissioning for Quality and Innovation) are projects agreed between the commissioners
and the Trust. The projects are set up to improve quality standards in key areas.
A proportion of the Trust’s income in 2011/12 was conditional on achieving quality improvement and
innovation goals agreed through our contracts with NHS Hounslow and NHS Richmond. Progress
against the achievement for each of our CQUIN targets is measured and reported to our commissioners
on a quarterly basis.
The outcomes we achieved
• We have developed a standardised consent form to be used by all staff across the organisation that
reflects the requirements of the Mental Capacity Act and the Trust’s consent policy. This has been
launched with guidance on best practice for obtaining informed consent.
• We have developed one service evaluation form to be used by all services across the organisation,
which has questions to monitor best practice for obtaining consent and will be used during 2012/13.
• We are in the process of developing the Trust website for patients/users of services outlining issues
relating to consent, which will include:
–– Definition
–– How we obtain consent
–– Making decisions
–– Who can give consent
–– Confidentiality
–– Trust consent policy
–– ‘Questions to ask’
–– Consent form example
• The Trust intranet site is also being updated to provide staff with a dedicated section relating to
consent that will include:
–– Trust consent policy
–– Approved Trust wide consent forms
–– Consent/Mental Capacity Act/Deprivation of Liberty Safeguards resources for staff
–– Good practice guidance
2011/12 CQUIN targets
NHS Hounslow
Target 1 Patients with heart failure, Chronic
Obstructive Pulmonary Disease (COPD)
The development of robust patient tracking
mechanisms to identify adults with heart failure,
COPD and risk of falls, or who have recently fallen,
or who have had a recent accident and emergency
(A&E) attendance. These patients may not be known
to community services, an assessment and self
management plan would be developed with onward
referral to an appropriate service.
Achievement: We have achieved the requirements
of this target in three out of four quarters. We have improved our partnership working with GPs, and
now hold regular meetings to coordinate care provided for these patients and through staff training. We
are providing an increased number of patients with self management plans, to provide better outcomes
for individual patients with these long term conditions.
Target 2 Children with respiratory disorders
The development of robust patient tracking
mechanisms to identify children with respiratory
disorders (asthma and wheezy children) who have had
a recent accident and emergency department (A&E)
attendance or are at risk of future attendance. These
patients may not be known to the community health
visiting service. An assessment and self management
plan would be developed with on ward referral to an
appropriate service.
• As well as updating our consent policy, we have developed a Trust wide policy for clinical
photography and video recordings of patients by Trust staff in relation to confidentiality, consent,
copyright and storage to complement our existing information governance policies
• We provided consent training for clinical staff to improve their understanding of all issues relating to
obtaining informed consent.
Although good progress has been made in ensuring our staff are obtaining consent consistently across
the organisation, and greater assurance will be available through revised service evaluation forms to be
used by all services during 2012/13, we feel that there is still work to be further progressed in this area.
We have therefore decided to develop this priority area, focussing in greater detail around the Mental
Capacity Act and Deprivation of Liberty Safeguards requirements of consent. We have subsequently
moved it to be a priority for improvement area for 2012/13, under the category of patient safety, to be
progressed alongside our safeguarding adults priority.
10 QUALITY ACCOUNT 2011/12
Respiratory physiotherapist Julie Read visits patients
with COPD in their homes to help them manage their
condition and prevent hospital admissions.
Asthma nurse Sanjeev Beharee with one of his
patients, nine-year-old Morgan Oakley of Feltham who
suffers from asthma. Since the introduction of the
asthma nurse, Morgan’s mum Claire Oakley says “We
haven’t been to A&E in the last six months. A few
years ago, I wouldn’t have considered that possible.”
Achievement: We have fully achieved this CQUIN
target, which built on a successful pilot that was set up
in response to high numbers of children attending the
A&E department with asthma. The pilot was successful
in significantly reducing A&E attendance from 1424
children between September 2010 and March 2011
to 602 children from September 2011 to March 2012
and at the same time supporting families in the self
11
PART TWO
Our quality improvements in 2011-2012
management of their children’s asthma and subsequently increasing confidence to enable more effective
self management in the future as detailed below:
Having fully achieved the CQUIN target in 2011/12, commissioners were so satisfied with the benefits of
this service, that it is now a fully commissioned service for 2012/13.
Target 3 End of life care
Use of the ‘Coordinate My Care’ electronic record in end
of life care
An increase in the numbers of the adult community nursing team by four, who move from
supplementary prescribing skills to achieving extended prescribing skills, with at least one extended
prescribing nurse in each of the three localities.
Achievement: We have successfully trained our staff to
input information onto the ‘Co-ordinate My Care’ end
of life electronic record, ensuring these patients have
the support and care they need when they need it. This
CQUIN was started mid-way through 2011-12 and is
therefore being carried across to next year’s targets.
Achievement: We have fully achieved this target and now have nurses with extended prescribing
qualifications (or who are in the process of completing their qualification) across all three localities in
Hounslow. This means that we will have more nurses who are independent prescribers. If a nurse is an
independent prescriber they can provide patients with a prescription at the time of their visit or in the
clinic rather than asking the patient to attend their GP practice to get a prescription or waiting for a GP
visit, which is not only more convenient for patients, but ensures they receive the medication they need
promptly achieving the best outcome.
Community matron Lesley Simmons is one of our leading nurses and is
an expert on end of life care. She says, “Coordinate My Care is a way
of electronically storing information about a patient’s illness and any
specific wishes and gives patients an opportunity to make decisions
and express their views and wishes about their care. The overriding
aim of the record is to improve clarification and communication of
information between healthcare providers for end of life care patients
to enable the patient’s wishes to be achieved while at the same time
avoiding unnecessary hospital admissions.”
Target 3 Extended Nurse Prescribers
Target 4 Continuing care team services
To clear the backlog of NHS continuing healthcare and NHS funded nursing care assessments pre
2011/2012 financial year.
Achievement: This CQUIN was to resolve an issue that has been affecting patients since the continuing
care team was created. We have successfully achieved this target and changes made will now ensure
that Hounslow continuing care patients awaiting a continuing care assessment or health needs
assessment for a registered care contribution in a nursing home will receive their assessment promptly.
NHS Richmond
Target 1 Rapid response and early discharge processes
The number of admissions prevented where the patient receives an appropriate service response within
two hours and the patient is not admitted to an acute unit for the same condition within five days.
Achievement: We have created rapid response and early supported discharge structures through
service re-design and the development of new roles. The achievement of this target has required staff
to work closely with colleagues from the acute sector and other partners, which has resulted in us
successfully achieving the target, with improved outcomes for patients. In 2012/13, we will be working
with the borough and commissioners to merge the integrated care team and re-enablement team.
Target 2 Early Discharge Service
The number of patients seen by the Early Discharge Service that have a community care plan to assist
with early discharge from an acute hospital inpatient episode.
Achievement: Although we successfully achieved this target in relation to the number of patients
seen, we are currently working with our commissioners to improve our documentation through an
agreed updated ‘facilitation log’. This has meant that patients in local hospital who are fit for discharge
have not had to stay in hospital longer than needed. We have worked with the hospital teams and the
patients, their families and carers to get them home. This can involve asking for a test to be done more
quickly, ensuring referrals to community teams take place or making sure equipment is in the patient
home if needed. Again the early supportive discharge was only achieved through effective partnership
working with acute Trust colleagues and other partners.
12 QUALITY ACCOUNT 2011/12
How we did against the quality indicators
we selected in 2011/12
The metrics or standards, set out in the tables below, were chosen to summarise our performance
against key quality indicators for patient safety, clinical effectiveness and patient experience. These were
chosen in consultation with our staff, clinicians, service users, carers and other key stakeholders.
1. Patient safety
It is not only crucial that services are as safe as they can be, but that we can demonstrate this to
ourselves, our partners, our services users and carers and to the public. We chose three indicators to
help demonstrate this:
• Incidence of MRSA bacteraemia
• Patient safety incident reporting: The National Patient Safety Agency (NPSA) is clear that those
trusts that report higher rates of incidents and near misses are the trusts with the best safety culture,
because they are open and honest.
• Staff sickness absence rate: We believe a stable, healthy and consistent staff team makes for a
safer and more reassuring service for our users, carers and visitors.
How we performed
Quality Indicator
Target
2011-12 end of year performance
Incidence of MRSA
Zero incidences
Achieved - no incidences reported
Patient safety incident reporting
To increase incident
reporting
Achieved - increased from 921 in
2010/11 to 1113 in 2011/12
Staff sickness absence rates
3% sickness rate across Not achieved - 3.8%
all services
13
PART TWO
Our quality improvements in 2011-2012
Incidence of MRSA bacteraemia:
Staff sickness absence rates
4 Target achieved
7 Target not achieved
Infection prevention and control is an essential element of patient safety and it is an absolute priority for
the organisation. Our staff are committed to providing clean, safe care and ensuring that all avoidable
healthcare associated infections can be prevented.
As an organisation we recognise that the wellbeing
of our staff is crucial to the welfare and safety of our
patients. We acknowledge that sickness absence
rates amongst our workforce can be an indicator
of morale issues and a measurement of the ’true
health’ of our organisation. High levels of sickness
amongst our clinical staff would compromise patient
safety. Our goal for 2011/12 was to achieve a
target rate of 3% sickness for all services across the
organisation, which we are extremely disappointed
to have not achieved.
To register with the Care Quality Commission (CQC) to provide care, NHS trusts must take part in an
assessment of whether they meet government regulations for managing infection, aimed at ensuring
that patients, staff and visitors are protected against the identifiable risks of acquiring a healthcare
associated infection, so far as is reasonably practical. The Trust is registered unconditionally with regard
to infection prevention and control.
Patient safety incident reporting
4 Target achieved
We are proud of our patient safety culture and identifying and managing risks is a part of our everyday
practice. All incidents are reported, including ‘near misses’ and are discussed openly and the learning
passed to all staff.
An incident can be any aspect of care or experience that does not meet the high standards expected or
affects our ability to provide a high quality service – for example, if there is a power cut which results in
an inability to communicate with patients or obtain information.
We encourage reporting of all incidents, no matter how minor, to ensure that we can identify where
triggers are occurring. Incidents are reviewed locally and monitored by our governance structure.
We actively encourage frontline staff engagement in the governance structure to ensure learning is
shared and improvements are evidenced as well as having patient representatives on our governance
committee. The Trust Board receives a quarterly quality report, which includes information on all
incidents reported, a thematic analysis and how lessons learnt have been shared across the organisation.
Total number of incidents for Hounslow and Richmond
2. Clinical effectiveness
An effective service can be defined as one that provides the right service, to the right person, at the right
time. This section demonstrates how we are doing on key measures of effectiveness.
We chose three indicators to help demonstrate this:
400
Number of Incidents
The organisation underwent a considerable amount
We held our first ever staff awards in July 2011 to
celebrate the hard work and expertise of our staff.
of change in 2011/12 and we acknowledge that
The Working Smarter award was jointly won by Ruth
this did have an impact on staff sickness rates. The
Aspell, Wheelchair and Specialist Seating Clinical
Trust Board endorsed a Healthy Workplace Strategy
Services Manager and the Hounslow Child Development
Adminstration Team. Ruth is pictured on the left
in November 2011 and the organisation has ensured
with Non-executive Director Judith Rutherford, who
that targeted actions are being undertaken to assist
presented the awards.
staff in returning to work promptly from episodes
of sickness. Managers regularly undertake reviews
with staff of their sickness records and we involve our occupational health and wellbeing service where
appropriate. We are still committed to achieving our target of 3.2% or below and will be carrying this
quality indicator across to 2012/13, to ensure the work undertaken has the results we are aiming for.
350
346
300
275
250
150
125
100
143
114
89
How we performed:
232
221
200
268
161
• New birth visits carried out between 10 – 14 days
• Clinical audit participation
• Human Papillomavirus (HPV) immunisation rates
159
109
50
Quality indicator
Target
End of year performance
New birth visits carried out
within 10-14 days
95% (national target)
Not achieved – average of 76%
throughout the year
Clinical audit participation
Achieve a minimum of 80 clinical
audits during 2011/12
Achieved – 115 audits in total
completed
HPV immunisation rates
Improve our vaccination rate to
90% (national target 80%)
Not achieved – we
achieved 87% for the 1st
immunisation and 86% for
the 2nd immunisation, the 3rd
immunisation is in progress.
0
Hounslow 2011-2012
Q1 - 2011/12
Richmond 2011 -2012
Q1 - 2011/12
Q1 - 2011/12
Totals:
Q1 - 2011/12
Although we have seen an increase in reporting, this is not always happening within 24 hours of the
incident occurring as required by Trust policy and seen as best practice by the CQC and National Patient
Safety Agency (NPSA). We have therefore decided to include the number of incidents reported within
24 hours as a quality indicator for 2012/13.
14 QUALITY ACCOUNT 2011/12
15
PART TWO
Our quality improvements in 2011-2012
New birth visits carried out within 10-14 days
completed local clinical audits and written reports) by 100 per cent. We have subsequently achieved a
continuous improvement in this area as detailed below:
7 Target not achieved
The national target is that 95 per cent of all new birth visits are carried out within 10-14 days of
birth and we are committed to achieving this. However, difficulties in recruiting into vacant health
visiting posts both across London and nationally has impacted on the Trust achieving the 95% target,
particularly in Hounslow where there are additional workload pressures associated with the specific
health needs of the population, together with high levels of safeguarding children concerns and high
caseload numbers (currently 800 families per full time working health visitor, compared to 500 families
in Richmond).
We have proactively worked on developing innovative ways of supporting our health visiting service to
deliver this important target, including the increase of skill mix, through the recruitment of additional
staff nurses to work within the health visiting teams. These staff nurses have been supported through
specific training to undertake early contact visits with families prior to a health visitor undertaking a full
health needs assessment. This has ensured that even when we have not had a health visitor available to
undertake a new birth visit at home to a mother and baby within the 10-14 day target, we have tried to
ensure that a visit at home is delivered by our trained staff nurses, ensuring important health promotion
and safety advice is given to the family and they have information on how to contact a health visitor for
telephone advice and through the attendance of weekly child health clinics.
We will continue to focus on recruiting into our vacant health visiting positions and are currently
supporting six health visiting students through their training, in an attempt to develop our own health
visitors to fill all vacant posts in 2012/13. We are delighted that all six are keen to stay with the Trust and
are currently applying for permanent health visiting posts to take up on completion of their training. In
addition, we have the full support of our commissioners in Hounslow and they have commissioned an
additional two full time health visitor posts to ensure caseload sizes are reduced, once we successfully
recruit into all of our vacant posts. In view of our commitment to delivering this target, we are carrying
this quality indicator over to our targets for 2012/13 and will continue to monitor it at every Trust Board
meeting.
Clinical audit participation
4 Target achieved
Participating in clinical audit enables
clinicians to not only benchmark the current
service but also identify any gaps or areas
of good practice. This then allows them to
either change the service to further improve
it or share good practice with others.
Clinical audit is clinically led and audits are
identified by the services with the aim of
improving patient care. Our participation
in clinical audit has significantly improved
over the past two years. In 2009/10, 20
local clinical audit reports were submitted.
The Board identified a need for significant
improvement in this area and the goal
for the following year (2010/11) was to
increase participation (the number of
16 QUALITY ACCOUNT 2011/12
Number of audits completed over the past
three years
Number of completed audits
120
Progress has been driven by the Trust Board and following the appointment of a new clinical audit
manager, the following has been implemented to improve participation and ultimately embed a culture
of continually striving to review and improve services delivered to our patients.
• Review of local clinical audit training
–– Clinical audit is now part of statutory and mandatory training requirements and training has been
accredited by the Royal College of Physicians
• Increased support and assistance for staff, including one-to-one/team/service specific bespoke support
–– Support delivered in community at service sites
–– Updated clinical audit page on Trust intranet
–– Weekly “drop-in” three hour sessions operating in each locality
• Trust Board support
–– Clinical audit championed, monitored and supported by the Trust Board
–– Monitoring at director-led committee
–– Service specific monitoring.
HPV immunisation rates
7 Target not achieved (although exceeded national target)
Human Papillomavirus (HPV) is the cause of most cervical cancers in women under 35 years of age. The
immunisation given at 12-13 years of age should result in a significant decrease in the incidence of the
disease in young women. Across the Trust we expected to immunise 2250 young women aged 12-13
years. This figure is based on the number of young women eligible for the vaccination in the boroughs
of Richmond and Hounslow. The vaccination programme involves the administration of three vaccines.
The national target is 80 per cent.
We set ourselves an ambitious target of achieving 90% during 2011-12. Although we haven’t quite
made this target, we have again performed extremely well and exceeded the national target of 80%,
with the 1st immunisation being given to 87% and the 2nd immunisation to 86% of the 2250 eligible
young women identified. The 3rd immunisation process is underway and HRCH are expecting similar
compliance, although confirmation will be received after publication of this document.
100
80
60
40
20
0
2009-10
20
2010-11
85
2011-12
115
17
PART TWO
Our quality improvements in 2011-2012
3. Patient experience
We chose the following three quality indicators to help demonstrate performance in this area:
• Walk in centre waiting times
• Improving patient experience through respect for privacy and dignity (PEAT)
• Single sex accommodation
How we performed
Quality indicator
Target
End of year performance
Walk-in centre waiting times
Less than 4 hours
(national target)
Achieved - we exceeded this target with
the majority of our patients completing
their treatment in under two hours
Improving patient experience
through privacy and dignity
PEAT score of excellent
for privacy and dignity
Achieved – excellent
Single sex accommodation
100% compliance
Achieved – 100% compliance
Walk-in centre waiting times
Improving patient experience through privacy and dignity
4 Target achieved
Although the national target is set at under four hours, we set a local target of under two hours waiting
time in the walk-in centre at Teddington Memorial Hospital (TMH). During 2011/12 nearly 47,000
patients attended the centre, with waiting times as follows:
Average triage waiting time
13 minutes
Average consultation waiting time
51 minutes
Average total waiting time
64 minutes
Once patients had been seen, the time taken to complete the treatment they required
was recorded as follows:
Treatment Duration
Number of patients
< 1 hour
16931
1-2 hours
20187
2-3 hours
7712
3-4 hours
2115
> 4 hours
18
Total patients treated
46,963
This means that on average our patients were seen and treated within 85 minutes during 2011/12.
We are proud of these achievements and know that the service is valued by our patients. We will
continue striving to deliver this high quality service during 2012/13.
18 QUALITY ACCOUNT 2011/12
4 Target achieved
We take the privacy and dignity of our patients extremely seriously and are delighted to again score
excellent in this year’s Patient Environment Action Team (PEAT) assessment score relating to privacy and
dignity. In a recent, very positive unannounced inspection from the Care Quality Commission, they
reported: “People who use the service are treated with dignity and respect. They have information about
their care and treatment and are able to make choices about these.”
Single sex accommodation
4 Target achieved
We are committed to providing every patient with
same sex accommodation because it helps to
safeguard their privacy and dignity when they are
often at their most vulnerable. As a result patients
who are admitted to Teddington Memorial Hospital
(the only hospital we provide inpatient services at) only
share the room where they sleep with members of the
same sex, and we have ensured that same sex toilets
and bathrooms are also close to their bed area. Teddington Memorial Hospital has received top marks three
years in a row in the national Patient Environment Action Team
(PEAT) assessment on the quality of its environment, food,
privacy and dignity. 19
PART THREE
Our quality improvements for 2012-2013
Part Three - Our quality improvements for 2012/13
How we decided our quality priorities for the next 12 months
In determining the areas the Trust should focus on for our quality improvements for 2012/13, we sought
the views of our patients, carers, staff and stakeholders in a number of ways, which included:
• An analysis of themes from the complaints received, incidents reported and concerns raised via our
Patient Advice and Liaison Service (PALS) during 2011/12
• Staff responses to a survey on our intranet
• Discussions with our staff in team and committee meetings and staff forums
• Dedicated discussion on the priority for improvement areas with members of our Patient, Public and
Involvement (PPI) Committee
• Feedback from external inspections, our commissioners, Hounslow and Richmond councils and both
Hounslow and Richmond Local Involvement Networks (LINks), ensuring the priority areas we choose
align with the specific needs of our very diverse local populations and support the work of our partner
agencies
• A consultation was also undertaken on our website for a four week period, but this attracted a
limited response rate. However, comments received were still fully considered and in fact the poor
response rate received to this consultation has in itself led to one of our priority for improvement
areas.
After careful consideration of the main themes that emerged from this feedback, our Trust Board agreed
five priorities for 2012/13. All five are about delivering better outcomes for patients.
Two of the priorities remain the same as last year so that we can build on the good progress that was
made, although one of these is being expanded to fully embrace the wider safeguarding adults agenda.
Three priority areas for improvement are new priorities for this year.
Looking forward – 2012/13 at a glance
The quality in
dicators we h
ave chosen to
measure:
Patient safety
• Patient safety in
ci
dent reporting
- 85% of all pat
hours as per Tr
ient safety inci
ust policy
dents reported
within 24
• Completion and
closure of all ac
tio
n
plans following
• Hand hygiene co
serious inciden
mpliance score
ts
s – to achieve
fu
ll
co
m
p
liance with 85%
Clinical effect
target
iveness
• Clinical audit ac
tivity – for ever
y service to com
service evaluat
plete at least 2
ion during 201
clinical audits an
2-13
d1
• New birth visits
10-14 days – to
ac
h
ieve new birth
• Urgent Care Cen
target
tre to treat 60%
of all non emer
• To achieve 85%
gency departm
target in the to
ent patients
p 5 priority stat
utory and man
Patient expe
d
atory training
rience
• Response to com
plaints – comp
ly with 25 day
• Provision of sing
response target
le sex accomm
o
d
at
io
n – achieve 10
• Staff sickness le
0% compliance
vels – achieve
3.2% target
ets set by our
rg
ta
t
n
e
m
e
v
ro
3:
Quality imp
UINS for 2012-1
Q
C
h
g
u
ro
th
rs
e
commission
NHS Richmond
as we have chosen:
The ‘priority for improvement’ are
Patient safety
le adults is
lity standard for safeguarding vulnerab
• To ensure a consistent, high qua
delivered across the organisation
rmed consent
rmed and supported to make an info
• Ensure all patients are fully info
for their treatment options
Clinical effectiveness
rity of pressure
towards reducing the number and seve
e
mad
ss
gre
pro
e
tinu
con
To
•
care
ulcers developed by patients in our
effective
quality of care is maintained through
high
nt
siste
con
a
ure
ens
To
•
clinical supervision
Patient experience
ices as a result of patient feedback.
• To demonstrate changes in serv
20 QUALITY ACCOUNT 2011/12
d of life care
unity nursing – en
CQUIN 1 - Comm
competencies
and mental health
tia
en
m
De
2
N
CQUI
lf care
rm conditions - se
CQUIN 3 - Long te
thermometer
CQUIN 4 - Safety
n
lth/health promotio
CQUIN 5 - Telehea
isation
CQUIN 6 - Immun
d bone health
CQUIN 7 - Falls an
ons
CQUIN 8 - Transiti
NHS Hounslow
fety thermometer
CQUIN 1 – NHS sa
ital strategy
ing the out of hosp
CQUIN 2 – Deliver
life
CQUIN 3 – End of
21
Our priority for improvement areas for 2012/13
Assuring patient safety
Priority 1 To ensure a consistent, high quality standard for safeguarding vulnerable adults is
delivered across the organisation
We are committed to delivering, implementing and monitoring the organisation’s structures, systems
and processes to safeguarding adults and fulfilling our ‘signed statement of commitment’ with both
Hounslow and Richmond’s Safeguarding Adults Partnership Boards to ensure high quality safeguarding
adults practice.
We recognise that some patients may be unable to uphold their rights and protect themselves from
harm or abuse. They may have great dependency and yet be unable to hold services to account for
the quality of care they receive. As a care provider, we have particular responsibilities to ensure these
patients receive high quality care and their rights are upheld, including their right to be safe.
We have representation on both the Hounslow and Richmond adult safeguarding boards and are
committed to working with our partners to:
• Prevent safeguarding incidents through the provision of high quality care
• Ensure effective responses where harm or abuse occurs through implementing multi agency
safeguarding adult procedures and policies
• Develop robust internal safeguarding adults governance arrangements, reporting regularly to the
HRCH Safeguarding Committee and to the Trust Board
• Contributing to safeguarding investigations, processes and acting as professional experts in services
commissioned by local authorities.
During 2011/12, we have completed a safeguarding adults self assessment tool (Safeguarding Adults
Self Assessment and Assurance Framework). This has enabled us to:
• Review and benchmark our safeguarding adults arrangements
• Provide assurance and accountability to our commissioners, partners and patients on areas we are
currently performing well in
• Develop action plans for improved outcomes
• Identify evidence or gaps in provision that will be relevant in complying with Essential Standards of
Quality and Safety and the Equality Act
• Support multi agency safeguarding adults objectives.
Although there are no statutory requirements for staff to attend safeguarding adults training, the Trust
has set its own high standard that requires all of our staff to attend safeguarding adults awareness
training as mandatory. In addition, clinical staff must attend further training which includes information
relating to the Mental Capacity Act 2005 (MCA) and Deprivation Of Liberty Safeguards (DoLS) in line
with their role and responsibility. Ensuring our workforce have a full understanding of safeguarding
adults principles and are clear about what is expected of them and how to gain support with raising a
concern is of utmost importance in achieving the high quality standard we desire across the organisation
in this area of practice.
Our aim – to achieve our mandatory training target for 85% of all staff to have completed
safeguarding adults awareness training as per policy
Measures we will report to our Board
What is our current position
Percentage of staff who have attended safeguarding
adults awareness training
30% as of 30 March 2012
Percentage of clinical staff required to attend MCA and
DoLS training who have completed this training
Not currently recorded
Other measures we will use to track progress
Number of safeguarding adults referrals made by our staff
All incidents including serious incidents relating to safeguarding adults cases
Priority 2 Ensure all patients are fully informed and supported to make an informed consent
for their treatment options
Consent is the principle that a person must give their permission before they receive any type of medical
treatment. It is also decision specific and is not a general principle. Consent is required from a patient
regardless of the type of treatment being undertaken, from a blood test to an organ donation.
What constitutes consent?
For consent to be valid, it must be voluntary and informed, and the person consenting must
have the capacity to make the decision. These terms are explained below.
• Voluntary: the decision to consent or not consent to treatment must be made alone, and
must not be due to pressure by medical staff, friends or family.
• Informed: the person must be given full information about what the treatment involves,
including the benefits and risks, whether there are reasonable alternative treatments, and
what will happen if treatment does not go ahead.
• Capacity: the person must be capable of giving consent, which means that they understand
the information given to them, and they can use it to make an informed decision.
Consent was chosen as a priority in our 2011/12 Quality Account. Although progress has been made
in relation to increasing information available to our staff and patients around obtaining consent, and
consent training is to be included as part of statutory and mandatory training in 2012/13, this is still an
area requiring further development. We have therefore chosen to continue with the theme of consent
as a priority for improvement this year, although we will focus on the area of mental capacity and
consent, linking it to our first priority around safeguarding adults.
22 QUALITY ACCOUNT 2011/12
23
PART THREE
Our quality improvements for 2012-2013
PART THREE
Our quality improvements for 2012-2013
Our aim - to be able to evidence through a patient survey undertaken by every service that
consent was gained appropriately for all patients surveyed
Measures we will report to our Board
What is our current position?
Measures we will report to our Board
What is our current position
Pressure ulcers (grade 3 and 4 ) developed in our care and
reported as serious incidents
87 (April 2011 - March 2012)
Any incidents or complaints relating to
consent issues
Not currently reported
Reported pressure ulcers grade 2 and above
291 (April 2011 – March 2012)
Annual report from completed patient surveys
across all services on consent compliance
Not currently reported
Percentage of all reported pressure ulcers which are severe
(grade 3 and 4)
30%
Other measures we will use to track progress
Reports following any CQC unannounced inspections where issues of consent are reviewed
% attendance of clinical staff on Mental Capacity Act and Deprivation
of Liberty Safeguards (DOLS) training
Other measures we will use to track progress
Percentage of pressure ulcers that deteriorate in our care
Percentage of patients assessed for risk of pressure damage on admission to our services
Percentage of patients with pressure damage with a care plan in place
Number of applications for DOLS assessments made by our staff
Developing clinical effectiveness
Priority 3 To continue progress made towards reducing the number and severity of pressure
ulcers developed by patients in our care
We want fewer patients to develop avoidable pressure ulcers whilst in our care, and where a pressure
ulcer does develop that effective treatment is given to control its severity. We want to further develop
the work undertaken last year to sustain improvement in this area.
We know our staff have increased their awareness of pressure ulcers from the 82% increase in the
rate of incident reporting during 2011/12. We can further improve the experience of our patients
by embedding the best practice in prevention, assessment and management of pressure ulcers being
described in the new guidelines developed by the pressure ulcer task force and sharing the learning
from our investigations of those reported as serious incidents.
We will do this through the work of our pressure ulcer task force, which has representation from clinical
teams across the organisation, as well as specialist tissue viability nurses. The task force will launch the
evidence-based pressure ulcer guidelines and a pressure ulcer champion will be identified in every team
that provides care to patients who are vulnerable to pressure damage to their skin, and provided with
training in pressure ulcer and wound care so that staff can monitor their progress at individual service
level.
We will support this by improving the data we collect on reported pressure ulcers so that staff can
monitor their progress at individual service level.
Our aim - a 30% reduction in avoidable category 3 and 4 pressure ulcers compared to
2011/12
Priority 4 To ensure a consistent high quality of care is maintained through effective clinical
supervision
We are committed to providing a clinical non-management supervision programme, which enhances
the clinical support and professional development for all healthcare staff who engage in face to face
patient/client activity.
Clinical supervision is recognised as a key element to supporting clinical governance that enables
practitioners to examine their practice, their skills, knowledge, attitudes and values in a safe structured
environment. Effective participation in clinical supervision is seen as individuals demonstrating their
accountability and taking responsibility for the continuous improvement of their practice, contributing
to more effective clinical risk management and improvements in patient care (Butterworth and Woods
1998).
The Trust has a clinical supervision policy, but there is a lack of assurance that all staff are participating
in clinical supervision and that there is a consistency across the organisation of the quality of clinical
supervision being received, which we must resolve.
Our aim – for 95% of clinical staff to receive clinical supervision as per Trust policy
Measures we will report to our Board
What is our current position
Percentage of clinical staff who have received
clinical supervision as per policy
Not currently recorded
Completed annual audit of clinical supervision
participation
Not currently recorded
Other measures we will use to track progress
All incidents and complaints relating to clinical performance
We currently have a clinically led task force developing processes for collecting this information.
24 QUALITY ACCOUNT 2011/12
25
Monitoring progress throughout the coming year
Improving patient experience
Priority 5 To demonstrate changes in services as a result of patient feedback
Being able to see our services from a patient’s viewpoint is crucial if we are to provide care which puts
our patients at the heart of what we do. We want to gather more of our patients’ views and learn
from more of their experiences, more of the time. Patient feedback remains a vital factor in shaping our
services and delivering the improvements that are needed in the quality of care we provide.
It is also important to listen to our patients to find out when we have got it right. We will ensure that
every service undertakes at least one patient satisfaction survey during 2012/13. In addition, we will
introduce online surveys, gather more patient stories with support from our Patient Experience Team and
continue to work with both Hounslow and Richmond LINks to facilitate feedback from local interest and
specialist groups. We have enhanced our Patient and Public Involvement Committee, with membership
that now provides good representation from the communities that we serve and we will continue to
utilise this committee to support us in our engagement with the population we serve, alongside the
excellent partnership we have already fostered with our LINks in Hounslow and Richmond.
We will continue to empower, engage and support our staff to enable them to provide the quality of
care which they would be happy for their families and friends to receive, as set out in our vision.
Our aim – 30% of services will show real changes based upon feedback from patients
Measures we will report to our Board
What is our current position
Percentage of patients surveyed rating their
overall experience as good or excellent
82%
Percentage of patients surveyed who would
recommend the service to a relative or friend
91%
Staff that would be happy with the standard
of care at the Trust if friends or family needed
treatment
66% of staff said they strongly agree or agreed
with this statement
Other measures we will use to track progress
Percentage of services in which patient feedback has resulted in specific change
Number of different ways services are seeking patients’ views and experiences
26 QUALITY ACCOUNT 2011/12
We have a dedicated committee focused on reviewing the safety, quality and effectiveness of our
services. This committee, known as the Integrated Governance Committee (IGC), will monitor our
progress throughout the year. In addition, our Patient and Public Involvement Committee is specifically
tasked with monitoring our performance against our Quality Account and will review progress and hold
us to account for their delivery.
Quality priority
Director responsible
Implementation committee
To ensure a consistent, high quality
standard for safeguarding vulnerable adults
is delivered across the organisation
Siobhan Gregory,
Director of Quality
and Clinical Excellence
Safeguarding Committee
Ensure all patients are fully informed and
supported to make an informed consent
for their treatment options
Siobhan Gregory,
Director of Quality
and Clinical Excellence
Safeguarding Committee
To continue progress made towards
reducing the number and severity of
pressure ulcers developed by patients in our
care
Jo Manley, Director of
Operations
Integrated Governance
Committee
To ensure a consistent high quality of care
is maintained through effective clinical
supervision
Jo Manley, Director of
Operations
Quality Safety Committee
and Clinical Effectiveness and
Audit Group
To demonstrate changes in services as a
result of patient feedback
Richard Tyler, Chief
Executive
Integrated Governance
Committee and Patient and
Public Involvement Committee
How we will report progress to the Trust Board and the public
throughout the year?
Progress in all these five priority areas will be monitored by our Board through our Integrated
Governance Committee. We have agreed a Board level sponsor for each priority and the same at
service level. Where possible we have selected indicators that can be compared across the Trust and
with other similar Trusts. These quality indicators will be reported through the balanced scorecard which
is published every month for the Trust Board and on our website within Trust Board papers for the public
and our staff to view. Our commissioners will also receive reports as part of our contracts with them.
27
PART THREE
Our quality improvements for 2012-2013
PART THREE
Our quality improvements for 2012-2013
Quality indicators chosen for 2012/13
Clinical effectiveness
The quality indicators detailed in this section of the report were selected through a process of
consultation with the Trust Board, staff, stakeholders (organisations we work with) and the public. The
indicators and targets ensure alignment with local, regional and national targets and are categorised
under three headings:
• Clinical audit activity – for every service to complete at least two clinical audits and one service
• Patient safety
• Clinical effectiveness
• Patient experience.
Patient safety
The Trust is committed to providing safe care and to recognise and reduce risks for our patients, staff
and visitors. We have chosen the following quality indicators and associated metrics or standards to
summarise our performance against these chosen areas.
• Patient safety incident reporting - 85% of all patient safety incidents reported within 24 hours as per
Trust policy
• Completion and closure of all action plans following serious incidents
• Hand hygiene compliance scores – to achieve full compliance with 85% target.
We have chosen the following four quality indicators and associated metrics or standards to
demonstrate how we will monitor and improve the clinical effectiveness of services we deliver.
evaluation during 2012/13
• New birth visits 10-14 days – to achieve new birth target
• Urgent Care Centre to treat 60% of all non emergency department patients
• To achieve 85% target in the top five priority statutory and mandatory training areas.
Patient experience
The experience of patients using our services is
of utmost importance to us and we have chosen
patient feedback and subsequent changes made
to services as a priority for improvement area in
2012/13.
We have chosen the following three quality
indicators and associated metrics or standards to
summarise our performance against these chosen
areas:
• Response to complaints – comply with 25 day
response target
• Provision of single sex accommodation – achieve
100% compliance
• Staff sickness levels – achieve 3.2% target.
All of the above quality indicators have been
included on our balanced scorecard, which will be
monitored at both the monthly Operations Board
and Trust Board.
Our Patient Advice and Liaison Team are available for face
to face or telephone advice. Jennifer Flannagan, PALS
officer is pictured here.
Our CQUINS for 2012/13
Our commissioners, NHS Hounslow and NHS Richmond, have set the following CQUINS
(Commissioning for Quality and Innovation) projects for 2012/13, aimed at improving quality standards
in key areas.
A proportion of the Trust’s income in 2012/13 is conditional on achieving these CQUINS, which will be
monitored and reported quarterly to our commissioners.
NHS Hounslow CQUIN schemes for 2012/13
CQUIN 1 – NHS Safety Thermometer
The Trust is asked to improve collection of data in relation to pressure ulcers, falls and urinary tract
infections in those with a catheter.
Our infection prevention and control nurses from left to right: Debbie Tyler, Nicola Sirin (lead nurse) and Esther Ekong.
28 QUALITY ACCOUNT 2011/12
Outcomes
• Collection of data on patient harm using the NHS Safety Thermometer harm measurement
instrument (developed as part of the QIPP Safe Care national workstream) to survey all relevant
patients in all relevant NHS providers in England on a monthly basis.
29
CQUIN 2 – Delivering the Out of Hospital (OOH) strategy
The Trust is asked to develop and realign universal services (adult community services) within localities, to
work and support target services and primary care, to establish standards and support the shift in care
delivery from reactive, unplanned care to more proactive planned care.
The aim of this CQUIN is to enable community services to support and deliver the OOH strategy and to
support and work proactively towards the development of care coordinators. This will be confirmed on
completion of the OOH strategy in June 2012.
Outcomes
• The Trust supporting and delivering the OOH strategy
• Evidence of more proactive planned care and less reactive unplanned care.
CQUIN 3 – End of life care
The Trust is asked to improve end of life care for people with an increase in the number of people on an
end of life care pathway dying at home and achieving the quality standards.
End of life care is referred to with patients with a life expectancy of less than 12 months. Our adult
nursing service is to actively liaise with GPs to identify and to be involved in multidisciplinary advanced
care planning, to enable patients to achieve their preferred place of death. They will work proactively to
facilitate the introduction of the Coordinate My Care (CMC) electronic record.
Outcomes
• Increase the number of registered end of life care patients and have an advanced care plan
Outcomes
• Identify staff that are eligible for training
• Staff to be identified to take part in the carers awareness training
• Staff to be identified to take part in dementia awareness training
• Assist in the acquisition of basic skills in mental health assessment, care and treatment for community
nursing and other relevant Trust services through education and training
• Raise awareness of the needs of older people with mental health problems
• Strengthen links with local mental health services to improve patient outcomes.
CQUIN 3 - Long Term Conditions: Self care
The project aims to ensure that all clinical staff providing community nursing, respiratory care and
community neuro-rehab care to adult patients with long-term conditions (LTC) provide self-management
education and support for patients and that this activity is integrated into routine healthcare with active
involvement of health professionals.
Outcomes
• 85% of clinical staff caring for adult patients with a LTC to have undertaken the Department of
Health e-learning tool for self care in order to deliver improved care to people living with LTC.
• An agreed set of self care planning tools implemented across the organisation.
• Agreed performance and quality measures that demonstrate that a systematic self care approach is in
place, demonstrating that every patient with a LTC has a self care plan.
• Number of patients with LTC seen by the community nursing service, respiratory care team and
community neuro-rehab team to have a self care plan in place.
NHS Richmond CQUIN schemes for 2012/13
CQUIN 1 – Community Nursing: end of life care
Community matrons, district nurses, the inpatient ward and other community nursing staff to actively
implement the end of life care pathway through the identification and management of end of life care
to enable patients to achieve their preferred place of care and death.
Outcomes
• A minimum of 370 new end of life care patients to have an end of life care assessment and plan
completed and regularly updated on the Coordinate My Care (CMC) record by a community nurse
• 75% of all patients placed on the CMC record by a community nurse will have a stated preferred
place of care and death
• 30% of the total number of patients put on the CMC record by a community nurse are from a
residential or nursing home
• 25% of patients who die from a long term condition die on a Liverpool Care Pathway
• Minimum 95% of all Coordinate My Care records are reviewed and updated in a timely manner
based on clinical requirements – a minimum of every three months.
CQUIN 2 - Dementia and mental health competencies
To ensure that older people in the Richmond borough receive appropriate, high quality care from
services and support that focus on the needs of individual patients and their carers and enable them to
live with dignity and security in their communities.
30 QUALITY ACCOUNT 2011/12
CQUIN 4 - Safety thermometer
The service aims to reduce attendances and admissions to acute units from nursing/residential homes
in the borough of Richmond by working with nursing/residential home staff to develop an ethos of
safe care within the older people’s homes. The service will work with nursing/residential home staff to
change the culture of care, to reduce harm and to deliver safe care. It will do this by increasing the skill
set of nursing/residential home staff, thereby preventing residents becoming unstable and requiring
acute treatment, and providing nursing/residential home staff with a clinical resource to assist them in
identifying and managing patients who are at risk of admission to hospital.
Outcomes
• A reduction in the number of A&E attendances
• A reduction in the number of emergency ambulance transfers to acute hospital
• A reduction in the number of emergency admissions to hospitals
• Reduced harms to patients (e.g. falls, pressure ulcers etc)
• Improved medicines management
• A reduction in safeguarding alerts
–– Set target from the current baseline based on council data
• All care homes included in the pilot to have protocols in place for falls, skin integrity, nutrition,
hydration, medicines management, mental health, and end of life care
–– Number of protocols completed
–– Number of homes rolled out across.
31
PART THREE
Our quality improvements for 2012-2013
CQUIN 5 - Telehealth/health promotion
The Department of Health (DH) believes that at least three million people with long term conditions
and/or social care needs could benefit from the use of telehealth and telecare services. Implemented
effectively as part of a whole system redesign of care, telehealth and telecare can alleviate pressure on
long term NHS costs and improve people’s quality of life through better self-care at home.
Outcomes
• Reducing hospital admissions and A&E attendances
• Reduced GP appointments
• Reduced travelling for community practitioners
• Greater patient understanding of LTC management
• Enhanced ability to self care
• Reassurance and improved quality of life for patients and carers.
CQUIN 6 - Immunisation
Data quality and accuracy is key to ensuring we have a true understanding of vaccine coverage
across the borough. It is envisaged that this CQUIN schedule will support the development and
implementation of a robust data flow pathway for immunisation data, supporting the delivery of
the childhood immunisation programme in Richmond. (For the purpose of this schedule, childhood
immunisations will be the key focus, i.e. those immunisations a child receives up until the age of
5 years.)
Outcomes
• 100% of GP practices with a named health visitor child health service/IT support contact for
immunisation
• 100% of practices to have immunisation data extracted from clinical systems on a weekly basis ready
to upload into RiO (those practices signed up to the data extraction programme)
• Identified inaccuracies from GP clinical system to be fed back to GP practices for amendment within
five working days
• Amend errors where appropriate or remove from automated upload until change has been made in
the practice within five working days
• 100% of data extracted is quality checked and uploaded into Rio on a weekly basis (either manually
or automatically once the automated upload tool has been introduced)
• 95% of children who had defaulted three times are followed up by a health visitor and an
immunisation appointment arranged.
CQUIN 7 - Falls and bone health
Falls are a major cause of disability and the leading cause of mortality resulting from injury in people
aged above 75 in the UK. Falls among older people are a large and increasing cause of injury, treatment
costs and death and have an impact on both NHS and social care services; hospital admission can lead
to additional complications.
Therefore the purpose of this scheme is to identify quality indicators within the Integrated Falls Service
(IFS) to encourage community staff to actively and opportunistically assess/screen patients aged 65 and
above for falls and bone health and to reduce the number of falls sustained by older people receiving
inpatient care at Teddington Memorial Hospital.
Outcomes
• Reduction in unscheduled admissions or attendance in A/E for people as a result of a fall
• Reduction in incidence of fractured neck of femur and other fractures, based on standardised
admissions ratio
• Improved quality of life for people at risk of falls
• Reduction in fear of falling
• Improved physical measures
• Patient satisfaction
• Reduction in the incidence of recurrent fragility fractures in the longer term.
• Increase in the number of patients referred who have had a previous fracture and successfully
completed a programme of care
• Reduction in falls of inpatients at Teddington Memorial Hospital leading to reduction in hospital
admissions.
CQUIN 8 - Transitions
It has been agreed that both the council and NHS Richmond will join together the roles and functions of
the intermediate care and reablement teams. Currently the reablement and intermediate care services
provide very similar services which seek to achieve the following four broad objectives in an efficient and
effective manner:
• Facilitating timely hospital discharge
• Preventing admission to hospital and care homes
• Reducing length of hospital stay
• Provide intensive community rehabilitation in order to promote independence and reduce lifetime
reliance on services.
To ensure the future success of the new service model, the Trust will need to go through a period of
change to achieve the aims and objectives of both the council and NHS Richmond. Therefore it is
recommended that a transitional CQUIN is implemented to ensure the outcome of the merger of both
services is a success.
Outcomes
• Reducing the inequalities in health across our population
• Improving both the quality and productivity of local services
• Improving how we do business, using the best commissioning and clinical advice, tools, technology,
innovation and evidence to drive results.
An Integrated Falls Service (IFS) aims to reduce the rate and risk of falls and fragility fractures in the
Richmond adult population through assessment and intervention. By addressing the risk factors and sign
posting to the correct services the holistic aim is to improve the quality of life for people at risk of falls
and fractures.
Comprehensive risk assessment and multi-agency intervention represent the most effective strategy
to identify those at risk and initiate multi-faceted management strategies to reduce the incidence and
impact of falls for older people (NICE, 2004).
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PART THREE
Our quality improvements for 2012-2013
PART FOUR
Statements from our stakeholders
Part four – Statements from our stakeholders
The Trust chose three indicators.
Statements from our Local Involvement Networks (LINks)
1. New birth visits carried out between 10 – 14 days after birth.
Hounslow LINk
This was an ambitious target, bearing in mind the availability of health visitors and the complex needs
of the community. While not achieving the target the Trust has used other qualified staff to provide a
service. The steering group notes that the Trust is actively recruiting two vacant posts.
Hounslow and Richmond Community Healthcare NHS Trust has engaged with Hounslow LINk since
its inception. Members of Hounslow LINk steering group are active participants on the Board and its
committees.
Priorities for Improvement
Priority 1 - The Trust has worked hard to ensure that the reporting of pressure ulcers has become a
standard reporting issue. This has meant that action plans could be put in place to stop pressure ulcers
deteriorating and eventually reduce the incidence of pressure ulcers in the community.
Hounslow LINk Steering Group looks forward to this priority developing in 2012/13.
Priority 2 - The second priority of participation in National Clinical Audit is important because it directly
links to improvements in patient care, by examining and measuring the gaps between best and current
practice and making improvements where necessary. The Trust exceeded its target of completing 80
local clinical audits.
Priority 3 - The third priority of improving evidence of obtaining consent from patients whilst important
in itself, is more important in the LINk steering group’s view because it checks that treatment options are
explained to patients.
The steering group notes the Trust’s commitment of ensuring that treatment options are explained in
a manner sensitive to patients background, culture, religion or nationality is essential to ensuring that
patients’ rights to determine what happens to their own bodies is maintained.
Commissioning for Quality and Innovation (CQUIN) Targets for 2011/12
The Trust has achieved the four targets in the projects agreed with the commissioners. The projects are
set up to improve quality standards in key areas. In achieving the targets the Trust has improved care to
patients and increased its income – a very good combination.
Quality indicators selected in 2011/12
The Trust achieved two of the three indicators it selected. These were incidence of MRSA bacteraemia,
and patient safety incident reporting. The third indicator of a 3% staff sickness absence rate was not
achieved. This is in some ways understandable, bearing in mind the rapid changes that the Trust has
undertaken and the drive to achieve foundation trust status. However, it is essential that staff feel
appreciated and involved in all processes that the Trust undertakes. The steering group will continue to
support the Trust to achieve this.
2. Clinical audit participation
In participating in clinical audit, clinicians are able to identify any gaps and/or areas of good practice. This
will allow the Trust to change the service to further improve it. It is encouraging that this indicator was
achieved.
3. Human Papillomavirus (HPV) immunisation rates
Cancer is one of the major diseases that affect patients. In setting an ambitious target of achieving 90%
during 2011/12, the Trust was pushing itself very hard. They achieved 86% and although that did not
achieve their target, it should be noted that it did exceed the national target of 80%. The Trust is to be
congratulated on this. The steering group hopes that the numbers of young women being immunised
in the coming year will continue to rise.
Patient experience
In this area the Trust has performed very well. Again the Trust chose three targets - walk-in centre
waiting times; improving patient experience through respect for privacy and dignity; and single sex
accommodation.
The steering group is pleased to note that all these targets were achieved, and we look forward to this
continuing in the coming year. The steering group also congratulates the Trust in providing a first class
walk-in centre in Teddington and questions why there is not a quality service in Hounslow.
2012/ 2013
Hounslow LINk steering group notes the Trust’s quality improvements for 2012/13 and looks forward
to working with the Trust as a critical friend in what we think could be a difficult year with all the
aspirations that the Trust has.
Richard Eason
Hounslow LINk
Clinical effectiveness
The Trust feels that an effective service can be defined as one that provides the right service, to the right
person, at the right time. So this section is very important, as it shows how effective or not the Trust is in
key areas.
34 QUALITY ACCOUNT 2011/12
35
Richmond upon Thames LINk
London Borough of Richmond upon Thames
This is a clear, easy to read account which provides some encouraging evidence of improvement in the
quality of community health services by the Trust, particularly amongst those priority areas identified and
reported here. We welcome the commitment that quality will be at the heart of the Trust’s agenda and
that this will be driven by the newly established Integrated Governance Committee. LINk membership
of this committee facilitates awareness of quality issues within the Trust.
London Borough of Richmond upon Thames (LBRuT) continues to work with HRCH NHS Trust in many
key aspects of service delivery where social care is key to the delivery of community healthcare support
to older people and to people with a sensory or physical disability (HRCH Community NHS Trust does
not provide community health services for people with a learning disability in the Borough).
Progress on priorities 2011/12
Regarding the incidence of pressure ulcers, we welcome the development of the pressure area task
force, the planned development of evidence-based guidelines and emphasis on relevant staff education.
It is encouraging to note the increase in reporting grade 2 pressure ulcers which indicates that more
effort has gone into identifying and reporting their incidence; however we are concerned to read of the
increase in grade 4 ulcers. It is noted that this area will remain a priority for the coming year and we will
be monitoring this closely.
We are pleased to see that local clinical audits are exceeding the target set within the Trust and the
move towards services evaluation.
We welcome the emphasis on improving evidence that patient consent has been appropriately obtained
and that this priority will be extended to 2012/13. Quality indicators 2011/12
It is reassuring that there has been no reported incidence of MRSA. Regarding patient safety incident
reporting, whilst it is good to see that there is an increased focus on the reporting of these, we are
unable to gauge the nature of the incidents or in which service area they are occurring. Likewise we are
unaware of the learning or change in practice that may have resulted.
At a strategic level, LBRuT has representation at the Trust Board, and has close working relations with
directors, managers and staff at all levels in community services and the wider organisation. LBRuT
contributes to key areas of work in the areas of governance and quality assurance, ensuring clinical
processes (e.g. clinical governance) are complemented by social care processes such as care governance,
safeguarding vulnerable people at risk and Deprivation of Liberty Safeguards (DoLS). Furthermore, there
is political and public scrutiny of the Trust’s work by way of the council’s Health, Housing and Adult
Services Overview and Scrutiny Committee.
Community services are managed through a senior officer arrangement. In addition the Trust is
a member of the borough’s Safeguarding Board, Serious Case Review subgroup and Children’s
Safeguarding Board.
We are in the process of further aligning intermediate care and reablement with a proposed move to a
fully integrated service in April 2013.
In the year ahead LBRuT will continue to work with the Trust on all issues that have a qualitative impact
upon the lives of patients and service users, and will support the Trust in delivering upon its quality
priorities.
Derek Oliver, Assistant Director, Adult and Community Services
London Borough of Richmond upon Thames
It is disappointing that vacant health visitor posts have meant that the target for new birth visits has
not been achieved. We will be looking for improvement in this area as well as a more equitable service
across the two boroughs. We welcome the addition of skill mix as a substitute measure to mitigate
against the effects of vacant health visitor posts.
Regarding patient experience it is excellent to see that the targets for quality indicators in this area have
been achieved, particularly those for the Teddington Memorial Hospital walk-in centre and the score of
excellent following the PEAT inspection.
Priorities for Improvement 2012/13
We welcome the priorities and quality indicators chosen for the coming year, in particular the emphasis
on safeguarding vulnerable adults. However we will require assurances that more staff are attending
relevant training. We also hope to see greater assurance that clinical supervision is being consistently
undertaken throughout the Trust as an indicator of high quality care.
We look forward to further involvement in the Patient Experience Team and to receive evidence that the
Trust recognises the importance of continuing dialogue with patients, carers and the public.
Paul Pegden-Smith
Richmond LINk
36 QUALITY ACCOUNT 2011/12
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PART FOUR
Statements from our stakeholders
Statements from our commissioners
NHS Richmond
NHS Richmond and the shadow Richmond Clinical Commissioning Group (CCG) has reviewed the
2011/12 Quality Account (QA) produced by HRCH and believes that this is a fair and accurate reflection
of the services delivered by the community provider to the residents of the London Borough of
Richmond upon Thames.
Looking back at HRCH’s performance during 2011/12, NHS Richmond and the CCG are satisfied that
significant improvements have been made in certain areas and that the development of services such
as the Rapid Response and Early Discharge Services have had a positive impact on outcomes and
contributed to the delivery of our QIPP plans. However we also recognise that the QA indicates that
there are improvements which need to be made during 2012/13 if HRCH are to achieve the quality
priorities they have set themselves and if they are to realise Foundation Trust (FT) status.
The main areas of achievement include the establishment of the Integrated Governance Committee
of the Board which has the specific aim of driving up quality improvement throughout all services.
Progress against the CQUIN’s set out by the commissioners has been good with the Rapid Response
and Early Discharge Service and End of Life Care schemes contributing to removing growth in short stay
emergency admissions and a reduction in excess bed days. The successful unannounced CQC visit to
Teddington Memorial Hospital should also be noted. The Safeguarding Children Team has designated
and named professionals who lead on all aspects of the health service contribution to safeguarding
children across Richmond. The team provide a vital source of professional advice on safeguarding and
child protection matters to all staff in Richmond and links with partner agencies, for example: Local
Authority Children’s Services Departments and the Richmond Local Safeguarding Children Board.
Three improvement priorities were identified in 2011/12. These were:
During 2012/13, HRCH have pledged to make improvements across a number of priorities and quality
indicators and NHS Richmond and the CCG will monitor these carefully through the re-established
Clinical Quality Review Group (CQRG) and contract review meetings. They relate to the three
fundamental elements of quality care which are:
• Patient Safety
• Clinical Effectiveness
• Patient Experience.
The priorities include:
• Delivering high standards for safeguarding vulnerable adults and ensuring patients are fully informed
to consent to treatment
• Delivering high standards for safeguarding vulnerable adults and ensuring patient’s are fully informed
to consent to treatment.
• To continue to make progress in reducing the number and severity of community acquired pressure
ulcers
• Demonstrate service improvements as a result of patient feedback.
• The quality indicators chosen include:
• Ensuring 85% of safety incidents are reported within 24 hours and closure of all action plans
following serious incidents.
• Every service to complete at least two clinical audits and one service evaluation.
• Compliance with the new birth visit target.
• Urgent Care Centre to treat 60% of all non emergency department patients.
• Maintenance of 100% compliance with the provision of single sex accommodation.
• To reduce the incidence of community acquired pressure ulcers
• Improve participation in National Clinical Audit (NCA) activity
• Better evidence of obtaining patient consent.
NHS Richmond and the CCG will continue to offer its conditional support to HRCH’s FT bid which will be
reliant on demonstrable improvements in service access and system redesign.
The target for improving NCA activity was exceeded, however whilst progress was made in reducing
community acquired pressure ulcers and patient consent there is still room for improvement. Both these
improvement priorities have therefore been rolled over into 2012/13.
• Improved waiting times for core services including those which are part of the Any Qualified Provider
Of the Quality Indicators chosen in 2011/12; waiting times at the Walk in Centre, the elimination of
mixed sex accommodation and the incidence of MRSA were all achieved. However the 95% standard
for new birth visits within 10-14 days was not achieved and is part of a wider agenda for improvement
required by commissioners for the Health Visiting Service in 2012/13. Additionally patient safety incident
reporting was identified as a Quality Indicator and the target was achieved, although incidents are not
always being reported within 24 hours of the incident occurring. This is in breach of HRCH policy and
best practice guidance by the CQC and National Patient Safety Agency. This measure has therefore been
included as a quality indicator for 2012/13.
In the main these relate to:
(AQP) process and full compliance with national AQP service specifications
• Measureable improvements to the provision of Health Visiting services
• Full involvement in the implementation of 111 in Richmond supporting the shift of urgent care into
the community
• Commitment to use the additional growth funds invested in 2012/13 to support the commissioners
achieve their QIPP goals.
HRCH has demonstrated in the 2011/12 Quality Account a clear intention and commitment to
continuously improve their services for patients. Through rigorous monitoring NHS Richmond and the
CCG will work closely with HRCH through the changes in the commissioning arrangements in 2012/13
to continue to achieve quality improvements for those patients who reside in the London Borough of
Richmond upon Thames.
Dr Andrew Smith,
Chairman, Richmond Shadow Clinical Commissioning Group
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PART FOUR
Statements from our stakeholders
NHS Hounslow
NHS Hounslow has reviewed Hounslow and Richmond Community Healthcare NHS Trust’s Quality
Account for the year 2011/12. In compliance with legislation, the Trust presented its Quality Account
for comments on 30 April and it has been reviewed by contract commissioners and the quality team.
This statement has been reviewed and approved by the Borough Director for Hounslow along with the
nominated GP contract lead, on behalf of the chair of the Clinical Commissioning Group (CCG). It has
also been reviewed and approved by the Non-Executive Chair of the Cluster’s Quality & Clinical Risk
Committee on behalf of the NHS North West London Cluster board. The Quality Account in general
complies with guidance as set out by both Monitor and the Department of Health.
In relation to the target for 95% of new birth visits to take place within 10-14 days, commissioners
understand the difficult issues in relation to recruitment of qualified Health Visitors and that this is not
unique to Hounslow and Richmond. Although it is therefore commendable to have a clear plan in place
to fill all vacant posts in 2012/2013, it would have been additionally useful if there was some specific
comparison with other community services to show how HRCH differs. For example, Brent, Ealing and
Harrow community services are reporting year to date figures of 87.4%, 90.2% and 85.7% respectively.
Central London Community Healthcare has reported a year-to-date-average of 95.1% for the eleven
months to the end of February 2012.
In relation to the review of the priority on reducing the incidence of pressure ulcers, it is noted that there
is a clear explanation as to why the number of pressure ulcers shown for 2011/12 has increased on the
previous year. It would have been helpful also to include the numbers of actual patients at risk and the
actions taken to reduce incidence. There could also be further evidence of progress on addressing the
causes of pressure ulcers identified. It is recognised that the Quality Account is required only to report on
priorities as they were previously described, and so this priority could have been better defined.
The Quality Account could also have better explained progress towards the current 76% average.
Commissioners from NHS Hounslow and colleagues at Hounslow Council have been working with the
Trust for a number of years on this issue. In August 2009, the Trust was reporting at 5% against this
target, linked not only to recruitment issues but also to a high number of on-going child protection
cases. An interim target of 50% was set for 2010/11, which was challenging but achieved, with the
Trust now working towards the 95% target as is now specified (in 2011/12 and 2012/13). Hounslow
commissioners are continuing to monitor this on a monthly basis and review progress with HRCH.
It is noted that the Patient Experience priority aimed at improving evidence of having obtained consent
from patients refers to “good progress” in ensuring a consistent approach. Included within this there
could also be some evidence of change in quality actually achieved for patients as a consequence of the
actions undertaken. This would help make clearer the outcomes achieved rather than processes which it
is currently focused on.
As for priorities for the year ahead, commissioners note and welcome an ambitious 85% target for
safeguarding adult awareness training above the current level of 30%. Commissioners note the
challenging 30% target on the planned reduction of pressure ulcers. Commissioners also note and
are supportive of plans to demonstrate service change following feedback across HRCH’s portfolio of
services, although it not clear what is meant by ‘real changes’ and so this could be more specific.
Commissioners commend the achievement of CQUIN targets, repeating overall success from last year.
Explanation of why some quarterly targets have been missed would be useful, along with percentage
attainment and supporting evidence where they have been achieved. Commissioners have addressed
with the provider that CQUIN failure is not acceptable, as is the failure not to submit robust evidence.
It is also recognised that, since CQUIN targets are incentive based, there is strong encouragement to
deliver but payments are withheld accordingly if providers fail to meet them. Hounslow commissioners
will continue to monitor this on a quarterly basis and review progress with HRCH.
A further improvement commissioners would encourage, which is not well demonstrated this year, is to
ensure that comparison can easily be made against performance in earlier years in order to chart clearly
any changing trends in quality and safety. This would be especially useful, for example, in relation to
changing CQUIN objectives, to ensure that any actions for continued improvement are sustained and
reported.
The Quality Account refers to improved partnership working with General Practitioners (GPs), and
that community teams are now having regular meetings and staff training sessions with GPs. This is
welcome, although current evidence does not wholly substantiate this. There is apparent variation in
approach with different surgeries, and in the amount of time spent discussing individual caseloads.
Anecdotal feedback also suggests that (1) fewer GPs are engaged than should be, (2) meeting agendas
do not make their purpose clearly explicit, and (3) there is limited identification of new patient cases.
Commissioners would therefore strongly encourage HRCH to make further improvement, in both
its actions and in gathering related evidence, if successful outcomes are to be demonstrated. It is
disappointing to note that the target for sickness absence was not achieved, which raises concerns
with commissioners about the morale of the workforce and therefore its ability to maintain consistent
service quality. It would be helpful if actions being taken to assist staff in returning to work were further
explained. Further indicators could also have been chosen to demonstrate workforce satisfaction, for
example how the Trust has been performing against its 12% target for staff turnover.
In summary, we welcome the Quality Account and will support HRCH to achieve its priorities and
improvements set out for the next year.
Dr Kapil Kotecha, Hounslow Clinical Commissioning Group GP Lead for Hounslow and
Richmond Community Healthcare NHS Trust
Sue Jeffers, Borough Director, NHS Hounslow
Data shown for the total numbers of patient safety incidents does not inform commissioners about the
quality of incident management. Commissioners acknowledge the fact that not all incidents have been
reported within 24 hours and consequently the inclusion of this indicator as a priority for 2012/2013.
There could also usefully be further explanation of how numbers of incidents shown compares to
previous years and whether subsequent investigations were carried out within agreed timescales. It
is recognised that the Quality Account is required only to report on priorities as they were previously
described, and so this priority could have been better defined.
40 QUALITY ACCOUNT 2011/12
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PART FOUR
Statements from our stakeholders
PART FOUR
Statements from our stakeholders
Equality and diversity
We are keen to ensure that we recognise and deliver culturally sensitive, inclusive, accessible and fair
services which make a difference to the individuals we serve.
We are also committed to providing employment practices which are fair and accessible for the diverse
workforce we employ. We aim to provide an environment that is equally welcoming to people of all
backgrounds, cultures, nationalities and religions.
As a publicly-funded body, we are required to ensure that diversity, equality and human rights are
embedded into all our functions and activities as per the Equality Act 2010, the Human Rights Act 1998
and the NHS Constitution. In performing our functions, we will:
EDS goal
Objective 2012/13
Empowered,
engaged and well
supported staff
Monitoring requests for and outcomes of flexible working applications and
reporting the results.
Inclusive
leadership at all
levels
Cultural competency training for frontline staff and middle managers and
Board training on the EDS framework.
• Eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the
Act.
• Advance equality of opportunity between people who share a protected characteristic and those who
do not.
• Foster good relations between people who share protected characteristics and those who do not.
NHS Equality Delivery System (EDS) and equality objectives
In 2012, we implemented the NHS EDS framework to help support improvements in patient access,
experience and outcomes and to improve our workforce practices and be seen as an inclusive
organisation. The EDS is a developmental tool and will help us to assess our performance annually with
local partners.
In partnership with local stakeholders such as our Local Involvement Networks and organisations such
as Diabetes UK, we graded our performance against 18 EDS outcome areas and identified four equality
objectives for 2012/13. The full report of our assessment can be viewed at http://www.hrch.nhs.uk/
about-us/equality-and-diversity/
Feedback
We hope you find this Quality Account a useful, easy to understand document that gives you
meaningful information about Hounslow and Richmond Community Healthcare NHS Trust and the
services we provide.
This is our second Quality Account. If you have any feedback or suggestions on how we could improve
our Quality Account, please let us know by emailing communications@hrch.nhs.uk or calling 020 8973
3143.
For comments or questions about our services please contact our Patient Advice and Liaison Service
(PALS) on 0800 953 0363 or email pals@hrch.nhs.uk
The information in this report is available in large print by calling 020 8973 3143.
In line with EDS guidance, one objective was identified for each of the four goal areas as outlined
below:
EDS goal
Objective 2012/13
Better health
outcomes
for all
Improved patient diversity monitoring so that more fields are captured in
addition to age, ethnicity and gender so that the Trust can report on NHS
Outcomes Framework indicators by diversity
Improved patient
access
and experience
Implement an effective Patient Public Involvement (PPI) strategy so
that:
- the diversity of complainants is monitored
- e vidence exists of engagement with local stakeholders representing all
protected characteristics contained in the Equality Act 2010
- t he patient survey 2012 monitors responses by sexual orientation, religion
or belief and marriage
- t he inclusion of local Dementia and Alzheimer’s Groups and members of
NHS Richmond community involvement group in our PPI forum.
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