Quality Account Report
2011/12
Excellent care, healthy communities
Contents
About the document
3
Section 1: Introduction to the Quality Accounts 2011/12
5
Section 2: Review of 2011/12 quality improvement and targets for 2012/1316
2.0 Patient safety
16
2.2 Clinical effectiveness
20
2.3 Patient experience
34
2.4 Health and wellbeing
40
2.5 National Institute For Health And Clinical Excellence (NICE):
guidance and quality standards
41
Section 3: Continuous quality improvement 2012/13
42
3.1 What we are adding to our quality improvement programme
42
Section 4: Quality statements
44
4.1 Data quality statement
44
4.2 Clinical audit
45
4.3 Learning from Serious Incidents
50
4.4Research
53
Section 5: What others say about us – Care Quality Commission
54
Section 6: Conclusion56
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Excellent care, healthy communities
1.0 About the document
What is a Quality Account and why is it important?
We are an organisation committed to continually improving the quality of the services we provide to
our patients. Our Quality Account is an annual report of:
•
•
•
•
Progress on last year’s quality priorities
How well we are doing against targets we are set by the Department of Health, our local Primary
Care Trusts (PCTs), Strategic Health Authority (SHA) and our own internal targets
Where we need to improve the quality of the services we provide
Our priorities for the coming year (2012/13)
Embedding the Quality Account and measuring performance
This year we have developed a quality scorecard based on the indicators from the Quality Account
so that staff can be more involved in measuring their performance and to help track how well we
are doing against our improvement targets. We have been reviewing the scorecard at our monthly
Quality Committee, the local directorate quality meetings, and in exception reports to our Trust Board,
with progress reports made available on our website. We review the quality of our services in a
variety of ways:
•
•
•
•
•
•
•
•
•
•
•
Trust-wide NHS Litigation Authority (NHSLA)
Trust-wide inspections by the Care Quality Commission (CQC)
Trust -wide pharmacy
Internal clinical assurance reviews
Quality and Safety Committee
Hygiene and Compliance Audits
Quality risk profile
Monitor Quality Governance Framework
National Institute for Health and Clinical Excellence (NICE)
Central Alert System
Clinical Audit.
If you need this document in a different format or language please contact our Customer Care Team
on 0300 123 1807 (local rate), email kcht.cct@nhs.net or write to us at:
Customer Care Team, Kent Community Health NHS Trust,
Trinity House, Eureka Business Park, Ashford, Kent TN24 4AZ
Getting involved in developing our Quality Account
We received feedback on the areas we should focus on as safety priorities in our Quality Account.
We did this through a series of workshops involving members of the public and patients.
Our staff have had the opportunity to put forward suggestions through Staff Zone (our intranet site for
staff) and local team meetings.
We would like to hear your views on our Quality Account.
If you are interested in being involved in helping to develop our Quality Account for 2012/13 please
contact Louise Cameron by emailing susan.riley@kentcht.nhs.uk or by ringing 01622 211923.
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Excellent care, healthy communities
About the services
Kent Community Health NHS Trust (KCHT) provides care for you in your own home and in other
locations including nursing homes, health clinics, community hospitals, minor injury units, gateways,
children’s centres and GP surgeries.
We work closely with GPs, Kent County Council, voluntary organisations and other healthcare
providers, to make sure you get healthcare which is co-ordinated and meets your needs.
We provide our services locally, so you get support and care that fits around you.
Our staff include community nurses, dieticians, health visitors, dentists, podiatrists, occupational
therapists, physiotherapists, family therapists, clinical psychologists, speech and language therapists,
radiographers, pharmacists, health trainers, health improvement specialists and many more.
We provide services for children and adults to keep you healthy, manage your long-term health
conditions and help you avoid going into hospital.
You can get advice and support about you and your child’s emotional and physical health and
wellbeing from a range of services including our health visitors, by attending one of our parenting
support groups or from our school-based nurses.
Our health and wellbeing services are here to support you to make positive lifestyle choices. Help is
available to increase exercise, eat healthily, quit smoking and assist you with wider health and social
needs.
Our sexual health services encourage safe sex and provide contraception and treatment.
If you do become ill and need treatment we have minor injury units across Kent, open seven days a
week, which treat a range of minor illnesses and injuries. We also provide emergency and specialist
dental treatment.
Our GP-based nursing and therapy teams provide care in people’s homes and help in managing
long-term conditions, so you don’t have to go into hospital unnecessarily.
If you do need in-patient care, for example while recovering from an illness, we support you to get
back home by providing rehabilitation at home and in our community hospitals.
We also provide specialist care in the community, for example for seriously ill children or rehabilitation
following a serious illness or injury and provide care for disabled children and adults.
For more information about our full range of services please visit our website www.kentcht.nhs.uk or
contact our Customer Care Team on 0300 123 1807 (local rate), email kcht.cct@nhs.net or write to
us at:
Customer Care Team,
Kent Community Health NHS Trust
Trinity House
Eureka Business Park
Ashford
Kent
TN24 4AZ
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Excellent care, healthy communities
1.0 Introduction to the Quality Accounts 2011/12
Our strategy
Our strategy is for the people who use our services to always receive high quality care which is safe
and effective, have a good experience of our services, which are continually improving.
By doing this we aim to be the provider of choice.
Working with our partners
We work with commissioners and other health and social care providers so that all of the health
and social care needs of our community are met in a co-ordinated way. This will improve people’s
experience and their health outcomes.
Providing care closer to home
Seventy per cent of the NHS budget is spent in acute settings, with an increasing number of bed
days being occupied by people with long-term conditions.
People are increasingly living longer with more complex health needs. Around 80 per cent of over 65
years olds now have at least one, and typically up to eight or more, health conditions as they get older.
To address this we need to promote good health, increase prevention, help people manage their
conditions better, provide care closer to people’s homes and avoid the need for them to go into
hospital unless this is appropriate.
When people do go into hospital they need to be discharged quickly with appropriate packages
of care when acute treatment is no longer necessary and be supported to manage their long-term
conditions.
Improving the health of our communities
We improve the health of our community from the very beginning, from health visitors working with
families to a range of services in schools and the community to support the emotional and physical
health and wellbeing of all children.
Our health and wellbeing services help people to maintain good health by eating healthily, exercising,
and stopping smoking and having good sexual health.
We are working increasingly closely with GPs, so that patients are assessed and their needs
identified, and addressed, at an early stage so they stay healthier for longer.
We are developing integrated health and social care teams to deliver care which meets individual
patients’ needs and we are developing a multi-skilled workforce able to carry out a range of
interventions, preventing multiple home visits by different professionals.
We are supporting people with long-term conditions to have more control over their lives, manage
their own care and spend less time in hospital, resulting in less disruption for them and better health.
Specialist services for children focus on children who are seriously ill and families with high levels of
need; meeting the needs of vulnerable adolescents and ensuring early support for disabled children,
young people and their families.
We will continue to develop our services using best practice, closely involving service users and
carers in monitoring and reviewing our services.
Excellent care, healthy communities
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How we are structured
We deliver care across the whole of Kent to a population of more than 1.4m people. There are three
operational clinical units, Adults, Children and Young People and Health and Wellbeing. We are
shaping our services to focus on the needs of individual communities within Kent.
The Children’s and Young Peoples and the Health and Wellbeing services are delivered through
teams which match Kent’s district and borough council boundaries. Our Adults service is structured
in localities, focused around the Clinical Commissioning Groups run by GPs and the main acute
hospitals in Kent.
Our services operate from a wide range of settings including 12 community hospitals, 26 community
clinics, 15 health centres, sure start centres and GP surgeries as well as patients’ homes.
Established in 2011 the Trust builds on community services which have been growing and developing
in Kent over many years. It has more than 5,400 staff and an income of more than £200m,
mainly from NHS Kent and Medway with some additional contracts with Kent County Council and
commissioners in other parts of the country.
Delivering the Strategy
Our immediate priority over the coming year is to strengthen our core services; spread best practice
across the county; address gaps in capacity; improve productivity and create robust and dynamic
clinical arrangements.
In the next two to three years we will focus on building alliances with other providers whether as
prime provider, prime contractor or through partnerships and joint ventures.
We will also continue to work towards full integration of health and social care teams with all
professionals working within a common framework both in supporting older people with personalised
care management and in their focus on early years and vulnerable children promoting resilience and
emotional well being.
In the years following, as the Trust builds a track record of delivering innovative high quality care it
will be in a stronger position to promote itself as the preferred provider offering new ways to improve
local services, delivering the most attractive models of care to local people as well as those in
neighbouring communities.
Marion Dinwoodie
Chief Executive
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Excellent care, healthy communities
Performance Targets 2011/12
Delivering services that are of a consistently high standard every time, to every patient and user
is the Trust goal. Our aim is to remove the variations in care delivery that lead to incidents where
patients and users experience poor or unsafe care. To support this there are national indicators set
by the Department of Health and internal indicators and targets that we have set ourselves in order to
drive, monitor and measure quality improvement. The measures listed in table 1 are known nationally
as indicators of care quality. By monitoring and measuring performance we are able to identify the
themes and trends in relation to our performance. With this information we undertake investigations
to gain insight and understanding of the contributory factors and respond with measures to address
the gaps.
Within our Board Quality Dashboard are the Commissioning for Quality and Innovation (CQUIN)
targets. The CQUIN is a payment framework that aims to ensure that quality is the organising
principle for all NHS services. It provides a means by which payments can be made to providers of
NHS services on the achievements of locally agreed quality and innovation goals.
In 2011/12 we had 18 targets on the Board Quality Dashboard including CQUIN. These were
measured regularly throughout the year and improvement measures were implemented when
appropriate. Of the 18 targets we met or exceeded the target in 15 of them. We are proud of our
achievements which demonstrates the hard work and commitment of our workforce at all levels of the
organisation.
However, we know that there is room for improvement, as a number of our patients had a fall
resulting in a fracture, developed grade 3 or grade 4 pressure ulcers or had an MRSA bacteraemia.
Although the percentage numbers when considered against the number of patient contacts in the
year are very low, our ambition is for zero harm to occur to our patients.
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Excellent care, healthy communities
Excellent care, healthy communities
Inpatients to receive a MUST
assessment within 24hrs of
admission
Improve the Patient Experience
– Sexual Health East Kent
Improve the Patient Experience
– ICATs East Kent
Improve patient experience
collection process
– West Kent
CQUIN2
CQUIN3
CQUIN3A
CQUIN3B
DCU: Data currently unavailable
KEY:
Pressure Ulcers –
Implementation of Quality
Standard
CQUIN1
Attributable Pressure Ulcers
(Grades 3&4)
HIA2
Indicator Description
Attributable Falls with Fractures
HIA1
Ref
Indicator Description
Ref
14
1
Apr
2011
10
1
May
2011
11
0
June
2011
14
1
July
2011
22
0
Aug
2011
High Impact Actions
26
3
Sept
2011
29
2
Oct
2011
DCU
May
2011
DCU
82%
95%
80%
DCU
Apr
2011
NT: No target
>=2000
year
end
>93%
>93%
>84%
=100%
year
end
Annual
Target
DCU
July
2011
875
95%
98%
83%
DCU
Aug
2011
On target
94%
97%
87%
DCU
June
2011
93%
94%
81%
DCU
Sept
2011
1188
94.5%
100%
90%
89%
(Kent)
Nov
2011
Dec
2011
1412
95%
96%
92%
Jan
2012
2276
95.5%
98%
96%
2587
93.5%
96%
94%
100%
(Kent)
Mar
2012
43
2
Mar
2012
*East Kent data only
*QR: Quarterly Report
1573
94%
98%
95%
Feb
2012
45
2
Feb
2012
98%
(Kent)
32
2
Jan
2012
90%
(Kent)
23
3
Dec
2011
90%
(Kent)
39
1
Nov
2011
Not on target
1188
91%
97%
DCU
85%
(EK)
Oct
2011
Commissioning for Quality and Innovation (CQUIN)
=0
=0
Annual
Target
Table 1. Performance Indicators and targets 2011/12.
8
2276
93%
97%
89%
98%
YTD
308
18
YTD
Excellent care, healthy communities
Personalised Care (Long
Term Conditions) – All patients
admitted onto the caseload
of the Long Term Conditions
Team, will have an individual
management plan
– East Kent
Personalised Care (Long Term
Conditions) – % of staff trained
in Personalised Care planning
via Implementation of training
and competency action plan
– West Kent
EQ Program
– Improve Performance
against established baseline
– Personalised Care Planning
Measure
EQ Program
– Improve Performance against
established baseline
– Management Measure
EQ Program – Improve
Performance against
established baseline – Drug/
Dose ACE/ARB Measure
CQUIN4
CQUIN4
CQUIN5.2A
CQUIN5.2A
CQUIN5.2A
DCU: Data currently unavailable
KEY:
Indicator Description
Ref
June
2011
July
2011
Aug
2011
Baseline collection in progress
Baseline collection in progress
May
2011
On target
Data collection currently being
undertaken to establish baseline for
target going forward. Collection started
1st September. First submission made
October 14th. Baseline collection to be
undertaken Sept to Nov inclusive.
Data collection currently being
undertaken to establish baseline for
target going forward. Collection started
1st September. First submission made
October 14th. Baseline collection to be
undertaken Sept to Nov inclusive.
Data collection currently being
undertaken to establish baseline for
target going forward. Collection started
1st September. First submission made
October 14th. Baseline collection to be
undertaken Sept to Nov inclusive.
Apr
2011
NT: No target
60.45%
75.64%
78.40%
100%
80%
Annual
Target
Sept
2011
100%
85%
Nov
2011
Not on target
Oct
2011
Commissioning for Quality and Innovation (CQUIN)
Table 1. Performance Indicators and targets 2011/12.
9
92.22%
91.94%
94.23%
Dec
2011
100%
82%
Feb
2012
Mar
2012
*East Kent data only
*QR: Quarterly Report
Jan
2012
92.22%
91.94%
94.23%
100%
85%
YTD
Indicator Description
Numbers of MRSA
Bacteraemia
Percentage of MRSA Screens
undertaken – podiatric surgery
Percentage of MRSA Screens
undertaken – community
hospitals
Numbers of Clostridium Difficile
Numbers of E Coli
Cleaning Scores (national)
Indicator Description
Complaints Level 1
Complaints Level 2
Complaints Level 3
Complaints Level 4
Never Events
Insulin Errors
(Numbers of incidents)
New Birth Visits offered within
10 to 14 days
Percentage Looked After
Children Attend Assessments
offered
Privacy & Dignity – Mixed Sex
Accommodation Breaches
Ref
IP1
IP2
IP2
IP3
IP4
IP5
Ref
Excellent care, healthy communities
Q&S1a
Q&S1b
Q&S1c
Q&S1d
Q&S2
Q&S4
Q&S5
Q&S6
Q&S7
=0
>85%
>90%
NT
=0
NT
NT
NT
NT
Annual
Target
>85%
NT
<34
year
end
=100%
=100%
=0
Annual
Target
0
100%
22
0
4
2
17
6
Apr
2011
DCU
0
0
100%
100%
0
Apr
2011
0
70%
100%
22
0
2
6
25
6
May
2011
DCU
0
0
75%
100%
0
May
2011
DCU
0
2
94%
100%
1
July
2011
DCU
1
1
75%
100%
0
Aug
2011
DCU
1
0
100%
100%
0
Sept
2011
0
100%
14
0
6
3
28
3
June
2011
0
100%
20
0
0
6
20
7
July
2011
0
76%
100%
15
0
6
7
21
7
Aug
2011
0
100%
5
0
4
1
25
7
Sept
2011
Patient Safety Indicators
DCU
1
0
100%
100%
1
June
2011
0
72%
100%
1
0
3
3
31
7
Oct
2011
DCU
0
0
82.0%
100%
0
Oct
2011
Infection Prevention and Control
Table 1. Performance Indicators and targets 2011/12.
10
0
78%
DCU
9
0
6
7
16
4
Nov
2011
0
1
100%
100%
0
Nov
2011
0
83%
100%
6
0
4
1
11
3
Dec
2011
0
0
100%
100%
0
Dec
2011
0
85%
100%
9
0
6
2
7
0
Jan
2012
0
1
82.1%
100%
0
Jan
2012
0
90%
DCU
9
0
2
2
12
0
Feb
2012
0
3
95%
100%
0
Feb
2012
0
DCU
DCU
3 (data
incomplete)
0
5
4
20
2
Mar
2012
0
2
DCU
100%
0
Mar
2012
DCU
0
90%
100%
125
0
48
44
233
52
YTD
DCU
3
10
91.2%
100%
2
YTD
Excellent care, healthy communities
Hand Hygiene
Infection Control Training*
Number of trained nurse
vacancies – Adults Services
Number of trained nurse
vacancies – Children's
Services
Adult Protection
Child Protection
Mental Capacity Act
Clinical Record Keeping
Information Governance
T1
T2
T3
T3
T4
T5
T6
T7
T8
DCU: Data currently unavailable
KEY:
Indicator Description
Ref
>100%
>100%
>100%
>95%
>95%
NT
NT
>80%
NT
Annual
Target
45%
75%
DCU
11%
DCU
90%
DCU
May
2011
NT: No target
44%
63%
DCU
15%
DCU
88%
DCU
Apr
2011
Table 1. Performance Indicators and targets 2011/12.
11
47%
73%
DCU
20%
26%
90%
DCU
June
2011
58%
76%
DCU
29%
18%
91%
DCU
Aug
2011
On target
55%
74%
DCU
23%
25%
91%
DCU
July
2011
Training
58%
31%
DCU
31%
17%
91%
DCU
Sept
2011
54%
31%
34%
31%
19%
73%
58%
48%
49%
49%
DCU
DCU
Nov
2011
61%
49%
48%
55%
55%
91%
85%
Dec
2011
Not on target
DCU
DCU
Oct
2011
61%
35%
48%
74%
73%
89%
82%
Feb
2012
61%
35%
48%
74%
72%
85%
79%
Mar
2012
85%
88%
YTD
*East Kent data only
*QR: Quarterly Report
59%
37%
48%
66%
66%
DCU
DCU
93%
88%
Jan
2012
PERFORMANCE 2012/13
2012/13 Quality Dashboard
The quality dashboard for 2012/13 includes indicators arising from the patient and user engagements
meetings and staff feedback, as well as national and Trust indicators. We aim to roll out and
embed all of the successful initiatives developed and implemented last year. This will ensure that
improvements are sustained and best practice is in place in all areas across the Trust. Our staff
will be creating new strategies and using alternative methodologies from national and international
arenas to maintain the drive for continuous improvement.
Quality and Safety
Measure
Target
Safe Care
Attributable falls with fractures
=0
Attributable pressure ulcers
(grades 3 and 4)
=0
Reduction of Catheter Associated Urinary
Tract Infections
50% (national target)
Reduction of Urinary Tract Infections
50% (national target)
Reduction in VTE
(Venous Thromboembulous)
50% (national target)
Reducing incidents of high risk
medication errors
10%
Medication reviews
100%
Percentage of Serious Incidents
investigated within SHA deadline
(excluding justifiable breaches)
100% by 31/03/12
Safety Thermometer (ST) Implementation
100% by 31/03/12
ST % harm free care
95% (national target)
Lead:
●●Assistant – Practice and
Quality Excellence
●●Head of Medicines
Management
CQUIN
Lead:
●●Assistant – Practice and
Quality Excellence
●●Deputy Director of Nursing
and Quality
●●Deputy Director of HR and
OD
Enhancing Quality Programme
– Heart Failure
Dementia, screening, risk assessment
and referral to specialist services
Long term conditions whole system
Safe Workforce tool
Awaiting
confirmation on
target
Patient Experience; complaints
Implementation of innovations, health and
wealth high impact innovations
Infection Prevention and
Control
Lead:
●●Head of Infection
Prevention and Control
Numbers of MRSA Bacteraemia
attributable to KCHT
12
Excellent care, healthy communities
=0
2012/13 Quality Dashboard (continued)
Quality and Safety
Measure
Target
Patient Safety
% MRSA screens (podiatric surgery)
=100%
% MRSA screens (community hospitals)
=100%
Number of attributable cases of
Clostridium
<17% national target
year end
Difficile to KCHT
year end
Numbers of E Coli
NT
Never events
=0
New birth visits offered within 10-14 days
>90%
% LAC attend assessments offered
>85%
Single sex accommodation
(MSA breaches)
=0
Implementation of Patient Safety alerts
within deadline
100%
Dignity and Respect 15 steps
implementation by 31/03/13
100%
Compliance in undertaking of pain
assessments (children and adults)
by 31/03/13
100%
MUST screening for inpatients
100%
Complaints relating to poor attitude/
behaviour
0
Venous leg ulcer healing within
12-24 weeks
100%
End of life care – was the patients
preferred place of care met?
95%
Length of stay 10% reduction in average
length of stay
10%
Percentage of NICE guidance assessed
within 3 months of publication (relevant to
KCHT)
100%
Productive Community Services %
coverage
100% by
March 2013
Lead:
●●Head of Infection
Prevention and Control
●●Assistant Director of
Clinical Governance
Care and Compassion
Lead:
●●Director of Operations
– Childrens and Young
People
●●Deputy Director of Nursing
and Quality
Clinical Effectiveness
Lead:
●●Interim Head – Clinical
Nutrition & Dietetics
●●Assistant – Practice and
Quality Excellence
Productivity
Lead:
●●Director of Operations –
Adult Services
●●Assistant Director of
Clinical Governance
13
Excellent care, healthy communities
2012/13 Quality Dashboard (continued)
Quality and Safety
Measure
Target
KPI Workforce/
Education Compliance
Hand Hygiene Training
95%
Infection Control Training
>80%
Lead:
●●Head of Infection
Prevention and Control
●●Deputy Director of Nursing
and Quality
Clinical Record Keeping
95%
Information Governance
95%
Services have 50% of registered
practitioners as qualified Mentors
85%
% of newly qualified practitioners with an
allocated Preceptor
90%
Number of completed competency based
assessments within 3 months of attending
training
80%
Adult Protection Training
= 95%
Child Protection Training
= 95%
Mental Capacity Act Training
= 95%
Serious Case Reviews
Monthly nos
No of Adult Protection incidents
implicating KCHT
Monthly nos
Delayed Transfers of Care (as a % of
Occupied Bed Days) Bed Days
28 days
Safeguarding Children
Lead:
●●Head of Safeguarding
Safeguarding Vulnerable
Adults
Lead:
●●Head of Safeguarding
Transforming Community
Services
Lead:
●●Director of Operations –
Adult Services
No of falls in community as % on
caseload
Improvement using validated case tool
% of patients on caseload not admitted to
hospital day 90
Targets to be
confirmed
Patient within end of life care plans on
Liverpool Care Pathway
100%
Preferred place of care (death)
100%
Re-admission within 28 days of discharge
0
Rate of cancelled appointments
Rate of DNAs
Targets to be
confirmed
% of home equipment within 7 days
100%
% of patients offered a time band for visit
100%
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Excellent care, healthy communities
QUALITY GOALS
2.1 Quality Goal:
No one will contract Clostridium Difficle or MRSA in
any of our community hospitals
2.2.1 Quality Goal:
Embed and measure quality improvement in services
in relation to pressure ulcers
2.2.2 Quality Goal:
Embed and measure quality improvement in services in relation to patient falls.
2.2.3 Quality Goal:
Embed and measure quality improvement in services
in relation to food and nutrition
2.2.4 Quality Goal:
Embed and measure quality improvement in services
in relation to Transfer of Care
2.2.5 Quality Goal:
Embed and measure quality improvement in services
in relation to executive patient safety walkabouts to move from a culture
of bureaucratic to proactive/generative organisation.
2.2.6 Quality Goal:
Embed and measure quality improvement in services
in relation to Health Visitors Programme
2.2.7 Quality Goal:
To promote a culture of safeguarding across all areas
of the organisation, which is embedded in the holistic care that
we provide to children and vulnerable adults.
2.3.1 Quality Goal:
Ensure patients report a positive experience in relation dignity and respect
2.3.2 Quality Goal:
Ensure patients and their relatives report a positive experience
in relation to end of life care
2.3.4 Quality Goal:
To achieve a year on year improvement in patients
reporting a positive experience
Excellent care, healthy communities
15
2.0 Review of 2011/12 quality
improvement and targets for 2012/13
2.0 PATIENT SAFETY
2.1 Quality Goal:
No one will contract Clostridium Difficle or MRSA in any of our community hospitals
Why was this a priority?
Healthcare associated infections go to the heart of public confidence in the NHS. Acquiring a
hospital infection is a major concern for any patient and their relatives. Therefore it is vital that we do
everything we can to reduce the likelihood of patients getting an infection whilst they are in hospital.
Although we have significantly reduced the levels of hospital acquired infections over the last few
years, we are committed to reducing these even further. We were successful in achieving the target
for Methicillin Resistant Staphylococcus Aureus (MRSA), a bloodstream infection; however it is vital
that this issue is still given the highest priority for patients in our care. Whilst we did achieve our
target for Clostridium difficile (C.diff), we recognise that we could make further progress to achieve
zero preventable infections.
What did we do to prevent Clostridium difficle and MRSA in 2011/12?
Over the course of the year we undertook a number of key actions to continue to improve our
infection control. These included:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Maintained the focus on hand hygiene building on progress to date
MRSA screening for elective surgery
MRSA screening for all “step up” admissions
Extensive infection prevention and control and hand hygiene training for staff
Implementation of the co-horting (putting patients together in a bay) and isolating patients
in single rooms
Bare below the elbows audits and monitoring
Clean your hands campaign
New policies and procedures for managing outbreaks of infection
Antibiotic stewardship
‘Bay a day’ cleaning and compliance with national standards for cleaning
Root cause analysis investigations of all Clostridium difficile and MRSA infections to ensure
lessons learnt
Commode cleanliness audits
Patient Environment Action Team inspections in all areas
An external audit of infection control and prevention practice.
Revised training programme and matrix for all staff
16
Excellent care, healthy communities
How did we perform in 2011/12?
There has been a concentrated effort on ensuring compliance with the Health Act Hygiene Code
- Code of Practice with particular attention to compliance with infection prevention and control
training and hand hygiene. Hand hygiene is the single most effective intervention to stop the spread
of infection. Service level risk assessments have been undertaken for both the requirement to
undertake infection prevention and control and hand hygiene training. This has ensured that the right
staff receive the appropriate frequency of training against the assessed risks.
In order to reduce the incidence of Clostridium difficile infection, we instigated a three pronged
approach:
Hand Washing - target audience level 1
Compliance percentage
82
80
78
76
74
72
70
68
66
Apr
11
May
11
Jun
11
Jul
11
Aug
11
Sep
11
Oct
11
Nov
11
Dec
11
Jan
12
Feb
12
Mar
12
•
Effective and appropriate hand hygiene is essential to the control of C. difficile in the healthcare
environment. This continues to be reported monthly by clinical services and is a mandatory
element of Infection Prevention and Control Training.
•
There has been a continued focus on high standards of cleaning of environment and equipment
using chlorine releasing agents when required. There has been use of steam cleaning where
appropriate and a ‘bay a day’ programme in community hospitals where a room is given a
thorough clean each day.
•
There has also been tight control on antibiotic prescribing which is also helping us to reduce
antimicrobial resistance. All prescriptions of antibiotics are audited against the antibiotic policy by
ward pharmacists, and any non-compliance is brought to the attention of the prescribing doctor
or other clinician. Pharmacists carry out regular review visits of Clostridium difficile patients who
advise and input into antibiotic prescribing and provide active antibiotic stewardship.
Monthly 2011/12 Apr
May Jun
Jul
Aug Sep
Oct
Nov Dec Jan
Feb
Mar
Cumulative
Cumulative
2011/12
0
1
0
3
1
1
1
1
0
1
3
2
14
Cumulative
2010/11
0
0
2
2
3
4
1
2
2
2
1
0
19
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Excellent care, healthy communities
Clostridium difficile incidence within community hospitals
In the past 12 months two cases of MRSA bacteraemia have been attributed to us. The two cases
were subject to root cause analysis investigations to determine the source of the infection and actions
were taken to improve practice and conditions. Both cases were identified as having been treated
at the same podiatry clinic operated by us within an acute Trust. Both patients were elderly and had
significant underlying pathologies including diabetes and accompanying vascular disease. The root
cause analysis investigation of both cases highlighted key issues that have since been addressed.
There was a review of infection control practices across podiatry and Essential Steps assessments
are now being undertaken monthly in each locality. A review of swabbing protocols and dressing
storage practice was also undertaken.
MRSA incidence associated community hospitals
Apr
2011/12
2012/13
0
0
May Jun
0
0
1
0
Jul
1
0
Aug Sep
0
1
0
1
Oct
0
0
Nov Dec
0
0
0
0
Jan
Feb
Mar
Cumulative
0
0
0
0
0
0
2
2
What we need to do in 12/13
Each year, the Infection Prevention and Control Team produce, and work to, a clear programme of
work. For the coming year, its focus will be on:
•
•
•
•
•
•
•
•
•
•
•
•
Monitoring compliance against MRSA screening, providing local support to areas of poor
performance.
Challenging existing assurance mechanisms and validate self assessment.
Following up sub-optimal standard of hand hygiene by small minority of staff.
Reducing the number of post 48hr E.coli bloodstream infections.
Focusing on decontamination of instruments/equipment
Ensuring that all national standard such as NICE for infection control are implemented
Resolving any issue in regard to waste
Holding an Infection control conference
Improving the cleaning scores to 95% within community hospitals
Improving the PEAT inspection scores and focus environment issues
Undertaking thematic reviews on any clostridium difficile cases within the Trust
Patient Environment Action Team (PEAT)
This is an annual inspection to look at non-clinical aspects of patient care and ensure that standards
of cleanliness in the care environment, the food and privacy and dignity are high.
Table 2 shows the results from the PEAT assessments.
18
Excellent care, healthy communities
Table 2. PEAT scores 2011.
Environment
Results
Food
Privacy & Dignity
2010
2011
2010
2011
2010
2011
Faversham
Cottage Hospital
Good
Good
Excellent
Excellent
Excellent
Excellent
Queen Victoria
Memorial
Hospital
Good
Excellent
Excellent
Excellent
Good
Good
Sittingbourne
Memorial
Hospital
Good
Excellent
Excellent
Excellent
Excellent
Excellent
Sheppey
Community
Hospital
Good
Excellent
Excellent
Excellent
Good
Excellent
Excellent
Excellent
Excellent
Excellent
Excellent
Excellent
Whitstable
& Tankerton
Hospital
Good
Good
Excellent
Excellent
Good
Good
Edenbridge
War Memorial
Hospital
Good
Acceptable
Good
Excellent
Excellent
Excellent
Gravesham
Community
Hospital
Good
Good
Good
Excellent
Excellent
Excellent
Livingstone
Hospital
Acceptable
Good
Excellent
Good
Excellent
Good
Sevenoaks
Hospital
Acceptable Acceptable
Good
Good
Excellent
Good
Tonbridge
Hospital
Acceptable Acceptable
Good
Good
Excellent
Good
Victoria Hospital
Deal
19
Excellent care, healthy communities
Environment Score:
This section takes into account the décor, lighting, cleanliness and tidiness, odour, furnishings,
maintenance, signage inside and out, floors, linen, arrangements for personal possessions and waste
management. Maintenance issues are still the main cause for concern across all sites and accounts
for any drops in level from the previous year. These issues are isolated to minor issues that have not
affected our over all scores and in some sites the scores have improved to excellent. Where there
has been a drop in score from the previous year, an action plan has been put in place and monitored
to completion to resolve any identified issues and to improve the environment for patients.
Food Score:
This section reflects the level of co-operation between catering and ward staff to ensure that the
availability of food and beverages meet the patient’s dietary requirements. The introduction of Patient
Experience Group (PEG) and the Nutritional Steering Group has provided two different forums where
all aspects of patient’s food requirements can be discussed. Plans for the year ahead in regard to
food and hydration will improve performance in relation to PEAT.
Privacy and Dignity:
This section includes equality and diversity training on all sites showing more awareness of patient
needs, concerning confidentiality, privacy, modesty, dignity and respect. We continue to ensure that
all staff achieves compliance with equality and diversity mandatory training requirements to strive for
excellence in this area.
What do we want to achieve in 2012/13?
•
•
•
•
•
•
•
•
•
•
To continue to strive for no avoidable HCAI (healthcare acquired infections)
To extend the link worker network to all services and to include the Essential Steps programme in
the remit of the link workers
To increase the quality assurance of the surveillance data
To increase visibility and accessibility of the infection prevention and control team
To deliver a reduction in catheter associated urinary tract infections by January 2013 as part of
the innovation project.
To achieve compliance against MRSA screening in all areas, providing local support to areas of
poor performance.
Challenge existing assurance mechanisms and validate self assessment.
Follow up sub-optimal standard of hand hygiene when this occurs
Focus on decontamination of instruments/equipment
Ensure that the cleaning scores are consistent across the organisation
20
Excellent care, healthy communities
2.2 CLINICAL EFFECTIVENESS
2.2.1 Quality Goal:
Embed and measure quality improvement in services in relation to pressure ulcers
If the surface of the skin is exposed to pressure for prolonged periods, for example if a patient
lies or sits in one position, it can cause damage to the underlying tissues which may later break
down to form a broken area or ulcer. The damage caused by this pressure is graded from minor
damage without breaking the skin (grade 1) to damage to the tissues that extend through to the
muscle layer to the bone underneath (grade 4). Some patients’ illness or frailty may increase their
vulnerability to developing pressure ulcers. Ensuring that patients are regularly re-positioned and
pressure relieving equipment is available and used appropriately is key to preventing pressure
ulcers.
Why was this a priority?
We want to provide consistently high quality care to our patients. It is recognised nationally that
pressure ulcers are a challenge that requires focus and action across the NHS. The incidence of
pressure ulcers are considered to be largely avoidable and an indication of the standard and level of
the quality of care delivered to patients by health care providers.
What did we do to prevent pressure ulcers in 2011/12?
Our target for the year was to establish a baseline from which to reduce the number and degree of
harm caused by pressure ulcers to patients. This would enable us to have an accurate picture of how
we perform and improvements needed. During the year we have implemented a robust framework to
raise awareness across all areas and set standards of practice to improve care and reduce incidents
of pressure ulcers to zero.
Many patients are transferred from other organisations and we have focused on distinguishing
between those pressure ulcers attributable and not attributable to us. We have focused on those
attributable to the organisation but continued to review the whole system position and thus bid for
Strategic Health Authorities monies to enable us to develop initiatives to work in partnership with
external organisations such as nursing homes to reduce the incidence of pressure ulcers.
We have also established a range of measures to improve practice in the prevention and
management of pressure ulcers including:
•
•
•
•
•
•
•
•
Zero tolerance for avoidable pressure ulcers programme
Targeted pressure ulcer training focusing on prevention and treatment.
Staff engagement events with the Director of Nursing and Quality
Introduction of the Team Leader Practice Standards and caseload management tool
Implementation of the Pressure Ulcer Quality Standards (CQUIN target agreed with our
commissioners)
Pressure Ulcer Safety Cross was introduced to motivate staff by providing an immediate, visual
representation of their progress in reducing pressure ulcers
All grade 3 and 4 pressure ulcer incidents identified as attributable to KCHT and avoidable
are investigated as Serious Incidents undergoing a robust investigation using the Root Cause
Analysis process
The equipment contract has been reviewed to improve the availability of equipment
21
Excellent care, healthy communities
•
•
•
•
A patient information leaflet has been developed and given to patients on the initial visit by the
community team
Introduction of the Trust Pressure Ulcer newsletter to staff highlighting changes in products and
procedures; improvement results. The Trust’s intranet also includes a page for staff on pressure
ulcers.
Training programme developed to deliver to nursing and residential homes in 2012/13
Introduced care bundles
How did we perform in 2011/12?
All incidents of pressure ulcers regardless of grade are reported on our incident system. Raising
awareness and training has been emphasised during the year and this has resulted in increased
reporting which indicates a healthy reporting culture. The information we now have is a baseline
which we will focus on reducing to zero. As part of the programme we introduced a pressure ulcer
standard to ensure consistency of care across the organisation. The quality standard was introduced
in October 2011 but was not available in all areas until November 2011. As shown below the standard
has been implemented in 100% of the services.
CQUIN 1 - Community Pressure Ulcers
Implementation of the Kent Community Health Trust Pressure Ulcer Quality Standard
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Values
(Kent wide
from Nov)
Target
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
The trends on the graphs below demonstrate an increase in both attributable pressure ulcers
(pressure ulcers that occurred or deteriorated under our care) and ‘not attributable’ pressure ulcers
(inherited pressure ulcers). These increases are most apparent from August onwards when the Zero
Tolerance to Pressure Ulcers programme commenced. As both classifications demonstrate a similar
trend, it is likely that the increases reflect a raised awareness of the requirement to report pressure
ulcers. The highest trend increase is in grade 2 pressure ulcers. Attributable pressure ulcers can be
further classified as avoidable or unavoidable. The latter category includes:
•
•
•
Incidents where all known interventions to prevent the pressure ulcer were in place
Where patients were informed of the risks and did not follow treatment plans
Where patients were in the terminal stages of end of life care.
22
Excellent care, healthy communities
This further classification of attributable pressure ulcers is currently being incorporated into the
incident reporting system and will be reported in 2012/13 Quality Account.
Attributable Pressure Ulcer Category 1 to 4
300
Strengthened incident
reporting Pressure
Ulcer Standard introduced
250
200
150
100
50
0
Apr
11
May
11
Jun
11
Jul
11
Aug
11
Sep
11
Oct
11
Nov
11
Dec
11
Jan
12
Feb
12
Mar
12
Not Attributable Pressure Ulcer Category 1 to 4
300
250
200
150
100
50
0
Apr
11
May
11
Jun
11
Jul
11
Aug
11
Sep
11
Oct
11
Nov
11
Dec
11
Jan
12
Feb
12
Mar
12
Attributable Pressure Ulcers by Grade
100
80
60
Cat 2
Linear (-Cat 2)
Cat 3
Linear (-Cat 3)
Cat 4
Linear (-Cat 4)
40
20
0
Apr
11
May
11
Jun
11
Jul
11
Aug
11
Sep
11
Oct
11
Nov
11
Dec
11
Jan
12
Feb
12
Mar
12
23
Excellent care, healthy communities
What do we want to achieve in 2012/13?
Continuing the focus on improvements in this area is absolutely vital as there were 308 incidents of
grade 3 or 4 pressure ulcers attributable and non-attributable in 2011/12, which is not acceptable.
With the right care, many are preventable and despite carrying out additional training, root cause
analysis with teams and sharing the reasons why a patient developed a grade 3 or 4 pressure ulcer,
we have not made adequate progress. The improvements required will be closely monitored and
tracked with each clinical team to ensure best practice is achieved consistently. We want to achieve
Zero Avoidable Pressure Ulcers in the coming year. We also want to ensure compliance with all best
practice standards applied consistently in all clinical areas, therefore we will be undertaking:
•
•
•
•
•
•
•
•
•
Audits against best practice standards expecting an increase in the percentage of teams
compliant.
Trust-wide implementation of the Safety Thermometer to monitor incidence of harm events to
patients and contribute to the national data capture
Continued compliance with Team Leader Practice Standards and Pressure Ulcer Quality
Standards
Working in partnership with other stakeholders such as acute hospitals and nursing homes to
deliver a whole health economy approach to the reduction in pressure ulcers
Monitoring of pressure ulcer incidents including compliance with reporting timescales and trends
and themes identified. Implementing team, service and organisation level actions to address
findings.
Working with other services such as podiatry who have been included in the Wound Management
training programmes and are involved in the investigation of pressure ulcers that occur on the
feet
Introduction of training for podiatrists and other allied health professionals (AHP) in assessing
patients at risk of developing pressure ulcers
Ensuring increasing focus on the factors known to assist in prevention such as nutrition and
hydration
Implementing a behaviours framework in all areas in relation to pressure ulcers
2.2.2 Quality Goal:
Embed and measure quality improvement in services in relation to patient falls.
Why was this a priority?
For patients who sustain a fall the impact can be hugely debilitating and the effects long lasting.
Therefore patient falls in community hospitals resulting in harm are categorised as serious incidents.
A root cause analysis investigation is undertaken for every patient whose fall results in a significant
injury i.e. head injury or broken bone. The information gathered is shared with ward managers and
their teams to ensure lessons are learnt and that actions are implemented across the organisation.
24
Excellent care, healthy communities
What did we do to prevent patient falls in 2011/12?
Work is ongoing to reduce the number of falls particularly within in-patient services and a number of
initiatives have been introduced during the year:
•
•
•
•
•
•
•
•
Implementation of all NPSA guidance
Seat and bed alarms, which alert staff when vulnerable patients leave their seat or chair
Comfort rounds; frequent (usually hourly) contact by staff with each patient to ensure they are
comfortable, for example have a drink, are taken to the toilet
Risk assessment and close observation of patients at risk of falling
Training for staff on falls prevention
Assessment and re-assessment of patients following a fall to ensure any further preventative
action is taken
Provision of ultra low beds that lower to the floor to reduce the risk of patient harm if they should
fall from the bed.
Development of a falls management policy.
How did we perform in 2011/12?
We recognise that we still have more to do to reduce the number of falls. There were 936 falls that
occurred in our community hospitals. We must improve on the 52(5%) which resulted in actual
moderate and severe harm.
Attributable Patient Falls by Level of Harm
120
Compliance percentage
None
Low
Moderate
Severe
100
80
60
40
20
0
Apr
11
May
11
Jun
11
Jul
11
Aug
11
Sep
11
Oct
11
Nov
11
Dec
11
Jan
12
Feb
12
Mar
12
25
Excellent care, healthy communities
What do we want to achieve in 2012/13?
We will work with all clinical teams, patients and their families to ensure the right level of support,
information and care is provided to make the significant reduction needed
We want to ensure that best practice standards are embedded and we will continue with the
interventions put in place in 2011/12 to ensure consistent high quality for all our patients by:
•
•
•
•
•
•
•
Reducing the number of falls by 10%
Focusing on improved interventions for patients with dementia
Undertaking an annual audit of the falls quality care bundle
Ensuring that a serious incident investigation is undertaken for all falls that result in harm to our
patients
Participating in the monthly National Safety Thermometer tool reporting on falls.
Ensuring that all new patients’ medications in community hospitals are reviewed by the medical
and pharmacy team to ensure that medication combinations that patients are admitted on are not
worsening the patient’s condition
Undertaking a review of the unwitnessed falls to identify the themes and develop an action plan to
help in reducing theses incidents.
2.2.3 Quality Goal:
Embed and measure quality improvement in services in relation to food and nutrition
Why was this a priority?
It is widely accepted that 20%-60% of patients are admitted to hospital with a degree of mal-nutrition
which can be worsened by being in hospital. There is evidence in the NICE guidance 32: Nutrition
Support in Adults (February 2006) that identified knowledge of the causes, effects and treatment of
malnutrition among healthcare professionals in the UK is poor. We recognise that all patients need to
be supported to maintain the fluids and nutritional intake. This supports their recovery and outcomes
We are committed to ensuring that our patients receive adequate nutrition and hydration which is vital
to maintaining optimal health.
26
Excellent care, healthy communities
What did we do to ensure our patients received adequate nutrition whilst under
our care?
We have taken action to meet the standards set in the NICE guidance and have focused on
improving knowledge and performance in relation to completing nutrition screening. This allows for
the early identification of patients at risk and implementation of prompt interventions including the
production of individualised nutrition care plans for all ‘at risk’ patients
In January 2012 we participated in the National Patient Safety Association (NPSA) nutrition and
hydration week. This was the ideal opportunity for our Nutrition Steering Group to launch its 12
month ‘Back to Basics’ campaign part of our 1st Class Care programme ( refer to page XXX) which
has been well received by patients and staff. The programme aims are that:
•
•
•
•
•
•
•
•
•
•
•
•
All nursing teams will have completed the nutrition and hydration training module and undergo
local refresher sessions.
Nutrition Across Boundaries Steering Committee to be developed between us and East Kent
Hospitals University NHS Foundation Trust to improve communication and patient care.
Nutrition links in all community nursing teams.
Patient representation is involved on our Community Nutrition Steering Group.
Catering staff: baseline training – emphasis on modified consistencies and special diets.
Shared nursing and dietetic objectives to deliver high standards of care around wound prevention
and management.
Dedicated dietetic services for west Kent patients in community hospitals and those living in the
community.
Integrate and align nutritional policies/practices in east and west Kent.
Comfort rounds
Established protected mealtimes
In some community hospitals volunteers have been trained to provide support to patients who
need assistance to eat and drink
Roll out the ‘red tray’ initiative that identifies to all staff patients ‘at risk’ and stops meal trays being
removed without the sanction of a registered nurse.
How did we perform in 2011/12?
CQUIN 2 - Malnutrition Universal Screening Tool (MUST)
% of inpatients to receive a MUST assessment within 24 hours of admission
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Values
(Kent wide
from
August)
Target
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
27
Excellent care, healthy communities
What do we want to achieve in 2012/13?
Although our performance has been above the target set for us by the Primary Care Trust (PCT)
we want to achieve 100% for our patients. We know that following the implementation of the
assessment training that our performance improved therefore we will continue to roll out the training
for all of our staff. In addition we will undertake the following:
•
•
•
•
•
•
•
•
•
•
Continuing the interventions of the previous year
Nutrition link nurse on each ward/unit who will co-ordinate Malnutrition Universal Screening Tool
(MUST) training attendance
Clear criteria for exclusion – such as patients on the Liverpool Care Pathway who are terminally
ill, certain cases of dementia. In such cases a clear process will be in place to give assurances of
appropriate care provision.
Facilitate the change in behaviours and embed new practice which demonstrates - nutrition and
hydration is integral to patient’s wellbeing
Empower practitioners to own and understand their responsibility and have clear referral
pathways, sign posting options and resources
Improve the quality of care for patients and minimise harm
Re-launch the Nutrition and hydration campaign training
Review the intentional rounding and ensuring hydration and nutrition is monitored effectively
Nursing and Quality Team’s Clinical days will include ‘deep dives’ to establish practice and
assurance
Learning lessons from incidents and looking at intelligence to identify trends, themes or actions
which can support improvements in practice
2.2.4 Quality Goal:
Embed and measure quality improvement in services in relation to Transfer of Care
Why was this a priority?
Transfer of care incidents occur when the responsibility for patient care moves from one service
to another, for example on discharge from acute hospital, on transfer from one community team to
another. Transfers of care can result in incidents where patients do not receive appropriate treatment
or extreme delays in treatment or specialist review. These incidents can be very distressing to
patients and their family and can affect outcomes for patients.
The vast majority of transfer of care incidents occurred when the patient was discharged from local
acute hospitals or tertiary hospitals and a small number were identified on transfer from a hospice
environment. The most common transfer of care incidents identified by us were:
•
•
•
•
•
•
Discharged from hospital with a pressure ulcer
Inadequate communication between services, so community teams may be unaware of the
patient
Medication errors or near misses
Inappropriate or failed discharge
Peripheral venous cannula not removed prior to discharge from hospital
Poor information on discharge.
28
Excellent care, healthy communities
What did we do in 2011/12?
•
•
•
•
•
Revised and improved the incident reporting system to allow monitoring of transfer of care
incidents
Worked with acute hospitals in Kent and Medway to agree incident categories
Undertook an audit of all transfer of care issues to gain an understanding of the issues and the
contributory factors
Started to undertake joint root cause analysis with other providers e.g. in relation to infection
control and pressure ulcers
The Directors of Nursing across the health economy are working together to address pressure
ulcers.
How did we perform in 2011/12?
•
•
•
•
•
Increased reporting of transfer of care incidents
Monthly monitoring of transfer of care incidents implemented and themes and trends identified
Clinical services have contacts within the local acute hospitals which ensures that alerts are
raised promptly
Tissue Viability Nurses (TVN) participate in the Kent TVN forum to share developments and agree
pan-Kent improvement strategies
Pan-Kent Deputy Director of Nursing forum established to share good practice and develop
improvement strategies
What do we want to achieve in 2012/13?
•
•
•
•
•
Reduce the number of incidents relating to transfers of care
Continue to strengthen links with nursing and residential homes across Kent e.g. developing and
delivering training packages for nursing and residential home staff
Ensure transfer of care incidents are consistently captured on the incident reporting system and
monthly reports are available and shared with other providers
Ensure involvement in and initiate locality based transfer of care groups with acute hospital
colleagues to review and resolve common causes of transfer of care incidents
Work with partners to improve the processes and information across Kent including undertaking a
review of transfer of care documentation e.g. community nursing referrals by acute hospitals and
nursing homes.
2.2.5 Quality Goal:
Embed and measure quality improvement in services in relation to executive patient safety
walkabouts to move from a culture of bureaucratic to proactive/generative organisation.
Why was this a priority?
It is estimated that one in ten patients experience an incident which puts safety at risk and that a
number of these could have been prevented. Patient safety must run through the organisation like
letters running through a stick of rock. Our Board has endorsed that patient safety must be a top
priority. These weekly walkabouts by board executives and non executive directors introduced in
January 2012 give frontline staff the opportunity to raise quality and safety issues directly with the
board. This enables Board members to understand the barriers to caring for patients as safely
as possible and to establish a strong leadership culture that encourages patient safety. This is an
internationally recognised way for board members to demonstrate their commitment to both quality
and staff feedback and for improvements in patient safety to take place.
29
Excellent care, healthy communities
What did we do to in 2011/12?
The walkabouts were introduced in January 2012 and are undertaken each week by members of
the Board and have been well received by staff across the organisation. They are structured and
modelled on the Manchester Patient Safety Framework – Primary Care (2006), which is a tool to help
NHS organisations and healthcare teams assess their progress in developing a safety culture. The
objectives are to:
•
•
•
•
•
•
Increase the awareness of quality and safety issues amongst all front line staff.
Make safety a priority for senior leaders by spending dedicated time promoting a quality and
safety culture.
Educate staff about quality and safety concepts such as monitoring and incident reporting.
Obtain and act on information gathered that identifies areas for improvement.
Build communication and relationships with front line staff.
Enable good practice and learning to be shared across the Trust.
How did we perform in 2011/12?
At the end of the walkabout the executive board member and team members agree actions which will
improve patient safety outcomes. This is building up a picture of patient safety culture along with the
key themes and trends in patient safety outcomes. This will enable the executive board members to
target organisational actions to improve patient safety across our services.
From January to March 2012 the walkabouts have been enthusiastically supported by staff and
verbal evaluation of the process and resources has been positive. Both the board members and staff
involved in the walkabouts have agreed and committed to actions to undertake both at organisational
and team levels to sustain and improve the quality and safety of care provided. The findings from the
walkabouts to date have been collated to provide an overview of the patient safety culture within the
organisation which has shown in the 14 walkabouts to date that the current culture of the organisation
is bureaucratic.
What do we want to achieve in 2012/13?
We aim to:
•
•
•
•
•
Move from a bureaucratic culture to a proactive/generative culture
Reduce the number of patient safety incidents and level of harm
Complete the executive patient safety walkabout in all areas across the Trust
Implement timely action arising from the walkabouts
Empower staff in providing safe care at all times.
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Excellent care, healthy communities
2.2.6 Quality Goal:
Embed and measure quality improvement in services in relation to Health Visitors Programme
Why was this a priority?
Increasing the number of health visitors is both a national and local target. We are committed to
achieving this objective to ensure that all parents and children across Kent have access to the
universal support they need, with early intervention to provide additional support for those who need
it including the most vulnerable families. This tiered model (aligned to the national approach) is
highlighted below:
Community
Sure Start services and the services
Families and communities provide for themselves
Health visitors work to develop these and communicate them
Universal services
Health visitors and supporting teams support Healthy Child Programme
Support for parents and access to a range of community services/resources
Universal plus
Rapid response from Health Visiting teams with specific expert help,
e.g. for postnatal depression, a sleeping baby, weaning etc.
Universal partnership plus
Ongoing support from Health Visiting team working with other Services to
manage complex issues with families over the longer term (including Sure Start
Children’s Centres and, where appropriate, the family nurse partnership).
S
A
F
E
G
U
A
R
D
I
N
G
What did we do in 2011/12?
We have been implementing a variety of initiatives to help achieve workforce growth:
•
•
•
•
•
•
•
•
Newly qualified health visitors via the Specialist Community Public Health Nurse (SCPHN)
training programme that will result in 165 new health visitors trained in Kent.
A programme investing in practice education and mentorship (clinical support in practice).
A programme has been created to develop the registered nurse (RN) workforce to create a local
pool of staff with the required skills to succeed as future SCPHNs, this programme will start in
April 2012.
A programme promoting “Return to Practice” for qualified health visitors has resulted in three staff
returning to practice this year and a further five expected to return next year.
A staff engagement process aimed at retaining and increasing our current qualified workforce
through flexible working and flexible retirement packages.
A focus on health, work and wellbeing.
National recruitment promoting Kent as a great place to live and work with 22 new health visitors
joining us during the last year.
Introduced the Family Nurse Partnership (FNP). The FNP is a licensed, preventive programme
for young first time mothers. It offers intensive and structured home visiting, delivered by specially
trained nurses (Family Nurses), from early pregnancy until the child is two. FNP has three aims:
to improve pregnancy outcomes, child health and development and parents’ economic selfsufficiency. Our first Kent Family Nurse Partnership (FNP) was formed in January 2012 and
it covers two of our most deprived areas: Swale and Thanet. The team currently consists of a
Supervisor and four Family Nurses, after intense training they are now recruiting clients to the
programme and at capacity they will be seeing more than 100 families.
Excellent care, healthy communities
31
How did we perform in 2011/12?
Our target for the year was to achieve a total Health Visitor workforce of 173.3 in post which was
achieved.
Quarter
Q1
Q2
Q3
Q4
2011/12
156
164
167.2
175.5
What do we want to achieve in 2012/13?
Over the period 2011 to 2015, we will in partnership with NHS Kent and Medway, Kent County
Council, local authorities and other stakeholders, deliver improved health visiting services for the
population of Kent and Medway resulting in the following key outcomes:
•
•
•
•
•
•
Achieve the Health Visitor programme recruitment target of 218.65 in post in 2012/13 and by end
of 2015 have 345 in post
Delivery of an aligned public health and healthy child programme for children aged 0 to 5 years
and their families.
All children aged 0 to 5 years will receive early intervention, prevention and health promotion
services which will help them achieve their optimum health and wellbeing.
Traditionally ‘hard to reach’ groups of children who are vulnerable due to ill health, disability and/
or disadvantage are reached in a timely manner to benefit from and receive the health input
required.
Outcomes for children as identified in national strategies are achieved.
Roll out FNP across the trust, the next team will be recruited in September 2012. The
Government is committed to the FNP programme and expects to double the number of places on
the FNP programme to 13,000 (at any one time) by 2015
2.2.7 Quality Goal:
To promote a culture of safeguarding across all areas of the organisation, which is embedded in the
holistic care that we provide to children and vulnerable adults.
Why was this a priority?
To ensure that we are safe in all that we do and that individuals are safeguarded with all staff being
clear about their roles and responsibilities. Staff must also understand and follow local safeguarding
procedures, and have access to appropriate safeguarding support and supervision.
What did we do in 2011/12?
•
•
•
•
•
32
Developed a system whereby each clinical service self assesses its compliance against national
(Care Quality Commission) safeguarding quality standards. These self assessments are then
validated at ‘challenge’ meetings held by an executive director, with service leads in attendance to
discuss and provide assurance in relation to the evidence they present
Updated our Adult Protection policy to reflect changes in local and national guidance
Introduced new, organisation-wide policies that impact upon safeguarding, to further embed
safeguarding practice into frontline care, in particular Mental Capacity Act (MCA) assessment
forms, Consent, Restraint, Wound Management, Transfer of Care and.Incident Reporting policies
Provided safeguarding training, including developing pre-course workbooks to support our MCA
basic awareness and Consent workshops.
Raised general awareness in our clinical services, by improving mandatory safeguarding children
training compliance from 31% to 74% and from 19% to 71% for vulnerable adults training.
Excellent care, healthy communities
How did we perform in 2011/12?
Following the local multi-agency inspection of Safeguarding and Looked After Children services by
CQC and Ofsted in October 2010, we have worked closely with partner agencies and across internal
services to:
•
•
•
•
Increase the number of review health assessments to Looked After Children, that are completed
on time, from 63% to 91% (the national target is set at 85%).
Develop preventative and early intervention services, to include increased delivery of the
Common Assessment Framework (CAF) – we have revised our internal family health needs
assessment framework to reflect the contents of the CAF, so that we may work in a seamless
manner with any children and/or families who may have safeguarding concerns and need
additional support from services other than health.
Ensure that child protection referrals made to Children’s Social Care services contain accurate
and sufficient information to support the timely completion of assessments and the provision of
appropriate action and support to vulnerable children and their families.
Reduce the number of children being made subject to a Child Protection Plan.
For vulnerable adults:
• There are more robust processes in place which have led to safeguarding being incorporated in
the review of complaints, serious incidents and other incidents. The lessons learnt that relate to
safeguarding are managed through the organisation’s governance structures.
• The Board is able to review all incidents relating to adult protection alerts that are raised
internally, where there were allegations implicating services or staff within the Trust.
• Safeguarding awareness has improved within services and reporting data evidences the increase
in reporting. However, there still remains the ongoing challenge of staff understanding the
interdependency of the various strands of adult safeguarding e.g. consent, restraint and capacity.
Work continues, to address this through our Safeguarding services working alongside clinical staff
in the provision of supervision, support and advice.
• Outcomes from safeguarding concerns raised within the organisation have led to the
development of an Out of Hours protocol for staff, to support them accessing safeguarding advice
and guidance during these times.
• Investigation learning has improved clinical practice, eg, shared care protocols, team reviews,
new handover systems.
What do we want to achieve in 2012/13?
In 2012/13, we will focus on the following priorities:
•
•
•
•
•
•
•
•
•
Gaining a common understanding of children and adult thresholds across the partnership,
including a reduction in the number of re-referrals to social care.
Addressing the high number of children in Kent subject to a CPP.
Increasing the number of CAFs within the context of scrutiny of Kent’s early intervention strategy.
Reducing the number of cases of adult neglect attributed to us
Ultimately, no reported cases of adult neglect attributed to us
Implement the finding of the external review of the Mental Capacity audit.
Achieve safeguarding training for adults and children of at least 95%
Ensure that MCA training is a 95%
Ensure that there is increased focus and reporting in regard to Deprivation of Liberties.
33
Excellent care, healthy communities
The focus will very much be on introducing an internal safeguarding assurance framework for
children and vulnerable adults, which will support frontline services embedding safeguarding into their
daily practice and decision-making. Competency frameworks will be developed to support this work,
which will be applied to safeguarding ‘champions’ roles throughout and across the organisation.
The Board will continue to review Safeguarding practice and outcomes on a regular basis, via the
Quality Committee and annually, when the Trust Board will receive an annual report on safeguarding.
In addition, a rolling programme of internal, unannounced safeguarding visits will take place across
key clinical areas and local compliance reports will be produced, to feedback to staff and service
leads on the safeguarding findings and recommendations.
2.3 PATIENT EXPERIENCE
2.3.1 Quality Goal:
Ensure patients report a positive experience in relation dignity and respect
Why was this a priority?
We believe that every patient has the right to have their privacy and dignity respected whilst receiving
health care.
What did we do in 2011/12?
We undertook a privacy and dignity staff survey across all the community hospitals alongside an
unannounced observational survey in eleven of the
twelve community hospitals. The staff survey
sought staff opinion about performance regarding privacy and dignity. Observers including trained
volunteers from patient groups sought patient feedback and scrutinised care delivery. The aim was
to assess that care in community hospitals is responsive, focused on patient need and respectful
of individual values and beliefs. Summary reports have been circulated to each of the 11 hospitals.
Action plans have been developed and are being implemented.
During the year we have also implemented several other measures to ensure privacy and dignity.
These include:
•
•
•
•
•
•
Updating the policy which reasserts the expectations we have of our staff when they are working
with people either in the clinic setting, the community hospitals or when in people’s homes.
Developing a privacy, dignity and respect standard which provides staff with further detail about
what they need to do to ensure that the care provided is delivered in such a way that respects
people’s privacy and dignity.
Developing a chaperone policy, which applies to both children and young people as well as
adults.
Developing a dignity champions action plan to increase capacity in the numbers of staff
undertaking the dignity champion role.
Capturing a number of patient stories and sharing with clinical areas to develop and improve
practice and there is a patient story detailed at every board meeting.
Auditing privacy and dignity in the patient experience data, taking the comments received from
patients very seriously and using negative patient feed back to drive through improvements in
patient care.
34
Excellent care, healthy communities
How did we perform in 2011/12?
Single sex accommodation is a visible affirmation of our commitment to ensuring privacy and dignity
in care. We remained vigilant and are compliant with the Government’s requirement to eliminate
mixed-sex accommodation except on those occasions when it is in the patient’s overall best interest,
or reflects their personal choice. From 24 May 2011 onwards community hospitals have complied
with the delivery of same sex accommodation.
In May 2011 (from 11 May to 23 May) there was one breach of single sex accommodation in one
of the community hospitals. One female and one male were placed in the same bay, for their own
safety, so that the nursing staff could closely monitor them and respond to their needs.
The patient experience data has been collected from all our services. The results indicate that our
patients feel that they were treated with dignity and respect. Of the negative comments received
during 2011/12 via comment cards, surveys and PALS, very few relate to privacy and dignity issues. Where patients have raised concerns they relate to the design or layout of clinics in older buildings
where sound-proofing is inadequate. What do we want to achieve in 2012/13?
•
•
•
•
•
•
•
Robust implementation of the privacy, dignity standard.
Develop and implement the 1st Class Care Programme (refer to page XXX) which will provide
a modular training programme, integrating and coordinating various training sessions which set
out clear, consistent competency assessments. Learning will be by various methods, including
reflective, action learning, table top exercises, allowing everyone to participate and share all
points of views e.g. from Patient to Chief Executive. The programme will be in place by April
2013 and will have been undertaken by all clinical staff within 3 years.
Re-energise the dignity in care campaign across the services including an increase in the
numbers of dignity champions.
Sustain compliance with single sex accommodation requirements.
Implement the actions from the community hospital 2011 privacy and dignity survey at local level.
Introduce a new privacy and dignity leaflet that describes what people can expect from our staff in
terms of privacy and dignity to make explicit what good quality care should look and feel like.
Introduce Fifteen Steps in our community hospitals which is an initiative from the Institute of
Innovation and provides a process for assessing a ward’s consideration of patient experience and
involvement
35
Excellent care, healthy communities
2.3.2 Quality Goal:
Ensure patients and their relatives report a positive experience in relation to end of life care
Why was this a priority?
We want all of our patients that are at the end of life, and their families, to be given choice and feel
supported in making decisions about where end of life occurs. We also want patients and families to
receive the level of care they need from staff who have the necessary knowledge and skills.
What did we do in 2011/12?
We have implemented the latest version of Liverpool Care Pathway which is a national tool that
supports clinical teams in managing the care of patients at the end of life.
The number of staff available within the organisation able to deliver training to our staff has been
increased with10 senior nurses having been trained to deliver Liverpool Care Pathway training.
End of life training was also made available to staff through funding provided by the Kent and
Medway GP Training Team.
We also introduced a requirement to monitor where end of life occurs.
How did we perform in 2011/12?
A target was set by the PCT as part of the Important Choices CQUIN. The target for preferred place
of death was 70%. This has been reviewed by the commissioners and will not be continued as a
CQUIN for 2012/13. We will continue to monitor our performance in this area and intend to continue
to make improvements. On average 94% of our patients on the end of life care pathway died in their
preferred place.
% of Patients that Died in their Preferred Place of Care
100%
90%
Values
(Kent wide
from
August)
80%
70%
60%
Target
50%
40%
30%
20%
10%
0%
Apr
May
Jun
Jul
Aug
Sep
Oct
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Excellent care, healthy communities
Nov
Dec
Jan
Feb
Mar
What do we want to achieve in 2012/13?
•
•
•
•
Review the cases where this standard was not achieved to better understand what the issues
were so that an action plan can be developed and put in place to make improvements in this area
Hold an end of life engagement event for staff and partners to highlight further areas for
improvement
Work with the Pilgrims Hospice on the end of life care project to further drive improvement across
the system
Ensure that all patients receive adequate pain relief during end of life care
2.3.4 Quality Goal:
To achieve a year on year improvement in patients reporting a positive experience
Why was this a priority?
Understanding the experience our patients and users have when using our services is key to us
making patient focused improvements.
What did we do 2011/12?
We used the Picker Institute core domains of patient experience as the basis of our community
services indicators of how patients and their families are experiencing their care and treatment. The
indicators include:
•
•
•
•
•
•
•
Staff attitude
Treatment with respect and dignity
Involvement in decisions about care and treatment
Communication (including listening)
Information giving (including explaining things in a way that the patient can understand)
Care and compassion
Encouragement to self-manage / take control.
There are a number of ways we capture patient feedback which includes comment cards, one-page
surveys, patient experience tracker, community hospitals discharge and telephone surveys.
Our target for real-time patient experience is 90%. The overall results of the data collection are
shown below. These represent patient’s responses between April 2011 to March 2012 and show the
overall percentage satisfaction based on five questions relating to involvement in care, privacy and
dignity, cleanliness, information and communication.
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Excellent care, healthy communities
Our performance against the target agreed with our commissioners.
CQUIN 3a and b - Patient Experience Tracker
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Improve the patient experience indicator from Patient Experience Tracker
(Sexual Health and ICATS East Kent)
Sexual
Health
ICATS
Target
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
CQUIN 3 - Improve Patient Experience Collection Process
e.g. Improve the number of patients feeding back (West Kent Local PET survey)
3000
2500
Values
2000
Target
1500
1000
500
0
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Data collected from July 2011 following confirmation of the target with the commissioners.
38
Excellent care, healthy communities
How did we perform in 2011/12?
On review of all our sources of patient feedback the overwhelming majority of our patients have a
positive experience. Areas that we do particularly well:
•
•
•
Attitude and behaviour of our staff
Patients have confidence in and trust our staff
Treating patients with dignity and respect
Areas that contribute to patients having a negative experience include:
•
•
•
•
Waiting times from referral to treatment
Waiting times in clinics (and not knowing how long the wait will be)
Appointment systems (i.e. not being given choice of venue or time and not being able to book
next appointment in advance)
Some of our clinic waiting areas are in need of improvement.
The two common areas of poor patient experience that relate to clinical practice are:
•
•
Lack of patient involvement in care / treatment (including advice on self-management and coordination of care)
Lack of information about other services / healthy living.
Both of these issues relate to clinicians sometimes failing to see the patient as a person and reflect
the wider culture in healthcare where patients are sometimes ‘done unto’ rather than involved and
encouraged to take control. The failure to sign-post patients to other services that may benefit
them (both within the health service and outside it) means the opportunity is lost to reduce health
inequalities and improve patients’ overall quality of life.
What do we want to achieve in 2012/13?
Improved access:
• Community hospitals will roll-out the use of signs to identify patients with visual impairment
• The new public website, including a directory of services and information library, will go live.
Improved involvement in care:
• Community nursing teams will start to use the ‘FACE’ assessment tool used by social services –
this will provide a more ‘person-centred’ assessment and encourage patients and families to be
more actively involved in decisions about their care.
Improved self-management:
• Kent-wide roll-out of the Expert Patients Programme. This is a free six week course, half a day a
week, that supports people to better self-manage their long-term conditions
Real-time Patient Feedback
• Roll out across our services of ‘Meridian’ an electronic approach to capturing the real-time patient
feedback. Patients and users will be able to complete surveys on the available electronic devices.
The responses are uploaded directly onto the system allowing teams to know immediately how
they are doing in relation to patient experience. The benefit of this approach is that teams will
know the impact of any changes made and can be more responsive to the feedback of patients.
39
Excellent care, healthy communities
2.4 HEALTH AND WELLBEING
Why was this a priority?
As a community health care provider we have a responsibility to improve health outcomes and
reduce inequality. Therefore, health and wellbeing is an important service we provide to our local
population including:
•
•
•
Promoting healthy living
Providing support to help patients manage their long term condition
Sign-posting patients to services both NHS or voluntary as required.
What did we do in 2011/12?
The preparation for the merger that became effective in April 2011 was an good opportunity for
us to review our service provision. In recognition of the importance health and wellbeing is to our
population we created a Health and Wellbeing department within our structure. To provide a health
and wellbeing service it is essential that we have the capacity that the new structure allows us. Our
staff are now able to work effectively and in partnership with GPs, pharmacies, local authorities and
the voluntary sector.
How did we perform in 2011/12?
•
•
•
The Kent C application was developed with the Primary Care Trust (PCT) and Public Health. The
initiative utilises modern technology in health promotion with applications and smart bar code for
smart phone users. This provides easily accessible information and raises awareness of sexual
health services. It has been well received by the public with positive press coverage
Healthy Weight Team has continued to develop its Nutrition Champion programme for community
leaders such as voluntary organisations that work with children, young people, older people and
people with learning disabilities as well as ‘hard to reach’ and ethnic groups. The champions
are able to provide information and assistance to people regarding nutrition and healthy eating.
The programme has been excellent in expanding capacity within the community to deliver health
improvement messages.
Health Trainers have been working closely with GP surgeries to help reduce A&E attenders by
educating clients on suitable alternatives. The project has so far achieved significant results
where it has been implemented with 79% reduction in A&E attendance over a 6 month period.
What do we want to achieve in 2012/13?
Chlamydia
The Chlamydia target has been revised and agreed with the commissioners. The target is now
focussed on the number of patients diagnosed rather than the number of patients tested. This change
means that the team can provide a much more targeted approach where higher risk clients are
approached. This will improve the quality of our service as more clients will be positively diagnosed
and therefore treated more effectively.
HIV Point of Care Testing
During the year Sexual Health Services will be exploring how new technology can help in the
screening of undiagnosed HIV infection and facilitate improved earlier rates of HIV diagnosis. The
service is working in collaboration with East Kent Hospitals University NHS Foundation Trust’s
Microbiology department to develop a quality assured service. This will ensure that there is suitable
training and guidance supporting any introduction of technological solutions.
40
Excellent care, healthy communities
Stop Smoking
It is estimated that there are approximately 3.7 million people in the UK with COPD. Only 900,000
are currently diagnosed and receiving appropriate care and treatment. COPD is the fifth biggest
killer in the UK. And it is estimated that 90 to 95% of all those identified with COPD have been long
term smokers. There is only a 45% identification rate of this disease; one of the most costly inpatient
conditions treated by the NHS. In response to this the stop smoking teams will be working with two
Clinical Commissioning Groups to indentify and help with early diagnosis of this disease. The service
has set up a screening service alongside current service delivery. Health checks
The Trust successfully met its target to offer 10,000 health checks and have now been commissioned
to deliver the full programme across West Kent. We aim to ensure there are seamless pathways from
screening to accessing relevant community services or sign posting to their GP to ensure patients are
reviewed in a timely manner
2.5 National Institute for Health and Clinical Excellence (NICE):
Guidance and Quality Standards
NICE guidance: Since 2000, NICE has publish guidance on effective care relevant to the care that
KCHT staff deliver.
NICE quality standards: are a set of specific, concise statements that act as markers of highquality, cost-effective patient care, covering the treatment and prevention of different diseases and
conditions. These have been published by NICE since July 2010.
KCHT compliance
We have a process in place to ensure that our staff are aware of NICE guidance and quality
standards. This ensures that our staff are able to plan and deliver effective care and identify any gaps
and rationale that may mean that they cannot be followed.
How did we perform in 2011/12?
We have a robust process, which is described in the policy for monitoring the implementation of NICE
Guidance and Quality Standards. Each clinical directorate has a named NICE lead who is responsible
for ensuring an assessment is undertaken of relevance to us, and how compliant we are against the
guidance/standard. If gaps are identified an action plan is developed, implemented and monitored.
A progress report is received by the clinical directorate Quality Group meetings each month which, in
turn, report into our Quality Committee each month.
Our clinical audit programme also includes audits that relate to the implementation of NICE guidance.
Technology Appraisals
Since January 2002, the NHS has been legally obliged to provide funding and resources in England
and Wales for medicines and treatments recommended by NICE’s technology appraisal guidance.
This means that when NICE recommends a technology, the NHS must ensure it is available to those
people it could help, normally within 3 months of the guidance being issued. We are compliant with
this requirement for those technology appraisals that are relevant to services we provide.
What do we want to achieve in 2012/13?
As a new organisation, we are in the process of undertaking compliance assessments against all
NICE guidance issued. This will run concurrently with the assessment of new published guidance and
will be completed by October 2012.
Excellent care, healthy communities
41
3.0 Continuous Quality Improvement 2012/13
3.1 What we are adding to our quality improvement programme
We have consulted with our patients and staff to find out what they consider should be our priorities
for 2012/13. The majority of key priorities are already being addressed but the feedback has
highlighted a few additional concerns which we will incorporate into our quality work programme and
quality dashboard that is used to monitor performance. This year:
•
•
•
Acute pain assessment and management in both adults and children
Reducing the length of stay
Patients with neuro-disabilities admitted to community hospitals feel safe, in control and involved
in decisions regarding their care and management.
During the year we will review our performance in these areas and gain further insight from our
patients into the issues of concern. Some further measures of quality that will be introduced in
2012/13 will include:
•
•
•
•
•
•
•
Reporting on mortality rates
Developing the 1st Class Care Programme including measures on:
standards for nursing practice
Establishing a competency based assessment framework
Establishing training programmes
Review baseline audits and set targets which can then be monitored through our local and board
quality reports
Benchmark against other comparable organisations
Dementia Care
Nationally and locally it is recognised that care for patients with reduced mental capacity needs
to improve. Patients who have reduced capacity through a learning disability or dementia do not
consistently get the support or have the optimum experience they need whilst under our care. We
want to improve the care we deliver to our patients with dementia and their carers. To do this we will
develop a strategy that outlines our plans for improving our service to this group. The strategy will
include our approach to patient assessment, how we aim to manage and refer on patients in this
group and how we will raise awareness and competency of our staff. This will be a national priority
but also a local priority in the coming year and we will make sure that we utilise the guidance and
best practice standards to enhance the care we deliver to our patients.
42
Excellent care, healthy communities
Energising for Excellence
Energising for Excellence is a umbrella initiative for a programme of actions aimed at helping
healthcare organisations deliver excellent and sustainable care. We have identified the key actions
that we will be implementing during the year under each themed heading, a sample of which is listed
below:
Patient safety
•
Pressure Ulcer work plan
•
Fall work plan
Delivering safer care
•
Implementation of the Safety Thermometer
•
Develop and implement a Dementia strategy and work plan
Patient experience
•
Roll out of real-time patient experience monitoring (Meridian)
Clinical effectiveness
•
Develop and implement service level quality dashboard
•
Reduce length of stay in community hospitals
Key commitments
•
Prevention and admission avoidance
•
Increase early supported discharge
•
Improve management of patients with long term conditions
Safety Thermometer
The NHS Safety Thermometer has been developed as a point of care survey tool. The tool
collects data from teams on pressure ulcers, falls, catheters and urinary tract infections and
venous thromboembolisations (blood clots). The purpose of this initiative is to provide frontline
teams, organisations and the wider NHS with a tool for measuring harm and provides details of
the proportion of patients that are ‘harm free’ at a given point in time. As every Trust will complete
the survey on the same day each month the real advantage is that it will allow national and local
benchmarking on harm incidents so that comparisons can be made. In addition analysis of this data
will assist in building a picture of both the number of harm incidents across the NHS and the number
of patients involved. We participated in the South East Coast SHA programme of quarterly data
submission which contributed to the development of the Safety Thermometer tool and definitions.
1st Class Care Programme
Our patients deserve and expect care with compassion, their dignity to be respected and to feel safe.
Getting the essentials of care right first time every time for our patients is a priority for us. To embed
the standards expected of our staff we are developing a competency based and skills enhancing
education programme that we have called the 1st Class Care Programme. The programme will draw
on patients’ experiences through the use of patient stories, patient/user participation and involving
table top exercises using role play to engage staff in learning in a non-threatening environment.
There will be a programme tailored to health care assistants, new staff/support workers, established
staff and one for our staff in clinical leadership roles with clinical supervision and action learning
embedded within each session. The programme will include modules covering nutrition, bowel and
bladder management and patient assessment.
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Excellent care, healthy communities
4.0 Quality Statements
4.1 Data Quality Statement
Effective delivery of patient care relies on good quality information and is essential if improvements
in quality of care are to be made. Historically the quality of data captured by services working
in a community setting has been poor due to a lack of investment in information systems. Kent
Community Health NHS Trust will be taking a number of actions to improve data quality.
Over 2011/12 the remit of the Information Quality Improvement Group has been extended to cover
both east and west Kent (previously this was an east Kent governance group). The group previously
reported into the Corporate Assurance and Risk Management Committee (CARM), but will report
to the Information Governance Steering Group in future. The group will continue to oversee the
implementation of the Trust’s Data Quality Policy. This policy aims to achieve the following:
•
•
•
•
•
•
Outline our obligations in relation to data quality and raise the profile of the importance of good
information to support both clinical and non clinical decision making
Ensure that the basic principles of data quality are understood and implemented across the Trust
Improve compliance with the data quality elements of the Information Governance Toolkit
Assessment
Improve the Trust’s rating with regard to the Information maturity assessment matrix tool
developed to support the Transforming Community Services programme
Encourage service and system leads to introduce and maintain robust change control processes
for all key information systems
Provide guidance for internal data quality audits
The IQIG has established a programme of data quality audits and will continue to oversee the
recommendations and actions resulting from these audits as well as generally monitoring data
quality. The remit of the group and the coverage of the audit programme will be extended to include
quality systems and the membership of the group will be amended to reflect this.
The implementation of a new Community Information System within the Trust during 2012/13 will also
have a positive impact on data quality as it will provide a single integrated electronic patient record.
The Trust’s Integrated Performance Report which is submitted to the Board on a monthly basis
contains a set of metrics relating to data quality (linked to Monitor’s Compliance Framework
requirements for community providers). The Trust is currently conducting a baseline audit of all
key information systems and will be creating an action plan to address areas of below threshold
compliance. This action plan will aim to ensure the Trust is compliant with the data completeness
metrics contained in the Compliance Framework. The action plan will be submitted to the SHA for
approval to support the Trust’s Foundation Trust application.
The Trust will also be working with the PCT Cluster and the CCGs to improve the quality of the data
which unpins the Trust’s contracts.
The Performance and Business Intelligence Service will be building data quality ratings into the
Trust’s Integrated Performance Report to highlight the confidence level in the data presented to the
Board and to provide a focus for data quality improvements.
NHS Number and General Medical Practice Code Validity
Kent Community Health NHS Trust did not submit records during 2011/12 to the Secondary Uses
service for inclusion in the Hospital Episode Statistics which are included in the latest published data.
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Excellent care, healthy communities
Information Governance Toolkit attainment levels
Kent Community Health NHS Trust Information Governance Assessment Report overall score for
2011/12 was 66% (provisional rating as assessment is not submitted until 31/03/12) and was graded
Red (scores are not RAGed within the IG Toolkit - labelled as ‘Not Satisfactory’). However, there was
only one key requirement which was not met at year end and an action plan is in place to address
this early in 2012/13.
4.2 Clinical Audit
National Audits
For the purpose of the quality account report it is necessary to review our 2011/12 clinical audit
programme against ‘National Clinical Audits for inclusion in quality accounts 2012.’ These are
audits included in the National Clinical Audit Patient Outcome Programme (NCAPOP). There are 51
NCAPOP audits included in this list, however the list does not distinguish between audits expected to
be undertaken in different settings such as an acute setting or a community setting. The list of audits
was reviewed by us to determine which audits were applicable to the organisation. We participated
in four national clinical audits for inclusion in quality accounts.
Quality Account National
Clinical Audit Title
Status
Comment
1.Neonatal intensive and
special care (NNAP)
Reported on each quarter by
East Kent Hospitals University
NHS Foundation Trust
We participated in this audit,
however the lead organisation
was East Kent Hospitals
University NHS Foundation Trust
2.Childhood epilepsy
(RCPH National Childhood
Epilepsy Audit)
First draft report
The finalised report will be
available in May 2012.
3.Diabetes
(RCPH National Paediatric
Diabetes Audit)
Analysis and report writing
We participate in these audits,
however the lead organisation
was East Kent Hospitals
University NHS Foundation Trust
4.Chronic pain
(National Pain Audit)
Data collection
We participated in part one
of this audit. This involved
completing an organisational/
service questionnaire
Table 3: KCHT participation in National Clinical Audit Patient Outcome Programme.
At the time of reporting, the audits were at various stages of the clinical audit cycle as shown in the
status column. Therefore the actions that we intend to take to improve the quality of healthcare have
not yet been identified. Actions from these audits will be included in next year’s quality accounts.
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Excellent care, healthy communities
We also participated in other national clinical audits (not NCAPOP audits) including:
National Clinical Audit Title
Status
Comment
1. Sexual History taking
Superseded
This audit has been superseded
by the 2012 British Association
for Sexual Health and HIV
(BASHH) audit for asymptomatic
sexual history taking audit.
2. National audit of
continence care
Completed
Every action from the action plan
has been implemented.
3. National audit of treatment
and care of HIV infected in
patients 2010
Data collection
The national report is due to
be published in July 2012.
Then local actions plans will be
developed.
4. National Patient
involvement project: older
peoples experience of falls
and bone health services
Local action plan is being
developed
National report has been
completed and local reports
were made available in April
2012.
Table 4: KCHT participation in National Clinical Audits (not NCAPOP).
Recommendation for
Improvement
Action taken
Evidence of Completion
1. Improvement of existing
training programmes to make
them more competency
based and evidence based
Meeting to discuss and
develop training programme
A new teaching programme
is in use and is competency
based. Evaluation forms and
completion of competency is
being monitored.
2. Introduction of bowel
assessment tool and
competency skills
Design of new Bowel
assessment tool
A new teaching programme is in
use and is competency based.
A new bowel assessment tool is
to be evaluated 3 months after
launch.
3. To improve training for
registrants and Healthcare
assistants in the process of
assessment
To develop robust training
programme with competency
based tasks
New assessment form launched
and now in use. HCA can access
all training modules.
4. To improve use of core
care plans
To develop use of core
care plans through training
programme
Good practice bench marking
document developed. Core
care plans now in use, ongoing
review.
Table 5: Action Plans for National Clinical Audits.
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Excellent care, healthy communities
Local audits
There were 193 clinical audits registered in the period 1 April 2011 to 31 March 2012. Ten of these
were national clinical audits (an additional three national audits were undertaken, but not registered
with the clinical audit department). As table 6 shows there were 107 projects completed by year end
2011/12.
Audits are commenced at different times during the year, therefore at year end a proportion will be
at various stages eg data collection, analysis, report writing. In addition, audits are not considered
closed until the action plan is fully implemented. Hence, 70 are reported to be carried over into the
2012/13 clinical audit year
The clinical audit reports have been reviewed by our governance groups. The CAG produces a
highlight report for the Quality Committee, chaired by a non-executive director. Any audit concerns
and risks are feedback by CAG to the Quality Committee with a recommendation for action. The
annual report is presented at the CAG, Quality Committee and to the Board.
Clinical audit programme activity
The table below shows the status of all the projects in the clinical audit programme
Current Status
Planning
Pilot
Data collection
Analysis & report writing
Awaiting action plan
Action plan awaiting committee ratification
Implementing action plan
Completed
Deferred
Ongoing
Discontinued
Grand Total
Total
2
2
9
19
8
2
24
107
1
3
16
193
Table 6 clinical audit projects completed.
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Excellent care, healthy communities
The information below gives a sample of best practice and/or changes made as a result of audit:
Leg ulcer audit (West Kent)
The leg ulcer audit is one of the Commissioning for Quality and Innovation (CQUIN) measures. The
audit will follow a patient pathway to evidence improvement in healing. The expected outcome of the
audit is that all patients are being appropriately assessed and healing rates are improving according
to NICE guidance and the Royal College of Nursing (RCN) guidelines.
Problems identified/recommendations
Actions taken
Wound assessment training to emphasise on
Doppler tests and increased training attendance
Training available and attendance now
managed and monitored by Training
Department
A re-audit to evidence improvement in Doppler
tests
This is on the clinical audit programme for
2012/13
The healing rate of 28.81% exceeded the CQUIN target of 23.63% to show an increased healing
rate of 5%.
Compliance with the use of the Assessment Tool for Sexually Active Young People
Following the death of a 14 year old and subsequent completion of a Serious Case Review for Kent
Safeguarding Children Board (KSCB) a concern was identified that there may be poor compliance
within West Kent Community Health Contraception and Sexual Health (CASH) services with the use
of the risk assessment tool for sexually active young people.
The recommendation of the KSCB procedure and practice guidance is that the tool is used on all
young people under the age of 16 accessing the service. The tool is intended to inform the judgement
of professionals working with sexually active young people as to whether their behaviours fall within
the continuum from sexual exploration, to seriously harmful behaviour. The emphasis is on working
with the young person and their partner to reduce potentially harmful relationships by providing
advice and services. An audit was carried out to establish whether the risk assessment tool for
sexually active young people has been consistently embedded into practice.
Problems identified/recommendations
Actions taken
A time limited working group was established to
review and redesign the current documentation
of the risk assessment tool.
Risk assessment tool revised and piloted
in October 2010. Following workshops final
document disseminated and integrated to CASH
services April 2011.
Following revision of the tool training is to be
facilitated across the sexual health services of
West Kent Community Health.
February – May 2011, five workshops across
the west of KCHT were facilitated to include
CASH professionals and MIU.
A further audit is undertaken regarding the uses
of the risk assessment tool.
Re-audit added to the 2011/12 clinical audit
programme.
East Kent Community Health to be informed
of the audit findings and the revised
documentation to be shared.
EKCH were informed of audit findings and
revised tool was shared.
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Excellent care, healthy communities
Annual report of audits of stop dates, length of course or review dates of antimicrobials
prescribed in community hospitals (West Kent)
Inappropriate prescribing of antimicrobials, not only increases the risks of adverse effects (eg
Clostridium difficile infections, gastro-intestinal problems) but also the development of resistances.
The British National Formulary and west Kent community health guidance on the management of
infection provide appropriate choices of antimicrobials for treatment infections advice on the duration
of treatment.
Quarterly audits were carried out on the prescribing habits with regards to limiting the time
antimicrobials are prescribed for patient in the community hospitals in the west of Kent during 2011.
Problems identified/recommendations
Actions taken
When patients are transferred from acute
hospitals to one of the community hospitals care
must be taken to transfer information regarding
the durations of treatment for antimicrobials
to the current prescription chart in use at the
community hospital.
Medicines reconciliation now carried out at time
of transfer and documented on the patient’s
prescription chart at the community hospital
by the charge nurse on duty at the time and/or
clinical pharmacist.
When a new chart is put into use for a patient
receiving antimicrobials, information regarding
limitation in therapy must be transferred from
chart.
Part of medicines reconciliation and
documentation on patient’s new prescription
chart.
All new members of staff (nurses and doctors)
should be made aware of the current edition of
Management of Infection Guidance for Primary
Care issued by KCHT.
All new staff attending orientation training day
are made aware of the importance of following
the Management of Infection Guidance for
Primary Care when prescribing antibiotics.
In addition to some of the audits above the Essence of Care (EoC) national benchmarking tool
formed a large part of the adult services rolling annual programme of audits and covers 11 domains
of best practice including privacy and dignity and record keeping. Each domain is audited over an 11
month period. These audits have resulted in highlighting several areas of good practice and some
areas where improvements need to be made. Action plans for each domain have been developed
with ongoing monitoring.
The therapy services audit three domains: record keeping, privacy and dignity and self care and
forms part of their annual programme of audits.
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Excellent care, healthy communities
A total of 479 actions have been identified from clinical audits in the current audit year. These include
229 process actions and 250 quality and safety actions. The quality and safety actions fit into the 10
categories shown in the graph below.
9
8
8
Provision of
equipment
Communication
12
Information
Governance
17
Access to
service
20
Patient
involvement
30
Policy
32
Risk
management
Training
39
Information
70
Documentation
Number of Actions
Quality and Safety Actions
310 of the 479 actions have been implemented to date, while 26 are not yet due for implementation.
All actions not due/or implemented in the current financial year are carried over into the 2012/13
action plan monitoring tool to ensure implementation. This is overseen by the Clinical Audit Group.
The actions are monitored by the directorate quality groups through the production of monthly action
plan monitoring reports. These reports include the total number of actions being monitored and the
implementation status of those actions.
4.3 Learning from Serious Incidents
Our reporting and investigating of serious incidents (SIs) is in line with the National Patient Safety
Agency’s National Framework for Reporting and Learning from Serious Incidents Requiring
Investigation (SIRIs).
We aim to ensure that all incidents involving patients are dealt with openly and honestly. We
investigate every SIRI, identify the root causes and learning outcomes and develop action plans
for implementation which will reduce the risk of similar incidents reoccurring, as far as practicably
possible. We provide our commissioned Primary Care Trust (PCT) with regular updates on the
investigation process. Our findings are presented to them and/or SHA and it is only with their
agreement that a SI can be closed.
We continuously monitor SIs, both at a local level and at Board and committee level. We look for
trends within the incidents, ensure root causes are mitigated, improvements are implemented and
learning is shared.
The themes most frequently reported at SIs during 2011/12 are pressure ulcers, falls and information
governance breaches. The following table shows examples of the lessons learned and actions
implemented within these three categories of SI raised by us between April 2011 and March 2012:
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Excellent care, healthy communities
Type
Lessons Learned
Change/amendment/
implementation of new processes
Pressure Ulcers
Documentation
• Need for completed holistic
assessment including risk
assessments, action from
assessment and care planning
• Need for documentation to be
consistent throughout patient
records and complete including
photographs of wounds
Documentation
• Training has been provided for staff
• New documentation has been
introduced to support improvement
in practice
• Documentation audit against
practice standards has been
included in the clinical audit plan
for 2012-2013
Communication
• Need for shared care prot ocol
between Community Nursing
Teams and carers to provide
guidance on the standards required
to maintain patient safety and fulfil
professional accountability and
responsibility within a shared care
arrangement
Communication
• Local teaching package for
residential nursing homes
developed.
• Shared care protocol now ratified
and in place PU
• Prevention of pressure ulcers
Information leaflets shared with
homes for patients and carers
Equipment
• Delays in delivery of appropriate
equipment have contributed to the
development of pressure ulcers
Equipment
• The amount and type of equipment
in equipment loan stores has been
increased and implementation of
contract with external provider to
ensure access 24/7 to equipment
across the trust and guidance has
now been published and circulates
to staff.
Training
• Need for wound care training to
include grading and description of
wound to be accessible to all staff
including bank staff
Training
• Wound care
• Bespoke training programme has
been delivered.
Practice Standards
• Clarification of roles,
responsibilities and agreed
standards required
Practice Standards
• Development and implementation
of practice standard relating to
pressure ulcers, reinforced by
Director of Nursing meeting all
community nursing team leaders,
Pressure ulcer newsletter detailing
good practice and lessons learned
and weekly teleconference to
discuss changes in practice
and identify and address any
constraints.
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Excellent care, healthy communities
Type
Lessons Learned
Change/amendment/
implementation of new processes
Information
governance
• All staff must ensure the security
of all personal identifiable
information in their care, in
accordance with organisational
policy and the Confidentiality Code
of Conduct
• Ensure that all staff are aware of
the responsibility to secure trust
property at all times.
• All staff directed to complete
information governance training
• Article regarding security,
information governance and staff
responsibility published on weekly
bulletin
• Amendment to the records
management policy to include
the guidance on clinical diary
management
Falls
• Post fall protocol agreed and in
• Need for robust patient
place across all community hospitals
assessment of falls risk prior to
•
Use of cushion with alarm as a
and post any fall.
warning to staff of high risk fallers
• Use of appropriate equipment/
movements
staffing levels to reduce the risk for
•
Increased staffing levels, as
patient sat risk of falling.
required, to ensure continuous
observation of patients at risk of
falling due to them not requesting
the necessary assistance
Never Events:
The Department of Health annually produce a list of Never Events. Never Events are SIs that
are considered unacceptable and eminently preventable. We have not had a Never Event during
2011/12.
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Excellent care, healthy communities
4.4 Research
The number of patients receiving NHS services provided or sub-contracted by us in 2011/12 that
were recruited during that period to participate in research approved by a research ethics committee
was 97.
Participation in clinical research demonstrates our commitment to improving the quality of care we
offer and to making our contribution to wider health improvement. Our clinical staff stay abreast of the
latest possible treatment possibilities and active participation in research leads to successful patient
outcomes.
We were involved in conducting four clinical research studies in the following medical speciality
during 2011/12:
Out of the four clinical research, two are topic studies, specifically stroke and primary care which
fall under the speciality of rehabilitation. For Comprehensive Clinical Research Network studies,
two specialities involved are dermatology and health services research including the Stop Smoking
Service.
The improvement in patient health outcomes demonstrates that a commitment to clinical research
leads to better treatments for patients.
There were 10 clinical staff participating in research approved by a research ethics committee during
2011/12. These staff participated in research covering four specialities.
In addition, in the last three years, two publications have resulted from our involvement in NIHR
research, which shows our commitment to transparency and desire to improve patient outcomes
and experience across the NHS. Our engagement with clinical research also demonstrates our
commitment to testing and offering the latest medical treatments and techniques.
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Excellent care, healthy communities
5.0 What others say about us – Care Quality Commission
We are registered with the Care Quality Commission (CQC) without conditions. A condition of
registration can be imposed upon a provider where there is evidence that they are not compliant, to
limit or restrict what they can do. We currently have 34 locations registered with the CQC.
During the past year we have revised our approach to assurance to reflect the CQC’s process.
The aim is to give the Trust’sBoard ongoing assurance that services are able to provide evidence on
compliance such as:
•
•
•
•
Audit and monitoring
Staff training and attendance
Patient information
Patient feedback.
Where gaps in compliance are identified services are required to produce a timely action plan
detailing how they will reach full compliance.
A programme of internal inspections tests frontline staff’s compliance with the Outcomes. These
are undertaken by the Director of Nursing and her Deputy and Assistant Directors, the Standards
Assurance Manager and Locality Directors and Assistant Directors. At least two visits are undertaken
each month and these will increase in frequency throughout the coming year. So far key issues
identified have been around consistency and accuracy of documentation and consistency of staff’s
knowledge and understanding of some policies and processes. It has also highlighted areas of good
practice within services and this has been shared to improve practice in other services.
During the year 2011/12 the CQC has visited two of our community hospitals and its learning
disability unit, Rohan at Sandwich.
At Rohan the CQC focused on standards relating to:
•
•
•
•
People understanding the care and treatment choices available to them and that their privacy,
dignity and independence is respected.
People experiencing effective, safe, good quality and appropriate care which manages the risks
to their health, welfare and safety.
Safeguarding people from abuse, or the risk of abuse and that their human rights are respected.
Staffing: that people are kept safe and their health and welfare needs are met because there
are sufficient numbers of the right staff that are competent and properly trained, supervised and
appraised.
At Sevenoaks and Edenbridge Hospitals the CQC focused on similar areas as well as infection
control.
The CQC also gave a judgement of full compliance for all three sites with the exception of minor
concerns at Edenbridge, where the CQC made a recommendation relating to staff training and
supervision to ensure that compliance with standards continues to be met. An action plan has been
produced and provided to the CQC and this will be monitored until completion on 30 August 2012.
The CQC’s Quality and Risk Profile (QRP) for the Trust was first published in August 2011. The QRP
is reviewed each month to ensure that any risks taken are addressed. The current QRP contains two
items that the CQC has assessed as being an area of potential concern. Both these areas have been
investigated and addressed.
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Excellent care, healthy communities
Feedback from the commissioner received on 19th June 2012.
NHS Kent and Medway comments on the 2011/12 Quality Account for Kent
Community Health NHS Trust (KCHT)
NHS Kent and Medway is the lead commissioning Primary Care Trust (PCT) for
KCHT and welcomes the publication of this quality account for 2011/12. Both
organisations are working closely together to ensure all aspects of patient safety and
care quality are consistently meeting high standards of care and sustain
improvements.
As far as NHS Kent & Medway can comment, the information contained in the quality
account is an accurate and honest reflection of progress made in many aspects of
service improvement.
KCHT demonstrate a very encouraging focus on improving quality of care and
patient experience outcomes.
Weekly Executive Patient Safety Walkabouts have been introduced and have proven
to be successful. Both Board members and staff involved have committed to actions
which will improve patient experience across the Trust.
KCHT achieved their target for increasing their Health Visitor workforce and have
successfully promoted a strong safeguarding culture across their services, and
particularly in Health Visiting.
Pressure ulcers continue to be a concern at KCHT. Whilst it is apparent that KCHT
are implementing a number of initiatives to reduce the number of patients developing
pressure ulcers, the PCT require further assurance on the Trust’s processes for
using and sharing lessons learnt from root cause analysis investigations. More
information on the Community Nursing team leadership, education and training
would be welcomed.
The PCT note that KCHT did not achieve their target for the Information Governance
Toolkit Assessment and are aware that there have been a significant number of issues
with the management of confidential information. The PCT will monitor the proposed
plans to implement performance indicators across all directorates to ensure the
target is met for 2012/13.
KCHT continue their work to reduce the number of in-patient falls and has introduced
a number initiatives, however, the PCT would like to see additional focus on how
patients in other community services are being assessed for their risk of falling.
The PCT will continue to work closely with KCHT to assure the quality of our local
health services and ensure the culture of continuous improvement is present in all
areas of the Trust.
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Excellent care, healthy communities
6.0 Conclusion
The integration of east and west Kent community services has been a major undertaking for the
organisation. In our first year we have worked with our patients, the public and our staff to understand
the community we serve. This has given us the opportunity to develop a vision and corporate strategy
for the next few years that will help us to deliver consistently high quality services. Working through
this process has been essential as in the coming year we want to be granted Foundation Trust status.
Achieving this will mean that following close scrutiny we are considered an organisation that:
•
•
•
Has a strong hold on its finances
Provides high quality safe and effective services
Works in partnership with patients, public and staff to develop new services, improves existing
services and understands patient experience.
The 2011/12 Quality Account demonstrates our commitment to our patients receiving safe care and
having a good experience whilst in our care or using our services. We are also serious in our focus
to use our resources efficiently and eliminate waste and duplication where it exists. Directorates
will maintain focus on getting the basics right. Mandatory training and appraisal targets will be
reinforced in the strategy. There will be a continued focus on prevention, admission prevention and
supporting early discharge. In working towards this objective there has been a huge amount of work
undertaken by our staff across the year, however, we know there is much more to do. In the account
we have highlighted many of the areas that we will be targeting through 2012/13 that we believe will
make the biggest difference to our patients. Our programme of quality improvement will support the
organisation’s journey to sustainability and Foundation Trust status whilst maintaining our vision to be
the provider of choice by delivering excellent care and improving the health of community.
Directors’ Statement of Responsibilities
Our Board is ultimately responsible for the delivery and quality of services delivered throughout the
organisation. It is therefore also responsible for the accuracy of information that is presented within
our Quality Account.
Assurance process
In order to assure themselves that the information presented is accurate, and that the services
described and the priorities for improvement are representative, our Board designated the Director of
Nursing to lead the process of developing the Quality Account and to report progress before gaining
final approval from the Board.
The Director of Nursing also ensured that staff and patients had an opportunity and were involved
in developing the key priorities for the Quality Account. The organisation’s executive committee was
pivotal in setting priorities. In addition to this other stakeholders provided an objective view.
The Quality Committee and the Board were provided with an opportunity to review the Quality
Account before the final version was agreed, thus ensuring as far as possible that the information is
accurate.
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Excellent care, healthy communities
Feedback from LINKS received on 30th May 2012 – page 1
Your LINk for improving health and social care
Supporting the development of Local Healthwatch
Kent LINk Statement for inclusion within the
Kent Community Health NHS Trust Quality Account 2011 / 2012
The Kent LINk would like to thank Kent Community Health NHS Trust for the opportunity to
comment on their Quality Account prior to publication. The LINk has used various methods
throughout the year to collect patient experience data from users of Kent Community Health
NHS Trust services in order to provide this statement for the Account.
•
Kent LINk Governors’ Group and Priorities Panel member’s comments, in line with
Department of Health document ‘Quality Accounts: a guide for Local Involvement
Networks’.
•
Kent LINk participants and Kent Community Health NHS Trust service users,
commenting on their experience of using the services, as well as the Trust’s
performance against last year’s priorities and how appropriate they felt this year’s
priorities are, via an online and paper survey.
•
Face to face interviews with patients and visitors within hospitals throughout Kent, who
were also asked to comment on the above areas.
•
The LINk has also used intelligence gathered throughout the year through its projects
and community engagement events.
•
LINk participants in the local area were also asked to comment on the presentation and
layout of the Account.
1. Is the Quality Account clearly presented for patients and public?
The draft presented to Kent LINk contained various references to more material yet to be
provided, so it is difficult to know what the final presentation will look like. The Trust has
included many performance targets for 2012 / 2013 but it was difficult to identify the Trust’s
major priorities for the coming year. The LINk would suggest that Kent Community Health
NHS Trust follows the examples of other Trusts, and identifies these priorities together on a
page near the beginning of the document.
The Quality Account provides a good explanation of the services provided by the Trust, and
how the Trust has sought to achieve its priorities laid out in the Quality Accounts published
last year by both Trusts before the merger.
KMN, Unit 24 Folkestone Enterprise Centre,
Shearway Road, Folkestone, Kent, CT19 4RH
Tel: 01303 297050
Email: info@kentlink.org
Office Hours: Monday – Friday 8.30am - 4.00pm
Page 1 of 3
(Answer phone available out of office hours)
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Excellent care, healthy communities
Feedback from LINKS received on 30th May 2012 – page 2
The Quality Account was of an appropriate length, 37 pages in its draft form, which makes the
document more accessible to the lay reader. Whilst font size and layout were considered
good, the use of photographs throughout the document would make the document more
appealing to the lay reader. Some tables throughout the document would benefit from further
explanation, as would information on patient numbers applicable to services and patient
groups. A glossary would add value to the Quality Account overall.
2.
Priorities for 2011 / 2012
Respondents to LINk surveys and those who took part in face to face engagement indicated
that the Trust appear to have made good progress with their priorities laid out in last year’s
Quality Account, and have clearly identified in this year’s Quality Account where there are still
improvements to be made.
3.
Priorities for 2012 / 2013
Respondents were in agreement with the priorities set out within the Quality Account, however
as previously stated the LINk would recommend that the Trust place the key priorities together
at the beginning of the document. Respondents also indicated that the Trust could identify
staff members responsible for delivery of the priorities laid out with the Quality Account.
4.
Safety, Communications and Staff
The LINk has received comments throughout the year rating the services provided by Kent
Community Health NHS Trust as highly efficient, effective and of a high quality. In particular,
users of the services have commented on the attitudes of staff members indicating that the
staff was kind, professional and friendly. Respondents to LINk surveys commented that Kent
Community Health NHS Trust staff treated patients with respect whilst maintaining patient
privacy and dignity. Respondents to surveys, and LINk data collected throughout the year
suggests that patients found Trust sites to be clean, accessible and comfortable. This is to be
commended. One respondent to a LINk survey commented on a Kent Community Health NHS
Trust site and can be quoted as describing the site as: “a centre of excellence for NHS care”.
It is also recognised that the Trust’s Management have been prepared to meet and engage
with patient representative groups to work together to resolve issues arising.
5.
Who has been involved in the preparation of the Quality Account
The Trust has mentioned in Section 3 of the Quality Account that they have consulted with
patients and staff to gather views on priorities for the coming year and the LINk was
represented at engagement events held by the Trust in April and May 2012. However, the
inclusion of further details on this engagement would of have been of benefit to the Account.
The LINk would like to take this opportunity to congratulate the Trust on the progress it has
made in its first year, and the excellent feedback received by the LINk regarding Kent
Community Health NHS Trust services.
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Excellent care, healthy communities
Feedback from LINKS received on 30th May 2012 – page 3
Under the Health and Social Care Act 2012, LINk’s are to be abolished in March 2012 and a
Local Healthwatch will commence operation in Kent in April 2012. The LINk is working with
the Local Authority to enable a smooth transition and introduction to Local Healthwatch and
will recommend that a Local Healthwatch utilises the LINk Quality Accounts toolkit when
making a statement on next year’s Kent Community Health NHS Trust Quality Account, and
would hope that Local Healthwatch and Kent Community Health NHS Trust can continue the
good working relationship that currently exists between LINk and the Trust.
John Ashelford
Kent LINk Governor and Quality Accounts Project Lead
May 2012
Page 3 of 3
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Excellent care, healthy communities
Our Response
We used patient feedback gathered through one page surveys and comment cards throughout
2011/12 to help set our Quality Priorities. We then tested these out through our Real Involvement
Newsletter and at five workshops held as part of engagement events across Kent during April and
May 2012. Feedback has been positive with changes suggested relating to the format and words
used rather than the choice of priorities. We have made changes as suggested by patients and
users and LINk.
References
Elia, M., Russell, C. (2009) Combating malnutrition: recommendations for action - executive summary
Redditch: British Association for Parenteral and Enteral Nutrition.
NICE guidance 32 (February 2006): Nutrition Support in Adults
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(Institute for Health Care Improvement, 2003, http://www.ihi.org/knowledge/Pages/Tools/
PatientSafetyLeadershipWalkRounds.aspx)
Excellent care, healthy communities