2011 : 2012

04
05
06
07
08
Priority 1 – patient safety
10
Priority 2 – clinical effectiveness
12
Priority 3 – patient experience
13
Monitoring and reporting
14
14
Review of services
14
Participation in clinical audits
14
National audit
15
Reviewing reports of national clinical audits
16
Local audit
16
Reviewing reports of local clinical audit
18
Research
19
Performance and
Commissioning for Quality and Innovation (CQUIN)
19
Performance overview
20
Use of the Commissioning for Quality and Innovation payment framework
23
The value of Commissioning for Quality and Innovation payment
24
Care Quality Commission
(CQC) registration
24
Information governance and data quality
26
26
Benchmarking
27
27
Safeguarding
29
Incident management
30
Serious incidents
30
How do we compare regionally or nationally?
31
Medicines management
32
Infection prevention and control
34
Medical devices
34
Risk management
35
35
Leadership
36
Emergency preparedness
37
38
Promoting equality and inclusion
38
Workforce profile
39
NHS staff survey
40
Relationship with trade unions
41
Staff engagement
41
Learning and development
41
Sickness absence
42
Disabled employees
42
Leeds Approach and service redesign
43
Safety Express
44
46
Multidisciplinary working
47
Technology
48
48
Patient satisfaction survey
49
Overall satisfaction
49
Priority questions
50
Results of young people’s satisfaction survey
51
Compliments and complaints
52
Patient advice and liaison service
52
Patient, carer and public involvement
53
Actions to improve the quality of patient experience
54
55
58
List of services
59
How to comment on the
Quality Acccount

T his is our first Quality Account as an independent NHS trust and demonstrates the significant progress we have made in our first year. It outlines our general performance in terms of our main duties. We know we are defined by the quality of care that we deliver and make this our primary consideration. Our Quality
Account features our quality objectives, stories and case studies from our services and service users. We hope you will appreciate the balance of the more formal, required elements with the content about our staff, services and service users.
We have made good progress this year. We have used the views of our staff, patients and partners to shape our vision and direction as an organisation. This is focused on:
Working with people to deliver high quality care
- the majority of our service and quality targets have been delivered; patient satisfaction remains high; safety and incident reporting is strong; we have developed a Quality Strategy for 2012 – 2015 and have undergone assessments with the NHS Litigation Authority and Care Quality Commission – both with strong results.
Being a good partner - we have worked closely with health and social care, the voluntary and third sector, our patients and the public. New, joined up services are being developed; and in autumn 2011 we consulted with our partners and the public about our future proposals to become an NHS community foundation trust.
and are delegating more power to the front line. More is being done on staff sickness and training as our next priority.
Being a viable organisation that delivers value for money - we have created a new Board and governance infrastructure; progressed our plans to become an NHS community foundation trust; met our financial duties and delivered significant cost improvements this year.
All these achievements have only been possible due to the efforts of our staff, through working with our partners and by talking to the public. We are hugely grateful for the contribution you have all made to our organisation and we look forward to more partnership working in the future.
Looking after our staff - we have seen improvements overall in our staff survey; engaged more widely than ever before;
To the best of our knowledge we confirm that the information in this document is accurate.
[04] Quality Account
Neil Franklin
Chair
Rob Webster
Chief Executive
We will do this by:
Working with children, adults and families to deliver high quality care
Being a good partner
Developing and valuing our staff
Using our resources wisely and efficiently
W e want our services to have a positive impact on people’s lives. A clear vision binds us together with a clear set of values that determines how we behave and guides us to always do the right thing. Together, they underline the importance of developing a caring organisation.
Overall, we believe that we can provide a high quality service to our patients, deliver improved health outcomes and demonstrate best practice to our commissioners and stakeholders.
Leeds Community Healthcare NHS
Trust (LCH or ‘the trust’) provides a wide range of community and specialist healthcare services for adults and children. We work in
Our vision is underpinned by our values:
We are open and honest and do what we say we will
We treat everyone as an individual
We are continuously listening, learning and improving communities across Leeds, helping the city’s 798,800 residents stay healthy; live with a chronic condition; recover from illness or accidents; and at the end of life. We work to keep people in their homes and reduce the need for people to go into hospital.
We provide services that are very personal to each patient. This means they receive care that’s individual and tailored to them.
Our services include community nursing, health visiting, physiotherapy, podiatry, community paediatrics, occupational therapy, intermediate care, speech and language therapy, community dentistry, primary care mental health, smoking cessation, prison healthcare and sexual health services. We work in a variety of locations including health centres, clinics, patient’s homes, GP (general practitioner) practices, hospitals, schools, prisons and other non
NHS buildings such as children’s centres.
We provide services 24 hours a day and seven days a week.
We employ around 3,000 staff and spend around
£130m each year.
Quality Account [05]

Our
L ast year Leeds Community
Healthcare NHS Trust chose to publish a Quality Account for the first time. This year all community trusts are required to publish a Quality Account and we want to be able to show how our results compare to those of other trusts so you can see if we are better, worse or about the same as other providers. The tools to allow us to do this are currently in development at the Yorkshire and the Humber Quality Observatory and we look forward to using them in the near future.
For this Quality Account we will benchmark our results for 2011 /
12 against those of 2010 / 11 and where national standards apply e.g. regarding Safety, we will use the appropriate figures.
The Quality Account is part of an ongoing dialogue with patients and staff about improving quality of care. As an organisation, we recognise the need to understand what quality means to all service users and to adapt where necessary to ensure we are meeting expectations.
This report provides insight into what we have done and what we intend to do to improve quality of care in our services, but it is not the whole story. Another project looking at quality and what it means to individuals is currently underway and you will be able to track the progress on our Facebook page.
[06] Quality Account
Q uality means different things to different people. In the NHS the quality of our services is based on the three dimensions of quality first established by Lord Darzi in High Quality Care for All (Department of Health, 2009) – Patient Safety, Clinical
Effectiveness and Patient Experience. The Quality Model below shows the elements of quality as central to Leeds Community Healthcare NHS Trust practices and plans for the future.
The vision of Leeds Community Healthcare NHS
Trust is to provide the best possible care in every community in Leeds . Over the last year we have been developing a Quality Strategy for 2012 – 15 to support this vision. The strategy lays out our plans for the long term development of quality and we will report on our progress in future Quality Accounts.
The objectives for quality improvement identified in the new strategy reflect the priorities identified in the 2010
/ 11 Quality Account. Since our last Quality Account we have been regularly monitoring the quality of our services and performance against last year’s priorities in a number of ways:
Clinical
Effectiveness
Safety Experience
Quality, Innovation,
Productivity and
Prevention
Through our formal reporting and Board structures – quarterly quality reports are written by the executive (nursing) director of quality and received at the
Board; the Quality Governance and Risk committee regularly review safety information; the performance dashboard includes a range of quality measures which are reported to
Finance and Performance and the Board; the executive team undertake a programme of service visits.
Through feedback from patients – services complete monthly patient satisfaction survey; we monitor the themes of complaints; we regularly engage in public and patient involvement activities at a strategic level and in every service
From staff – staff complete an annual survey that informs service quality; we engage with staff on an industrial scale and staff incident reporting is very high
With commissioners – we regularly meet with commissioners to discuss
Commissioning for Quality and
Innovation (CQUIN) targets and contracting
The information gathered through this monitoring and the objectives from the new strategy have helped us identify the priorities for this year. To make sure that we have identified the right priorities we have also:
• Commissioned patient and public involvement work to collect the patient’s perspective
• Engaged with general managers and services about what is important to them
• Asked staff for feedback on what has gone well and what we need to do better.
• Considered the services’ integrated business plans
• Discussed our development with partner organisations
Our aspiration for next year is to achieve NHS community foundation trust status. Quality services are central to this. With this in mind, we have identified the following priorities all of which are equally important to our ongoing commitment to improve quality across all services.
Quality Account [07]

L ast year Leeds Community
Healthcare NHS Trust pledged to ensure that safety always comes first in our organisation. Building upon this pledge, our long term aim is to improve safety and reduce harm to patients.
Our objectives for 2012 / 13 are to effectively manage and reduce the risk of harm occurring to patients by maintaining a positive culture of incident reporting, incident management and evidence based harm reduction.
Some specific actions relating to these objectives are detailed opposite, alongside performance in meeting our objectives in 2011 / 12.
See Section 3 for further details of our work in 2011 / 12.
[08] Quality Account
Action
Safeguard adults
Achieved
2010 / 11
95% of staff were trained in safeguarding adults
Safeguard children
Protect people from harm and infection
Learning from incident investigations
(new action for 2012 / 13)
91% of staff were trained in safeguarding children
72% of staff updated their
Infection
Prevention and Control training n/a
Embed and maintain robust safety systems
NHSLA 1 – maintain level
1
Target 2011 / 12
100% of eligible staff to be trained or compliant in safeguarding adults
Achieved 2011 / 12
79% of staff are compliant with required level of safeguarding adults training
Maintain and improve the number of staff updating their training within year
Increase the number of staff completing infection prevention and control training update within year n/a
89% of staff are compliant with required level of safeguarding children training
84% of staff updated their
IPC training in 2011 / 12
Retain level 1 as an organisation in our own right
Projected outcome
2012 / 13
• 100% of all eligible and available staff will be trained or compliant in safeguarding adults
(new target for 2012
/ 13)
• 100% of all eligible and available clinical staff will be trained in and compliant with the Mental
Capacity Act
100% of all eligible and available staff will be trained or compliant in safeguarding children
Increase the number of staff with up to date IPC training within the next year to
90%
• Implement the LCH
Incident and Serious
Incident policy ensuring all incidents are investigated at the appropriate level.
• Specialist reviewers look at all incidents to identify learning and themes.
• Identify areas for change and recommendations to help minimise recurrence
Achieved level 1 registration with a high score (48 / 50)
• Improved processes to ensure action plans are completed
• All root cause analysis investigations have clear actions and deadlines
• Increased sharing of learning and themes through reports to general managers
Consider moving to level 2 subject to the business rationale being clear
In 2011 / 12 the percentage of staff trained in safeguarding adults and children has not reached the organisation’s target of 90%.
The trust has implemented a new e-learning system which should allow more staff to complete training in the coming year as they are no longer restricted by the times
/ locations of classroom sessions.
Please see section 3 for further information about safeguarding.
To make sure that we achieve our projected outcomes for 2012 /
13 some actions we need to take include:
Support and monitor staff attendance at statutory mandatory training
Work with staff to measure and proactively manage health care associated infections
Benchmark against National
Patient Safety Agency data and use the local quality framework to ensure services can demonstrate learning from incident and complaint management
We will measure these actions by monitoring our serious incident and incident reporting rates at a service level and strategically.
Quality Account [09]

L ast year Leeds Community Healthcare NHS Trust pledged to deliver the best possible care for patients. Our long term aim is to demonstrate our success in outcomes, backed by clinically effective interventions and better patient reported outcomes / experience.
1
Our first objective is to ensure all services develop
1 – 3 clinical outcome measures by 2012 / 2013.
An outcome measure is a tool used to assess change in a patient or patient’s circumstances over time.
They measure change in meaningful areas of a person’s life in a way that informs collaborative decisions about treatment.
This is derived from our strategic objective to measure our success in outcomes and to demonstrate clinical effectiveness and value for money. This goal is supported by commissioning targets for 2011 /
2012.
Some specific actions relating to this aim are detailed opposite (top) alongside our performance in
2011 / 12. See section 3 for more information on our successes in
20012 / 12.
[10] Quality Account
Action
Develop the use of
Outcomes
Based
Accountability
Develop the use of Patient
Reported
Outcome
Measures
Achieved
2010 / 11
Staff trained in Outcomes
Based
Accountability
Current Patient
Reported
Outcome
Measures relate to patient experience
Target 2011 / 12 Achieved 2011 / 12
Outcomes Based
Accountability embedded in the organisation as a tool to demonstrate population accountability and performance accountability
Outcomes Based
Accountability is being used in some children’s services and in some adult integration work
Patient Reported
Outcome Measures identified and reported on for nomination services
Patient Reported Outcome
Measures have been used in the long term condition team to meet
Commissioning for Quality and Innovation targets
Projected outcome
2012 / 13
Outcomes Based
Accountability embedded in the organisation with every service developing a outcome measure
Services to state where
Patient Reported
Outcome Measures contribute to the outcome measures for their services
2
Our second objective relates to staff and is to ensure that our staff are appropriately supported, developed and led to ensure our interventions are evidence based and clinically prioritised.
Some specific actions relating to this aim are detailed below alongside the actions and projected outcomes for
2012 / 13.
Action
Develop appropriate mechanisms for and promote the importance of clinical supervision to staff and offer training
Ensure all staff receive an appraisal
Achieved
2010 / 11
44% report that they participate in clinical supervision
69% of staff have an agreed appraisal within the last year
Target 2011 / 12 Achieved
2011 / 12
Increase percentage of staff who participate in clinical supervision
Quarter 3 figures show
67%.
Projected outcome 2012 / 13
Increase the number of staff engaging in clinical supervision to
90%
Implement a new leadership strategy
Development of peer review systems for services (new action for 2012 / 13)
The clinical and professional development strategy includes leadership objectives n/a
All staff to receive an appraisal
Increase the percentage of staff who have an agreed appraisal within the year to 90%
Development of a leadership strategy that promotes leadership at all levels of the organisation n/a
87% of staff have had an appraisal in
2011 / 12
(according to staff survey results)
Leadership strategy has been developed n/a
Increase the percentage of staff who have an appraisal within the year to 90%
Leadership mapped in every service in the organisation
All services have an agreed plan for the implementation of peer review
We will measure these actions through the quality framework and the workforce information to ensure that all staff are supported and developed. Developing outcome measures is part of our strategic plan and will be monitored through Board sub committees.
We will be answerable to our commissioners for the achievement of peer review in all our services.
Quality Account [11]

L ast year we pledged to deliver the best possible care for patients; see Section 3 for the results of work done in 2011 / 12. We wanted to ensure that patients felt involved and engaged in their own care and the future of our organisation as we work to become an NHS community foundation trust.
Our long term aim is to ensure that people using our services have the best possible experience.
Our objectives are to ensure all of our staff and services, listen to, report on and demonstrate learning from patient experience; and that our complaints, concerns, comments and compliments processes spread learning across the organisation.
The outcome should be that patients have a positive experience of health care in which they feel involved in the planning of their care. We aim to make every contact count.
If things do go wrong, patients should expect an apology, full explanation and resolution of the issue within agreed timescales. Some specific actions relating to these objectives are detailed opposite, alongside performance against 2011 /
12 targets.
In 2011 / 12, patient satisfaction with involvement in planning of care and the ability to contact staff fell and failed to meet the 95% target for satisfaction. We have looked carefully at the figures for each service to try and understand this. We know that there are high levels of dissatisfaction from prison services and we are working to address this.
[12] Quality Account
Action
Maintain high levels of performance and ensure that all patients are able to contact the staff and services easily
Ensure all patients feel involved in the planning of their care
Continuously improve our learning form comments, concerns, complaints and compliments
Develop an engagement network of patients
/ service users, carers, public and stakeholders as a precursor to full membership
Achieved
2010 / 11
86% of patients who completed our patient satisfaction survey felt they could do this
89% of patients feel they are involved at present
High levels of assurance from internal audit that systems are effective
Target 2011 / 12
Increase the percentage of people who feel able to contact the services they need easily, particularly in groups that find it difficult to access care
Increase the percentage if patients who feel involved in the planning of their care of treatment
Further develop the process for combining all forms of feedback and relating these to learning and service improvement
Patient and public involvement strategy in place with high assurance from
National Institute for Health and Clinical
Excellence
Develop a comprehensive
Membership strategy that delivers on NHS community foundation trust requirements, our commitment to engage with the community and to actively engage patients / service users
Achieved
2011 / 12
Projected outcome
2012 / 13
86% of respondents about adult services and 87% of respondents about children’s services felt staff were easy to contact
Improvement on percentage of patients who report being able to reach required services easily
87% of respondents about adult services and 88% of respondents about children’s services felt they had been involved in the planning of their care
New systems in place to ensure services receive timely feedback on complaints and that complaints information is considered with incident information
A comprehensive membership strategy is developed along with a membership recruitment plan
Improvement on percentage of patients who report being involved in their care
All complaints responded to within the agreed timeframe.
Benchmark our complaint achievement with other similar organisations
Sufficient members recruited by target dates
We will measure these actions through ‘back to the floor’ visits by the executive team; the local quality framework quarterly returns; performance reviews; quality trend analysis and monthly analysis of patient satisfaction, complaints and compliments.
Smart measures include our performance matrix to maintain and improve on our overall satisfaction level of 95% for adult services and
96% for children’s services and to improve the percentage of survey respondents who feel involved in the planning of their care.
T he priorities and actions identified in the Quality Account will be reported and monitored through a number of different routes.
Some will be included in our balanced scorecard that is reviewed on a monthly basis by the Finance and Performance committee. Other priorities and actions will be reported on every two months to either the Safety and Experience Group or the Quality Governance and Risk committee. All of these committees report into our Board meetings.
Reporting and monitoring in this way ensures that the priorities and actions remain aligned to our strategic objectives and our business plan. We will also communicate with staff how services are performing through quarterly quality reports to general managers.
Quality Account [13]

D uring 2011 / 12 Leeds Community
Healthcare NHS Trust provided and / or subcontracted 65 NHS services. The trust has reviewed all the data available to them on the quality of care in 65 of these NHS services.
The income generated by the NHS services reviewed in 2011 / 12 represents 100% of the total income generated from the provision of
NHS services by Leeds Community Healthcare
NHS Trust for 2011 / 12.
D uring 2011 / 12 nine national clinical audits and one national confidential enquiry covered NHS services that Leeds Community
Healthcare NHS Trust provides. During that period
LCH participated in four (44%) of the national clinical audits and one national confidential enquiry which it was eligible to participate in.
The national clinical audits and national confidential enquiries that Leeds Community Healthcare NHS Trust was eligible to participate in during 2011 / 12 are as follows:
Adult asthma
Bronchiectasis
Chronic obstructive pulmonary disease
Adult diabetes
Chronic Pain (National Pain Audit)
Epilepsy 12 (Royal College of Paediatrics and Child
Health National Childhood Epilepsy Audit)
Parkinson’s disease (National Parkinson’s Audit)
Stroke (National Audit Programme)
Falls and non-hip fractures (National Falls and Bone
Health Audit)
National confidential enquiries:
National Confidential Inquiry into Suicide and
Homicide by People with Mental Illness
The national clinical audits and national confidential enquiry that Leeds Community Healthcare NHS
Trust participated in, and for which data collection was completed during 2011 / 12, are listed below.
The number of cases submitted to each audit as a percentage of the number of registered cases required by the terms of that audit or enquiry is also listed.
National clinical audits Cases submitted Cases required
Chronic Pain (National Pain Audit)
Falls and non-hip fractures (National Falls and
Bone Health Audit)
25
68
Parkinson’s disease (National Parkinson’s audit) 32
25
Number determined by each trust
20 (median)
%
100 n/a
National confidential enquiries
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness
Cases submitted Cases required
As required * n/a
% n/a
*The enquiry team contact Child and Adolescent Mental Health services on a case by case basis to enquire whether the individual has been under the care of the service. The information is supplied and no further action is taken.
[14] Quality Account
The report of one national clinical audit was reviewed by the provider in 2011 / 12. Leeds Community Healthcare NHS Trust intends to take the following actions to improve the quality of healthcare provided:
National clinical audit
Falls and non-hip fractures
(National
Falls and
Bone Health
Audit)
LCH action
• Primary care colleagues to be included in the next audit
• Falls assessment tool to be revised to include specific medication questions identified in the audit
• Tier II assessment to include an assessment of need for referral for electrocardiogram (ECG)
• Validated screening assessment of cognitive function tool to be developed and rolled out across all services
• List of practices with DXA bone density scanners to circulated to Tier II falls assessors
• Training delivered to LCH Tier II falls assessors October – November 2011
As part of the action plan for
2010 / 11 it was agreed that national clinical audits for 2011 /
12 would be shared with services. This was achieved through sharing the list at the organisational audit workshop on 15 July 2011. A process was also agreed on how we would share the list for 2012 / 13 and this has been written into the organisational
Clinical Audit policy.
Quality Account [15]

All teams and services complete an annual documentation audit. Year on year results are measured to demonstrate improvements and highlight areas for development. Some of standards requiring action across the vast majority of services are listed below:
Recording next planned intervention on care plans
Entries are not timed
Completing initial contact sheet
Signing and dating alterations
Each service / team has devised an action plan in response to the documentation audit.
Recording ethnicity
Recording next of kin
Marking records as confidential
Entering patient’s full name and NHS number on every page
Recording communication requirements
Providing patients with details on information sharing
The reports of 13 local clinical audits were reviewed by Leeds Community Healthcare NHS Trust in 2011
/ 12 and we intend to take the following actions to improve the quality of healthcare provided:
Local clinical audit
Annual documentation audit
LCH action
• Services to ensure feedback given to teams and individuals
• Teams to ensure action plans are developed to improve adherence to standards
• Individual documentation to be reviewed as part of the appraisal process
• The annual documentation audit should incorporate a check between entries in electronic records and entries in patient held records
Podiatry Central Sterile
Supplies department – tote boxes
Paediatric physiotherapy
– clinical supervision
• Re-enforcement of standard operating procedure for the removal of blade
• Re-audit through Datix® incident reporting
• Increase the number and accessibility of supervisors in the service
• Improve record keeping processes
• Re-audit September 2013
Intensive Family Support service – common assessment paperwork
Musculoskeletal Service
– lower back pain audit of clinical coding
Overseas Travel Clinic – cold chain audit
• When completing an assessment on families (common assessment tool) please remember to include carer’s / parents own perceived needs
• Complete common internal record assessment on all families including where child protection plan is in place
• Feedback results emphasise the requirements
• Re-audit 2012
Intermediate Care team
– care planning
• Training in how to download and interpret data from the data logger
• Re-audit October 2012
• Patient involvement to be captured via appropriate systems and feedback to teams
• Expected standards of practice for care planning meetings to be developed and rolled out
• All patients should have an identified key worker to ensure that the action plan identified in the integrated health care records is being met and that the team base are using agreed systems
• Re-audit in 2012
[16] Quality Account
Local clinical audit
Community matrons – workload audit
Paediatric Occupational
Therapy – outcomes
LCH action
• Messages about recording on SystmOne to be shared across the service and the rest of the organisation
• All ‘lost activity’ should be reported to the service manager on a monthly basis, so that anomalies can be identified, addressed and communicated to the team to ensure best practice
• The updated best practice guides produced by the SystmOne team should be circulated across all services
• The annual documentation audit should incorporate a check between
SystmOne entry and patient held record
• Feedback to team provided in January team meeting
• To re-audit in August 2012
• From February, referrals to groups will not be put into action unless goals are in electronic file. Relevant staff to be notified if goals are missing
• SystmOne training conducted on 11 January 2012 for team to revise how to use goal bank, and how to input goals correctly
• Devise a visual postural care plan template
• Training to all staff on new template
• Generic assessment checklist to be devised to ensure all aspects covered
Paediatric Occupational
Therapy and
Physiotherapy joint audit – postural care pathway
Child and Adolescent
Mental Health services – self harm
• Young person should be admitted to ward overnight; where exceptions to this occur, the reasons should be documented
• Young people should be seen with a responsible adult; where exceptions to this occur, the reasons should be documented
• Account from ward staff should be sought and documented
• Clinical correspondence should be copied to patient / family as appropriate; where exceptions to this occur, the reasons should be documented
• The repeat self harm protocol should be initiated if a young person presents following 3 episodes of self harm in a 6 month period. This could be documented on CareNotes as an alert for clarity
• Following assessment, letters should be available on CareNotes
• Re-audit 2013
• Feedback results to the team
• Implement training on required standards
• Re-audit 2012
Intermediate Care team
– nutritional assessments on Community
Intermediate Care Unit
Nutrition and Dietetics
– adult team under nutrition
• Change to exit criteria to make dietetic outcomes clearer. All exit criteria should be related to oral intake and weight
• Discuss methods of increasing adherence NICE guidance standard
• Feedback the results to practitioners and triage team
• Promote malnutrition screening within the community
• Training of healthcare professionals to use a validated screening tool
• Promotion of existing training packages including Food for Life and SAFER
• Re-audit December 2013
Quality Account [17]

T he number of patients receiving NHS services provided or sub-contracted by Leeds Community Healthcare
NHS Trust in 2011 / 12 that were recruited during that period to participate in research approved by a research ethics committee are included in the 627 patients recruited to research by NHS
Airedale, Bradford and Leeds
(formally known as NHS Leeds).
The trust conducted 34 clinical research studies in various medical specialities, for example, child and adolescent mental health services
(CAMHS), children’s services, prison setting, tissue viability, long term conditions and Primary
Care Mental Health during 2011
/ 12. The improvement in patient health outcomes in areas such as prison and tissue viability have already shown that a commitment to clinical research leads to better treatments for patients by patient feedback or the development of more robust evidence-based healthcare.
There were 26 staff members participating in research approved by the trust and having full research governance approval during 2011 / 12.
In the last three years, nine publications or conference presentations have resulted from our involvement in National
Institute for Health Research
(NIHR) research. This shows our commitment to transparency and desire to improve patient outcomes and experience across the NHS.
Over the last 12 months, the trust‘s involvement in portfolio research has increased.
We are the lead NHS organisation for a major
NIHR programme grant for a research study Managing
Pain in Prison with the prison clinical director as one of the co-applicants. The study will look into how pain is perceived by people within the prison setting to determine the best way for services to meet patient needs and to develop systems to manage this information. We are currently waiting for the result of two National Institute for Health
Research, research for patient benefit applications. Both projects will take place in the prison setting.
[18] Quality Account
The Tissue Viability team continues to participate in a major National Institute for
Health Research wounds care programme and the Primary Care Mental Health team has been awarded Department of Health flexibility and sustainability funding to prepare NIHR grant applications.
We currently have 57 studies which are active. This is an increase from last year and we had 13 studies in total which ended throughout the last year. The dissemination of research into the trust is an area which needs more development work and this forms part of the research strategy work plan.
2
T he services provided by LCH are monitored locally and at a national level. This is undertaken through a series of performance indicators such as waiting times for treatments and diagnostic procedures. We also have set quality standards, including the rate of infections associated with healthcare and key public health targets, such as smoking cessation and breast feeding.
LCH is performing well against both the national and local targets. Some of the highlights for 2011 / 2012 are outlined as follows:
As part of the drive to eliminate waits, the overall number of patients seen within 18 weeks from initial referral to treatment continues to be over
95% with 95% of our patients on an 18 week pathway being treated within 9 weeks
All patients with long term conditions have a personalised care plan
Quality Account [19]

All patients admitted to our in-patient units are assessed with regard to their nutritional need and their risk of developing a pressure ulcer
We have had no Methicillin-resistant
Staphylococcus aureus (MRSA) cases and only one
Clostridium difficile case attributable to LCH
98% of mothers are assessed as to whether they are continuing to breast feed at 6 weeks - 47% are continuing to breastfeed
4,627 people supported to give up smoking and we have the highest quit rate in the country 2
All eligible in-patients received appropriate screening for pressure ulcers, nutritional assessment and falls risk
Over 90% of looked after children received a health needs assessment within the 21 day target
2 Reported data as at April 2012 for the NHS Leeds
Stop Smoking Service
The trust achieved its target of 130.5 whole time equivalent health visitors at 31 March
The trust delivered these achievements whilst managing an increase in referrals of over 10% and an increase in face-to-face contacts of over 8%
Looking forward to 2012 / 13 the trust aims to maintain its high performance standards. We will seek to improve on the numbers of mothers who continue to breast feed at six weeks
and to improve the numbers of people who express a preference as to their place of death and are
able to die at that place.
Almost £1.5m of the trust’s income in 2011
/ 12 was conditional on achieving quality improvement and innovation goals for our services. These goals were agreed between LCH and any person or body with whom we entered into a contract, agreement or arrangement for the provision of NHS services, through the
Commissioning for Quality and Innovation payment framework. The trust was paid in full for its achievement of these quality goals.
Further details of the agreed goals for 2011 /
12 and for the following 12 month period are available on the following page.
In 2012 / 13 income from Commissioning for
Quality and Innovation payments is up to £2.4m across the following quality targets:
Patient safety thermometer
Venous thromboembolism risk assessment
Dementia risk assessment and diagnosis
Looked after children health needs assessment
Development of peer review
Making every contact count
[20] Quality Account
The table below details our Commissioning for Quality and Innovation (CQUIN) targets agreed in 2010 / 11 with the commissioners and our performance against those targets.
CQUIN indicator
Improving the quality of palliative care
Rationale
Patients and carers will be able to expect the highest possible standards of end of life care
Target
90% of patients will have the opportunity to die in their preferred place of care
(2% tolerance) n/a 3 Use of Common
Assessment Framework for vulnerable children
Level of child protection supervision given to level 3 staff that has regular contact with children, young people and parents.
(level 3 as defined in safeguarding children and young people
Improve safeguarding of vulnerable children
‘Effective communication is important to promoting good standards of practice and to support individual staff members.’ ( Working Together to
Safeguard Children , DH 2006)
We would like to know the number of staff who are in regular contact with children, young people and parents who have had child protection supervision
Nutritional assessment Use of a validated nutritional indicator screening tool to reduce rates of malnutrition and associated adverse outcomes
85%
Pressure ulcers Improve pressure ulcer prevention and management
98% for nutritional screening on admission
98% plans in place following screening
98% reassessed prior to discharge
98% have pressure ulcer screening
98% assessed as at risk have management plan in place
98% of patients with grade
II ulcers and above to have incident forms completed
98% root cause analysis of pressure ulcers with NICE
Category IV and above
Actual
88.2%
44.1%
94%
99.6%
100%
100%
99.6%
100%
100%
100%
Reduction in ‘did not attend’ (DNA) appointments
Reduction in sickness absence in the nursing and midwifery workforce
Falls risk assessment
An appointment lost as a result of patients not attending without prior notice results in wasted resources and has an impact on other patients
Reduced sickness absence results in increased continuity of staff which leads to increased continuity of care and has a positive impact on the experience of patients and their relatives
All patients should be assessed for risk of falls to enable appropriate care planning and help reduce harm
6% or below
Reduction of 0.5% sickness absence overall compared to
2010 / 11
98% assessed within 24 hours of admission
98% level 2 assessment completed
98% have an appropriate care plan in place
5%
5.6%
100%
100%
100%
3 Improvements trends rather than actual targets were set for these indicators
Quality Account [21]

CQUIN indicator
Annual health assessments for looked after children
Attendance at case conferences
Neighbourhood teams and risk-stratification
Patient experience – long term conditions
Implementation of recording systems
Rationale
Looked after children are required to have an annual health needs assessment by a school nurse or health visitor
Improve safeguarding of vulnerable children
Structured stratification of risk and generic patient-centred proactive management of patients though integrated primary and community provision is identified as key to effective management of patients with long term conditions by the
Department of Health long term condition Quality Innovation
Productivity and Prevention (QIPP) programme
Patients with long-term conditions should feel supported in managing their condition.
Recent survey results show that there is opportunity to increase the number of patients who report that they felt supported in managing their condition
Work has taken place to assess the risk of patient falls and pressure ulcer development in in-patient areas. NHS Airedale,
Bradford and Leeds (formally
NHS Leeds) wishes to support the introduction of appropriate measurements for pressure ulcers and patient falls in the wider community
Target
87%
96%
1. Formation neighbourhood teams for all demonstrator sites with partners
2. 50% of community matron caseloads identified by riskstratification by practices utilising predictive modelling.
3. Joint plan with commissioners of how community matron provision will be distributed
Provider survey shows achievement of 58% or greater patients with long-term conditions saying that they are satisfied with the service they receive
Report outlining work programme for implementation of recording systems of falls risk assessment and pressure ulcer incidence
/ severity for patients under the care of the
Infection Prevention and
Control team.
Report to include proposed milestones for quarters 2, 3 and 4
Actual
93.8%
98.5%
Progress made to plan as part of integration work with
Clinical
Commissioning
Groups and the local authority
Progress made to plan
100%
[22] Quality Account
This year, 5 of the Commissioning for Quality and Innovation indicators have included making quality improvements along pathways of care and with partner organisations. By maintaining an ongoing dialogue with commissioners and our commitment to quality improvement we are seeking to reduce the impact of those health inequalities and the risks associated with them.
We know the vast majority of people approaching end of life would prefer not to die in hospital. This year we supported 88.2% of end of life patients to die in their preferred place of care.
This is an improvement of approximately 2.7% on last year and compares well to other NHS organisations nationally.
In 2012 / 13 a number of initiatives are likely to further support patients to be cared for in their preferred place of care.
The creation of new roles focused on supporting discharge from hospital at the end of life
A rapid discharge pathway for patients in the last days and hours of life is being developed to support discharging patients from hospital to their usual place of residence the same day or within
48 hours
A project aiming to improve sharing of information about patients’ wishes and preferences for end of life care, including their preferred place of care, is underway.
Next year we aim to achieve NHS community foundation trust status.
In line with this objective, the trust desires to be transparent and the requirements of Monitor (The
Independent Regulatory of NHS
Foundation Trusts) the value of the
Commissioning for Quality and
Innovation payment to the trust in
2011 / 12 was £1,453,162.
Quality Account [23]

L eeds Community Healthcare NHS Trust is required to register with the Care Quality
Commission and provide evidence that it meets the expected standards. The trust’s current
Commission or have participated in any special reviews or investigations during 2011 / 12.
During the year, the Care Quality Commission registration status is full unconditional registration.
The Care Quality Commission has not taken enforcement action against Leeds Community
Healthcare NHS Trust during 2011 / 12 and we are not subject to periodic reviews by the Care Quality conducted an unannounced inspection of the
Community Rehabilitation Unit and a planned inspection at HMP Wealstun. We were delighted to receive very good reports showing full compliance for both sites with a small amount of work required to improve sink facilities in one area at HMP Wealstun.
I nformation governance and data quality are important to us. The trust continues to believe that data quality is fundamental to maintaining and improving performance in the organisation.
Action for 2011 / 12
Continue regular data quality meetings with partner organisations
Outcome 2011 / 12
Data quality is discussed as part of the pan Leeds Informatics Board agenda.
The Board has members representing
LCH, Leeds Teaching Hospitals NHS
Trust, Leeds and York Partnerships NHS
Foundation Trust and Leeds City Council.
The trust’s Information
Governance Assessment report overall score for 2011 / 12 was 81% and was graded satisfactory.
In the 2010 / 11 Quality
Account, the trust committed to the following actions in order to improve data quality:
Continue to be an active member of the pan
Leeds data quality group
Continue to build on the adoption of our new clinical IT system,
SystmOne, for data collection, analysis and intelligence
This group was run by NHS Airedale,
Bradford and Leeds but was disbanded in 2011 / 12. Currently there is no group dealing exclusively with data quality issues at a Leeds-wide level; however data quality is intrinsic to the success of the initiatives being led by the
Informatics Board.
SystmOne has been rolled out to almost all appropriate services. We have further increased our reporting capability through the development of our data warehouse
In addition to the actions listed in the Quality Account 2011 / 10, the trust has also taken the following actions to improve data quality:
Renewed sharing arrangements with social care
Commenced the implementation of mobile working technologies
Carried out an independent review of data recording and reporting
Worked closely with community matrons to support accurate reporting
Embedded data quality as a measure for the Board to regularly review
[24] Quality Account
Moving forward, we will be taking the following actions to improve data quality:
Action for 2012 / 13
Specific pieces of project work with clinical services to check that ‘end to end’ processes are robust to provide assurance that all data is recorded by clinicians and that it is subsequently processed and reported accurately
Building data quality measures, such as NHS number completeness into the performance matrix which is reported to the
Finance and Performance committee on a monthly basis
Validation exercises on data captured by clinical services, for example scrutiny of waiting lists
Proposed outcome 2012 / 13
Following the success of the exercise with community matrons, we will conduct a similar data quality exercise with long term condition services
Data quality measures identified and adopted
A waiting list validation exercise is due to complete by the end of
March 2012 and will be reported in the 2012 / 13 Quality Account
Continued implementation of mobile working technologies, to support flexible access to patient information
Mobile technologies available in services such as Leeds children’s continuing care team short breaks, children’s therapies, health visitors, sickle cell, Watch
It, family nurse partnership, musculoskeletal, continence, urology and colorectal service, looked after children and podiatry
Leeds Community Healthcare 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. A plan is in place to start collecting Secondary Uses data for outpatients in the first quarter of 2012 / 13. Inpatient data submissions will be possible when a suitable system has been procured.
Leeds Community Healthcare NHS Trust was not subject to the payment by results clinical coding audit during 2011 /
12 by the Audit Commission.
Quality Account [25]

T o be clear about areas that the outcome measures relate to the Department of Health published the NHS Outcomes Framework. This identifies five areas called domains for health services to be measured against. The domains are:
I t is important to demonstrate not only what we have achieved but also how our performance compares to other similar services. We will do this throughout the report by: Domain 1: Preventing people from dying prematurely
Domain 2: Enhancing quality of life for people with long-term conditions
Domain 3: Helping people to recover from episodes of ill health or following injury
Domain 4: Ensuring that people have a positive experience of care
Domain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm
Comparing with how we did last year
Comparing with national statistics where available
Comparing with similar services where available.
The Yorkshire and the Humber Quality Observatory is currently working to create a tool that will allow us to show how we are doing in comparison to other community NHS trusts. We look forward to using the community benchmarking tool when it is available.
Domains 1 to 3 include outcomes that relate to the effectiveness of care, domain four includes outcomes that relate to the quality of the patient experience and domain five includes outcomes that relate to patient safety.
To show how our services have contributed to these outcomes and the health of people in Leeds, we will refer to then as they relate to the three dimensions of quality; safety, experience and effectiveness.
[26] Quality Account
The NHS Outcomes Framework domain relating to patient safety is Domain 5 (opposite).
Some of our achievements this year that have kept our patients and staff safe include:
Launching a risk management strategy and revising our risk register
Implementing Datix® managements system for reporting of incidents and complaints
Continued our focus on safeguarding and infection prevention and control
Retained out NHS Litigation Authority level 1 accreditation
A ny member of staff or volunteers who have direct or in-direct contact with children and families must undertake statutory safeguarding children training. It is a requirement that the training is updated every three years. There is no national target for compliance however the trust aims to achieve
Through partnership working, a framework for initial child protection conferences has been developed. This takes a more solution focused approach and reports are shared with all parties including parents prior to the conference.
90% compliance rate. This includes those who require initial or refresher training and those who are compliant but do not require training.
At the end of March 2012 89% of LCH staff were recorded as compliant and have received some
safeguarding children training within the last three years.
Following our most recent Ofsted
(the official body for inspecting schools) inspection and in light of Care Quality Commission recommendations, the trust has carried out an evaluation of child protection supervision.
This has included a review of the child protection supervision policy which will be re-written towards the end of 2012. The policy will take into account the recommendations of the new
Working Together guidance to be published by the Department for
Education in late 2012.
A child safeguarding training strategy has been developed which includes a flowchart highlighting training needs for different staff groups. The aim is to clarify competency requirements ensuring staff access the correct level of training. Level
1 and 2 training is now accessed via a national e-learning package.
Quality Account [27]

T here is an ongoing commitment from the trust to strengthen work around safeguarding adults at risk and assessing the mental capacity of the population of
Leeds who come into contact with our services. In 2011 / 12 a named nurse was identified to take a lead role in Mental Capacity Act and
Deprivation of Liberty safeguards.
The nurse has worked closely with
NHS Airedale, Bradford and Leeds to develop a training and support programme for champions from clinical teams across the organisation.
The trust has developed a strategy for adult safeguarding including the production of an annual work plan. This work plan consists of
10 separate work streams and will be monitored by a monthly operational group.
Moving into 2012 we have taken the opportunity to integrate adult and child safeguarding by creating a single team with one head of service. In recognition of the growing needs of adults at
In light of changes to the
Leeds multi agency policies and procedures, and changes in terminology, LCH reviewed its operational policies and introduced a reporting and recording flowchart.
The mandatory training programme for clinicians now includes safeguarding alerter
(level 1) and Mental Capacity Act training. Compliance is achieved through e-learning packages. As an organisation the trust has set a compliance target of 90% and is working hard to achieve this. In
2011 / 12 87% of our clinical staff were compliant with safeguarding adults training. The organisation as a whole achieved 79% compliance.
This will be addressed this year.
risk, we have increased resources assigned to adult safeguarding.
Structures and roles within child safeguarding are now mirrored for adult services, bringing Mental
Capacity Act and Deprivations of
Liberty safeguards under the same umbrella. We recognise that there is still work to do regarding adult safeguarding, but we hope we can learn from our colleagues in child safeguarding and explore new and innovative ways of working.
[28] Quality Account
L eeds Community Healthcare
NHS Trust is committed to the delivery of a safety culture in which all of our employees proactively identify, assess, report and manage risk. Any incident resulting in an unintended or unexpected event that could have led to or did lead to harm or damage, must be reported. This enables us to learn from incidents and serious incidents, to control risks and improve safety.
Reporting and Learning System so that we can contribute to and learn nationally. It also enables storage of evidence to support compliance with the Care Quality Commission’s
Essential Standards for Quality and Safety .
This has supported us to develop a comprehensive quarterly quality report which outlines trends in all aspects of patient safety activity for example the number of patient
/ staff safety incidents.
We have a systematic approach to incident reporting, which enables us to investigate incidents effectively, to review practice and to identify trends and patterns.
It enables the quick detection and resolution of any problems resulting from inadequate procedures, lack of training, or pressure of work.
Last year we established a new safety team within the trust with the specific responsibility for the management of the incident / serious incident process, health and safety, risk management and clinical software.
The chart below shows that in
2011 / 12 staff reported 4,549 incidents of which 73% resulted in no harm.
The total number of incidents reported has increased by 353 on last year. The trust commends its staff for ensuring that all accidents, incidents, and near misses are reported so that we can learn from such incidents and identify early trends. This helps the organisation to strive to improve standards of care in order to minimise patient safety issues.
We purchased Datix® for our organisation and successfully implemented the web based incident reporting management system. This links to the National
The trust continues to be one of the top trusts in the region for reporting incidents. The National Patient
Safety Association recognises that high reporting is a mark of a ‘high reliability’ organisation. Research
Number of incidents reported quarterly over a three year period 2009 – 2012
1300
1200
1100
1000
900
800
700
600
Quarter 1 Quarter 2 Quarter 3 Quarter 4
Quarter
2009 / 10 2010 / 11 2011 / 12 shows that trusts with significantly higher levels of incident reporting are more likely to demonstrate other features of a stronger safety culture.
During 2011 / 12 the trust has developed and issued thirteen learning from patient safety memos.
These are written following one off incidents or as a result of a developing trend of incidents and enable other staff to learn from and reduce the risk of reoccurrence.
A routine review of incidents involving medication highlighted that a number of patients missed insulin administration visits by the district nursing service between April and
June 2011. A number of actions were put in place to address this including a detailed survey of the 192 patients in receipt of daily visits for the administration of insulin; a review of the systems, processes and standard operating procedures for allocating visits within neighbourhood teams, and individual patient reviews by the
Community Diabetes service. As a result of these actions, the number of reported occurrences of missed insulin administration visits has fallen from 13 in quarter 1 (April - June 2011) to 3 in quarter 4 (January to
27 February 2012).
Quality Account [29]

L eeds Community Healthcare
NHS Trust Board of Directors is informed of those incidents that meet the criteria set out in the NHS North of England and the trust’s Incident and Serious Incidents policy as being serious and warrant reporting to our commissioners and
NHS North of England.
During 2011 / 12 5 serious incidents were reported to the Board. This compares to 5 in 2010 / 11, 12 in
2009 / 10, and 23 in 2008 / 09 as shown in the graph opposite.
Number of serious incidents reported quarterly over a five year period 2007 – 2012
12
10
8
6
4
2
0
Quarter 1 Quarter 2 Quarter 3 Quarter 4
Quarter
2007 / 08 2008 / 09 2009 / 10 2010 / 11 2011 / 12
T he National Reporting and Learning
System has provided an overview of patient safety incidents reported by our organisation between 1 April and 30
September 2011. Comparative reporting rates between our organisation and 19 other primary care organisations with inpatient provision within this time period, identifies we are one of the top three reporters. 73% of our incidents resulted in no harm to the patient, compared to 68% nationally which reflects our proactive safety culture.
We have been able to reduce the number of serious incidents reporting year on year by developing a safety culture where incident reporting is high. This has enabled learning from incidents before they become serious and has made the services we provide safer. We will ensure that we continue to improve the safety culture within our organisation to further build on this success.
[30] Quality Account
W e see many of our patients in their own home and this can often include supporting them with their medication. Last year we
reduced the paperwork for medicine management on our inpatient unit The intermediate care service identified that the number by 57% to release clinical time. This year we have achieved the same for of time consuming documents needed completing to support patients to take their medication. This caused our intermediate care teams reducing the documentation from eight forms to two documents.
confusion amongst staff and increased the risk of errors occurring. A focus group of staff redesigned new
medication documentation (reducing the previous eight separate forms into two documents) and tested it out over the autumn / winter. As a result of the new paperwork, staff can focus their time on patient care, the possibility of errors occurring has been reduced and the quality of the information recorded has improved.
Often when caring for people in their own homes we need to work closely with other organisations or take over care from other organisations. This year our staff highlighted a number of issues relating to medicines management for people that are unable to swallow. Working closely with our partner organisations we have successfully implemented a standardised approach to ensure that patients remain safe on discharge form hospital.
A number of issues were raised by staff regarding the administration of medicines for patients who can’t swallow. As a result, a focus group representing a range of services (both adults and children) and colleagues from Leeds Teaching Hospitals NHS Trust met during
2011 to develop best practice guidance to support the administration of crushed medication. The guidance includes the process for gaining authorisation from the prescriber of the medication and a checklist to ensure that medicines that cannot be crushed are not inadvertently given to patients in this way.
A standardised approach across services and on discharge from hospital will help support more patients to get the most out of their medicines, whilst ensuring that prescribing is cost-effective.
Quality Account [31]

D uring 2011 / 12 Leeds
Community Healthcare NHS
Trust has been committed to reducing the number of healthcare associated infections by fostering an organisationally driven zero tolerance approach to these incidents.
The focus for improvement this year was communication and integrated working between the
Infection Prevention and Control team and internal and external stakeholders. The aim of this was to foster closer working relationships and networks.
From July the community
Infection Prevention and Control team has been able to access local laboratory (microbiology) results via an information technology system. This project has enabled the Infection
Prevention and Control team to monitor all community patients with specific organisms e.g. Methicillin-resistant
Staphylococcus aureus (MRSA) and ensure that the appropriate infection prevention and control measures and treatment regimes are implemented to enable individual personalised care.
The programme has improved communication between care teams and specialist services and anecdotally contributed to a reduction in the number of community related MRSA bacteraemia incidents.
A detailed review of Methicillinresistant Staphylococcus aureus
(MRSA) bacteraemia cases undertaken during the previous year (2010 / 11) identified that the presence of an indwelling urinary catheter as one of the primary root causes or contributing factors for the development of an Methicillinresistant Staphylococcus aureus bacteraemia. Work has been undertaken in association with the Community Urology and
Colorectal service to reduce the infection risks associated with these devices and includes initiatives such as:
Development of a catheter risk assessment tool
Guideline for managing patients with a catheter at high risk of developing an infection
The production of a short video outlining risk reduction strategies for catheter management
Highlighting catheter associated risks during IPC training sessions
From 1 April 2011 to 31 March
2012 there have been no cases of
Methicillin-resistant Staphylococcus aureus bacteraemia where the root cause is directly linked to the presence of a urinary catheter. As shown in the graph below, the number of MRSA bacteraemia episodes attributed directly to LCH involvement has also reduced, with no cases being identified during this period.
Number of cases of MRSA infections related to catheters
10
8
6
4
18
16
14
12
2
0
17
15
13
1
2 0
2009 / 10 2010 / 11 2011 / 12
Year
LCH attributable Not LCH attributable
[32] Quality Account
Number of cases of Clostridium difficile (C diff) in the community health economy
250
200
150
100
50
0
153
160
193
7 0 1
2009 / 10 2010 / 11 2011 / 12
Year
LCH attributable Not LCH attributable
The chart opposite shows the number of Clostridium difficile (C diff) infections within the community health economy over the last three years. There was a general rise in the number of cases identified within the wider healthcare economy.
There are a number of reasons for this increase and work has been undertaken in collaboration with Leeds Teaching Hospitals NHS Trust and other partner agencies to develop measures to reduce future numbers.
The Infection Prevention and Control team undertakes route cause analysis reviews of all Methicillinresistant Staphylococcus aureus bacteraemia (MRSA) cases that are identified within 48 hours of admission to hospital. The learning from the route cause analysis is shared with community health services. This learning enabled the district nursing team at Chapeltown Health
Centre to demonstrate excellent practice in the care of a patient with multiple MRSA risk factors. In particular their risk assessment, management processes and standard of documentation was commended.
Throughout the year the Infection
More recently this learning enabled an intermediate care nurse to act promptly when she recognised the signs of infection in an elderly patient she was visiting. Her actions ensured that the patient was able to receive lifesaving treatment.
Prevention and Control team has further aligned itself to the clinical teams within
LCH and as a result has become a more visible and proactive service. Within the wider health economy a determination to work more collaboratively with secondary care and care home partners has led to a more integrated approach to the prevention and control of healthcare associated infections.
Quality Account [33]

T he Medicines and
Healthcare Products
Regulatory Agency and the National Patient Safety
Agency issue notices about the safety of equipment and devices following notification of incidents. LCH has a robust system in place to establish whether we use any of the equipment identified or if we could have issued it to any patients. The relevant services are then asked to check any equipment they have and take the specified action, reporting back when they have done so.
During 2011 / 12, the trust received 99 medical device alerts which is an increase on the 77 received in 2010 / 11.
All alerts were responded to within the appropriate time frame. Of the alerts received,
30 (30.3%) required action and 69 (69.7%) were not applicable to LCH.
In 2012 / 2013 we plan to improve our systems for recording what equipment staff use by implementing new risk management software. This will allow us to keep up to date information on our equipment including when it needs servicing, which staff groups are able to use it and what level of training they require. It will also allow us to monitor and link incidents to equipment and safety alerts, increasing patient and staff safety.
[34] Quality Account
A revised Risk Management strategy was launched in November
2011 as part of our proactive approach to safety. The aim of the strategy was to identify how LCH will identify, assess and manage the risks associated with providing healthcare.
“Leeds Community Healthcare’s risk strategy aims to create a safety culture in which all employees proactively identify, assess, report and manage risk; systematically manage risk to reduce harm to patients, staff and visitors; ensure compliance with regulatory, legislative, financial and statutory requirements; provide assurance to the Board that risks are managed and a risk culture is embedded within the organisation; to ensure the organisation can capitalise on opportunities within an agreed risk appetite.” (LCH Risk Management strategy, November 2011).
Priorities within the strategy include:
Development of a Datix® web risk register
Implementing a risk framework
Risk management and monitoring training
Work on delivering the strategy is underway. We have already revised the trust’s risk management process which will aim to provide clear instructions on the identification of hazards and the process and management of those hazards, with regard to risk assessment. It will ensure:
A consistent approach to managing all risks (clinical, financial, environmental and organisational) and the actions necessary to reduce each risk
A robust mechanism for the integrated prioritisation of all risks
Staff are aware of their roles and responsibilities within the assessment process
The trust Board is fully aware of the risks
C linical effectiveness is concerned with how well what we do improves things for the patient / service user. It includes how efficient we are and how we change services to improve them. The three domains from the NHS Outcome Framework that relate to clinical effectiveness are domains
1, 2 and 3 (highlighted on page 26).
Some of our achievements this year have included:
The development of organisational development, workforce and leadership strategies.
Improving how we deliver services through the Leeds Approach including sharing this work nationally and internationally
Working in partnership with our health, social care and other partners
Leading regionally on the Safety Express work.
I t is recognised that strong effective leadership is necessary at all levels of the organisation to drive forward the quality of services provided. This year we have developed our leadership strategy with engagement form clinicians and managers.
The strategy recognises the importance of clinical, professional, operational and strategic leadership and how they work together supporting each other in the delivery of care. This is represented in our leadership pyramid below.
Clinical
Leadership
Professional
Leadership
Operational
Leadership
Strategic
Leadership
The leadership strategy identifies how we will ensure that we have good leadership to take the trust forward to NHS community foundation trust and support integration and partnership working.
In 2010, it was identified that we needed to improve clinical and professional leadership in out of hospital care. Clinical lead roles were created in nursing, physiotherapy and occupational therapy. This year they have:
• Led the development of skills for registered and unregistered staff
• Influenced the selection of measures where we can show we have improved patients’ health and well-being
• Developed the skills of staff, providing training to ensure that they work using the best evidence available to deliver high quality care
• Developed incident investigation audit; guidelines for manual handling of complex patients in the community; and medication documentation to ensure patients received the right medication at the right time
• Supported the teams and worked with other services and organisations to deliver clinical changes to how services are run
• Developed communication networks internally and externally to enable clinical staff to develop high quality care.
Quality Account [35]

In 2011 / 12 we made significant improvements in our emergency preparations:
We reviewed our business continuity plans and improved resilience by including how we would respond to a combination of different risks
We created a plan for how to continue to provide services during severe / wintry weather
We updated our plans for how we would deal with a major incident within the local area
We trained some of our staff and the entire senior management team in how to deal with emergency situations
These plans were tested during a public sector pensions strike; a number of days of snowy weather; and more recently responding to fuel shortages. In all instances the plans were successful in maintaining services.
[36] Quality Account
D uring 2011 / 12 we began to look at some key indicators that help us understand and assess how well we are doing with staff. In particular, this includes information regarding sickness absence which has been higher than the targeted rate throughout the year. In response to this we have revised our sickness absence policy so that the initial meetings to support staff can be held more speedily.
We have also introduced direct access to musculoskeletal and staff counselling services in response to the most common reasons for staff absence to support staff in returning to work quickly.
packages that 97% of staff have access to using a Smartcard.
Another area of support for the workforce that we wanted to improve was clinical supervision.
For example, within cardiac services, staff now have a formal arrangement with Leeds Teaching
Hospitals NHS Trust to receive bi-annual supervision sessions with a consultant cardiologist for heart failure. During the sessions, which are attended by secondary care and community staff, there is an opportunity to bring cases to discuss. Overall we have seen figures grow with 67% of staff now being supervised.
Supporting the development of the future workforce is also important for the delivery of quality care. An integrated approach of university study and practical placements helps to ensure a well-rounded educational programme for future staff. At
LCH we are proud of the work that goes into preparing for and carrying out the placements by staff and students. Between
April 2011 and March 2012 we supported 1,154 students in placements within LCH services.
Evaluations by 346 students were completed and the overall satisfaction rate was 94.5%.
For the calendar year 2011 the average number of days lost due to sickness per full time equivalent member of staff was 11. This equivalent to a sickness rate of 4.9%.
We have also been monitoring our uptake of staff appraisals. We benchmark well on appraisals in the latest staff survey with 87% of staff having an appraisal. We have not been hitting the target of
90%. To address this we are closely monitoring attendance at training, monitoring when appraisals are delivered, and have introduced e-learning
Quality Account [37]

W e are committed to creating equal opportunities for all of our staff regardless of their
This year we have developed an
Equality strategy for 2012 – 2016 with the objective of providing a comprehensive service, available
The strategy provides a framework for compliance with the Equality Act 2010,
Care Quality Commission to all. The strategy has been gender, age, race, ethnicity or requirements and to deliver the developed through leadership religion. We routinely examine NHS constitution principles and our rates amongst different at Board level and involvement with community groups, Leeds equality monitoring groups for values. The strategy will also help us reflect the diversity of every
City Council, Stonewall and staff turnover dismissal, appraisal, community in Leeds as part of communities in Leeds through training and promotion as part of our membership plans for the involvement facilitated by the our commitment to equality.
NHS community foundation trust.
University of Central Lancashire.
T he charts below illustrate the make-up of our workforce. The first two charts show illustrate that the majority of our staff are in the 46 - 50 year age range; and that 90% of our staff are female.
The final chart demonstrates the areas where full time equivalent staff work within the operations directorate.
Here the majority of staff, 25% work within the healthy child area, followed by 18% in adult community nursing.
Leeds Community Healthcare NHS Trust staff age profile
E ach year the trust develops an action plan in response to the findings of the national staff survey. There is significant research which demonstrates that staff who are well supported, engaged in decision-making and report being proud of their organisation deliver better healthcare than those who are not. The latest survey completed between October and December
2011, was based on a sample of staff and a pilot of an e-survey which was open to all staff, resulting in an overall coverage rate of 43.5%. This exceeds the sample return significantly.
We have seen some improvements in staff survey results when comparing the results with
2010 to 2011 and the number of questions where results have improved.
Comparison with 2010 LCH results
10
8
6
4
18
16
14
12
2
0
Worse
Remained the same
Improved
When our results are compared to other community trusts we score well on the following areas:
Good communication between senior management and staff
Staff feeling valued by their colleagues
Low numbers of staff experiencing harassment, bullying or abuse from other staff
Fair and effective incident reporting procedures
Leeds Community Healthcare
NHS Trust gender profile
Male
10%
Female
90%
Operations directorate - full time equivalent staff in post
6% 6%
16%
18%
7%
14%
8%
25%
[38] Quality Account
Support services 134.84053
Vulnerable groups and prisoners 135.84053
Adult community nursing 449.05506
Child and adolescent mental health services
162.40483
Healthy child 620.22891
Long term conditions 185.98994
Out of hospital care 324.76532
Specialist services 371.77405
Quality Account [39]

The top 4 areas in our latest staff survey compared with our benchmark group of 15 community trusts are:
Area LCH 2011 survey score %
37% Staff reporting good communication between senior managers and staff
Staff reporting feeling valued by their colleagues
Staff experiencing harassment, bullying or abuse from staff in the last 12 months
Staff say there is fairness and effectiveness of incident reporting procedures
84%
9%
3.56
(scale summary score)*
National average %
29%
81%
12%
3.5
LCH average score in 2010
33%
82%
11%
3.51
(2009)
The lowest 4 scores for Leeds Community Healthcare NHS Trust when compared to our other scores are:
Area LCH 2011 survey score %
32% Staff who have had equality and diversity training in the last 12 months
Staff who said that hand washing materials are always available
Staff who said they had suffered work related injury in the last 12 months
Staff who said they were satisfied with the quality of work and patient care they are able to deliver
47%
15%
66%
*A scale summary score is a score on a scale of 1 to 5, the nearer to 5 the better
National average %
60%
60%
11%
73%
LCH average score in 2010
44%
50%
13%
69%
We take the results of the staff survey very seriously. Work has already been undertaken to identify why we are performing badly in some areas and what actions we need to take to address this. For example equality and diversity training dipped due to gap in provision that has now been corrected by the introduction of an e-learning facility. We also plan to hold staff focus groups to discuss any areas of concern and to build on the improvements we have already made.
Looking at the matter of quality and the delivery of patient care, this can be broken down into two questions. These show that:
I am satisfied with the
87%
ree
91%
T
here is a well established relationship with trade union representatives within the trust and we are committed to working in partnership with unions and professional bodies to mutually agreed principles. We have funded and dedicated staff side support time and formal joint negotiating committee meetings on a monthly basis which are regularly attended by the chief executive and executive directors. There is a separate joint negotiating committee with medical and dental staff of the trust.
[40] Quality Account
T he trust has a well developed approach to staff communication and has engaged with staff significantly in determining the vision and values of the current organisation and in respect of our journey to become an NHS community foundation trust in 2013.
In recognising the importance of staff communication a variety of different methods are used including a weekly staff e-bulletin, a quarterly staff newspaper, monthly team brief and cascade and a question and answer forum on the intranet, ‘Ask Rob’, for staff to post anonymous questions to the chief executive.
W e continue to offer a wide range of learning and development activities.
This includes statutory and mandatory training and continuing professional development in line with individual’s or service requirements. Over the last year we have significantly enhanced the training support available through the introduction of e learning packages. We have not seen the level of achievement on statutory and mandatory training we would have liked in 2012 / 12. This will be a priority in 2012 / 13.
This year we have developed a leadership strategy that includes a concept of ‘leadership from every seat’ of the organisation. In practice, this means that all staff will be encouraged to develop within their role and that teams and services can make decisions locally to improve the delivery of high quality care.
Recognising that 78% of our budget is spent on staff, a significant investment is made in specific leadership programmes, training and development which includes approximately £200,000 on Institute for Leadership and
Management courses, workforce support for appraisal development training and external funding to support clinical leadership for transformation.
W e have devised a staff health and well-being strategy to support staff on lifestyle matters such as nutrition, work life balance, the effects of smoking, drinking and obesity. We monitor staff sickness levels on a monthly basis through a sub-committee of the Board.
Sickness absence levels have been running at higher than the targeted rate throughout the year. To help improve this we have revised our sickness absence policy and introduced fast track access to musculoskeletal and mental health services and expanded staff counselling in response to the most common absences identified.
Whilst sickness absence rates, at
4.9%, were slightly lower in 2011
/ 12 than the previous financial year, the rate is still higher than we would like. We are committed to reducing the level of absence to
4% over the coming year. An action plan is being developed which will include workshops for managers, toolkits and more robust reporting and monitoring and reporting mechanisms to ensure that staff receive the help and support they need, at the right time.
2008 / 09 2009 / 10 2010 / 11 2011 / 12
Sickness rate 4.8% 4.5% 5% 4.9%
Quality Account [41]

W e are currently reviewing our staff disability policy, as a result of the continuing equality work identified in the Equality strategy
2012 – 16. We continue to be awarded the 2 ticks disability symbol by Jobcentre
Plus for meeting Jobcentre Plus’s 5 commitments for employers.
I n 2010 Leeds Community Healthcare NHS Trust launched the Leeds Approach. This is our internal programme for service improvement with the aim of improving quality, productivity and efficiency. Initially the programme was based around the NHS Institute for Innovation and Improvement Productive series. As the different services have gone through the programme, it has expanded to include the learning from our partnerships with NHS North of England and Jönköping in Sweden and the development of our organisational development strategy.
The Community Intermediate
Care Unit was an early implementer of the NHS
Institute for Innovation and
Improvement Productive
Ward programme by looking at ways of working more efficiently to release time to care. By knowing our processes such as medicines round, staff shift handover, admission and discharge of patients and ward rounds we were able to analyse the way we worked. This resulted in several processes being reviewed and transformed to allow more time for direct patient care and offering a more fluent and efficient, patient centred service.
Overall we managed to:
• Increase clinical support worker patient care time by 12%
• Increase staff nurse patient care time by 40%.
Our Musculoskeletal service has looked closely the service to understand the local demand and to improve the capacity, without increasing the costs.
The capacity and demand group actively looked for, identified and addressed bottlenecks within the service. To ensure patients had a rapid and efficient access to services regardless of where they lived, a two week standard waiting list across the city was agreed.
The two week standard waiting list was achieved by: improving waiting list management; reducing the number of appointments where patients failed to attend; implementing directly bookable
Choose and Book appointments; standardising treatment times; and regularly reviewing performance to ensure that the patients are being treated in the most effective and efficient way.
[42] Quality Account
Some of our service changes have been recognised externally.
The Bupa Foundation Patients as Partners prize has recognised the work of the Prisoner Health
Representative scheme in prisons.
The scheme aims to improve the link between patients and clinical teams and has been successful in reducing missed appointments by 10%, increasing healthcare appointments by 380% and increased the uptake from hard to reach prisoners by 50%.
The prison healthcare team have also had a successful approach to reducing deaths in custody.
Self-inflicted deaths in custody in
England and Wales were reduced from 66 in 2006 to 58 in 2010
(12% reduction). Locally, selfinflicted deaths in custody reduced from nine in 2006 to only two in 2010 (a 78% reduction). The approach includes development of a ring fenced primary care mental health service, use of electronic records, SystmOne, for referrals between teams; rigorous examination of serious incidents and developing patients as partners as part of the Prisoner
Health Representative scheme.
The prison team has also implemented a discharge pathway for patients leaving the prison services who are not registered with a general practitioner. This has been possible by merging the Health Access Team and No Fixed Abode services for people with no address to create the York Street Health Practice.
Merging these teams has enabled us and to increase the provision for vulnerable people in Leeds.
Other service change has been in partnership with other agencies within healthcare. For example, the Child and Adolescent Mental
Health team has extended the age of services users from 17 years to
18 years and worked to develop transition services to adult mental health services.
Adult Mental Health services and
Child and Adolescent Mental
Health team senior managers and clinicians meet regularly to review and update a transition protocol and to revise practice continually in response to the views of service users and staff. Every six months the meeting is extended to include representatives from primary mental health care, the
Community Mental Health teams, psychological therapy service, personality disorder clinical network and key voluntary organisations. The transition team have worked closely with
YoungMinds
(a charity committed to improving the emotional well-being and mental health of children and young people) to include service-user feedback in the development of their work.
Leeds is also developing a multi agency transition strategy discussed at the Joint Strategic
Commissioning Board - Young
People in Transitions subgroup outlining the principles of best practice for all agencies in
Leeds who are working with young people moving between children’s’ and adults’ services.
Child and Adolescent Mental
Health transition team has input into this through the multi-agency meetings.
Safety Express is a national programme launched in January
2011 with the aim to support harm free care by reducing harm in:
Falls
Community acquired urinary tract infection
Pressure ulcers
Venous thromboembolism
Leeds Community Healthcare
NHS Trust is the first community services organisation within the region to adopt Safety Express .
The Community Intermediate Care
Unit at Seacroft Hospital and the
Community Rehabilitation Unit at
St Mary’s Hospital launched Safety
Express in May 2011.
Clinical leads within the units set up a working group and developed an action plan to ensure successful implementation. Data on 329 patients was recorded during the six month period. The data collected shows 98% of patients treated were harm free. The unit has been commended for its support of Safety Express and the improved outcomes that have been demonstrated as a result.
Quality Account [43]

S ome of our partnerships are formal around commissioning and provision of services and others are developed as we shape services with patients and carers. Examples of this include the healthy eating shopping tours we support at Kirkgate market and the support given to children with disabilities to integrate into playtime at school.
home care providers and other staff will communicate with each other on a regular basis and share information to support people better. Eventually patients may have a single care coordinator who is their main contact point.
Integration work is currently well under way in adult services. Three
‘demonstrator sites’ in Kippax /
Garforth, Meanwood and Pudsey have already started to work in the new, integrated way. The
Partnership working in 2012 / 13 will be essential in achieving the integration agenda for both adult and children’s services. People in
Leeds regularly have to repeat the same information about their health to health and social care professionals and this can be frustrating.
By integrating health and social care services we are working to improve the services we provide.
Over the next two years, GPs, health workers, social care staff and others will increasingly be working side-by-side, sharing information and taking a more coordinated approach to the way services are delivered.
With these changes, the process will become much smoother.
District nurses, social workers,
[44] Quality Account approach will then be gradually rolled out across the city. From the start, the three pilot areas will involve local patients and their families in designing the new ways health and social care services will work together.
Play is important for all children including those with a disability. This was identified as a concern by a child at a Leeds school who also need to be included more in playtime games.
We supported the child and their classmates to look at how the games they play might exclude a child with a disability so they could adapt the games for everyone to join in.
The children were supported to redesign the games and create a booklet so everyone in the school could share the games.
The child we supported says she now finds playtimes much more fun as her friends take more time to check what she wants to do, and she is more confident in sharing her opinions with them.
Over the last year a community dietician has conducted monthly healthy eating shopping tours at Kirkgate Market in Leeds. The tours support people at risk of health problems or those with long-term conditions including heart disease, diabetes or stroke make healthier eating choices easier. The first year has been very successful:
110 participants have attended tours
A wide range of ages have attended and the majority of participants are female (79%)
The tours have attracted a wide diversity of people living in Leeds - 60% from white communities and
40% from other ethnic communities (Asian 21%; Black
5%; Mixed 4%; other Chinese 12%)
45% of those coming to the tours were from areas of the city where the budget for food will be tight
The tours were attractive to people across the city (24% from south Leeds; 22% east Leeds;
17% north east Leeds; 14% north west Leeds and 4% west Leeds).
Quality Account [45]

L eeds Community Healthcare NHS trust employs many different types of staff each with their own area of expertise and training. How we work together to deliver quality care to patients and service users is important and we regularly review how we are doing this. Over the years we have developed new roles and shared roles and new ways of working. Over the coming year we will be doing this with our colleagues in adult social care and GP practices as we work together on the
To decrease the length of stay and reduce bed occupancy the Community Intensive Care Unit has launched a discharge planning meeting to replace the traditional multidisciplinary team weekly meetings. The discharge planning meeting has been designed to ensure
that firm discharge plans and dates are set for each individual patient to encourage a more timely discharge.
Roles and responsibilities for each member of the meeting have been identified and ground rules agreed. A questionnaire is being used to evaluate the new process and identify the effect it has had on length of stay and bed occupancy.
integration agenda.
Through work as part of the Leedswide health and social care transformation programme, we have been involved in a project to ensure greater involvement from pharmacists to help ensure patients in the community get the right medicines for their care. This involves a consultant pharmacist working with the community matron service including joint patient visits, staff training, developing links with hospitals and promoting a regular medication reviews. This support is proving invaluable for patients with long term conditions who have or are to risk of being admitted to hospital frequently. To date the project has helped improve partnership working, reduce wasted medicines, improved medicines management and lead to enhanced quality of life for patients.
[46] Quality Account
W e have continued to roll out the clinical record keeping system (SystmOne) to all our services. To improve data capture and electronic record keeping / sharing.
This has already allowed some services to go
‘paperless’, such as Tissue Viability.
Leeds Community Healthcare NHS Trust has an information technology strategy that includes the increased use of mobile working for staff. To date we have provide 500 members of staff with Toughbooks to enable them to have more ready access to patient notes, reduce the duplication of note taking and to reduce travel time. We aim to increase mobile working to all services where it is appropriate as well as to explore other ways that technology can be used to release time to care.
Technology is also being used in treatment. We are working closely with partners in social care, the voluntary sector and industry to develop telehealth and telecare solutions.
Both the respiratory and community matron teams have been involved in the introduction of new Telehealth Bosch equipment in partnership with NHS Direct. The use of this equipment alongside work around predictive modelling has helped to identify patients with chronic obstructive pulmonary disease who are at risk of frequent exacerbations of their illness and admission to hospital. Through the work of the project we have been able to avoid some patients being admitted to hospital. Currently there are approximately
13 patients receiving care through this work and the results are being evaluated by Brunel
University.
Quality Account [47]

Some of our achievements this year include:
Generally a high overall satisfaction rate with our services
Developed a Patient and Public Involvement strategy
Developed an equality strategy
Most services have achieved the bronze level standards for PPI
D elivering a high quality patient experience is of paramount importance to us. We recognise that where things go wrong, we can only improve by listening to the views and experiences of our patients. To help us do better we introduced a patient satisfaction with the aim to gather as much feedback from service users and carers as possible and use the information in conjunction with our other patient experience data.
During the period April 2011 to March 2012 we received 8,021 completed surveys. The response rate for the year can be seen in the table below.
T he overall satisfaction rate (averaged over the year) was 95%.
This meets the target set at the beginning of the year. The following graph shows the satisfaction scores for each month since the survey began in October 2010.
The overall trend is of consistently high satisfaction (between 93 and 97%) with only three months falling below the target of 95%.
T he two questions that have consistently had the lowest scores remain the same as last year (averaged across all services):
The chart below shows the satisfaction trends for each of these questions during 2011 / 12.
Involvement in the planning of care is important to ensure that service users are at the heart of all decisions made about their own health. A number of groups are working to improve this by looking at the language used when talking with service users and the methods of recording care plans.
In response to contacting staff and services, the trust has developed contact cards for services to use from
March 2012. The Patient Experience team will monitor whether these have an impact on the satisfaction level for this question.
We are working with Yorkshire and the
Humber Quality Observatory to analyse all patient experience data in detail.
This will enable the trust to better understand the reasons for fluctuations in reported satisfaction, and ultimately ensure care is consistently of the highest quality.
Quality Account [49] [48] Quality Account

F rom April 2011 to March 2012 the trust received 298 completed surveys from children and young people who have used our services.
The relatively small number of responses means that the results are not truly representative of the youth communities of Leeds. As a result it is difficult to draw firm conclusions.
We are developing new methods for collecting feedback from young people such as using social media and text messaging. We aim to increase the number of responses so that the results fully represent our youth population.
[50] Quality Account
D uring 2011 / 12 we have improved our complaints handling process with the launch of a new complaints management policy. This year we have received a total of
72 complaints, 14 less than last year. Of these, 40 were upheld locally either in full or partially.
We recognise that each complaint is a learning opportunity for the organisation. As the year progresses we intend to have more information readily available about how to give feedback, feedback we have received and actions we have taken.
The charts below show the number of compliments and complaints received in 2010 / 11 and 2011 / 12. We are working to improve the manner in which we collect data and we are confident this will mean compliments are recorded more consistently.
Complaints received quarterly in 2010 / 11 and 2011 / 12
20
15
10
5
0
35
30
25
32
2
26
22
6
20
22
28
Quarter 1 Quarter 2 Quarter 3 Quarter 4
Quarter
Complaint 2010 / 11 Complaint 2011 / 12
By email to: lch.complaints@nhs.net
Or by post to: Complaints Manager, Leeds Community
Healthcare NHS Trust, Quality and Professional Development
Department, 1st floor, Stockdale House, Headingley Office Park,
Victoria Road, Leeds LS6 1PF.
Quality Account [51]

T he Patient Advice and Liaison Service (PALS) provides a listening and advocacy service to ensure that patients and their relatives, carers and friends can have their questions and concerns resolved as quickly as possible.
In 2011 / 12 we received 1,584 calls, letters and emails to the
Patient Advice and Liaison Service. The table below shows the number of contacts received each month.
The majority of contacts were regarding access and waiting for example, requests for status updates on referrals and how long the patient was likely to wait. There were also a large number of requests for information such as contact details.
In response to this the organisation has developed contact cards for staff to use with the aim of ensuring patients have the information they need. These were implemented in March 2012 and their impact will be monitored.
The peak contacts in June and July 2011 was largely due to a public consultation on continence products with patients and carers seeking clarity on the proposed changes.
T his year we have worked hard to improve patient, carer and public involvement the organisation. In partnership with patient, carers and staff we have developed a three year Patient and Public Involvement strategy. The strategy has four aims:
1
To develop a culture across the organisation whereby patient, carer and public involvement is ‘everybody’s business’ and patients are at the centre of everything we do
2
To embed high quality patient, carer and public involvement across the organisation
3
To increase the number and representation of patients, carers and public who are effectively taking part in patient, carer and public involvement and who register for NHS community foundation trust membership
4
To work in partnership with patients, carers, families and partners in the delivery of patient and public involvement.
[52] Quality Account
Each aim has measurable objectives. These include working towards a year on year increase in comments and feedback from service users; providing staff with the skills to use interactive participatory appraisal methods and supporting fifty service users to be involved in staff recruitment.
Our patient and public involvement activities in 2011 / 12 included:
All 65 services will have achieved the bronze level of the patient, carer and public involvement standards. The standards are a set of actions that ensure all services are involving service users on an on-going basis, giving feedback and involving and working with the public, carers and communities
Several engagement activities have been undertaken including consulting with the public on the membership scheme and the organisation vision and values; engaging with service users during location changes to child and adolescent mental health services, gaining seldom heard service user views on the survey and involving service users in the staff recruitment process for out of hospital care
Continued to work in partnership with
Leeds LINk, being a partner of the Leeds adult safeguarding engagement work stream and procuring two voluntary sector projects to undertake consultation with the public.
Working towards achieving the nationally recognised ‘hear by right’ children and young people participation award
Our future plans for patient and public involvement will be closely aligned to our membership strategy and will include:
Embedding self care and co-production across the adult older people and long term conditions integration programme
Continuing to embed the patient, carer and public involvement strategy via services working towards achieving the silver standard. For services this includes working towards increasing partnership working with local and national voluntary sector agencies
Supporting the procurement and development of
Leeds Healthwatch
Recruiting the public to become members, establishing a public governor’s structure and increasing the number of patient, carers and the public who are taking part in patient, carer
and public involvement activities.
L eeds Community Healthcare NHS Trust priorities for improving patient experience over the next year are detailed in section one. Other actions that we will be taking to continue to improve patient experience include the work that we are currently doing with adult social care, local children’s services and health partners to integrate services and work more closely together.
Quality Account [53]

I n the 2011 / 12 the organisation has been involved in partnership work with NHS Airedale,
Bradford and Leeds, Leeds and
York Partnerships NHS Foundation
Trust and Leeds Teaching
Hospitals NHS Trust in a city wide approach to meet the statutory requirements of the Equality Act
2010 Public Sector Equality Duty and Specific Duties.
The city wide group commissioned the University of Central
Lancashire to consult with communities in Leeds about their experiences of NHS services in Leeds. In January 2012 the university trained 23 community facilitators and involvement in the community took place in February
2012. This event was followed by an event for the workforce and both have informed the organisational equality objectives and future work.
It was agreed that all organisations would use the NHS Equality
Delivery System as a framework to support the organisation in driving up equality performance and embed equality into mainstream organisation business.
The Leeds City Wide Equality
Delivery System Advisory Panel, comprising of interested parties, including Leeds City Council,
Voluntary Action Leeds and
Touchstone, met in February 2012 and awarded an overall grading of
‘developing’ to the trust. Progress on improvement actions will be presented to advisory panel on an annual basis and to the LCH Board through internal governance arrangements.
Further information on the
Equality strategy is available on our website.
Adoption of the equality delivery system will ensure that the trust meets its statutory duties around equality in all aspects of quality.
[54] Quality Account
Leeds LINk and its members feel that a good working relationship has existed between the LINk and
Leeds Community Healthcare NHS
Trust this year with a proactive approach from the staff, and the encouragement of the chief executive.
The priorities identified by LCH for the coming year - Patient Safety,
Clinical Effectiveness and Patient
Experience have the approval and support of the Leeds LINk membership and members are particularly pleased to see an emphasis on patient experience.
We would like LCH and partners to utilise Leeds LINk as an empowerment tool for people who use their services by making people aware of the LINk at an early stage. We hope that Leeds
LINk will have opportunities in the coming year to visit some of the
LCH services to encourage people to get involved. It would be good for Leeds LINk (and, in future,
HealthWatch) to be mentioned in the literature distributed to patients by LCH and partners.
Leeds LINk would urge people to make comments about services, both positive and negative directly to the LINk.
Leeds LINk supports the importance that LCH is placing on patient safety in its broadest definition. The LINk recognises the need to safeguard patients and ensure that the staff are well-trained in maintaining safe practice.
The LINk commends efforts to maintain vigilance against the spread of infection by good training practice, both with staff and with patients, and with a view to prevention from harm.
Within the Quality Account the LINk welcomes the advent of learning from incidents and investigations within the overall strategies governing practice and hopes that approaches like this will mean that LCH remains vigilant and reflective at all times.
Learning and reflection are useful tools which LCH is evidentially planning to best meet the needs of patients. Good practice of peer review systems within LCH should ensure cooperative and cohesive working, achieving best results.
It is important to recognise that clinical effectiveness requires evidenced practice and highly skilled staff with supportive supervision, appraisal and leadership training. Leeds LINk would expect these factors to also have a significant effect on staff morale and retention of staff.
On page 21 members noted the reporting around Grade II and above pressure ulcers and were glad to see targets exceeded.
Leeds Teaching Hospitals NHS
Trust has made pressure ulcer prevention one of their priorities for this year and it is good to see this area being addressed across the board as progress in the prevention of pressure ulcers will be mutually beneficial to both organisations. If you come out of hospital with a pressure ulcer you have to be nursed in the community, and vice versa if you go into hospital with an existing pressure ulcer developed at home this will complicate your treatment requirements whilst in hospital and lesson your wellbeing.
Quality Account [55]

Leeds LINk is pleased to see the emphasis LCH is placing on patient experience, including involvement and engagement as an active contributor to one’s own care and services more generally. We would be keen to help LCH progress. One potential area for this would be to have input into the development of engagement networks in Leeds mentioned on page 13. The LINk is also keen to develop innovative ways to engage with young people so this is another priority we share with LCH (see page 51) and we would welcome the opportunity to work jointly where possible to engage young people. The reference on page 47 to the use of social media highlights LCH’s commitment to engaging in new and proactive ways.
Engagement practice which matures and delivers rewarding involvement leading to shared decision making between volunteers and professionals will shape services and protect the essential functionality of a changing system. This will be an important development in the future.
Page 48 makes reference to LCH’s achievement of developing a basic PPI strategy this year. Some
Leeds LINk members were actively involved in this and were pleased to see active involvement from not only the patients and the public but LCH staff – showing open, transparent involvement and commitment.
There has been evidence of professionals within the organisation evaluating and working in partnership with patients determined to achieve best outcomes. These are welcomed developments which should ensure time and money are invested wisely and effectively in tailoring provision
[56] Quality Account to match need as closely as possible. A good example of this is the move towards systematic self management exemplified by the work being currently undertaken with NESTA funding
(National Endowment for Science,
Technology and the Arts). The self management board includes a Leeds LINk representative alongside other partners from across the city.
Leeds LINk would recommend better engagement of patients in the making of appointments as often patients receive letters telling them an appointment has been made when they have had no opportunity or choice to influence the time or day offered.
Members feel that if more efforts were made to fit appointments around patients’ availability the number of DNA appointments
(those where the patient does not attend / is not at home at the scheduled time) would reduce.
Members also recommend use of modern technology or forms of communication such as email
/ text message reminders when individuals have appointments coming up.
It is good to see comments and complaints processes with new systems in place to promote timely feedback as it is paramount that individuals feel that their case is being treated with the respect it deserves, that they are not lost in the system and that their complaint will not be swept under the carpet. Dealing with complaints appropriately will increase the respect that patients and public have for the organisation.
The public value NHS provision and often raise concerns on behalf of the wider general public hoping to avoid others going through the same experience. It is therefore important to maximise the potential for learning from complaints considered alongside any incident information. It is very positive to find such informed thinking within the
Quality Account.
In its statement last year, Leeds
LINk had concerns around hospital discharge. There appear to have been improvements in this area since the last statement was published. Members are happy to hear about the efforts that have been made so far to address concerns. Vigilance and learning from readmission should produce evidence for the importance of planning for discharge and good communication with patients and visitors. Such planning and communication should deliver better results under the pressures around availability of hospital beds.
Thank you for offering NHS
Airedale, Bradford and Leeds the opportunity to review your Quality
Account. I am pleased to provide the following comment:
“NHS Airedale, Bradford and
Leeds welcomes the opportunity to comment on this quality account from Leeds Community
Healthcare NHS Trust. We have reviewed the Account and believe that it is a fair representation of the quality of services provided in the year being reported upon. We also believe that the information published in this Quality Account, that is also provided to the PCT as part of the contractual agreement, is accurate.
We are supportive of the priorities proposed for the forthcoming year. We note the commitment to effectively manage and reduce the risk of harm and the associated actions. However we also note that the projected outcomes for 2012 / 13 in this area are in some cases lower than 2010 /
11, such as adults and children’s safeguarding training and percentage of staff completing infection prevention and control training. We expect that the trust will strive for outcomes that are significantly higher than those anticipated in the account.
We also trust that more robust improvement measures and thresholds will be developed inyear.
We are pleased to note the commitment to develop outcome measures for all services, as we believe that there will be much greater shift towards outcome based commissioning in future years. Likewise, we expect that future accounts should include information on benchmarking, to enable comparison with other providers of similar services.
We note the proposal to ensure that staff are appropriately supported, developed and led, and note the work that is required to improve the numbers of staff participating in clinical supervision and appraisal processes. A specific trajectory would be welcomed, rather than the basic intention to improve.
As part of the Commissioning for
Quality and Innovation (CQUIN) process for the forthcoming year, we have asked the Trust to develop a peer review system, and we are pleased that this is reflected in the quality account.
We note the local audit that has taken place over the past year, and expect to see this continued to ensure that services are clinically effective. A greater level of detail on the aims of the audits would be helpful in understanding the actions that have been identified as a result. We would expect audit for the forthcoming year to include work relating to the transformational agenda, including long-term conditions such as heart failure and diabetes.
We note the commitment to robust incident recording and management and the continued drive to ensure that healthcare associated infections are kept to a minimum. We are pleased to note the high levels of satisfaction reported by users and for the
Trust’s plans to engage with users, carers and the public in order to ensure services are responsive to their needs.
The forthcoming year will be a challenging one as new commissioning bodies develop and new ways of working emerge. As the main provider of community healthcare we expect that the Trust will embrace the opportunity to work positively and collaboratively with clinicians and service users in providing a responsive, high quality service to the people of Leeds.”
The Scrutiny Board (Health and
Well-being and Adult Social Care) has had the opportunity to look at the Quality account and has not offered any comments for inclusion.
given in commenting on this years quality account. Their support and feedback is welcome in the development of our organisation and valuable in helping us achieve our aims.
We are pleased to see that the objectives we have set are supported and the focus put on the continued improvement in patient experience is recognised.
We accept the comment that the projected outcomes for some priorities could be more robust.
We thank NHS Airedale, Bradford and Leeds for sharing with us their initial thoughts before giving formal feedback. This had enabled us to address their concerns in the final published document. It is our intention to provide the best possible care in every community in Leeds. We acknowledge that to achieve this we need to ensure that our measurements are robust, our services continue to focus on quality and that our achievements are benchmarked. We look to reflect our achievements in these areas in next years quality account.
We acknowledge that the coming year will provide new challenges and new ways of working and we look forward to working in a positive and collaborative way with all our partners in health and social care.
Leeds Community Healthcare NHS
Trust is grateful to NHS Airedale,
Bradford and Leeds, the LINk and the Scrutiny Board (Health and
Well-being and Adult Social Care) for their time and consideration
As a result of the feedback we:
Have revisited the targets and trajectories identified in the priorities
Will increase regular benchmarking in our ongoing quarterly monitoring to Board
Will continue to work collaborative and positively with all our partners
Quality Account [57]

• Anticoagulant service
• Cardiac service
• Child and adolescent mental health service (CAMHS)
• Child development centres
• Children’s continuing care
• Children’s integrated clinics
• Chronic pain service
• Community brain injury rehabilitation team
• Community children’s nursing service
• Children’s community occupational therapy
• Children’s community physiotherapy
• Children’s growth and nutrition service
• Children’s speech and language therapy services
• Community dental service
• Community intermediate care unit (CICU)
• Community matrons
• Community multiple sclerosis team
• Community paediatric audiology service
• Community paediatric clinic
• Community stroke team
• Complex and palliative continuing health care service (CAPCCS)
• Continence, urology and colorectal service
• Contraception and sexual health (CaSH)
• Diabetes
• District nursing
• Ear nose and throat (ENT) service
• Falls service
• Health visiting
• Intensive family support service
• Intermediate care service
• Intermediate care / rapid community response
• Joint care management
• Language liaison service
• Leeds community equipment service
• Long term conditions
• Musculoskeletal and rehabilitation service
• Neurology services
• Nurse led pain service
• Nutrition and dietetics
• Occupational therapy for adults with learning disabilities
• Ophthalmology service
• Paediatric opthalmology
• Palliative care service
• Parkinson’s disease nurse specialist
• Physiotherapy for children with learning disabilities
• Podiatry
• Primary care mental health service
• Prison health service
• Respiratory service
• Safeguarding children team
• Salaried primary care dental service (SPCDS)
• School immunisation team
• School nursing and specialist inclusive learning centres (SILC)
• Sickle cell and thalassaemia service
• Smoking cessation (Leeds NHS stop smoking service)
• Special care dentistry service
• Specialist nursing service
• Speech and language therapy adults
• TB service
• Tissue viability (wound care) and dermatology
• Twilight nursing
• Watch it
• Weight management service
• York Street Health Practice
• Young adult team
[58] Quality Account
If you would like to comment on this document you may do so in several ways:
• By email to QPD.account@nhsleeds.nhs.uk
• In writing to:
Quality and Professional Development Department
1st Floor, Stockdale House
Headingley Office Park
Victoria Road
Headingley
Leeds LS6 1PF
If you have any other comments that you would like us to hear then please contact the
PALS (Patient Advice and Liaison Service) on 0800 052 5270
Quality Account [59]

www.leedscommunityhealthcare.nhs.uk
© Leeds Community Healthcare NHS Trust, June 2012 ref: 0505