Quality Account
2011/12
Putting you first is at the heart of everything we do
Contact
Trust Headquarters
Bridge House
Unit 16, The Point
Lions Way
Sleaford
Lincolnshire
NG34 8GG
Tel: 01529 220300
Website: http://www.lincolnshirecommunityhealthservices.nhs.uk/public/
Communications
For more information about communication activities happening across the
Trust please contact:
Sue Barnston
Head of Communications
Tel: 01529 220300
E-mail: lchsecomms@lincs-chs.nhs.uk
Trust Board Information
For more information on our Trust Board please contact:
Bev Wormald
Trust Board Secretary
2
Tel: 01529 220373
E-mail: bev.wormald@lincs-chs.nhs.uk
Lincolnshire Community Health Services NHS Trust
Contents
Contact2
Contents3
Glossary4
Part 1 - Welcome
6
Our Services
7
Statement from the Chief Executive and the Board
8
Statement of Directors’ Responsibility in respect of the Quality Account
9
Part 2 - Our priorities for quality improvement in 2012/13
10
Clinical Effectiveness - Record Keeping
10
Clinical Effectiveness and Patient Safety - Improving Venous
Thromboembolism (VTE) prophylaxis
12
Patient Safety
Reduction in falls resulting in harm
14
Patient Safety
16
Reduction in medication errors
16
Patient Experience
Reduction in avoidable Pressure Ulcers
18
Statements relating to quality of NHS services provided
20
Statement from the
Care Quality Commission
21
Statement on Data Quality
22
Part 3 - Review of Quality Performance 2011/12
24
Patient Safety
24
Clinical Effectiveness
24
Patient Experience
25
East Midlands Leadership Academy
25
Quality Achievements in 2011/12
26
Staff Survey
28
Examples of Outstanding Practice
29
Complaints and Compliments
34
National Health Service Litigation Authority (NHSLA)
35
Statement of changes to content of Quality Account post consultation
36
Statements from other bodies 36
Quality Account 2011/12
3
Glossary
AHP
Allied Health Professional
BAPEN
British Association of Parenteral and Enteral Nutrition
CCG
Clinical Commissioning Groups
COPD
Coronary Obstructive Pulmonary Disorder
CQC
Care Quality Commission
CQUIN
Commissioning for Quality and Innovation – a scheme to encourage improvement
DVT
Deep-vein Thrombosis
IV
Intravenous Therapy
LCHS
Lincolnshire Community Health Services NHS Trust
LINk
Local Involvement Network
MRSA
Meticillin-resistant Staphylococcus Aureus
NHS
National Health Service
NHSLA
National Health Service Litigation Authority
NICE
National Institute for Health and Clinical Excellence
NMC
Nursing and Midwifery Council
PALS
Patient Advice and Liaison Service
PE
Pulmonary Embolism
PEAT
Patient Environment Action Team
ULHT
United Lincolnshire Hospitals Trust
VTE
Venous Thromboembolism
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Lincolnshire Community Health Services NHS Trust
Quality Account 2011/12
5
Part 1
Welcome
A Quality Account is a report about the quality of services provided by an NHS
healthcare service. The report is published annually and is made available to
the public on the Lincolnshire Community Health Services NHS Trust website
and NHS Choices website, www.nhs.uk.
At Lincolnshire Community Health Services NHS Trust (LCHS) we provide
community healthcare services for the population of Lincolnshire, one of
the largest healthcare communities in the country, covering an area of 2,350
square miles and a population of 735,000.
Our 2,600 staff care for thousands of patients every day in our community
hospitals, health clinics, walk in centres and minor injuries units. If you are
housebound, we come to you at home or in your place of care. Health visitors
and school nurses support our young families; we provide primary care
services out of hours; our teams of nurses, therapists and specialists care for
those across the county whether suffering from respiratory conditions, heart
problems, diabetes, cancer, or wounds such as leg ulcers.
Our teams support rehabilitation following stroke or other illness/accident
with physiotherapy, occupational therapy and speech and language
difficulties; our sexual health teams provide a confidential and nonjudgmental service to all who need it and our weight management and
smoking cessation teams can help you improve your health. At the end of life,
we are there to support you and your family with dignity at home if that is
your preference.
Our Vision and Values are simply defined – we want to be your first choice
for community health care. Our Patients First values say putting you first is
at the heart of everything we do… and we embed this in every aspect of our
services.
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Lincolnshire Community Health Services NHS Trust
Our Services
Family and
Healthy
Lifestyles
Health Visiting
and School
Nursing
Safeguarding
Vulnerable
Children and
Young People
Children’s
Therapy
Services
Smoking
Cessation,
Weight
Management
Sexual Health
Community
Hospitals
Services
provided at the
4 Community
Hospitals,
County Hospital,
Louth,
Johnson
Hospital,
Spalding
John Coupland
Hospital
Gainsborough
and Skegness
Hospital
Integrated
Community
Based
Services
Adult integrated
Teams
(Including
Community
Nursing,
Specialist
Nursing and
Community
Response, and
Rehabilitation)
Adult Therapy
Services,
(Physiotherapy,
Occupational
Therapy, Speech
and Language
Therapy, and
Podiatry)
Assisted
Discharge
Stroke Service
Anti
Coagulation
Service
Adults Electronic
Assistive
Technology
Service (EATS)
Quality Account 2011/12
Infrastructure
Corporate
Services
Primary Care
Services
GP Practices
Walk in Centre
Human
Resources and
Organisational
Development
Out of Hours
Informatics and
Performance
Services
Finance
Communications
Clinical
Governance &
Risk
PALS
Patient & Public
Involvement &
Engagement
Care Quality
Commission and
NHS Litigation
Authority
Assurance
7
Statement from the Chief
Executive and the Board
In April 2011, we became a new, independent NHS Trust after separating from
NHS Lincolnshire as part of the Government’s NHS reforms. This started our
journey to becoming an NHS Foundation Trust.
We firmly believe that this path will give us greater freedom to shape our
services in response to the needs of our patients and to improve services
locally whilst still being part of the NHS. We want to support you and those
you care for to receive high quality services close to where you live and to stay
independent and confident at home.
Ellen Armistead
Chief Executive, LCHS
There is nothing more important than ensuring that our patients receive
the highest standard of clinical care. Last year we put together our first ever
Quality Account, looking at quality in the areas of patient safety, clinical
effectiveness and patient experience. We are pleased to say that all of the
initiatives we committed to have been delivered. This year we will build on
those priorities and identify future priorities to ensure that quality services
continue to drive LCHS forward.
Our service portfolio is diverse, providing integrated community services
to adults and children, community hospitals, primary care and a number of
specialist services which makes the organisation an attractive proposition as a
viable NHS Foundation Trust.
Our Strategic Aims for 2012-2013 are to:
Listen to our users, value their views and improve the patient experience
Deliver the highest quality healthcare services; person centred, safe,
effective, efficient, equitable and timely
Deliver a quality driven financial strategy
Develop and lead a workforce proud to be part of LCHS
Dr Don White
Chair, LCHS
Ensure our services are reflective of the needs and wishes of the
community
Manage the reputation of the organisation, through effective
engagement with our stakeholders
Use technology to enhance patient experience and improve efficiency
and effectiveness
Ensure the environment is appropriate, fit for purpose and meets and
exceeds the need and expectations of users
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Lincolnshire Community Health Services NHS Trust
Statement of Directors’
Responsibility in respect of
the Quality Account
The directors are required under the Health Act 2009, National Health Service
(Quality Accounts) Regulations 2010 and National Health Service (Quality
Account) Amendment Regulation 2011 to prepare Quality Accounts for each
financial year. The Department of Health has issued guidance on the form
and content of annual Quality Accounts (which incorporate the above legal
requirements).
In preparing the quality report, directors are required to take steps to satisfy
themselves that:
The Quality Report presents a balanced picture of the Trust’s
performance over the period covered;
The performance information reported in the Quality Account is reliable
and accurate;
There are proper internal controls over the collection and reporting
of the measures of performance included in the Quality Account, and
these controls are subject to review to confirm that they are working
effectively in practice;
The data underpinning the measures of performance reported in the
Quality Account is robust and reliable, conforms to specified data quality
standards and prescribed definitions, is subject to appropriate scrutiny
and review;
The Quality Account has been prepared in accordance with Department
of Health guidance.
The directors confirm to the best of their knowledge and belief they have
complied with the above requirements in preparing the Quality Account.
To the best of the knowledge of the Chief Executive, the information reported
in the Quality Account is accurate and a fair representation of the quality of
healthcare services provided by LCHS.
By order of the Board
Chairman..............................................................Date......................
29-05-2012
Chief Executive.....................................................Date.......................
29-05-2012
Quality Account 2011/12
9
Part 2
Our priorities for quality
improvement in 2012/13
Clinical Effectiveness
Record Keeping
Good record keeping is an integral part of nursing and practice, and is
essential to the provision of safe and effective care (NMC 2010). Accurate
record keeping is fundamental to high quality, safe patient care. It should
reflect the high standards of effective practice and standards that equally
demonstrate the communication with other people involved in patients’
care. It should document clearly the individual practitioner’s professional
accountability and responsibility, supporting effective clinical judgements
and decision making alongside patient preferences for care and consent to
treatment.
Aim/Goal
LCHS aims to improve the accuracy and completeness of its clinical records.
Current Status
The Trust has policies and guidelines for record keeping that meet national
and professional standards. Audits have shown that the standard of record
keeping can vary considerably.
Identified Areas for Improvement
All patients are able to access their care record in a format that meets
their needs
A single electronic care record is used to provide consistency and
continuity of care
All care plans reflect the patient’s needs and are based on best practice
Current Initiatives in 2011/12
Record keeping audits are carried out and the results are shared with
clinical staff to improve their practice
The Trust has policies in place that reflect national and professional
standards
New Initiatives to be implemented in 2012/13
The Trust will implement reviews of patient case notes to ensure that all
records are comprehensive, accurate, clear and reflect best practice
The Family and Healthy Lifestyles Business Unit will carry out peer
reviews of records on a quarterly basis
A new training package on the principles of record keeping and the legal
aspects and implications of accurate record keeping will be introduced
for all clinical staff
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Lincolnshire Community Health Services NHS Trust
Monitoring and Reporting of the priority area
Quarterly Record Keeping audits will take place across LCHS services and
will be reported to the Clinical Governance and Risk Committee and
LCHS Trust Board through the Quality and Risk Report
A peer review process of the quarterly audits will take place within the
Family and Healthy Lifestyles Business Unit and will be reported to the
Clinical Governance and Risk Committee and LCHS Trust Board through
the Quality and Risk Report
The Human Resources and Organisational Development Committee will
receive updates on staff compliance with Record Keeping training
Board Sponsor
Chief Nurse/Director of Operations
Implementation/Programme Lead
Head of Safeguarding
Quality Account 2011/12
11
Clinical Effectiveness and Patient Safety
Improving Venous Thromboembolism (VTE)
prophylaxis
Venous Thromboembolism (VTE) is the formation of a blood clot in the veins.
It most commonly occurs in the deep veins of the leg or pelvis, this is known
as deep-vein thrombosis (DVT). An embolism occurs if all or part of the
clot breaks off from the site where it forms and travels through the venous
system. If it lodges in the lungs, this is called pulmonary embolism (PE). Deepvein thrombosis (DVT) and pulmonary embolism (PE) are the most common
manifestations of VTE.
Aim/ Goal:
LCHS will implement the NICE guidance on risk assessments for VTE, and we
will ensure that every patient identified as being at increased risk of VTE
receives appropriate preventative measures (prophylaxis).
100% of patients will be risk assessed for development of VTE
Those identified as being at increased risk of VTE receive the
recommended mechanical and pharmacological prophylaxis at the right
time and for the appropriate duration
Current Status
LCHS aims to improve the accuracy and completeness of its clinical records.
The Trust has policies and guidelines for record keeping that meet national
and professional standards. Audits have shown that the standard of record
keeping can vary considerably.
NICE guidance on VTE was introduced in Community Hospital wards at
Louth County Hospital in 2010 and clinical audits demonstrate high rates of
compliance.
Identified areas for improvement
All patients in community hospitals will be risk assessed for development
of VTE in line with NICE guidance and those identified as being at risk will
receive appropriate prophylaxis (prevention)
New initiatives to be implemented in 2012−13
All Community hospital staff will be competent in VTE assessment and
prevention to ensure all staff are aware of the significance of this initiative on
an on-going basis
Introduction of VTE audits in all community hospitals, these will be reviewed
at Clinical Governance meetings to ensure that clinicians and all members of
the multidisciplinary team understand their responsibility for delivering the
initiative.
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Lincolnshire Community Health Services NHS Trust
Monitoring and Reporting of the priority area
Quarterly audits of risk assessments will take place across LCHS and will
be reported to the Clinical Governance and Risk Committee and LCHS
Trust Board through the Quality and Risk Report
Quarterly audits of prescribing of prophylaxis will take place across LCHS
and will be reported to the Clinical Governance and Risk Committee and
LCHS Trust Board through the Quality and Risk Report
Board Sponsor
Chief Nurse/Director of Operations
Implementation/Programme Lead
Project Facilitator
Quality Account 2011/12
13
Patient Safety
Reduction in falls resulting in harm
Over recent years increasing attention has been paid to patient falls both in
terms of harm and the number of falls. National evidence suggests that more
could be done to protect patients from harm.
Aim/Goal
Although in LCHS the level of harm from falls is low, we have decided to
set ourselves the goal of reducing the level of harm even further in our
community hospitals
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Number of Falls Resulting in Harm
Current Status
Identified Areas for Improvement
LCHS have put together an improvement team to test and pilot falls
prevention strategies. This will involve rigorous monitoring and scrutiny of
when and why falls happen. Clinical teams will be learning what prevention
strategies they need to adopt for their group of patients.
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Lincolnshire Community Health Services NHS Trust
Current Initiatives in 2011/12
The improvement initiatives will be tested at Welland Ward, Johnson
Community Hospital in the first instance and then rolled out to all wards
in the community hospitals, using the same methods and sharing lessons
learned.
LCHS has an agreed falls strategy and carries out risk assessments on all
patients is its care.
New Initiatives to be implemented in 2012/13
Roll out of improvement initiative to all community hospitals
Monitoring and Reporting of the priority area
Monthly monitoring of the total number of falls and the number of falls
resulting in harm will be reported to the Clinical Governance and Risk
Committee and LCHS Trust Board through the Quality and Risk Report
Board Sponsor
Chief Nurse/Director of Operations
Implementation /Programme Lead
Project Facilitator
Quality Account 2011/12
15
Patient Safety
Reduction in medication errors
Medication errors are broadly errors in prescribing, dispensing or
administration of a drug. They are the single most preventable cause of
patient harm. (National Patient Safety Agency 2004).
Aim/Goal
In LCHS the level of harm from medication errors is low; however we have
decided to set ourselves the goal of reducing the level of harm even further.
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Reduction in Medication Errors Resulting in Harm
Current Status
Identified Areas for Improvement
Further reduce all types of medication errors
Current Initiatives in 2011/12
LCHS has introduced a medication chart checker to reduce administration
errors. LCHS carries out detailed investigations into all medication errors and
has introduced a competency framework for staff who make errors.
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Lincolnshire Community Health Services NHS Trust
New Initiatives to be implemented in 2012/13
The Trust will use recognised improvement techniques to analyse, where and
why medications errors occur. Strategies will be put in place to reduce errors.
The work will commence on Scotter Ward, John Coupland Community
Hospital. The improvement techniques will then be rolled out to all
community hospital wards using the same improvement methods.
Monitoring and Reporting of the priority area
Monitoring and Reporting of the priority area
Monthly monitoring of the total number of medication errors and
the number of errors resulting in harm will be reported to the Clinical
Governance and Risk Committee and LCHS Trust Board through the
Quality and Risk Report
Board Sponsor
Medical Director
Implementation Lead/Programme Lead
Project Facilitator
Quality Account 2011/12
17
Patient Experience
Reduction in avoidable Pressure Ulcers
Most pressure ulcers, or bed sores, are a complication of illness which with
appropriate care can be avoided. People who are unable to move some of all
of their body due to illness, paralysis or advanced age often develop pressure
ulcers which are graded from 1 (least serious) to grade 4 (most serious). At
LCHS we strive to ensure that no patient suffers from a pressure ulcer that
could be avoided through preventative measures.
Aim/Goal
No avoidable pressure ulcers at Grade 2, 3 and 4 by December 2013.
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LCHS acquired Grade 3 and 4 pressure ulcers
Current Status
Identified areas for improvement
All patients will be assessed for their risk of developing a pressure ulcer.
A treatment plan will be put in place for them and they will be carefully
monitored.
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Lincolnshire Community Health Services NHS Trust
Current Initiatives in 2011/12
Pressure ulcers are a widespread and often underestimated health problem
and as of 31 March 2010 there was no nationally set way of measuring and
recording the incidence of pressure ulcers or of comparing the incidence levels
between providers.
In order to reduce the number of patients acquiring pressure ulcers:
A pressure ulcer prevention treatment pathway is in place
We are updating our pressure ulcer prevention treatment pathway and
auditing our compliance against patient assessments
All Grade 3 and 4 pressure ulcers are reported as a Serious Incident
and investigated through the Root Cause Analysis process which is an
investigation to determine the fundamental contributing factors of the
pressure ulcer. This process ensures lessons are learnt and practices are
improved.
New Initiatives to be implemented in 2012/13
We are developing our IT reporting systems
We are updating our pressure ulcer prevention tool and auditing our
compliance against patient assessments
We are developing a mandatory training package for all clinical skills
We are improving our incident reporting system and publishing our
performance on a team by team basis
Monitoring and Reporting of the priority area
Monthly monitoring of the total number of grade 2, 3 & 4 pressure ulcers
and the number of avoidable pressure ulcers will be reported to the
Clinical Governance and Risk Committee and LCHS Trust Board through
the Quality and Risk Report
Board Sponsor
Director of Operations/ Chief Nurse
Programme Lead
Senior Project Manager
Implementation Lead
Clinical Nurse Specialist Tissue Viability
Quality Account 2011/12
19
Statements relating to quality of NHS
services provided
Review of Services
During 2011-12 Lincolnshire Community Health Services NHS Trust provided
and/or sub-contracted 42 NHS services.
LCHS has reviewed all the data available to them on the quality of care in 5 of
these NHS services.
The income generated by the NHS services reviewed in 2011-12 represents 28%
of the total income generated from the provision of NHS services by LCHS for
2011-12.
Participation in Clinical Audit
During 2011/12, 1 national clinical audits and 0 national confidential enquiries
covered NHS services that Lincolnshire Community Health Services NHS Trust
provides.
The national clinical audits and national confidential enquiries that
Lincolnshire Community Health Services NHS Trust was eligible to, and
participated in, was the National Continence Pilot Audit during 2011/12.
Participation in Clinical Research
The number of patients receiving NHS services provided or sub-contracted
by Lincolnshire Community Health Services NHS Trust in 2011/12 that were
recruited during that period to participate in research approved by a research
ethics committee was 1512.
Goals agreed with Commissioners
A proportion of Lincolnshire Community Health Services NHS Trust’s income
in 2011/12 was conditional on achieving quality improvement and innovation
goals agreed between Lincolnshire Community Health Services NHS Trust
and NHS Lincolnshire, through the Commissioning for Quality and Innovation
(CQUIN) payment framework.
For further details go to: http://www.lincolnshire.nhs.uk/en/Commissioning/
CQUIN---Commissioning-for-Quality-and-Innovation/
NICE Quality Standards
NICE quality standards measure NHS Trusts delivery of high-quality, costeffective patient care. LCHS is committed to achieving these standards across
the organisation’s services.
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Lincolnshire Community Health Services NHS Trust
Statement from the
Care Quality Commission
Lincolnshire Community Health Services NHS Trust is required to register
with the Care Quality Commission and its current registration status is
fully registered. Lincolnshire Community Health Services NHS Trust has no
conditions on registration.
The Care Quality Commission has not taken enforcement action against
Lincolnshire Community Health Services NHS Trust during 2011/12.
LCHS is registered to carry out the following regulated activities:
Treatment of Disease, Disorder or Injury
Surgical Procedures
Diagnostic and Screening Procedures
Family Planning
Nursing Care
Paul Robinson, Deputy Chief
Executive, LCHS
Board nominated individual
for CQC
LCHS has not been subject to unannounced visits from the CQC in 2011/12.
LCHS has not participated in special reviews or investigations by the Care
Quality Commission during 2011/12.
Unannounced Quality visits
As part of the continual quality review process Senior Managers within LCHS
conduct unannounced spot checks to services. These are conducted in a
similar style to that of the CQC unannounced checks, to ensure that service
quality is monitored.
During 2011/12 LCHS carried out a total of 6 spot checks, these covered:
Louth Hospital – Urgent Care Centre
Louth Hospital - Wards
John Coupland Hospital, Gainsborough
Johnson Hospital, Spalding
Skegness Hospital – 1 day and 1 night visit
Internal spot checks assure compliance with the CQC outcomes. Information
gathered from the spot checks is reported to the Clinical Governance and Risk
Committee where action plans are agreed and monitored. Spot checks will
also be carried out in 2012/13 with the outcomes for review being selected by
the Trust Executive Group.
Quality Account 2011/12
21
Statement on Data Quality
LCHS will be taking the following actions to improve data quality:
Receive external assurance of the 2011/12 Quality Account to test the
quality of the data information provided in the report.
This is not a mandated requirement of the Quality Account but will provide
assurance to LCHS as an aspirant Foundation Trust and determine areas for
improvement.
NHS Number and General Medical Practice Code Validity
LCHS submitted records during 2011-2012 to the Secondary Uses service for
inclusion in the Hospital Episode Statistics which are included in the latest
published data.
The percentage of records in the published data which included the patient’s
valid NHS number was:
100% for admitted patient care
99.2% for accident and emergency care
The percentage of records in the published data:
100% for admitted patient care
100% for accident and emergency care
Information Governance Toolkit attainment levels
The Information Governance Toolkit is a performance tool that draws
together the legal rules and central guidance that ensures organisations
process and handle information in an appropriate manner. It covers personal
information i.e. relating to patients/service users and employees and also
corporate information, e.g. financial and accounting records. The purpose of
the assessment is to enable organisations to measure their compliance against
the law and central guidance and to see whether information is handled
correctly.
Where partial or non-compliance is revealed, organisations must take
appropriate measures, with the aim of making cultural changes and raising
information governance standards through year on year improvements.
The ultimate aim is to demonstrate that the organisation can be trusted to
maintain the confidentiality and security of personal information.
LCHS Information Governance Assessment Report overall score for 2011/12
was 68% and was graded as satisfactory. Level 2 was achieved for all areas
with the agreement that LCHS achieve 95% compliance with Information
Governance training by the end of April 2012. As at the 12th April 2012 91%
compliance had been achieved.
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Lincolnshire Community Health Services NHS Trust
Clinical Coding error rate
LCHS was not subject to the Payment by Results clinical coding audit during
2011/12 by the Audit Commission.
Due to the low numbers of uploaded Secondary Uses Service consultant led
activity, LCHS was not subjected to nor requested to take part in an audit.
The Clinical Coding team have completed the foundation training coding
qualification and necessary refresher courses. An arrangement is in place with
United Lincolnshire Hospitals Trust (ULHT) to strategically manage the team
due to the numbers of staff.
Quality Account 2011/12
23
Part 3
Review of Quality
Performance 2011/12
LCHS has a Quality Improvement Strategy and has undertaken a review of
its quality governance systems. As a result LCHS has improved the reporting
of incidents, improvement in patient safety from Board to Ward and is
developing a quality dashboard at ward and team level.
In addition LCHS is being supported by the Institute of Improvement and
Innovation to implement the Safe and Productive Care for Older People
programme across its inpatient and community settings.
This section is a review of the Trust’s quality performance over the past year
based on the priorities set within the 2010/11 quality account. The areas that
were selected to be reported against were identified as the most important
by patients, staff, Board members and people who purchase our services on
behalf of the local population
Patient Safety
Medicines Management
Monitoring of medicines administration for all disciplines
A Medicines Management Lead has been appointed within LCHS to ensure
that the Medicine Management Improvement plan is progressed. The
Medicines Management Committee ensures that policy and guidance are
followed and education and learning are paramount to ensuring patient
safety. Medication errors are reported through the incident reporting system
and associated investigations and action plans are put in place and monitored
locally through the Clinical Governance Committees.
Clinical Effectiveness
Transforming Community Services
Introduction of Business Units in the new NHS Trust and the
development of integrated services
The introduction of Business Units took place in April 2011. Staff engagement
has been a key focus within the Business Units in order to ensure effective
communication regarding the new structure of the organisation. The
formation of Business Units is enabling better integration of services with
key stakeholders including patients, carers, public and health and social care
providers as well as the new Clinical Commissioning Groups.
Business Units are enabling a mapping of services to take place in relation to
availability of resources and requirements of specifications to ensure safe and
effective service delivery.
Quality improvements are being made through Clinical Audit, Patient
Involvement, Patient Experience, Incident reporting and learning
through experience.
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Lincolnshire Community Health Services NHS Trust
Patient Experience
End of Life Care – project to evaluate patient and carer
experience of End of Life Care
Individual experiences influenced the review of services and work is in hand
to ensure that more is being done to listen to those who care for a relative,
friend or loved one towards the end of their life is heard.
During 2011/12 carers were routinely invited to feedback to transform future
service delivery for those people and their carers towards the end of their life.
Carers are going to be routinely invited to meet with the Trust six months
following the passing of their loved ones with the aim of highlighting what
was helpful in respect of services received from Lincolnshire Community
Health Services NHS Trust and also where the carer feels the service could be
improved.
Sue Cousland, Chief Nurse/
Director of Operations, LCHS
East Midlands Leadership Academy
In 2010 a team of health professionals from LCHS won first place in a regional
leadership challenge beating ten other teams to secure £50,000 of funding to
further develop their project to deliver Intravenous Therapy (IV) in a range of
community settings including patients’ homes and Community Hospitals.
The aim of the project was to explore the feasibility of providing an IV delivery
of therapies from within community based services.
Benefits of the project included:
Patient choice of environment in which they receive the therapy
Improved quality of care
Empowerment for patients to manage their own health
Promotion of dignity and independence
Prevention of unnecessary hospital admissions
Reduction in length of hospital stay
Promotion of care giver/patient partnership in the delivery of care
Improved experience for care givers/significant other i.e. less travel,
reduction in financial cost
To date the clinical teams have received training in cannulation and
IV administration.
Quality Account 2011/12
25
Quality Achievements in 2011/12
LCHS continues to make progress with regards to quality improvements and
achievements in areas such as the Patient Environment Action Team (PEAT)
inspections (a tool to ensure improvements are made in non-clinical aspects
of care including environment, food, privacy and dignity), health acquired
infection reporting, feedback from staff surveys and compliments and
complaints.
PEAT Scores
Dr Phil Mitchell
Medical Director, Lead for
Infection Control, LCHS
PEAT is self-assessed and provides a framework for inspecting standards to
demonstrate how well LCHS is performing in key areas including:
Food
Cleanliness
Infection control
Patient environment (including bathroom areas, lighting, floors and
patient areas)
Assessments are carried out by various members of LCHS staff including
nurses, matrons, doctors, estates and facilities staff, executive and nonexecutive directors, dieticians and estates directors. Patients, patient
representatives and members of the public are also part of this assessment
process.
The PEAT inspections are carried out in the four Community Hospitals in
Gainsborough, Louth, Skegness and Spalding. Below a comparison of the 2010
and 2011 results are shown.
Environment
Food
Privacy and Dignity
2010
2011
2010
2011
2010
2011
John Coupland Hospital
Gainsborough
Excellent
Good
Excellent
Acceptable
Excellent
Excellent
Johnson Hospital
Spalding
Excellent
Excellent
Excellent
Excellent
Excellent
Excellent
County Hospital
Louth
Acceptable
Good
Excellent
Excellent
Good
Good
Skegness Hospital
Excellent
Good
Excellent
Excellent
Excellent
Good
Our community hospitals are audited for environmental cleanliness on a
monthly basis and consistently achieve greater than the 90% target set for
cleanliness.
26
Lincolnshire Community Health Services NHS Trust
Health Care Associated Infection
Controlling the risk of avoidable infection is a key role for LCHS and we aim to
ensure that all service users who access healthcare and the staff who provide
the care do so in a safe and clean environment. This can be demonstrated
through the low Meticillin-Resistant Staphylococcus Aureus (MRSA) results for
both 2010/11 and 2011/12.
Number of admissions
3213
4838
3715
Number of screens completed
3219
4877
3691
Number of MRSA positive screens
63
80
59
MRSA Blood Stream Infection Comparison for LCHS
1.6%
2009/10
Quality Account 2011/12
2.0%
1.6%
2010/11
2011/12
27
Staff Survey
The results from the 2011 staff survey have shown improvements in some of
the key areas, the response rate for the survey was 56%. 64 questions were
asked in the survey of which 30% were rated higher than in 2010.
Ian Warren
Director of Human Resources
and Organisational
Development, LCHS
The 2011 survey demonstrates that staff experiences have improved most in
the following areas:
Staff are able to carry out their work to a standard they are pleased with
Care of patients is the Trust’s top priority
The trust helps to balance work and home life
Training levels for both equality and diversity and infection control have
increased
Senior managers are acting on staff feedback
The number of staff injured or unwell because of work related stress has
reduced
Areas where the Trust has performed well against the national average are:
Communication with senior management and staff is effective
Care of patients is the Trust’s top priority
Senior managers act on staff feedback
They or a colleague reported an error that could hurt staff
They or a colleague reported an error that could hurt patients
Staff injured or unwell because of work related stress has reduced
The staff survey identified that there were some areas for improvement; these
were the opportunity for all staff to discuss:
Flexible working
Goals and objectives
Career progression
Receive clear feedback
Recommendations have been made and actions put in place to ensure areas
requiring improvements and further achievements are made.
28
Lincolnshire Community Health Services NHS Trust
Examples of Outstanding Practice
Regional Innovation Fund to undertake a ‘New Ways of
Working Project’
LCHS secured £60k funding through the Regional Innovation Fund and is
launching a new Quality Improvement programme called ‘The New Ways of
Working programme’ this has been set up to work with staff to develop new
and better ways of working for you in the organisation. The areas that the
programme has been commissioned to implement are:
SystmOne (S1) Briefcase - This is a new functionality that allows staff to
access a limited amount of a patients record that can then be saved to a
S1 briefcase and staff can travel around to care for patients and update
their S1 patient care records offline and thus reduce connectivity issues.
It is to be used as a new tool if identified as suitable by LCHS teams. The
team are looking at the functionality of S1 Briefcase and working with
staff and system trainers to introduce more efficient ways of working.
S1 refresher training: Systems training will be available to support LCHS
staff throughout the New Ways of Working Quality Improvement Board
(NWWQIB) Programme for any training relating to S1 e.g. for S1 Briefcase
and for S1 rotas & visits. This training is going to be offered as flexibly as
possible for each team.
Telehealth: There is a new Telehealth system being introduced into
Lincolnshire, with partnership working between Lincolnshire County
Council, Lincolnshire Partnership Foundation Trust, United Lincolnshire
Hospitals Trust & Lincolnshire Community Health Services NHS Trust
available called Florence or Flo which sends reminder / prompt texts
messages to patients. Clinical teams need to identify suitable patients
that could benefit from using this Telehealth technology e.g. Diabetic
patient receiving reminders to check their blood glucose levels.
Technology and Connectivity: Producing plans in 10 phases - to send to
IT to ensure a good standard of connectivity. Ensuring workplace is fit
for purpose for each team.
Estates: The estates project is to manage the closure of some estates or
to relinquish some estate leases - and relocate staff to other estates.
Quality Account 2011/12
29
Article in Cancer Nursing Practice Journal
Louise Lee, Macmillan Nurse in the Grantham Team and her colleagues from
ULHT have had an article accepted for publication in the Cancer Nursing
Practice Journal
In November 2011, Louise Lee, Macmillan Nurse from Grantham, along
with a Macmillan Nurse and the Macmillan Cancer Information Services
Lead designed and set up a countywide study day for all grade 6 staff and
AHP from all provider organisations in Lincolnshire to raise awareness of
sexual problems for cancer patients . This followed on from the campaign by
Macmillan Cancer Support to raise awareness of this issue.
Louise and her colleagues evaluated the study event and wrote an article for
publication – Sexual problems in people with cancer- Evaluation of a study
event.
Article in Royal College of Nursing – Community Nursing: Transforming health
care. Published 21st November 2011 www.rcn.org.uk
Article in Royal College of Nursing Journal
Enabling dignified end-of-life care
Candice Pellett: Case Manager District Nurse and Queen’s Nurse working
in an integrated community nursing team, Lincolnshire Community
Health Services NHS Trust, England. Candice was also seconded two days
a week with the Department of Health as the clinical nursing lead in the
Transforming Community Services programme
Candice piloted an end-of-life care guide which she helped to produce while
on secondment with the Department of Health. Where Candice works in
South West Lincolnshire 90% of those who wish to die at home are supported
to do so compared with the national figure of 20 percent.
Candice said. “I work with a great team of community nurses, Macmillan
Nurses and GPs. If one of our patients expresses a wish to die at home we
try to prepare in advance and not leave anything until the last minute. Every
five weeks we meet to discuss the patients we believe to be in the last six to
12 months of their life, irrespective of condition. We use these meetings to
discuss their condition, their medication and their carers’ needs, where they
wish to die, any recent hospital admissions as well as welfare concerns such as
benefit entitlements.”
“We pull in support from whatever source is necessary to help the patient and
their loved ones.”
30
Lincolnshire Community Health Services NHS Trust
The Wolds Baby Café, Market Rasen
Baby Cafes are branded drop in centres that promote the psychological and
physical benefits of breastfeeding. Although Baby Cafés appear informal and
relaxed, mothers can expect a certain type and quality of service that are
underpinned by key concepts, evidence based information and a high level of
professionalism
The Baby Café model must be health led and the Lead Facilitator who is a
Health Visitor with specific qualifications in breastfeeding must be present at
all sessions. There is also a variety of resources that the mums can hire such
as baby slings. The idea is to give mums the chance to chat with other parents
and breastfeeding experts for support and information in a café atmosphere.
Quality refreshments are served including fresh fruit and filter coffee.
The Wolds Baby Café was launched in June 2011 and is held every week in
Market Rasen Children’s Centre. Already in the first six months of its opening
65 breastfeeding mothers have attended.
Here are some comments from our mums so far:
‘Friendly supportive
group’
‘Its brilliant and I
miss it if I did not
come one week.
Fantastic service’
Quality Account 2011/12
‘I enjoy coming
every week; it picks
my spirit up after a
bad week’
‘I would have given
up at 5 weeks as my
baby was feeding
every 20 mins it was
nice to have the
reassurance that all
was normal’
31
Queens Nurse Award
The title of Queen’s Nurse (QN) is open to individual nurses who want to
demonstrate their commitment to patient-centred values and continually
improving practice. Two of our nurses have achieved their ‘Queens Nursing
awards’ this year - Julie Bevan and Tracy Cunningham.
Tracy Cunningham, Respiratory Complex Case Manager
Tracy Cunningham, Respiratory Complex Case Manager based in Skegness
said. “I want to become more involved in policy making, to help improve the
services offered to patients with respiratory disease. In Lincolnshire we are
very fortunate to have a COPD service that supports patients in their homes
from diagnosis to end of life. But this isn’t the case everywhere and there
are millions of patients that go undiagnosed throughout the country. As
a Queen’s Nurse, I will be supported to look at this and will also be helped
to develop the service we currently offer, to improve respiratory care for
patients.”
Outstanding examples of End of Life Care
Suzanne Wells, Case Manager
Suzanne is a Case Manager in the Holbeach and Moulton area providing
support and clinical care for patients in their own homes.
Positive feedback was received from a patient’s relative on the care
administered by Suzanne and her team. With Suzanne’s support the patient
was able be cared for at home in the final weeks of his life, as he had wished.
The family’s appreciation was shown within the local press by way of an
acknowledgement to Suzie Wells to say a special thank you for all she had
done for the patient and his family.
Natalie Herring, Macmillan Specialist nurse
Natalie is a Macmillan Specialist nurse who cares for patients with cancer,
providing palliative care in the patient’s own home whenever possible.
Natalie was nominated for an internal award following receipt of two letters
from patients’ relatives thanking Natalie and her team for the care and
kindness they had received. With Natalie’s support the patients were able to
be cared for at home in the final weeks of their lives, as they had wished.
32
Lincolnshire Community Health Services NHS Trust
Irene Woodrow, Case Manager, Community Nurse
Irene is a Case Manager in the Spalding area providing support and
clinical care for patients in their own homes.
Irene was nominated for an internal award following receipt of a letter
from a patient’s relative expressing her sincerest thanks for the great
comfort Irene had given to the patient and relatives during the patient’s
illness and last days of her life when she had to be taken into hospital.
Irene made a real difference to this patient, helping her in her last days
of life by giving her dignity and comfort as well as clinical care and
helping her relatives through a very difficult, traumatic time by giving
them strength and comfort to cope with their loss.
Outstanding example of Nutritional Support
Anne Duncan, Case Manager/District Nurse
Anne is a Case Manager providing support and clinical care in the
community with an interest in nutrition and malnutrition.
Anne has written Guidelines for the Management of Malnutrition
in Primary Care to enable patients with nutritional difficulties to be
identified and managed quickly and efficiently.
Anne has also worked with workforce development to develop an
e-learning program to enable clinical staff within the organisation to
access training on nutritional screening. The e-learning program has
been endorsed by BAPEN (The national association responsible for
advancing clinical nutrition).
Falls education for Residential Care Homes
Kai Brownhill – Community Staff Nurse
Kai Brownhill developed a standard training approach for staff working
in residential care homes. As link nurse for falls he decided to educate
and develop staff working within one care home in Sleaford in relation
to fall. The aim was to empower care home staff through the provision
of training, tools and techniques to reduce the number and impact of
falls.
Kai delivered 3 teaching sessions to staff in his spare time, one of which
was delivered late evening to ensure night staff could access the training.
A falls register was deployed and information collected and collated to
show recurrent fallers and the severity of falls. This information was
then used to assist and support the home to assess and plan care to
prevent future falls.
The pilot has been a great success, with a reduction in the number of
falls, increased confidence in the staff and reduced requirement for
intervention from GP’s, community staff and the acute sector.
Quality Account 2011/12
33
Complaints and Compliments
200
During 2011/12 LCHS received 145 complaints, of the number of complaints
received during this time period 3 have been reviewed by the Ombudsman.
Two complaints remain open with the Ombudsman, these complaints were
raised in the reporting period 2010/11, and the Ombudsman began the review
of these complaints in the reporting period 2011/12. The Ombudsman has
advised that they will not be taking action on the third complaint. LCHS
ensures that all complaints are acknowledged within the set National
Standard of 3 working days. When acknowledgment of the complaint is made
a timeframe for the response is agreed with the complainant. This is usually
agreed as 25 working days. If however the complaint is complex, an extension
on the timeframe can be negotiated with the complainant.
160
145
140
120
100
80
During the reporting period 2011/12 the number of complaints received
was 37 less than that of 2010/11. LCHS are being proactive to address issues
raised through the Patient Advice and Liaison Service (PALS) by ensuring that
action is taken prior to a formal complaint being made. For the reporting
period 2011/12, 81 concerns were reported formally to PALS with a number
of concerns being addressed by services directly. This measure is helping to
ensure that the number of formal complaints received is reduced.
60
40
20
20
11
by
/1
du O
2
ri n m b
g ud
20 s m
11 a
/1 n
2
ie
w
ed
20
10
/
11
3
Compliments are received directly by LCHS services from patients and carers.
These compliments are recorded by the services and influence the monitoring
of service quality.
Re
v
Number of Complaints received and reviewed by Ombudsman
180
LCHS responds to all complaints received from patients or carers and ensure
that lessons are learnt from these to ensure that good quality services are
delivered to the population of Lincolnshire.
182
My father has asked me
to contact you to express
his deep gratitude for
your support and care.
He said that the kindness
shown was above and
beyond the call of duty,
lifting his spirits … more
importantly, listening to
his concerns
34
Lincolnshire Community Health Services NHS Trust
National Health Service Litigation Authority
(NHSLA)
The NHSLA regularly assess healthcare organisations against a range of
standards and assessments. The standards that healthcare organisations are
assessed against are available at: http://www.nhsla.com/RiskManagement
LCHS have successfully been awarded level one compliance against the NHS
Litigation Authority risk management standards in March 2012. This award
reflects the high standard of policies which exist within LCHS to address
specific areas of risk.
Quality Account 2011/12
35
Involvement and engagement
36
A number of stakeholders have been consulted with throughout the production
of the Quality Account. These have included:
Staff
LCHS Members, including patients and carers
The Public
LCHS Readers Panel
LCHS Staff Network Groups
Health Overview Scrutiny Committee
Lincolnshire Local Involvement Network
NHS Lincolnshire
Clinical Commissioning Groups (CCG)
Thank you to all those who contributed in the consultation process.
Quality Accounts Audit Guidance 2011-12, published 2 April 2012 says that
‘Auditors will provide the Trust’s management with a signed limited assurance
report by 29 June 2012’. Unlike Acute and Mental Health Trusts, Community
Trusts are not required to obtain assurance from their External Auditors on
the Quality Report. However, management of the Trust expressed a desire for
assurance on the 2011/12 Quality Account, which the review was designed to
provide. The Quality Account has been amended in line with this report.
Statement of changes to content of Quality
Account post consultation
The following changes were made to the Quality Account following the
consultation process:
Layout of report has been altered
Graphs have been simplified
Monitoring and reporting of information for priorities included
Information Governance Toolkit information expanded
Additional staff survey data included to demonstrate balance of data
Compliments and Complaints data expanded to provide context with
graphical representation of complaint numbers
Statements from other bodies
As part of the process for developing the Quality Account we were required
to share a draft version with a range of other organisations and publish their
comments. Responses are published over the page.
Lincolnshire Community Health Services NHS Trust
Commissioning high quality, safe patient services is NHS Lincolnshire and CCGs
highest priority and the areas identified will enhance the patient experience
and improve patient safety and clinical outcomes. NHS Lincolnshire therefore
welcomes the focus that the Trust still places on reducing harm from falls
in community hospitals and the additional focus on eliminating avoidable
pressure ulcers.
In terms of performance against the 2011/12 CQUIN indicators, the following
indicators were achieved:
Stroke - Improving treatment planning and reviews for those patients
who have had a stroke. Ensuring that the patients are nursed and treated
in accordance with NICE Quality Standards
Percentage of Personalised Care Plans with a defined content
The percentage of people discharged from hospital and benefiting
from intermediate care/rehabilitation enablement who have not been
readmitted to hospital by day 90
PPI - Increasing qualitative awareness and understanding of carers’
experiences of services relating to End of Life services delivered by LCHS
Out of Hours - A reduction the number of avoidable admissions within
the Out Of Hours service
Children - Improvement in triage and serviced involved in the
management of children from A&E, Minor Injuries and Illness Unit
The following CQUIN indicators were partially achieved:
High Impact Actions Composite Indicator: Falls; Pressure Sores;
Catheter UTIs
Median waiting time for treatment and therapy services
Long Term Conditions - A reduction in inappropriate admissions and readmissions from a Complex Case Manager caseload
Data systems/quality - To increase data quality and improve reporting on
electronic systems
The following CQUIN indicator was not achieved:
Breastfeeding – To measure the number of mothers who are
breastfeeding at their primary visit are still breastfeeding at 6-8 weeks
Quality Account 2011/12
37
NHS Lincolnshire supports the examples of the quality improvement schemes
that have been worked on during 2011/12 and areas that have been identified
for development within 2011/12. In particular LCHS has undertaken a review of
its quality governance systems and as a result has improved the reporting and
closure of incidents. Further in order to improve patient safety there has been
Board to Ward reporting in the form of a quality dashboard at ward and team
level.
NHS Lincolnshire acknowledges the achievement by the Trust in securing
60k funding through the Regional Innovation Fund to launch a new Quality
Improvement programme called ‘New Ways of Working’ This has been set
up to work with staff to develop new and better ways of working in the
organisation and include more efficient technology to support patient record
keeping backed by specific training in its use.
NHS Lincolnshire notes that the Trust’s current registration status with the
Care Quality Commission is full and unconditional.
LCHS has not been subject to unannounced visits from the CQC in 2011/12.
LCHS has not participated in special reviews or investigations by the Care
Quality Commission during 2011/12.
NHS Lincolnshire notes the considerable hard work undertaken by the Trust
to maintain and achieve greater than the 90% target with regard to the
PEAT inspections across the four Community hospitals and the high level of
cleanliness achieved in these services. Specifically we note that the Trust has
made progress on eliminating mixed sex accommodation.
NHS Lincolnshire endorses the areas identified for improvement for 2012/13
and the associated initiatives as detailed within the Quality Account as:
Record keeping
Venous thrombo-embolism risk assessment and thrombo-prophylaxis
Reducing levels of harm from falls
Reducing medication errors
Reducing the number of avoidable pressure ulcers by 100%
NHS Lincolnshire welcomes the specific attention detailed within the Quality
Account, to the assessment, reassessment and management of patient
mobility and risk of falls; patient nutrition and hydration; including, the
assessment and management of tissue viability. Further, the consistent and
appropriate utilisation of patient risk assessments for both community and
community hospital patients is supported as an area for improvement.
38
Lincolnshire Community Health Services NHS Trust
Additionally, the priorities identified by NHS Lincolnshire as CQUIN indicators
for 2012/13 include:
NHS Safety Thermometer- data submission in relation to pressure ulcers,
falls, catheter urinary tract infections and VTE
VTE Risk Assessment – reduce avoidable death, disability and chronic ill
health from Venous-thromboembolism (VTE)
A Patient Revolution - Net Promoter score
To improve patient safety and reduce the incidence of additional
healthcare activity as a result of pressure ulcers whilst in the care of the
Trust
Offering referral to the weight management clinic for children in
reception year (4 years) and year 6 (10 year olds).
Making Every Contact Count - one of the 5 SHA ambitions in the
Regional Commissioning Framework - Encouraging healthy lifestyles
Tele- heath – (High Impact Innovation)
Serious Incidents (SIs) - to complete within 45 days rather than 60 days
for all SIs.
Improving diagnosis of dementia in community hospitals
NHS Lincolnshire supports the work underway to improve the patient
experience and to capture real time feedback from patients across the Trust
regarding whether they would recommend the service to family and friends.
NHS Lincolnshire endorses the accuracy of the information presented within
the LCHS Quality Account and the overall quality programme performance will
be reviewed through the formal contract quality review process.
Quality Account 2011/12
39
Statement on Lincolnshire Community Health Services NHS Trust
Trust’s Quality Report for 2011/12
This statement has been prepared jointly by the Lincolnshire Local
Involvement Network (LINk) and the Health Scrutiny Committee for
Lincolnshire.
Priorities for 2012-13
The Lincolnshire LINk and Health Scrutiny Committee for Lincolnshire
express concern that medication errors continue to be an issue for the Trust
commenting that the responsibility of health professionals to prescribe and
administer medication accurately is a fundamental necessity. It would appear
that existing processes have not improved the situation over the last year and
we therefore welcome the fact that this continues to be a high priority for
the Trust and are supportive of systems in place to monitor and identify the
difference between human error and incompetence. We feel that with these
strategies in place the target should be zero.
The LINk and Health Scrutiny committee welcome all the other priorities
outlined within the Quality Account most notably the aims to improve record
keeping, reduce falls and to eradicate pressure sores.
The LINk and Health Scrutiny committee is pleased to hear that the Trust is
developing effective relationships with the Clinical Commissioning Groups
and suggest therefore that this should be mentioned within the report but
is disappointed to note that there is very little information in the Quality
Account about the services provided by the Trust within the community,
for example district nurses, school nurses, health visitors, and also services
provided in village halls.
Achievements
We commend the Trust on its efforts to involve and engage with the public
and staff and congratulate members of the nursing staff on the achievement
of the Queens Nurse Award.
40
Lincolnshire Community Health Services NHS Trust
Patient and Public Involvement
Both the Health Scrutiny Committee and LINk have developed a strong
working relationship with the Trust and continue to be appreciative of the
arrangement of pre consultation prior to a major public consultation which we
feel is very valuable.
Complaints and Compliments
The LINk and Health Scrutiny Committee emphasise the importance of using
complaints as a learning process and of highlighting compliments received in
order to demonstrate positive patient experience.
We commend practices which support patients to complain in real time
without fear of reprisal and recommend ensuring that pathways and time
frames for complaints processes are clear and accessible.
Conclusion
We are grateful for the opportunity to provide comment on the Trust’s draft
Quality Account and believe that the Quality Account is a true reflection of
the services provided by the Trust.
Quality Account 2011/12
41
Patient Advice and Liaison Service (PALS)
PALS is a confidential service that helps patients, their families and carers
to find answers to questions or concerns regarding the care or treatment
received from NHS Trusts in Lincolnshire.
As a patient, relative or carer you may sometimes need to turn to someone
for on-the-spot help, advice and support. This is what the Patient Advice and
Liaison Service does on a daily basis. We provide confidential advice and
support, helping you to sort out any concerns you may have about the care
provided by the NHS and guiding you through the different services available.
PALS can:
give you information about local health services
listen to any problems you may have in relation to your health care or the
health care of a loved one or friend
help you ask questions about your health care
tell you about help and support groups for you or your carer
Tel: 0845 602 4384
Calls via Typetalk/Text Relay are welcome
Email: info@lincspals.nhs.uk
Write to us at:
Lincolnshire PALS
Greetwell Place
Lime Kiln Way
Greetwell Road
Lincoln
LN2 4US
A member of the team will be available Monday to Friday, 9am - 5pm
(Except Bank Holidays)
This service is confidential
42
Lincolnshire Community Health Services NHS Trust
Membership
For further details of how you can get involved with Lincolnshire Community
Health Services NHS Trust and to find out how you can become a member
follow the link below:
http://www.lincolnshirecommunityhealthservices.nhs.uk/public/content/
lincolnshire-community-health-service-trust-membership
Quality Account 2011/12
43
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large print or in other languages.
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Bridge House, Unit 16, The Point
Lions Way, Sleaford
Lincolnshire, NG34 8GG
Tel: 01529 220300
http://www.lincolnshirecommunityhealthservices.nhs.uk/public/