1
Quality Account
for
Garrow House,
Northern Pathways
2011/2012
2
Contents
Part One- Page 3
Statement on Quality from the Chair of the
Northern Pathways Board
Part 2- Page 4
Priorities for Improvement and Statements of Assurance
from the Board
Part 3-Page 9
Review of Quality Performance
3
Part One Statement on Quality from the Chair of the Northern Pathways Board
Garrow House in York is a 12 bedded high support service for women stepping down from secure
care. The service was developed by Northern Pathways, which is a joint venture between Turning
Point and The Retreat. The service is part of a national Department of Health (DoH) pilot scheme and
has been developed through a strategic partnership between the Department of Health, The
Yorkshire and Humber Secure Services Commissioning Team (SSCT), Northern Pathways and the
newly formed Leeds and York Partnership Foundation Trust (Formerly North Yorkshire and York).
The service was developed in response to national high level policy guidance, including Women's
Mental Health: into the Mainstream (2002) and the subsequent Implementation Guidance (2003), a
regional strategy document, Forensic Services for Women a Strategy Document 2004-2008 and was
informed by a strategic review of population need and service provision and a detailed service user
involvement project. The result is a high quality service for women that enhances the care pathway
for women in secure care. After several years in the planning, the service opened in January 2009
and as such 2011/12 has been its third full year of operation.
A key aspect of the service development approach was to ensure that Garrow House was informed
by the views of the women for whom the service was intended. A project was commissioned by the
Forensic Catchment Group to consult with the women and to ensure their views were fully
incorporated into the service specification and design of the building and service model. The result of
this was the Women's Involvement Project (2007) which produced a comprehensive range of
suggestions about the service philosophy, physical design and range of treatments and activities that
should be offered within the service, all of which have been incorporated into the service.
As a new service and a new company, we were committed to ensuring robust structures, and
systems were set up from the outset to define, monitor and assess quality. These have included:
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Development of Northern Pathways Board.
Monthly Risk Management Group.
A quarterly Northern Pathways Governance Committee including all key parties to ensure
business and clinical governance.
Implementation of Turning Point’s internal quality assurance tool (IQAT) mapped to the Care
Quality Commission (CQC) Independent Hospital standards.
Women’s involvement systems including the appointment of an Involvement Worker in the
service set up phase and the following women’s involvement processes: weekly community
meetings, weekly involvement group, one to one women’s sessions, monthly women’s
governance meetings, representation from the women on the governance group and
committee, the Department of Health (DoH) monitoring meetings, attendance at the steering
group, the service model’s workshop and all away days and partners’ workshops. Also a
representative attends the Regional Involvement Strategy and project groups. The women
also sit on the newly formed Recovery and outcomes Group.
Involvement in the DoH national evaluation of the pilots.
Amendments to the staffing and management structure to create a Clinical Lead post to
ensure clinical quality, and introduction of dedicated Project Worker posts leading on quality
assurance and CQUIN Achievement.
During the third year of the pilot, Garrow House has worked hard to maintain and develop a high
quality service and we are very pleased with the results. In the 4th quarter of 2012 the service
achieved all the innovation goals agreed between Northern Pathways and the regional
commissioners for the provision of NHS services, through the Commissioning for Quality and
Improvement payments framework and achieved all available incentive payments. Robust
involvement systems are in place which means that the women within the service are actively
involved in all aspects of their care and service delivery. To date this has resulted in high levels of
satisfaction and development of a service which the women consistently state is meeting their needs.
4
There has been a continual rolling quality action plan managed by the Service Manager and reported
on to the Governance Committee which has covered all areas indentified where quality improvement
has been required.
We feel that there has been a proactive approach to quality assurance and that staff alongside
service users have worked hard to identity areas where improvement is required and have taken the
relevant actions to ensure that all areas are resolved and improved. Quality improvement is an
ongoing priority for the service and it is always top of the agenda.
I, Andy James, state that to the best of my knowledge the content of this report accurately reflects the
account of quality activities and the current situation.
Signed, Andy James, Chair Northern Pathways
Part 2 Priorities for Improvement and Statements of Assurance from the Board
2.1 Priorities for improvement 2012-2013
In 2012 Northern Pathway’s three priorities reflect the Board and leaderships team`s commitment to
continuously improving patient safety, clinical effectiveness and patient experience:
Priority 1.
The introduction of a new Risk Management Group and Policy Ratification Group.
Rationale.
In the CQC regular inspection at the end of 2011 it was identified that we needed to make
improvements to our risk management and audit processes. The Risk Management Group was
introduced to ensue that our risk management processes are clear. It will ensure incidents are
rigorously reviewed and lessons learnt cascaded to the whole team. It is to be supported by
attendance from Turning Point`s Risk and Assurance department. It will also take responsibility for
audit in response to our CQC action plan.
The Policy Group has been established to ensure that Northern Pathways develop operational
policies that reflect its ethos of involvement. On behalf of the Clinical Governance Committee the
Policy Ratification Group (PRG) will be responsible for the approval of all local Garrow House
documents. The group will identify where there is a need for a local Garrow House policy and where
it is more appropriate to follow a core Turning Point policy.
Plan.
Establish new risk management and policies groups including Terms of Reference and standing
agendas by end of Q1.
Establish new audit and policy review schedules by the end of Q2
Monitoring.
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By Risk and Assurance by their attendance at Risk Management Group meetings
By the Northern Pathways Governance Committee through quarterly meetings.
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•
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By Northern Pathways Board through the reports provided by the Governance committee.
By Commissioners through the monthly CQUIN reporting system, and contract meetings.
By CQC inspections.
Through the Internal Quality Assessment Process
Reporting.
Reporting will be through the Governance Group to the quarterly Governance Committee, who will
report quarterly to the Board.
Project Lead.
Service Manager; Chris Dawson
Senior Management Lead.
Assistant Director Janine Strange
Priority 2.
In collaboration with the women who use our service, our partners and commissioners we will
strengthen and improve our recovery pathway. This will be done by participating in and achieving
Specialist Mental Health CQUINs 2012/13:
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Shared Pathway – Recovery and Outcomes
Implementing a standard secure pathway
Secure Forensic Pathway Feasibility Project
In addition to the monitoring measures described below a Recovery and Outcomes Group
has been established in collaboration with the women.
Rationale.
Northern Pathways was established to support women who required a high level of support to move
out of secure care. With a high level of involvement and socially inclusive activity it has successfully
supported many women to live more independent and fulfilling lives. In 2012 -13 it will continue to
focus its energy on improving its recovery pathway in preparation for the service participating in
clustering and payment by results initiatives.
Plan:
• Establish a Recovery and Outcomes Group at Garrow House
• Attend regional groups cascading good practice.
• Participate in and achieve pathway related CQUINs
Monitoring:
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By the Northern Pathways` Governance Committee through quarterly meetings.
By Northern Pathways` Board through the reports provided by the Governance committee.
By Commissioners through the monthly CQUIN reporting system, and contract meetings.
Reporting.
This will be through the Service Manager and to Northern Pathways Board. Reports will be submitted
to Commissioners within 20 working days of the end of each quarter.
6
Project lead:
Clinical Development Specialist, Karen Abrahams and Involvement Lead, Holly Baker
Senior Management lead
Assistant Director, Janine Strange.
Priority 3
Improve the services response to self harm by the introduction of a shared protocol (agreed with the
women) on self harm and the provision of DBT training for staff.
Rationale
This priority reflects our awareness that while overall numbers of incidents are relatively low, self
harm continues to be the most frequently reported area of concern.
Our aim is to provide a collaborative supportive response to the women requiring support in this area.
We also want to increase the staff team’s confidence in providing interventions around self harm.
Plan.
Establish a shared learning group related to self harm to enhance the teams skill and provide
a forum to look at issues it raises. By end Q 1.
Establish a community based “Managing Emotions” Group for the women by end Q 1
Write a protocol with the women relating to self harm outlining what the women can expect
from the staff and what the staff can expect from the women. By end Q2
Provide training for the staff in therapeutic intervention in self harm.Q2 Q3 and Q4
Garrow House will participate in regional initiatives relating to self harm including work
undertaken by a Sub Group of in the Adult Secure Providers Security and Operational Group.
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Monitoring
o
o
o
By the Northern Pathways’ Governance Committee through quarterly meetings.
By Northern Pathways’ board through the reports provided by the Governance committee.
By the leadership team at weekly meetings
Reporting
This is a Northern Pathways Governance action but regular reports will also go to Risk
Management and Leadership Groups
Project Lead
Consultant Psychologist, Lindsay Jones and Service Manager, Chris Dawson
Senior Management Lead
Assistant Director, Janine Strange.
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2.2 Statement of Assurance from the Board
Review of Services
During 2011/12 Northern Pathways provided 1 NHS service, namely Garrow House.
Northern Pathways has reviewed all the data available to them on the quality of care in the 1 NHS
service.
The income generated by the NHS services reviewed in 2011/12 represents 100% of the total
income generated from the provision of the NHS services by Northern Pathways for 2010/11.
Participation in Clinical Audits
During 2010/11 0 national clinical audits and 0 confidential enquiries covered NHS services that
Northern Pathways provides.
During 2010/11 Northern Pathways participated in 0 national clinical audits and 0 national
confidential enquires, of the national clinical audits and confidential enquiries it was eligible to
participate in.
The reports of 7 local clinical audits were reviewed by the provider in2011/2012 and Northern
Pathways intends to take the following actions to improve the quality of healthcare provided:
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Set up a new Risk Management Group
Provide increased training in area indicated as requiring improvement.eg Self harm, 12 essential
standards of CPA Rapid Tranquilisation and electronic record keeping system.
Increased monitoring of all SUI and audit actions through leadership and Risk Management
Groups.
In addition to the local audits Northern Pathways participates in an Internal Quality Assessment tool
hosted by one of the partner organisations Turning Point. This Internal Quality Assessment tool
(IQAT) is a set of audit tools that detail how the service will deliver regulated activities and meet the
essential standards of Quality and Safety.
The Service also provides a quarterly report to the North of England Specialist Commissioning Group
(Yorkshire and Humber) of Key Performance Indicators.
Research
The number of patients receiving NHS services provided or sub-contracted by Northern Pathways in
2011-2012 that were recruited during that period to
Participate in research approved by a research ethics committee was 0
Garrow House has participated in a Department of Health commissioned evaluation of all services
within the Department of Health High Support Services pilot scheme being undertaken by London
Metropolitan University. The findings of this pilot are pending.
A National Service Evaluation- Women's Pathways of Care in Secure Services:
Garrow House participated in this Research by The University of Central Lancashire.
The purpose of the study was to assess whether women are appropriately placed and examine
obstructions and facilitators to moving women on. With other providers in the region Garrow House
took part in this evaluation study and received positive verbal feedback from the researchers on the
ethos of the service.
Goals Agreed with Commissioners
8
A proportion of Northern Pathway` income in 2012/11 was conditional on achieving quality
improvement and innovation goals agreed between Northern Pathways and the regional
commissioners for the provision of NHS services, through the Commissioning for Quality and
Improvement payments framework.
The following CQUINs were participated in in 2011/2012:
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Essence
HoNOS
Length of Stay
25 hours of meaningful activity
Involvement, Choice and Responsibility
Recovery Planning
We achieved 70% compliance In Q2 and 80% compliance in Q3
We have addressed areas where we didn’t achieve the CQUIN payment by improving our
governance and reporting systems.
What Others Say About Us
Garrow House, Northern Pathways is required to register with the Care Quality Commission and its
current registration status is registered.
The Care Quality Commission has not taken any enforcement action against Northern Pathways
during 2011/2012.
Northern Pathways is subject to periodic reviews by the Care Quality Commission and a regular
inspection was conducted in December 2011.Of the 22 essential standards 6 were specifically
reviewed on the day of the inspection of these 3 required compliance actions and one required an
improvement action.
Northern Pathways has not participated in any special reviews or investigations for the CQC during
the reporting period.
Data Quality
Northern Pathways did not submit records during 2011/12 to the Secondary Users service for
inclusion in the Hospital Episode Statistics..
Northern Pathways was not subject to the Payment by Results clinical coding audit during 2011/12
by the Audit Commission.
Northern Pathways was not subject to scoring for Information Quality and Records Manager
assessed using the information Governance Toolkit
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Part 3 Review of Quality Performance
3.1 Review of Quality Performance in 2011 – 2012
One of the most important aims for the service must be to look back and objectively review our
performance and position throughout 2011/12 in order to ensure that we build on the success of the
pilot service which officially ends in March 2013. The priorities we identified over the last financial
year have been listed as below and updates made for the board.
Update on priorities 2011-2012.
1. Maintain registration with CQC as Northern Pathways and achieve full compliance with CQC
standards, so enhancing our clinical effectiveness.
The service received positive feedback from the inspectors around respecting and involving people
who use our services. However, the service was non compliant in 3 areas, an action plan has been
written to address these.
Quality standards were also consistently monitored through the Internal Quality Assessment Tool
(IQAT). This is modelled on the CQC standards and provides a systematic framework for reviewing
each standard. Garrow House has consistently achieved the majority of these standards and has
action plans to address the few outstanding standards.
2. Achievement of the Quality and Innovation standards (CQUIN) as detailed in the annual contract,
linked to the patient experience.
These included:
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Risk - Use of HoNOS, HCR 20 Assessment tools
Innovation - Use of Essence Climate Scale Environmental scale
Service User experience – Involvement choice and responsibility, CPA Standards, Dining
Experience and 25 hour Structured Meaningful Activity
Effectiveness - Use of recovery planning tool, Recovery Star, Arrow Toolkit
The service successfully has successfully implemented all the tools and initiatives described in
CQUINs leading to positive improvements for the women who use our service. A number of new
tools are now firmly embedded in our electronic records management systems. The women have
also benefitted from increased therapeutic activity including complimentary therapies and a dining
experience that supports both communal and self catering experiences .In the third quarter 80% of
the CQUINs were achieved with only the quality of one report requiring improvement. In the fourth
quarter the service achieved 100% of the CQUIN requirements.
3. Reduction in incidents (particularly self harm and aggression) by proactive trend and clinical
analysis and improved intervention measures, links to patient safety.
Garrow House provides a very safe environment in the least restrictive environment necessary to
maintain the safety of women who had previously been cared for in higher security. This is reflected
in relatively low levels of incidents in all area, with the exception of self harm. For example there are
rarely incidents of physical aggression. At Garrow House the prevalence of self harm as a coping
strategy is also characteristic of some the women the service supports and remains a priority
Therefore the service will continue to proactively develop a strategy to address self harm.
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3.2 Outcomes
To enable us to evidence that the women are able to move forward significantly in their recovery,
Garrow, we utilise a number of outcome measures within the service. CQUIN (Recovery Star,
HoNOS and the Essences Environmental Scale), data has also been collected using the Symptom
Checklist- 90 (HCR-20). The data from routine risk assessments (HCR-20 and START) is also being
recorded as an outcome measure.
All women have an initial Recovery Star within 2 weeks of admission to the service and thereafter
complete a self assessment, with a staff member, quarterly, to evidence their recovery journey. The
results of these are entered into our Client Information Management (CIM) system, and the results
are shown on a distance travelled pie chart for April 2012.
This data is based on the 6 active clients who have more than one Star reading. The % of people
improved/decreased or stayed the same is based on the difference in scores between the first Star
reading and the most recent star reading.
17%
% Improved
% No Movement
50%
33%
% Decreased
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Outcomes of Involvement
Involvement has been and continues to be integral to the ethos of Garrow House. Everyone within
the service plays a key role within involvement. Involvement is not owned, it is shared, and there is a
culture of involvement across the organisation.
The women within the service are empowered to be involved in their own recovery, service
development, regional involvement development and national involvement agendas. Within the
service the clinical governance structure and the community meetings ensure that there is an
opportunity to communicate the ideas and opinions of the women and to feedback any service
development, with the women attending or chairing these meetings.
It is recognised that involvement aids recovery, and as such the women are involved as much as
possible in all aspects of their recovery and in anything that affects their experience at Garrow
House, from co writing all their recovery plans, to being consulted about any service changes or
delivery that is being proposed before any changes take place. In this way the women we support are
active participants within the service and drive their own recovery and experiences here.
The priorities for involvement within the service are based on the User Defined Standards. The
outcomes from these standards are increased involvement, greater choice, speedier recovery, and
enhanced empowerment and control. A large piece of work was recently undertaken by the
Involvement Coordinator and the women at Garrow to write an Involvement Strategy for the service,
what areas will be worked on, how progress will be tracked and what the outcomes will be. This piece
of work will drive involvement and ensure that we keep pushing ourselves to enhance involvement at
Garrow House and the women’s experiences here.
Laura (Service User at Garrow House 2011-12)
Laura is a 21 year old woman who came to Garrow House from a medium secure service in February
2011. She was lacking in confidence and struggled to trust and engage with staff initially. She
frequently used self harm as a strategy to cope with her emotions. Her confidence slowly grew and
she began to attend community meetings regularly in the house, expressing her views eloquently.
She began to feel passionately about involvement and attended the regional Recovery Involvement
for Improvement workshops with the Involvement Coordinator at Garrow. This also slowly developed
over a period of a few months where she began to take a more active role in this setting, co chairing
and planning these meetings with the regional involvement lead, the involvement coordinator from
Garrow House and a staff member and service user from another hospital in the region. Towards the
end of the Recovery workshops Laura was confident enough to stand up in front of 50-60 staff and
service users from secure services across Yorkshire and Humber and co chair the workshops.
Laura became informal within 4 months of coming to Garrow House, and although she struggled at
times her self harm decreased significantly and her confidence grew. Laura also sat on interview
panels for new staff coming into the service and wrote reports about her experiences on the
Recovery workshops and piloting ChatNet (a web based involvement and discussion forum) for the
YHSCG website.
Laura was discharged from Garrow House in May 2012 and is now living in a flat in the community.
She has not self harmed for the last 6 months, and is keen to get a job and help people in a similar
situation to herself in the future.
“Involvement supports women to have a voice, it helps women to communicate, and it’s a way
forward. It boosts your self esteem because you feel listened to. You feel more self-aware, I think it
helps you to think about the other women in the service; it’s like you’re not the only one with a voice
so it makes you a better listener. Speaking for other women in the service makes you think of others
as well as yourself; I think it is this that helps to build relationships in the house. I think it is very
empowering to become an advocate and voice for the women, it makes you communicate on lots of
levels, speaking, listening and supporting.”
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Megan (Service User at Garrow House)
“I have been involved with Garrow House for at least 5 years. I had input into the design of the
service and what women wanted from a high support service. I then came into Garrow House 2 years
ago. I think that Involvement empowers you to care for yourself and if you get involved as much as
possible and see results it makes you feel valued. I go to different regional meetings and get to have
a say in the way services are shaped across the region. I think that this helps the women to speak
their minds and this happens most of the time at Garrow.
Things have changed at Garrow and become more individual. The women are asked what they want
to work on and what their interests are and the therapeutic timetables and recovery plans are done
jointly with the women. I think that if you decide what you want to do and draw up the timetables and
the recovery plans with the staff, it makes you want to do it more, so you take ownership of your work
and recovery. If you are making your own decisions and are involved in all aspects of your recovery it
means more and you get more out of what you are doing.
Garrow House is different and it has changed, but this is not a bad thing as it is evolving to meet the
needs of the women in the service. This means that it is doing what it said it would. ‘The service fits
around the women, the women don’t fit around the service.”
(Service User at Garrow House 2012).
3.3 Complaints, comments and compliments
One measure of quality around patient experience used by Northern Pathways is the analysis of the
complaints, comments and compliments made by the service users.
We received two formal written complaints in 2012.
Both were low risk and minor impact .They were investigated and resolved with the complainants.
We received one concern that was resolved to the satisfaction the women concerned.
Garrow House has a weekly Community meeting where complaints, concerns and compliments can
be raised and resolved informally at the earliest opportunity.
Compliments received through the community meetings centre around new women thanking
everyone for making them feel welcome in the service, and staff thanking the women for their hard
work in contributing to the day to day activities in the house, as well as how well the women support
each other.
Other compliments include the women thanking each other for the support they have received from
peers, and thanking the staff for facilitating activities that they have particularly enjoyed.
We also received a compliment from a visitor to the service for the women and the staff.
“I just wanted to thank all the women and staff that I met during my recent visit to Garrow House - for
your hospitality, time and information sharing.
It was a very informative visit for me, the service you provide at Garrow stands as a real example for
how I hope our service will develop.
3.4Clinical Effectiveness
Between April 2011 and the end of March 2012 Garrow House assessed 18 and admitted 8.The
service achieved an average occupancy rate of 91.6% (11 Beds).
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The following graph indicates the occupancy trend over the past 24 months. .
Occupancy
Occupancy 2010-2012
12
11.5
11.0
11
10.3
10
10.0
9
8
7
6
10-11
11-12
12-13
Target
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
•
Although occupancy dipped in December and January, there were 2 prompt
admissions and the service was full again by the end of the year
•
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Average Occupancy for 2011-12 = 91.66%. (11 beds)
This is just below the target of 93% (11.6 beds)
The service has had at least 10 beds full for the past 24 months
The service is currently full (May 2012) and the occupancy has not dropped below 10 in the past 24
months. There are currently 4 women who are informal patients, three women regularly attend
college and three who undertake voluntary work. .We are actively developing pathways into less
secure care for example by working with Leeds personality disorder pathway service and increasing
our social work provision. The development of pathways is also a major CQUIN objective. To this end
we have set up a Recovery and Outcomes Group
In order to ensure staff competency to deliver clinical effectiveness the following has been
developed:
•
An annually-reviewed service specific competent worker programme is in place. This ensures
that all new staff have a comprehensive induction and complete all relevant learning and
development within their six-month probationary period. Completion in recorded centrally and
reviewed regularly.
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Learning & Development
Training Modules Completed (excludes Casual workers)
Face to Face
NP
staff
33
% Jun
%Aug
% Sep
% Dec
% Apr
%
Change
NHS
E-Learning Modules
E Learning
Mental
Capacity
Safeguarding
Food
Key
EmerHygiene Act and
Info
Vulnerable
Working
gency
Intro to
DepDementia
Security
Adults & Young Level 2
Skills First Aid at
IG
rivation of
People (Front
E
Guidelines
Day 1
Work
line Workers) Learning Liberty
Awareness
30
25
27
8
27
28
85%
85
82
82
80
74%
74
71
76
63
85%
85
82
82
87
18%
21
24
24
27
3
-20
-13
5
3
n/a
3
85%
85
82
82
77
88%
88
85
85
80
n/a
-5
-5
Only 8 Competent Worker modules are less than 90% complete
All other modules are 80% complete or higher;
• Face to Face- 15 modules
• E-learning – 11 modules
In addition, the staff team at Garrow House has developed competencies to meet the needs of
the complex client group. Staff have participated in specialist training in the following areas:
•
•
•
•
•
.
Cognitive Analytical Therapy training
Relational Skills training
Equality and Diversity training
The Knowledge and Understanding Framework for Personality Disorder
Four support workers are being supported on the foundation degree nursing programme.
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Health & Wellbeing
The staff team is an essential part of the success of Garrow House. It has continued to be a relatively
stable element of the service as the graph below shows.
Workforce Performance - Turnover
Leavers & Joiners 2011-12
4
Leavers
Joiners
3
2
1
0
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
Vacancy
Staff
Staff and Vacancy Numbers 2011-12
36
30
24
18
32.5
33.4
32.4
32.4
33.2
33.4
33.5
33.5
33.5
32.5
31.5
30.5
31.5
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
12
6
0
During the past year there have been 6 leavers and 4 new joiners, although 2 of the leavers have
since rejoined the service. Exit interviews are routinely completed.
This stable, highly trained and highly motivated staff team has impressively low levels of sickness.
Over the past year, sickness levels have been both below the target the service set for itself, and
against the benchmark of the CIPD average for the sector of 0.8 Lost Working days per employee
per month. There has been no long-term sickness since July 2011.
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HR - Employee Welfare
Lost Working Days 2011-12
45
LT
ST
30
15
17
Mar
1.5
9
1
0
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Garrow
Target 1.0
CIPD 0.8
Average Lost Working Days per Employee
1.0
0.5
New
policy
0.0
Mar
•
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Sickness continues to be low, with no long-term sickness since July. After the seasonal
increase in Dec & Jan, sickness levels have dropped
The Garrow House therapeutic model aims to enhance psychologically informed care through
relational understandings. Within the model, staff support and supervision is viewed as essential. It is
acknowledged that the work can be emotionally demanding and that the staff team need to be well
functioning in order to provide high quality care. Supervision and support for staff is therefore seen as
integral to the model, and a reflection culture is encouraged. Staff protected time each day allows for
this. Staff have weekly group supervision facilitated by an external therapist. There is also a weekly
risk supervision group in which the risk assessments, formulations and management plans are
discussed. Shared formulation meetings are also held. More informal opportunities for reflective
practice are also encouraged, including the introduction of weekly shared learning seminars. In
addition, all staff have identified clinical supervisors and are expected to access a minimum of one
hour of individual clinical supervision each month.
3.1.3 Patient Safety
Through the Quarterly Governance Committee patient safety has been assessed. An analysis of all
incidents is undertaken monthly through the service governance and this group reports to the
Quarterly Governance Committee. To date the service has been a high incident reporting service and
the committee wished to analyse the type of incidents and trends to determine any improvements to
service delivery.
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Incident analysis for 2011/12.
The most frequently reported incident type across the period was self harm. Hence a priority for
2012-2013 is the establishment of a shared protocol on self harm agreed with the women who use
our services.
Incidents are reported to Turning Point’s Risk and Assurance team through an electronic reporting
system (DATIX).They are also reviewed internally by the leadership team who cascade learning from
incidents to the wider team .As of June 2012 all incidents will undergo review by the newly formed
Risk Management Group.
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Under contractual arrangements serious incidents are also submitted for review to Yorkshire and
Humber Secure and Specialist Mental Health Commissioning Team. Reports are submitted within 24
hours and at 5 day and 12 week intervals.
Garrow House participates in the Adult Secure Providers Security and Operational Group Meeting.
This meeting brings together commissioners and providers from the region enabling the sharing of
good practice and quality initiatives.
Statements from Local Involvement Networks, Overview and Scrutiny Committees and PCT’s
Service User experience at Garrow House is second to none. The underlying ethos of women being
involved in all aspects of their care has been maintained and has led to the provision of a service that
is an exemplar of good practice. The biggest challenge for the service continues to be maintenance
of the partnership between the two 3rd sector providers and the NHS – ‘sub contracting’ for the
medical and psychological input continues to exacerbate this. The formation of LYPFT allows this
relationship to be developed beyond a contractual level and I would encourage this.
Mick Burns
Senior Commissioning Manager
Secure and Specialist Mental Health Commissioning
North of England Specialised Commissioning Group-Yorkshire and the Humber Office
19
York LINk
Holgate Villa
22 Holgate Road
York
YO24 4AB
Mr Chris Dawson
Service Manager
Garrow House
115 Heslington Road
York
YO10 5BS
15th June 2012
Dear Mr Dawson
Garrow House Quality Account 2011 - 2012
Thank you for giving York LINk the opportunity to comment on your Quality Account for
2011-2012.
Most of the account was very easy to read and understand although there was a little
difficulty with the Learning and Development Table.
We were particularly impressed with the Introduction to the Account which provided clear
details about the services offered at Garrow House. We would, however have liked to see a
glossary of terms plus an explanation of the abbreviations used to make the account more
accessible.
We are pleased that you have involved the residents in setting up new systems to improve
your services.
During the coming year, if there is any way you feel that the LINk could be of assistance to
you in improving or enhancing your residents’ experience, please do not hesitate to get in
touch.
Yours sincerely
Mrs Lesley Pratt
Chair, York LINk
20
3.2 Feedback on Garrow Houses Quality account.
For more information on Garrow House or to give feedback on this account please visit our
website on
http://www.northernpathways.co.uk/ and complete a contact form.