Brook Avon
Quality Account
2012/13
Part One Introduction and statement from the board
What is a quality account?
Quality accounts are Brook’s annual accounts to the public about the quality
of services we offer. The Health Act 2009 and supporting regulations place a
legal obligation on all providers of NHS healthcare in England to publish
annual quality accounts.
Our quality accounts are published electronically on NHS Choices website
and a copy is sent to the Secretary of State.
Quality accounts aim to:
improve accountability to the public
engage trustees in quality improvement
enable providers to review services and decide where improvement is
needed
demonstrate improvement plans
provide information on the quality of services to the public.
A quality account must include a statement from the board summarising the
quality of NHS services provided, the organisation’s priorities for quality for the
forthcoming year, a series of statements from the board which are set out in
the regulations and a review of the quality of services provided during the
year.
In developing a quality account and setting priorities for the future there is an
expectation that providers of NHS healthcare will engage with their staff,
trustees, clients and commissioners.
Who are we?
Brook is the leading UK provider of contraception and sexual health services
to young people under 25. The charity has 49 years’ experience working with
young people across the UK.
Brook’s mission is to ensure that all children and young people have access to
high quality, free and confidential sexual health services, as well as education
and support that enables them to make informed, active choices about their
personal and sexual relationships so they can enjoy their sexuality without
harm.
Brook wants a society that values all children, young people and their
developing sexuality. We want all children and young people to be
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2012/13
supported to develop the self-confidence, skills and understanding they need
to enjoy and take responsibility for their sexual lives, sexual health and well
being.
Brook provides free and confidential sexual health information,
contraception, pregnancy testing, advice and counselling, screening and
treatment for sexually transmitted infections and outreach and education
work from locations in the UK and Jersey (see map below).
In 2012/13 Brook had contact with 287,000 young people through clinics,
education work and Ask Brook, the national information service.
Ask Brook offers a confidential helpline, an online enquiry service and an
interactive text message service. Ask Brook is available free and in
confidence to young people on 0808 802 1234, by text on 07717 989 0236
(standard SMS rates apply) or by secure online message at www.brook.org.uk
Contraception, advice about sex and relationships and sexual health is often
one of the first forms of health care that young people will seek
independently of their parent or carer. As such Brook takes pride in ensuring
that young people have an outstanding first experience when using our
services.
Brook works with the UN Convention on the Rights of the Child, and in
particular the following values drive our ethos, design and delivery of services:
Confidentiality – the right to confidential advice, information, contraception
and treatment
Education – the right to high quality education about sex, relationships,
emotions and sexuality
Sexuality – the right to express their sexuality through puberty, adolescence
and into adulthood
Choice – the right to make informed choices about sexuality, relationships,
contraception and abortion
Involvement – the right to be involved in decisions that affect them
Diversity – the right of children and young people to fulfil their potential, free
from prejudice and harm
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2012/13
Brook Avon
Brook Avon, also known as Brook Bristol, has been delivering services to young
people in Bristol since March 1968. Brook Avon is now part of the South-West
and Wales Area.
Brook Avon delivers service in Bristol, South Gloucestershire and North
Somerset. The dedication and skills of the whole team continue to be the
reason for Brook’s success. Their commitment to providing quality services to
young people continues to be inspiring. In November 2012 we relocated to a
more central location. We are now based within a youth centre and
purpose designed premises. The new premises will enable us to see more
young people and provide a wide range of complementary clinical and non
clinical services.
In 2012/13 we saw a total of 8,657 individual young people in our main clinic
and satellite outreach clinics in schools.
In the main clinic we saw 5,148 individual clients (9,274 contacts). The
counselling service which operates 12 hours per week within the main clinic
supported 70 clients.
The Bristol and South Gloucestershire outreach services provide weekly
satellite clinics in 25 schools and continues to support vulnerable young
people to access sexual health services. This outreach school-based team
supported 3,509 individual young people (a total of 6,184 client contacts 5,025 in Bristol schools and 1,159 in South Gloucestershire schools) during the
course of one year. The number of individuals compared to visits
demonstrates that young people using Brook services in these outreach
settings have confidence to return to the service, and is testament to the
quality of the services that Brook offer.
Bristol Early Intervention team supported 1,047 vulnerable young people who
are not in education, employment or training. This team also provides a wide
variety of clinical and educational services to support these young people’s
health and wellbeing in the local community.
In addition to service delivery the Brook Avon team has worked to ensure the
maintenance of our Care Quality Commission registration.
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Quality statement from the board of trustees and chief
executive
We are very pleased to introduce the second set of quality accounts for
Brook services in Avon. As part of the nationwide Brook organisation we
welcome the opportunity to demonstrate our commitment to continuously
improving the quality of our services for young people.
Brook is committed to delivering high quality, young person centred services
which are welcoming to all young people in venues that they are
comfortable in, wherever possible in their own communities.
We are committed to:
providing consistently high quality services and support for young people
supporting staff to ensure they are equipped to deliver continuously high
standards of service
involving young people in decision making across Brook so they can
influence the design and delivery of services
measuring and demonstrating the impact we make.
2012/13 was a transformative year for Brook. Having become a unified
organisation with a single accountability and governance structure in 2011
we have designed and implemented a new structure for the organisation.
An important part of this transformation is the establishment of a Quality and
Safeguarding Directorate which is designed to ensure strong professional
leadership, innovation and knowledge exchange across Brook to underpin
the delivery of safe and high quality services to young people.
Brook’s internal transformation ran parallel to significant change within the
national health system. We are immensely proud of the way Brook staff
focused determinedly on meeting the needs of the young people we work
with throughout this process.
We encourage staff, clients, partners and commissioners to look at our quality
accounts to get a snapshot of what we do well and what we intend to
improve in the coming 12 months. To provide further assurance the service
commissioner for each contract, the local authority overview and scrutiny
committee (OSC) and the local Healthwatch have been offered an
opportunity to comment on the account. Given the major restructuring in the
health system in England this year it is unsurprising that in many cases a
comment has not been received. We will continue to actively seek feedback
from clients, commissioners and other partners as the new structures take
shape over the coming year.
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2012/13
We are looking forward to remaining resolutely focused on the needs of
young people and supporting continued quality improvement during
2013/14, ensuring all our services remain of the highest standard and
accessible to all young people.
The board of trustees is accountable for ensuring the accuracy of the
information within this quality account. The local Service Manager is
responsible for the preparation of this report and its contents. To the best of
our knowledge, the information reported in this quality account is accurate
and a fair representation of the quality of healthcare services provided by
Brook in Avon.
Julia Nibloe
Service Manager
Quality account
Eve Martin
Chair of the Board of Trustees
7
Simon Blake
Chief Executive
2012/13
Part Two Priorities for improvement
Progress against our 2012/13 organisation wide priorities
Clinical effectiveness
Priority 1 Brook wide clinical audit programme
We said that all clinical delivery services would take part in a Brook wide
programme of four clinical audits. We set a benchmark for all services to
select a minimum of 40 sets of client notes for each audit.
Four Brook wide clinical audits were completed in the following areas:
note keeping
contraceptive implant fitting and removal
sexually transmitted infection(STI) screening
emergency contraception.
All services took part and submitted data from at least 40 sets of client notes
with the exception of two services who submitted fewer.1 The
recommendations from the audits are described in Part Three of this account.
Priority 2 Clinic support worker training and development programme
We said a standard induction, training and development programme would
be developed for Clinic Support Workers (CSWs) and implemented by all
services. We said that all newly appointed CSWs would have access to a
standard induction programme and that all existing CSWs would have access
to a standard ongoing professional development programme.
During the early part of the year Skills for Health was asked by the Department
of Health to develop a Code of Conduct and Minimum Training Standards for
Health Care Support Workers2.
Brook welcomed this development. Once the Code of Conduct and
Training Standards are published, we will review them for their relevance to
Brook’s specific sexual health work with young people. If appropriate these
will become the foundation of Brook’s CSW competency framework and
adopted across the organisation.
These two services did not see sufficient clients during the audit period to meet the inclusion
criteria.
2 The scope of a Clinic Support Workers role falls within this definition
1
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2012/13
Client safety
Priority 3 Review of Incident reporting procedures
We said that we would review the organisation’s incident reporting
procedures to ensure there is a consistent approach to the management of
serious incidents across the organisation so that risks can be scale rated,
trends identified and action plans implemented to mitigate risks and improve
client safety.
Organisational wide quarterly reporting requirements were revised to improve
categorisation of incidents. Categories included incidents relating specifically
to information governance, medicines management and other clinical
incidents. This has enabled high risk incidents and trends to be easily
identified and cross organisation learning to be shared.
A sub-committee of the board receive and review these quarterly reports to
ensure continuous improvement.
During 2013/14 we will review organisation wide incident reporting procedures
to ensure consistent reporting of patient safety incidents.
Client experience
Priority 4 Development of a client experience questionnaire
We said we would develop a client experience questionnaire to evaluate
clients’ experience of the clinical consultation and the quality of care
provided. Our benchmark was that 40 client satisfaction surveys should be
completed for 50% of clinicians in all locations.
Following the successful pilot of Counter Measures in 2011/12 we decided to
use this kinaesthetic approach to gathering client feedback instead. This is
an effective method of taking an exit survey that requires a minimum of
materials and is accessible to most, if not all young people. Clients are
given a counter and asked to drop it into one of two containers in response
to a closed survey question to elicit a ‘yes’ or ‘no’ response.
Two Counter Measures survey were carried out, each for two weeks. The first
ran from 20 August 2012, with the question ‘Did Brook help you today?’ The
second ran from 18 February 2013 with the question ‘Would you recommend
Brook to a friend?’. The results are presented in Part Three of this account.
The Counter Measures surveys were relatively successful in engaging clients.
We therefore intend to continue using this survey methodology for measuring
client experience.
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2012/13
Progress against our 2012/13 local priorities
Clinical effectiveness
Priority 1 Developing the skills of the nursing team
We said that we would increase our nursing team’s ability to diagnose and
treat more Genito Urinary Medicine (GUM) conditions and develop the role of
nurse practitioner to diagnose and treat pelvic inflammatory disease and to
support nurses to fit, check and remove IUD/S.
The nursing team have undertaken a comprehensive training programme
designed and developed by the Clinical Lead and are now able to diagnose
and treat GUM conditions where appropriate. In addition there has been an
increase in the theoretical knowledge of pelvic inflammatory disease and
therefore suspected detection and referral on to appropriate services for
medical intervention. Updates to this training will continue throughout the
coming year with plans to offer more specialist support to specific client
groups, including young men and lesbian, gay, bisexual and transgender
clients.
The Nurse Practitioner has achieved competency in fitting and removing
IUD/IUS at Brook Avon. She is now working towards achieving registration with
the Faulty of Reproductive and Sexual Healthcare as a Faculty Nurse
Registered Trainer.
We had planned to develop a laboratory in the new premises from which the
clinical team could offer microscopy. During the refurbishment it became
apparent that the costs to set up a laboratory suitable for microscopy were
out of the budget scope. The laboratory area in the new premises is fit for
purpose for urine testing but not for microscopy. It is hoped that in the future
when funds are available we will be able to reconsider this development
opportunity.
Client safety
Priority 2 Review of infection control and incident reporting systems
We said we would review infection control policies as part of our ongoing
clinical governance processes to improve the standards for cleanliness and
hygiene within the clinic. We also said that we would review our incident
reporting policies to ensure that there was a robust reporting system.
During 2012 Brook Avon reviewed and updated our infection control policies
ensuring they were fit for purpose in our new premises. We also appointed a
dedicated infection control link nurse to keep the team up to date with
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changing clinical practices. The nurse also completes the Brook wide
infection control audits, undertakes local audits and spot checks and ensures
our continued compliance with the Care Quality Commission (CQC)
standards. Our Nurse Manager has undertaken RCN Accredited Infection
Control Training.
We have reviewed our incident reporting systems, updating the way we
report and record incidents. We have established a Clinical Governance
Group that is responsible for quarterly reviews of incidents. This group
comprises of our Clinical Lead, Nurse Manager, Education and Training
Managers, Service Manager and a representative from the local sexual
health service. This work has enabled the importance of raising incidents and
near misses and subsequent learning opportunities to be re-emphasised
across the service.
Client experience
Priority 3 Service relocation
We said that we would relocate to new premises during 2012 to improve
client access especially for disabled young people and to facilitate Brook
Avon’s training plan.
During the week of 29 October 2012 we relocated to new premises, opening
the service to clients the following week on the 5 November 2013. Our new
premises are purpose designed with additional clinical and consultation
rooms to enable us to see more young people. It is also accessible to clients
with mobility impairment and is wheelchair accessible. In the first five months
of being in the new premises activity figures already suggest a slight increase
in numbers of younger clients accessing the service. By June 2013 we aim to
be in a position to fully launch services to new clients, specifically targeting
young people who are harder to reach.
The move to new premises has enabled us to extend our training offer to all
staff. We hold weekly staff meetings where information is cascaded to all
team members and monthly training sessions are delivered by our Clinical
Lead, other key members of the team or external agencies.
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2012/13
Priorities for organisation wide improvement 2013/14
Brook’s organisational priorities for improvement in 2013/14 are set out below.
Progress on all priorities will be monitored by and reported to the quality and
safeguarding team and the clinical governance sub-committee of the board.
Clinical Effectiveness
Priority 1 Brook wide clinical audit programme
In 2013/14 all services will take part in six audits covering:
abortion referral
emergency contraception
implant fitting and removal
infection control
note keeping
sexually transmitted infection screening.
All services will be expected to participate in the audit programme. A
minimum of 40 sets of client records will again be included in each audit. By
comparing results with the 2012/13 audits we will be able to evidence
improved practice and identify areas where further improvement is required.
We will be able to assess how effectively the recommendations have been
implemented at service level and where remedial action is required. Services
will be expected to use the comparison information to assess how effectively
their local recommendations have been implemented. Where
recommendations fall below the expected improvements an agreed process
for addressing this has been agreed.
Client Safety
Priority 2 Appointment of a pharmacist
Brook has historically been commissioned to provide clinical services by the
NHS. From April 2013 sexual health services are commissioned through Local
Authorities in their public health role. In the new health system medicines
management support will no longer automatically be available to Brook
through its commissioning body.
We will employ our own pharmacist who will lead the development of Brook
Patient Group Directions (PGDs) and advise on medicines management. By
the end of March 2014 we intend that 90% of our services will be using Brook
developed PGDs.3
3
Achieving this will be subject to Brook being able to authorise its own PGDs.
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2012/13
Client Experience
Priority 3 Review of complaints and compliments process
We will complete a review of the organisation’s complaints and compliments
process. This will be in line with the recommendations from the Office of the
Children’s Commissioner in their Common Principles for Child Friendly
Complaint Processes:
1. All organisations working with children and young people should value
and respect children and young people, as well as develop positive and
trusting relationships with them
2. Complaints from children and young people should be seen as positive
and valuable service user feedback and considered from a safeguarding
perspective
3. Children and young people should be involved in the development and
implementation of the complaints process they may wish to use
4. All children and young people should have access to information about
complaints processes. This should be provided in a variety of formats
including online. It should be age appropriate and take account of any
additional needs that a young person may have
5. All children and young people should be able to make complaints in a
variety of ways
6. Written responses to complaints should be timely and where possible,
discussed with the young person. The young person should always be
given an opportunity to provide feedback.
7. Staff should be well trained and have access to training in listening to and
dealing with complaints from children and young people.
8. Children who need additional support to make a complaint should have
access to an independent advocate.
The revised process will be rolled out across Brook through 2013/2014. The
review will involve young people and users of Brook services and will result in a
more accessible and better used complaints and compliments process.
Complaints and compliments will be shared with staff and services to share
learning across the organisation.
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2012/13
Priorities for local improvement 2013/14
Brook Avon’s local priorities for improvement in 2013/14 are:
Clinical Effectiveness
Priority 1 Introduce Blood Borne Virus (BBV) testing
We plan to introduce Blood Borne Virus (BBV) testing in the clinic. HIV
prevalence in the local community is now above 5% which triggers the need
for community based screening.
Our plan is for the nursing team to be able to offer BBV testing to all clients
who attend Brook. The type of blood testing we choose to use at Brook is
under discussion and this will affect how we manage the results care
pathway. The Clinical Lead and Nurse Practitioner will design and implement
a training programme to enable the clinical team to achieve competency in
venopuncture.
In conjunction to developing the clinical skills we will develop local care
pathways for results management. We will train and develop the skills of the
youth work team to work along side the clinical team in offering pre test
discussions to clients.
Progress will be measured and reviewed by the Nurse Manager, Clinical Lead
and Service Manager. Progress will be reported to the Bristol Clinical
Governance Group and the Quality and Safeguarding Directorate.
Client Safety
Priority 2 Review local safeguarding protocols in relation to our satellite school
clinics
We will review our local safeguarding protocols in relation to our satellite
school clinics. Our evidence indicates there are safeguarding peaks at the
end of the school term. This is challenging for the team with regards to
continuity of care and ongoing communication with the school and the
young person. It is imperative that safeguarding actions and
recommendations are maintained over holiday periods.
Communications with school’s safeguarding teams are especially difficult at
this time of the academic year. As a result we will look at how communication
with schools can be improved and how we can work in partnership with local
social care teams.
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2012/13
We will review our local Safeguarding protocols in conjunction with the
Quality and Safeguarding team to ensure that we have a robust system that
supports continuity of care.
Progress will be measured by logging discussions and reports that take place
between Social Care teams and the team at Brook Avon. We will review the
discussions and their outcomes. These will then be reviewed by the Clinical
Governance Group at their quarterly meetings. Advice and
recommendations will be cascaded to the team at the regular safeguarding
training updates.
Progress will be reported to the Brook Quality and Safeguarding Directorate
via quarterly reports.
Client Experience
Priority 3 To develop participation work and opportunities for young people to
have a voice within the organisation
Brook Avon will develop participation work to ensure that young people have
a stronger voice within the organisation and to ensure that local services are
developed to meet the needs of young people.
Brook Avon will set up and run a service user involvement group that meets
regularly. This group will set its own terms of reference and we anticipate that
young people will steer service developments and become involved in local
campaigns along with Brook’s national campaigns.
Progress will be measured and reviewed by the Education and Training Lead.
Progress will be reported to the Service Manager, local commissioner and the
Quality and Safeguarding Team in Brook.
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2012/13
Statement of assurance from the board
The following are a series of statements that all providers must include in their
quality account. Many of these statements are not directly applicable to
providers of community sexual health services.
Review of services
During 2012/13 Brook Avon provided and/or sub-contracted two NHS services.
Brook Avon has reviewed all the data available to them on the quality of
care in two of these NHS services.
The income generated by the NHS services reviewed in 2012/13 represents
100% of the total income generated from the provision of NHS services by
Brook Avon for 2012/13.
Participation in clinical audits
During 2012/13, no national clinical audits and no national confidential
enquiries covered NHS services that Brook Avon provides.
During that period Brook Avon was not eligible to participate in any national
clinical audits or any national confidential enquiries of the national clinical
audits.
As Brook Avon was ineligible to participate in any national clinical audits and
national confidential enquiries, no data collection was completed during
2012/13, and therefore no cases were submitted for audit or enquiry as a
percentage of the number of registered cases required by the terms of the
audit or enquiry.
As no national clinical audits covered the services provided by Brook Avon no
reports of national clinical audits were able to be reviewed by the provider in
2012/13 and no actions to improve the quality of healthcare provided could
be identified.
The reports of five local clinical audits were reviewed by the provider in
2012/13 and Brook Avon has taken or is planning the following actions to
improve the quality of healthcare provided.
Has facilitated training of a member of the nursing team to become
competent in IUD/IUS fitting to increase access to emergency IUDs.
Has introduced regular training sessions on quick starting contraception for
clinical staff.
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2012/13
Is offering STI testing to all clients and documenting the response from the
client.
Has facilitated refresher clinical training sessions on sexual history taking by
clinical and non clinical staff involved with clients.
Has adopted recommendations for the management of unscheduled
bleeding with an implant in situ. Nursing staff have received training in the
management of unscheduled bleeding delivered by the Clinical Lead.
Training in sexual history taking is planned for the youth work team.
Participation in clinical research
The number of patients receiving NHS services provided or sub-contracted by
Brook Avon in 2012/13 that was recruited during that period to participate in
research approved by a research ethics committee was zero.
Use of the CQUIN payment framework
Brook Avon’s income in 2012/13 was not conditional on achieving quality
improvement and innovation goals through the Commissioning for Quality
and Innovation payment framework because this was not part of our
commission agreement with the NHS.
Statements from the CQC
Brook Avon is registered with the Care Quality Commission and is currently
fully registered to provide diagnostic and screening procedures, family
planning and treatment of disease. Brook Avon had an inspection at its new
premises on 14 March 2013 and was found to be fully compliant against all
inspected outcomes. Brook Avon has no conditions on its registration.
The Care Quality Commission has not taken enforcement action against
Brook Avon during 2012/13.
Brook Avon has not participated in any special reviews or investigations by
the CQC during the reporting period.
Data quality
Statement on relevance of Data Quality and your actions to improve your
Data Quality.
Brook Avon will be taking the following actions to improve data quality.
We will be ensuring that our data system will enable us to report to
GUMCAD as part of our public health surveillance function.
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2012/13
We will ensure that we can produce quarterly reports as defined and
requested by our commissioner.
We will improve the reporting of equality and diversity profiles of our clients.
NHS Number and General Medical Practice Code Validity
Brook Avon did not submit records during 2012/13 to the Secondary Uses
service for inclusion in the Hospital Episode Statistics which are included in the
latest published data.
Information Governance Toolkit attainment levels
Brook Avon Information Governance Assessment Report overall score for
2012/13 was 68% and was graded Red (not satisfactory).
To achieve a satisfactory score we will introduce an easy to understand
information leaflet that informs clients how their information is used, who may
have access to that information, and their own rights to see and obtain
copies of their records. A Brook information leaflet is being produced that will
be available for clients by September 2013. This will bring our IGT score into
the satisfactory range.
Clinical coding error rate
Brook Avon was not subject to the Payment by Results clinical coding audit
during 2012/13 by the Audit Commission.
Patient Safety Incidents
Year
2011/12
Number of
incidents
13
2012/13
20
Brook Avon considers that this number is as described for the following
reasons.
By reviewing our reporting procedures to enable staff to be more able to
recognise and report incidents, and undertaking incident report training with
staff we believe these actions contributed to the rise in incidents.
We do not consider this number of incidents disproportionate or unreasonable
given the number of clients that we see, the figures represent less than one
percent of total clients. The overall grading of the incidents remains low risk
and of low impact to client experience or safety.
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2012/13
Brook Avon will take the following actions to improve this number, and so the
quality of its services by:
closely monitoring and reviewing learning from reviews of clinical incidents
and near misses
sharing the learning from reviews of clinical incidents and near misses with
service staff and providing training and support as required
continuing to support staff in reporting incidents and near misses and
providing training and support as required
recognising reporting of clinical incidents as one of the key mechanisms in
enabling Brook to identify and understand how clinical experience and
practices can be improved.
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2012/13
Part Three Review of quality assurance
Review of Brook organisational performance 2012/13
On 1 April 2011 Brook changed from a Network of 17 independently
constituted Brook charities to one nationwide organisation. In becoming ‘One
Brook’ the organisation committed to achieving excellent quality, the best
clinical governance framework and the highest standards for all our services.
In 2012/13 following a transition year the new organisational structure was
established and the Executive and Management teams were appointed.
There are five directorates:
Policy and Communications
Quality and Safeguarding
Business Development and Operations South
Business Development and Operations North
Finance and Corporate Services.
All Brook services are organised within one of six areas:
South West and Wales
London and the South East
East of England
Midlands
Greater Manchester
Northern England and Scotland
Brook Northern Ireland was legally established as a subsidiary of the Brook
parent company In April 2012.
The formation of a Quality and Safeguarding Directorate, with professional
leadership in clinical governance, as well as centralised IT, finance, and
human resources functions will help drive quality and standards, streamline
operations, and improve efficiency and knowledge exchange.
The management structure will support staff more effectively, minimise and
manage risk, and respond to changes. The full benefit of this change will
continue to be realised in 2013/14.
Brook took the following organisation wide specific actions to improve quality
and performance during 2012/13.
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2012/13
Establishing a Quality and Safeguarding Directorate
An Executive Director of Quality and Safeguarding was appointed in April
2012. The Executive Director of Quality and Safeguarding is Brook’s
appointed Caldicott Guardian.
The Quality and Safeguarding Directorate team is set out below:
Executive
Director, Quality
and
Safeguarding
Executive
Assistant
Head of
Education
Head of Nursing
Regional
Nursing Lead
(North)
Regional
Nursing Lead
(South)
Regional
Education Lead
(North)
Quality and
Safeguarding
Manager
Regional
Education Lead
(South)
Clinical Director
Head of
Counselling
Quality and
Safeguarding
Administrator
Data and
Impact
Coordinator
Participation
Lead
The Clinical Director was appointed in September 2011. The Head of Nursing
was appointed in August 2012. Two part-time Regional Nurse Leads were
appointed in January and February 2013 to promote efficient and effective
professional leadership for all nursing and clinical staff within their regions.
These posts will be pivotal in working with clinicians and support staff who
work within our clinical environment to drive ongoing improvement and
quality.
Clinical effectiveness
Clinical governance
Brook’s clinical governance standard was reviewed to ensure it was up to
date with regulatory and best practice requirements and reflected the new
organisational structures. All services will re-assess themselves against the
standard during 2013/14.
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2012/13
The Clinical Director completed a programme of visits to all services. All
services were found to be providing safe and effective care. The Clinical
Director noted the Brook ethos and commitment of staff to ensure that young
people get a friendly and positive experience of health care at all our
services.
Four Brook wide clinical audits were coordinated during the year and the
findings were reviewed by the Clinical Director. A number of
recommendations were made to improve consistency in good practice
across the organisation, all of which were accepted and endorsed for
implementation by local services.
Note keeping audit - it was recommended Brook switches to electronic
patient records wherever possible. In the interim services with paper
records were instructed to obtain a stamp with staff name and
designation, saving time and improving accountability.
Implant fitting and removal audit - it was recommended to ‘quick start’4
an implant where possible and to undertake and document that an STI
screen has been done for all women with irregular bleeding.
Sexually transmitted infection audit - it was recommended that Brook asks
about and documents the sexuality of the client; determines STI risk by
asking about previous infections; provides a test of cure for clients with
gonorrhoea and works with partner services to improve partner
notification.
Emergency contraception audit - it was recommended that all women
are offered an Intrauterine Device as the first line option and referral to
local providers is facilitated as required; Brook offers ‘quick start’
contraception at presentation and advises all women to have a
pregnancy test at three weeks. This latter offer should be combined with
an STI screen if the woman had a new partner.
The Clinical Director and Head of Nursing used the Pan-London Patient Group
Directions as the basis for developing a suite of Brook Patient Group
Directions. These aim to ensure that young people using Brook services
receive a consistent, safe and high quality service. These will be finalised
following the appointment of a pharmacist who will provide medicines
management support across the organisation and will be integral in enabling
Brook to move closer to becoming an authorising body for PGDs in its own
right.
If a health professional is reasonably sure that a woman is not pregnant or at risk of
pregnancy from recent unprotected sexual intercourse, contraception can be started
immediately unless the woman prefers to wait until her next period.
4
Quality account
22
2012/13
Sharing knowledge and good practice
A fortnightly briefing for Brook’s local clinical leads was introduced in July 2012
to share evidence, updates, provide advice and improve communication.
The fifth annual Clinical Leaders’ Conference for Nurse Managers and Senior
Doctors was held in March 2013 to facilitate sharing of best practice and
quality improvement. Two regional meetings for clinical leads were held in
September and October 2012.
Staff support and development
Senior doctors from across Brook met in February 2013 to begin work on
determining how to maximise the skills and talents of doctors within Brook.
The Clinical Director was successfully revalidated and confirmed as Brook’s
Responsible Officer.
Progress was made towards developing a standard appraisal system for Brook
doctors and nurses and a national training programme for appraisers which
will be rolled out 2013/14.
Client safety
Quality and risk reports
The Quality and Risk report completed by all services on a quarterly basis was
reviewed. The report now provides a more detailed analysis of clinical
incidents and safeguarding referrals to provide enhanced assurance that
appropriate actions are being taken to ensure the safety of Brook clients.
Safeguarding
Following the annual review of Brook’s Protecting Young People Policy a
programme of refresher training for all staff was delivered by the Executive
Director of Quality and Safeguarding. All services were provided with an
‘essentials of safeguarding’ folder to ensure contact details for Brook’s
safeguarding leads and information about local safeguarding services are
available to all staff at all times and consistent escalation pathways are in
place within Brook.
Infection control audit
All services participated in the second Brook Infection Control Audit to ensure
compliance with infection control standards. There was an overall
improvement on 2011/12. 100% of services achieved a green rating on each
Quality account
23
2012/13
of the eight standards in the audit tool. Average scores for each of the eight
standards also improved as set out in the table below.
100%
Score
95%
2011
90%
2012
85%
80%
1
2
3
4
5
6
7
8
Standards
Key to standards
1 Hand hygiene
2 Environment
3 Kitchen Area
4 Disposal of Waste
5 Spillage and/or
Contamination with
blood/body fluids
6 Personal Protective
Equipment
7 Prevention of blood/body
fluid, sharp injuries, bites and
splashes
8 Specimen Handling
Information governance
Brook reviewed our information governance in 2012/13. This has resulted in a
suite of revised and updated policies to strengthen Information Governance
at all levels and support services in their Information Governance Toolkit
submission.
Client experience
Counter Measures
Two national Counter Measures surveys to establish levels of client satisfaction
with Brook services were carried out during 2012/13. Each survey ran for two
weeks in every service. Clients were given a counter and asked to place
them in collecting boxes marked ‘yes’ or ‘no’ in response to a closed
question. The first survey was conducted in August 2012 and the second in
February 2013.
The proportion of clients answering ‘yes’ to the first survey question ‘Did Brook
help you today?’ was consistently high, ranging from 94% to 100%. The
mean was 99%. The percentage of client visits that produced a survey
response varied from 11% to 100%. The mean was 62%.
The proportion of clients answering ‘yes’ to the second survey question
‘Would you recommend Brook to a friend?’ ranged from 86% to 100%. The
mean was 99%. The percentage of client visits that produced a survey
response was slightly lower on average than the first survey at 57%. The
variation in response rates ranged from 21% to 100%.
Quality account
24
2012/13
Counter Measures Survey: Response rates
62%
57%
Demonstrating impact
The sexual health outcomes star reported on in last year’s account was
finalised. The star will enable us to measure the extent of the change that
Brook services make in enabling young people to enjoy their sexuality without
harm. Phase two of the roll out planned for 2012/13 was deferred to 2013/14
when the unified management structure will be in place.
Quality account
25
2012/13
Review of local performance 2012/13
Brook Avon took part in all of the organisation wide initiatives for quality
improvement. In addition the service took the following actions to improve
quality and performance during 2012/13.
Clinical effectiveness
In 2012/13 all nurses attended the Sexually Transmitted Infections Foundation
Course run by British Association of Sexual Health and HIV. This was in
preparation for the team being able to deliver a more comprehensive sexual
health service including blood borne virus testing. The nursing staff also
attended the local contraception and sexual health update day.
Client experience
During 2012 we won a tender to ensure that our early intervention work with
vulnerable clients continued beyond March 2013. The Bristol Youth Links (BYL)
contract will guarantee the expansion and continuation of this service for a
further three to five years. The project will provide ongoing specialist work for
young people engaging in or at risk of sexually harmful or unsafe behaviour.
The early intervention team will engage vulnerable groups and individuals in
order to build awareness of their sexual and emotional health. This includes
targeted work to re-build self-esteem and positive relationships. This work will
also ensure that hard to reach young people receive additional support and
in-depth targeted services.
As part of the BYL contract we have also secured funding to develop specific
services for young people who identify as Lesbian, Gay, Bisexual and/or
Transgender (LGBT) and for those young people who are questioning their
sexuality. This service will offer a safe and supportive environment where
young people can explore their sexual orientation, meet others, and develop
friendship networks. As part of an ongoing programme developed with
young people Brook Avon plans to deliver positive activities and provide
advice, support and appropriate information for LGBT young people.
During 2012 it was noted that we were seeing an increasing number of young
people with mild to moderate learning disabilities in our clinic and outreach
clinics in schools. We were also receiving requests for additional support for
our early intervention team to work with learning disabled clients on a one to
one basis. As a result of this emerging need Brook Avon has developed a
local training programme for staff that explored practical approaches to
working with young people with learning disabilities in the area of sexual
health. The aim was to skill up a whole staff team to appropriately respond to
these clients’ needs and to ensure the knowledge to signpost onto other
service where necessary.
Quality account
26
2012/13
This training has now been rolled out successfully in the city through the local
4YP training scheme to non Brook professionals working with young people
with learning disabilities and has been successful. As a result of this success
Brook Avon has secured funding from our local commissioner to develop our
services for learning disabled clients during 2013/14. We hope this project will
contribute to enabling more learning disabled young people to access Brook
Avon and to receive high quality services from a range of local community
services.
Quality account
27
2012/13
Supporting statements
Primary Care Trusts ceased to operate on 31 March 2013 so it was not possible
for the commissioning PCT to comment on this quality account.
No supporting statements were received from Healthwatch or the local
authority Overview and Scrutiny Committee by the time of publication.
Public Health Commissioner
Brook Bristol has had a challenging year which has included securing and
moving to new premises, staff changes and a move to new commissioning
arrangements. Despite this, the service has continued to deliver and thrive in
its new environment. Over the next year we will work together to look at the
profile of the young people attending and ensure that Brook is offering its
services to the young people who will benefit most. This will be part of a
review of young people’s sexual health services across Bristol. The priorities for
the coming year from a commissioning perspective will include the increased
participation of young people in the design and delivery of services, and work
to ensure that young people with learning disabilities are able to access
services. As a commissioner in public health, I look forward to working with
Brook over the next year to ensure the continued delivery of excellent services
for young people in this area.
Anne Colquhoun
Young Peoples Public Health Team Manager
Quality account
28
2012/13
Brook Avon
3rd Floor
The Station
Silver Street
BS1 2AG
www.brook.org.uk
Registered Charity Number: 900431
Limited Company Registered in England & Wales Number: 2486565
Brook is a trading name of the charities in the Brook Advisory Group