Brook Bedfordshire
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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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 Bedfordshire
Brook Bedfordshire is one of three services within the East of England Area, the
others being Brook Luton and Brook Milton Keynes. Brook Bedfordshire was
launched on 1 December 2009 and continues to work in partnership with the
Terrence Higgins Trust (THT) to deliver a fully integrated sexual health service to
the residents of Bedfordshire. We offer a full range of contraception and
testing and treatment for sexually transmitted infections.
Brook delivers a service for under 25’s whilst THT is an all age service. This is an
effective partnership and benefits clients as they have access to a wide
range of drop in and appointment based services. It enables a continuous
and consistent service with no complex transition into adult services. THT are
the contractor and lead on the clinical governance aspects of the service.
The main hub for Brook Bedfordshire is at Broadway House at the top of the
High Street. Brook also runs clinics in satellite locations and 12 upper schools
across Bedfordshire. In addition, we have a Peripatetic Nurse to support
vulnerable young women who may not otherwise access our services. The
nurse works on an outreach basis and regularly supports the education team.
The nurse supports young mothers to be and advises them about future
contraception needs. Young women who have had a termination of
pregnancy are referred to the nurse as a part of the referral pathway from
Bedford and the Luton and Dunstable hospitals. This is an opportunity to
prevent subsequent unplanned pregnancies by supporting the women to
access a suitable method of contraception. The Peripatetic Nurse is able to
offer implant fittings in the home of the client.
The education team operates under two separate contracts and consists of a
Boys Worker, Education Worker, and Risky Behaviours Worker. This team
provides advice and information to young people across Bedfordshire in a
variety of settings including schools, youth clubs, children’s homes, hostels,
training providers, colleges and Pupil Referral Units.
During 2012 /13, Brook Bedfordshire had 5,808 visits to clinics and the
education and outreach team made contact with 10,525 young people.
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Quality account
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2012/13
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 Bedfordshire. 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 Bedfordshire.
Sally Horton
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 Clinical audit and measurable outcomes
We said that we would ensure our clinical effectiveness via measureable
audit outcomes.
Brook Bedfordshire has taken part in the four national audits outlined in the
previous section and undertaken four local audits. As a result of these audits
we have been able to identify areas of good practice to build on and, most
importantly, areas where our practise and procedures need to be improved.
The action to be taken to improve quality is set out in Part Two of this account.
We have refreshed our documentation for recording client consultations with
staff receiving significant support and training for this process. The new
documents provide a more consistent framework for effective reporting
against audit requirements.
We have reviewed and renewed our reception systems and this has enabled
clients to be triaged in a more efficient manner.
Partner notification remains a priority and we continually review our systems to
ensure that we improve, with some success.
Client safety
Priority 2 Developing a culture of client safety
We said that we would continually build a culture where the safety of the
client is paramount.
All incidents are recorded on the ‘THT portal’, a web-based incident
management system, and assigned to the Service Manager to investigate.
Appropriate action and needs analysis is undertaken by the Service Manager
to ensure that each incident is responded to in a relevant and timely manner.
All new clinical staff have a robust induction into our policy and procedures.
All staff are provided with on going support via mentoring, one to one support
and supervision.
All staff have received safeguarding training from the national Executive
Director of Quality and Safeguarding. We have implemented the Essentials
of Safeguarding ‘Purple Folder’ which contains key safeguarding information
including emergency contacts and referral agencies. This is kept on
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reception and information about this has been disseminated to staff through
several routes. Due to our extensive satellite provision, all outreach staff keep
a copy of key information with them.
Safeguarding is a permanent agenda item at staff meetings and we review
at least one case study during the meeting.
All staff are accustomed to escalating any concerns regarding client safety
and wellbeing to the Service Manager or a member of the emergency on
call rota. The Service Manager maintains a detailed ‘record of concerns’.
All safeguarding referrals to external agencies are reported back to the
national executive team.
Client experience
Priority 3 Improving consultation processes
We said we would continually improve our consultation processes with clients.
We maintained our ‘You Said … We did’ board using this as a way to
communicate directly with clients.
Clients are consistently invited to complete feedback cards regarding their
visit. This feedback is sought from all school and satellite clinics also.
Brook Bedfordshire took part in the two national ‘Counter Measure’ surveys
with really positive results. The ‘Did Brook Help You Today’ survey was
completed by 111 respondents with a 98% ‘Yes’ rate. ‘Would you
recommend a friend to Brook?’ had 103 respondents with a 100% ‘Yes’
response.
We have also recently (2012) conducted a survey regarding the clinic waiting
area and as a result made changes in the way we advertise our services.
Our most recent client satisfaction survey in 2013 had a 100% yes response
rate to the question ‘Were you greeted in a friendly & positive way?’
The complaints procedure is on display in the waiting area and all complaints
are recorded and responded to and noted in our quarterly reporting systems
to commissioners and the national executive team.
Brook Bedfordshire is liaising with the national team to develop groups of
young people to focus on the ‘Sex Positive’ Campaign, details of which can
be found on the Brook website.
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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 Bedfordshire’s local priorities for improvement in 2013/14 are:
Clinical Effectiveness
Priority 1 Recording client consultations
Brook Bedfordshire is constantly reviewing recording systems to ensure that
they are accurate, consistent and continually improve our compliance with
record-keeping standards. Our aim for this year is to introduce an almost
paperless system of recording client data using the new Sherpa 5 system. This
will enable us to reduce the space required for client files and maximise
efficiency during consultations, with a view to increasing the number of young
people we see. As we incorporate the new system, we aim to offer training
and support to other services who intend to implement the same.
Progress will be measured via local and national audit systems. The office
manager will continually review how staff are managing the systems and
identify ongoing training and development needs. These will be recorded
within our audit procedures.
We will report on our successes in the next quality account. We will include
updates of our new systems in our quarterly monitoring reports to
commissioners. Local information will be reported into the senior
management team within Bedfordshire and the East of England.
Client Safety
Priority 2 Provision of counselling services
Brook Bedfordshire is aiming to develop an effective counselling service using
trainee counsellors from local colleges. Counsellors will undertake their
practice in accordance with BACP regulations and will be supported by an
external supervisor. By ensuring clients have access to vital counselling
services, we can increase our ability to provide enhanced services and
improve client safety through targeted one to one sessions.
Progress will be measured via counselling hours undertaken on a quarterly
basis. Brook Bedfordshire will require supervisor’s reports related to the
practice of the trainees.
Progress will be reported in the quarterly monitoring report to commissioners
and this will include basic details of numbers of counselling sessions
undertaken.
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2012/13
Information will be reported to staff via meetings and supervision
opportunities. Developments will be fed into the national team.
Client Experience
Priority 3 ‘Sex Positive’ & LGBT communities
Brook Bedfordshire is in the process of identifying young people who are
willing to become volunteers to drive forward key local and national
campaigns. We intend to form groups across Bedfordshire to maximise the
voice of young people. We intend to set up a LGBT group in partnership with
4YP. We will support these groups to identify and apply for funding to support
their volunteering.
Progress will be measured as follows:
numbers of young people engaged
funding secured
successful campaigns managed
feedback from young people.
Progress will be reported, via the quarterly monitoring systems already in
place, to commissioners.
All staff will be updated via staff meetings, one to one support and supervision
opportunities. Good practice will be shared with the national team.
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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 Bedfordshire sub-contracted one NHS service and one service
that is funded by Central Bedfordshire Local Authority.
Brook Bedfordshire has reviewed all the data available to them on the quality
of care in both of these services.
The income generated by the NHS services reviewed in 2012/13 represents
96% of the total income generated from the provision of NHS services by
Brook Bedfordshire for 2012/13.
Participation in clinical audits
During 2012/13, no national clinical audits and no national confidential
enquiries covered NHS services that Brook Bedfordshire provides.
During that period Brook Bedfordshire was not eligible to participate in any
national clinical audits or any national confidential enquiries of the national
clinical audits.
As Brook Bedfordshire 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
Bedfordshire 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 eight local clinical audits covering Emergency Hormonal
Contraception, Implant, IUD/IUS, Depo-Provera, Sexually Transmitted
Infections, Infection control, Documentation and Notes Taking were reviewed
by the provider in 2012/13 and Brook Bedfordshire intends to take the
following actions to improve the quality of healthcare provided:
improve sexual orientation data collection
improve sexual history taking and updating client health records
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2012/13
ensure there is a test of cure for Gonorrhoea clients following treatment
continue to develop partner notification strategies
ensure that patient information leaflets are offered to all clients
clinic staff Inductions to include training on segregation and disposal of
clinical waste
Fraser competency and under 16 form improved during client notes
review.
Participation in clinical research
The number of patients receiving NHS services provided or sub-contracted by
Brook Bedfordshire in 2012/13 that were recruited during that period to
participate in research approved by a research ethics committee was zero.
Use of the CQUIN payment framework
Brook Bedfordshire income in 2012/13 was not conditional on achieving
quality improvement and innovation goals through the Commissioning for
Quality and Innovation payment framework because it was not available.
Statements from the CQC
Brook Bedfordshire is required to register with the Care Quality Commission
and is currently fully registered to provide diagnostic and screening
procedures, family planning and treatment of disease. Brook Bedfordshire
had an unannounced inspection on 8 November 2012 and was found to be
fully compliant against all inspected outcomes. Brook Bedfordshire has no
conditions on registration.
The Care Quality Commission has not taken enforcement action against
Brook Bedfordshire during 2012/13.
Brook Bedfordshire 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 Bedfordshire will be taking the following actions to improve data
quality:
monthly audits of service data
spot checks of appointment and drop-in registers
annual audits from THT.
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2012/13
NHS Number and General Medical Practice Code Validity
Brook Bedfordshire 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 Bedfordshire Information Governance Assessment Report overall score
for 2012/13 was 84% and was graded ‘satisfactory’.
Clinical coding error rate
Brook Bedfordshire was not subject to the Payment by Results clinical coding
audit during 2012/13 by the Audit Commission.
2.7
Patient Safety Incidents
Year
2011/12
Number of
incidents
23
2012/13
30
Brook Bedfordshire considers that this number requires reduction. The number
has increased in the current year due to taking a more effective and
systematic approach to incident recording. Six of these incidents (20%) were
linked to patient safety and related mainly to the treatment process. The
other 80% include issues such as unlabelled swabs and electronic systems
malfunction.
Brook Bedfordshire has taken the following actions to improve this number,
and so the quality of its service 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.
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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
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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%.
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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.
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2012/13
Review of local performance 2012/13
Brook Bedfordshire 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
Clinical audit
Brook Bedfordshire has undertaken eight clinical audits during the last year
and the outcomes and actions from these audits are monitored by the
management team.
As a result of the audit processes this year we have:
revised and refreshed client paperwork
fully embedded an electronic database
offered staff training and development opportunities
changed reception systems
made changes to the waiting areas
offered an ‘opt out’ system for Chlamydia screening
made alterations to drop in and appointment services
implemented text messaging reminders
established six new school clinics.
Management of waiting times and consultations
Brook Bedfordshire has undergone some systematic changes in client
management to allow reception staff to manage waiting times in a more
effective way. We have also moved towards an ad hoc appointment system
within busy drop-in clinics to reduce the waiting time for clients.
Clinical staff have received support in their management of consultation
times and they are working more in line with national guidance on
consultation times. This is enabling us to maximise efficiency without
compromising the quality of the consultation.
Brook Bedfordshire is an integrated service with THT making us a service for all
ages. We have maximised the opportunities this offers by using THT
appointment systems to reduce the burden on staff during busy drop in
sessions. Young people over the age of 18 are routinely offered an
appointment, especially for STI screening and repeat pill.
A Chlamydia Lead has been appointed within the nursing team to promote
good practice in uptake and positivity rates.
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2012/13
Staff support and development
THT‘s Practice Development Nurse and the Medical Directors have supported
us to enhance the clinical competencies of staff during the year, especially in
the management of clients with STI symptoms.
The Lead Nurse is offering regular training and development sessions for nurses
where they receive Continuing Professional Development and opportunities
to network and share good practice.
All staff have accessed mandatory training this year for safeguarding, moving
and handling, infection control, CPR and anaphylaxis.
Work in schools
A nurse has been appointed as School Co-ordinator to ensure a more
systematic approach to our work in schools and that we provide excellent
services that safeguard young people.
School clinics are led by a nurse and advice worker and run for two hours per
week during term time. These are a beneficial addition to our services and
are proving to be popular and well accessed by students within the school
setting. Since the six new clinics started between September – December
2012, there have been almost 300 visits.
Client safety
Incident reporting
Brook Bedfordshire has completed quarterly monitoring reports relating to
safeguarding and quality issues, and these have been returned to the
national Quality and Safeguarding Directorate.
Systematic recording of incidents is now embedded and all staff have access
to the THT portal to report incidents that are then analysed by the
management team. All incidents form a part of our quarterly monitoring
system to commissioners. The management team decide on the appropriate
course of action, depending on the type of incident.
Safeguarding
The national Executive Director of Quality and Safeguarding provided
safeguarding training to all Bedfordshire staff. A number of clinical staff have
attended additional training events this year including: ‘Child Sexual
Exploitation’; ‘Female Genital Mutilation’; ‘Violence in teenage relationships’
and foundation training from the Local Safeguarding Children Board in
Bedfordshire.
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2012/13
Brook Bedfordshire has implemented the use of the ‘Purple Folder’. This
contains key safeguarding information, referral agencies and emergency
contact numbers. This has been fully disseminated to all staff.
Clinical staff are integrating the national ‘traffic light tool’, for assessing sexual
behaviour into their daily practice. All staff are fully aware that any concerns
must be escalated to the safeguarding lead for discussion and decision on
appropriate action to be taken.
Confidentiality notices are displayed in the waiting area and leaflets are
provided in satellite clinics and school settings. The leaflets outline our
commitment to confidentiality whilst at the same time explicitly stating that
we are not able to collude with silence if a person is at risk of harm.
Recording and reporting systems
Audit outcomes related to client safety have been recorded and are
constantly monitored. Where there are omissions, the management team at
Bedford have used staff meetings, one to one support and supervision as
opportunities to highlight important issues with staff.
The Practice Development Nurse has developed our clinical recording
systems and provided robust on going training and support in its
implementation.
Assuring competence of new staff
All staff now receive a full clinical induction pack. This introduces them to the
service and their role and responsibilities. All new staff are observed by a
senior member of staff in order to verify their competence.
Health, safety and infection control
The management team regularly review practical arrangements and a
member of staff has responsibility for updating the ‘Retention File’ where all
information related to health and safety is recorded, including waste disposal,
cleaning and toilets. During the last year we recorded no accidents or injury
to staff or clients and we remain vigilant about clinic rooms, waiting area and
access into the building.
We achieved a satisfactory infection control standard and the Lead Nurse
consistently monitors infection control systems. We have no plumbing systems
in the Bedford clinic and use portable wash basins. Sinks are flushed through
weekly with cleaning fluid and this is monitored and recorded. All sinks are
checked regularly and soap dispensers, antibacterial gel and hand cream
are available in each clinic.
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2012/13
Clinic rooms were redesigned during 2012 to comply with health and safety
standards
Client experience
Waiting areas and waiting times
As stated in the Clinical Effectiveness section, Brook Bedfordshire has
undergone some system changes. These were to not only reduce the burden
for staff, but to maximise the experience of the client as identified from client
feedback.
Clients state clearly via a tick box list, what they have come to clinic for. They
are made aware that this is what they will be treated for during this
consultation. This has enabled the reception staff to triage clients to avoid
long waiting times.
Systematic changes within the clinical setting have reduced some of the
stress from the waiting area. We ensure that the radio is on during clinic
times, provide a daily newspaper and up to date magazines for male and
females, to make the waiting experience less boring.
We have surveyed client views of the waiting area. As a result we have
made some subtle changes to the displays in the clinic and the message on
the ‘A Frame’ board that stands out on the street.
We have looked into the possibility of a drinks and food machine to be
located in the waiting area but the cost implication of this was not viable.
Water is provided in the waiting area.
Client feedback
Clients are regularly asked to provide feedback and we respond to this via
our ‘You said we did…’ board. We also took part in two national Counter
Measures surveys and the results of this are displayed in the clinic after the
event. Clients consistently state that they feel valued and have been
treated well within the service.
Since the beginning of 2013, we have started to collect feedback from school
clinics and have set achievable targets around this for the school based staff.
The feedback so far has been positive. The most common complaint is
regarding accessibility and incorporates clinic location within the school;
waiting area and waiting times.
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2012/13
Since the start of the academic year in 2012, over 1200 students have
accessed school clinics. This does not include quarter four data. Numbers
visiting these clinics bear testimony to their popularity.
Impact monitoring
The education and outreach team has developed an impact monitoring tool.
They are using this to evaluate the effect of their input on the students. This is
allowing us to monitor the trajectory of travel and to start developing some
evidence based practice based on national guidance. Evaluations from
students accessing the education and outreach team remain of a
consistently high standard and the evaluations provide some evidence of
how much students value the work.
Young people’s participation
The education team has done a lot of foundation work to establish a
participation group. They have met with the national Participation Lead and
attended national training on how to support and develop volunteers. They
have identified a core group of young people who are eager to be involved
and they are in the process of seeking funding to support this work.
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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.
Quality account
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2012/13
Brook Bedfordshire
1st Floor Broadway House
4/6 The Broadway
Bedford
MK40 2TE
www.brook.org.uk
Registered Charity Number: 1038372
Limited Company Registered in England & Wales Number: 02916478
Brook is a trading name of the charities in the Brook Advisory Group