Brook Birmingham
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 Birmingham
Brook Birmingham was established in 1966 and is now part of the Midlands
area alongside Brook in Sandwell and Dudley. Brook Birmingham provides a
full range of contraception including all Long Acting Reversible
Contraception (LARC) methods. (implant, injection, IUD, IUS) as well as
contraceptive pills and condoms. We take time and care to work with clients
to identify the method of contraception that will be most appropriate for
them.
We provide both emergency hormonal contraception and emergency IUDs.
Pregnancy testing is supported by counselling and we can make direct
referrals to termination providers where this is the client choice.
We are part of the National Chlamydia Screening Programme and all clients
are offered a dual test which can identify Chlamydia and Gonorrhoea.
Chlamydia treatment is also offered at the service.
Clinic services are supported by a team of qualified counsellors who are
available at all times to work with vulnerable clients. We are extremely proud
that there is no waiting list for counselling services so we are able to provide
immediate support for young people. Our outreach counselling service has
continued and expanded and now includes a sixth form college, a young
people's centre and a children's centre.
During 2012/13, there were 20,321 client visits to the service; the majority of
visits were by young people aged from 16 to 19.
In addition to clinical work the service works with colleges, schools and other
services to deliver Relationship and Sex Education programmes and also hosts
a Genito Urinary Medicine service. We participate in the local HIV Forum and
contribute to local campaigns and producing national guidance.
In October 2012, we commenced operating the National Chlamydia
Screening Programme for the Black Country (Sandwell, Dudley and
Wolverhampton). This is a three year contract and involves working in
partnership with a range of providers including contraception and sexual
health services, GPs and pharmacists.
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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 Birmingham. 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 Area Director 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
Birmingham.
Penny Barber
Area Director
Quality account
Eve Martin
Chair of the Board of Trustees
6
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 Introduce clinical supervision rotas
We said that we would introduce a revised clinical supervision rota.
Staff are now providing evidence of supervision at appraisal. Group
supervision is being facilitated for all clinical staff including nurses, doctors and
support workers on a quarterly basis.
Priority 2 Develop a more robust appraisal process
We said we would develop a more robust appraisal process for clinical staff.
Brook is reviewing the appraisal process, which is being led by the Head of
Nursing. Development of an implementation action plan based on the policy
review will be led locally by the Nurse Manager. As an interim measure the
local appraisal process has been strengthened so that nurses provide
evidence of progress against performance and training objectives and
supervision. Performance objectives and a professional development plan for
the next 12 months are also now part of the local interim appraisal process.
Priority 3 Carry out local audits
We said we would carry out local audits and this has been achieved.
We have carried out an EllaOne emergency contraception audit and an IUD
audit. Recommendations and learning have been shared with clinical staff
at clinical meetings. Audits will be repeated to ensure that practice has been
improved and continues to be maintained.
Priority 4 Ensure staff are up to date with practice
We said we would ensure staff are up to date with practice.
A personal development allowance of one hour per month for nursing staff
has been introduced. This time allocation is recorded and a review of how
the time has been spent to improve personal development takes place at
appraisal. Medical meetings take place quarterly to ensure clinical
knowledge is up to date and best practice is shared.
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2012/13
Client safety
Priority 5 Carry out infection control audits
We said that we would carry out infection control audits.
We have set up a monthly infection control audit programme which is run by
our Infection Control Lead Nurse. There is a monthly clinic audit and sixmonthly centre audits. We submit an annual infection control report in line
with the Brook wide requirement.
Priority 6 Set up a robust safeguarding reporting pathway
We said we would set up a robust safeguarding reporting pathway. We have
implemented the Essentials of Safeguarding ‘Purple Folder’ which every
member of staff has access to. It contains up to date information on the
reporting pathway. The local service safeguarding team are identified. The
Nurse Manager is the Designated Safeguarding Lead for the service and is
responsible for ensuring that the Purple Folder remains up to date. The
Designated Safeguarding Lead is responsible for overseeing the safeguarding
procedures. They are not the only person staff can contact for advice and
support around a safeguarding issue.
Priority 7 Develop a robust medicines management programme
We said we would develop a more robust medicines management
programme.
The existing Medicines Management Policy has been reviewed and refresher
training has been delivered to all staff on storage and dispensing of
medicines.
Medicines management incidents and near misses will be monitored to assess
compliance with the policy and training.
Client experience
Priority 8 Ensure continuous client feedback
We said that we would ensure continuous client feedback is sought.
Client comment boxes were well used throughout the year and comments
slips were reviewed four-weekly at the Managers meetings.
Managers shared learning with staff teams and actions as a result of the client
feedback were displayed the waiting area.
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2012/13
We took part in the two Counter Measures surveys during 2012/13 to establish
levels of client satisfaction.
In response to the August question ‘Did Brook help you today?’ a total of 310
clients’ responded and 98% said’ Yes’. In response to the February question
‘Would you recommend Brook to a friend?’ a total of 266 clients responded
and 98% said ‘Yes’.
Our annual survey was completed by 362 clients over a 2 week period. Clients
overwhelmingly reported that staff are polite and pleasant, it felt safe to talk,
staff are knowledgeable and the information is helpful. Waiting times were
the main concern with 15% of respondents not receiving the service they
wanted because of waiting times.
We investigated our client waiting times and carried out a skill mix analysis
which identified a shortage of clinical staff. As a result we conducted a
substantial recruitment campaign and have recruited additional nursing staff.
We will continue to monitor waiting times.
Priority 9 Ensure client accessibility
We said we would ensure client accessibility to our services.
We have continued to maintain our evening opening times up to 7.00pm
each weekday to ensure that the a service is provided outside school hours
making access easier for young people who are in education.
We have been working with other agencies such as Aquarius who work
specifically with young people around substance misuse and Hawthorne
House GUM clinic.
We have promoted our FE college outreach service more extensively, by
equipping college staff to describe and discuss the service and participating
in college promotional events.
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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 Birmingham’s local priorities for improvement in 2013/14 are:
Clinical Effectiveness
Priority1 Increase the number of contraceptive implant fitters
Brook Birmingham aims to support all clinical staff to be able to fit and remove
contraceptive implants.
All nurses will be provided with the training and support to fit and remove
implants. This will be achieved by the Nurse Manager completing her Faculty
Training Status and working alongside the Doctor who is also a Registered
Faculty Trainer. The Nurse Manager and Doctor will then be in a position to
offer training to any Brook staff, including those in the Midlands Area, to fit
and remove implants.
Progress will be monitored by the Nurse Manager on a six monthly basis and
individual progress reviewed at appraisal.
Progress will be reported to the Area Director, Regional Nurse Lead and Head
of Nursing as there is likely to be a positive organisational wide benefit.
Client Safety
Priority 2 Implementation of the supervision policy at local level
Clinical supervision supports the development and improvement or
maintenance of high quality clinical and professional practice in the delivery
of client care. This priority follows on from the introduction of the supervision
rota during 2012/13 and will dovetail with the introduction of an organisation
wide supervision policy as part of the appraisal process.
The service will encourage and support clinical staff to keep their own clinical
supervision records as part of their personal portfolios along with any training
and personal development achievements.
Clinical staff must be able to provide evidence of supervision at appraisal.
The evidence will be collected at the time of appraisal and reported in the
quality accounts.
Progress will be measured by feedback through medical meetings and
individual one to one meetings. Progress will be reported to the Area
Director, Regional Nurse Lead, Head of Nursing and the HR team
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2012/13
Client Experience
Priority 3 Review of client clinical feedback.
Clients will be asked to give feedback and comment on the clinical service
they receive. This will be more specific than the general client feedback
forms currently used by the service and will give a greater sense of the level of
satisfaction clients have with the clinical aspects of the service.
Responses will be reviewed and discussed as part of annual appraisal
however this may only be possible in broad terms unless specific staff
feedback is received.
Progress will be measured through review of the feedback and will be
reported on within six weeks of each survey.
Progress will be reported to the Area Director and Regional Nurse Lead.
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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 Birmingham provided and/or sub-contracted 10 NHS
services.
Brook Birmingham has reviewed all the data available to them on the quality
of care in all 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 Birmingham for 2012/13.
Participation in national clinical audits
During 2012/13, no national clinical audits and no national confidential
enquiries covered NHS services that Brook Birmingham provides.
During that period Brook Birmingham was not eligible to participate in any
national clinical audits or any national confidential enquiries of the national
clinical audits.
As Brook Birmingham 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
Birmingham 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 two local clinical audits were reviewed by the provider in
2012/13 and Brook Birmingham intends to take the following action to
improve the quality of healthcare provided:
we will re-audit the records of TOP clients to ensure the improvement we
have seen in the audit this year is maintained for both chlamydia testing
and on going contraception.
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2012/13
Participation in clinical research
The number of patients receiving NHS services provided or sub-contracted by
Brook Birmingham 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 Birmingham income in 2012/13 was not conditional on achieving quality
improvement and innovation goals through the Commissioning for Quality
and Innovation payment framework as this is not available.
Statements from the CQC
Brook Birmingham 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 Birmingham
had an unannounced CQC inspection on 30 January 2013 and was found to
be fully compliant against all inspected outcomes. Brook Birmingham has no
conditions on its registration.
The Care Quality Commission has not taken enforcement action against
Brook Birmingham during 2012/13.
Brook Birmingham 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 Birmingham will be taking the following actions to improve data quality.
We will implement the Brook organisational guidelines on recording client
activity within the service.
NHS Number and General Medical Practice Code Validity
Brook Birmingham 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.
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2012/13
Information Governance Toolkit attainment levels
Brook Birmingham did not complete the Information Governance Toolkit for
the year but this will be a priority action within the first quarter of 2013/14.
Clinical coding error rate
Brook Birmingham 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
1
2012/13
0
Brook Birmingham considers that this incident rate is as it is because there is a
focus on client safety underpinned by procedures relating to premises safety,
client records and information as well as clinical governance procedures.
Brook Birmingham intends to 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.
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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
22
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
23
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
24
2012/13
Review of local performance 2012/13
Brook Birmingham 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
The service has introduced dual infection testing (Chlamydia and
Gonorrhoea) for all clients attending the service. This is offered more than
once within each client visit. Uptake has been very positive.
Client safety
Infection control has been introduced as a standing item in all staff meetings
as this impacts on all staff within the service whether they are clinical or
service support staff. This has had a positive impact on our infection control
audit outcomes due to raised staff awareness.
Client experience
Discussion of alcohol and substance abuse has always been a consideration
and integral component in consultations. We have formalised this by
designing a briefing toolkit based on Alcohol Concern information. All clinic
staff have been trained to use the toolkit. 500 Alcohol Brief Interventions have
taken place in the year and client feedback has been very positive.
Quality account
25
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
26
2012/13
Brook Birmingham
59-65 John Bright Street
Birmingham
B1 1BL
www.brook.org.uk
Registered Charity Number: 702584
Limited Company Registered in England & Wales Number: 02462978
Brook is a trading name of the charities in the Brook Advisory Group