Brook Cornwall 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 Quality account 2 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 Quality account 3 2012/13 Brook Cornwall Brook Cornwall, part of the South-West and Wales Area, opened its first clinic in Pool, Redruth in 1993, and currently runs clinics in Newquay, Pool, St Ives, Torpoint, Launceston, Truro, Bude and Hayle, as well as weekly clinics in Cornwall College St Austell and Truro Penwith College. Brook Cornwall provides contraception, screening and treatment for sexually transmitted infections, pregnancy testing and referral for termination of pregnancy. During 2012/13, there were 6,519 visits to Brook Cornwall’s clinics by 3,365 young people. Brook Cornwall’s education outreach team offers Relationships and Sex Education (RSE) to all secondary schools in Cornwall. Brook's Boys and Young Men's Worker provides sexual health education sessions for boys and young men across Cornwall, targeting vulnerable and 'hard-to-reach' groups who are often most at risk of poor sexual health. Brook’s Young Fathers’ Project provides a weekly support group and one-to-one work identifying support requirements and signposting young fathers to services, helping them to care for their families. Quality account 4 2012/13 Quality account 5 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 Cornwall. 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. Quality account 6 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 Cornwall. Kay Rundle 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 Quality account 8 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. Quality account 9 2012/13 Progress against our 2012/13 local priorities Clinical effectiveness Priority 1 Develop the audit process We said that we would continue to be compliant with the organisation’s audit programme and develop the audit process to include more of our satellite clinics. We complied with all national Brook audits and discussed the results at local clinical meetings, implementing recommendations where indicated. This has provided the opportunity for ongoing evaluation and improvement within local services. Local recommendations implemented following these audits are presented in Part Three of this account. Owing to staffing shortages and smaller client numbers at our weekly satellite clinics, we were unable to achieve the audit numbers required within the timeframe for these locations to be included separately within the organisation wide audits. However, in 2013/14, we plan to develop a local audit programme to incorporate satellite clinics. Priority 2 Review staff training and development We said that we would review our staff training and development policy and fully implement a staff training schedule with clear training timescales. We have developed an extensive training schedule which ensures that all staff receive initial and refresher training in line with good practice recommendations and local requirements. This ensures that all staff are appropriately trained to provide a consistently high quality service. Client safety Priority 3 Review incident reports to identify trends We said that we would review our local risk management procedures and introduce a more systematic approach to reviewing incident reports. Our Nurse Manager has implemented a risk management procedure. She regularly reviews incident reports to identify trends and sends monthly incident report summaries and action plans to staff. Quality account 10 2012/13 Client experience Priority 4 Introduce new client experience measurement We said that we would analyse the results of our most recent client satisfaction survey and continue to develop ways to monitor client experience of our service. We analysed our client satisfaction survey. All aspects of the Brook service received an average rating between good and excellent apart from privacy in the waiting area, which received a rating between ok and good. We have developed an action plan for improvements which we have publicised to clients in our waiting area. This includes alterations to the reception area which will improve privacy. We introduced the new national Brook Counter Measures survey. The results of both the Counter Measures and the client satisfaction survey are presented in Part Three of this Quality Account. Priority 5 Develop the role of our service users group We said that we would develop the role of the service users group. We are continuing to develop plans for our service users group so that volunteers are consulted on a wider range of service delivery. However, these plans have been impeded by a lack of staff hours to coordinate the group. We intend to apply for funding for a local Volunteer Coordinator to develop and implement a volunteering programme locally which will enable young people to get more involved in service design and development. The Volunteer Coordinator will develop the role of our service users group to integrate client involvement into service decision-making. Priority 6 Review accessibility of services We said that we would continue to review the locations where we deliver services to ensure they are as accessible to young people as possible. Using our client satisfaction surveys, we reviewed the accessibility of two of our main clinic sites. Clients were asked to rate the location, how easy it was to find and to get to. In all cases, these were rated between good and excellent. Our plans to recruit a Volunteer Coordinator will enable us to review accessibility further using a range of methods to consult with young people. Quality account 11 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. Quality account 12 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. Quality account 13 2012/13 Priorities for local improvement 2013/14 Brook Cornwall’s local priorities for improvement in 2013/14 are: Clinical Effectiveness Priority 1 Clinical audits The service will continue to prioritise clinical audit again this year. We will analyse local data from the Brook wide clinical audits and develop our own service specific recommendations and action plan to be completed within three months of the original audit. The Nurse Manager will train and support nurses to take part in the Brook organisation wide clinical audits. This will increase the involvement of satellite clinics in clinical audit and will improve staff skills and enhance local capacity. We aim to train two nurses so that they are involved in clinical audits during 2013/14. We will monitor progress at local management meetings. We will report progress to the Regional Nurse Lead and Area Director so that learning can be shared across Brook services. Client Safety Priority 2: Conduct staffing level assessments for all services We will conduct a staffing level assessment to evaluate staffing levels against client activity levels. There have been considerable changes in client activity levels at some clinics. Regularly assessing activity and staffing levels will better safeguard client safety by ensuring staffing ratios are appropriate for the number of clients usually seen and the type of service to be delivered, this will in turn improve client experience. We will monitor and regularly review staffing and activity at local management meetings. We will report progress to staff and to the Area Director. Client Experience Priority 3 Introduce greater service user involvement within the services to improve client experience This priority is a follow on from our work in 2012/13. We intend to apply for funding for a local Volunteer Coordinator to develop and implement a volunteering programme which will enable young people to be more Quality account 14 2012/13 involved in service design and development. The Volunteer Coordinator will develop the role of our service users group to integrate client involvement into service decision-making. We will measure progress at local management meetings and also work with the Brook Participation Lead. Progress will be reported to service staff, the Area Director and the Participation Lead. Quality account 15 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 Cornwall provided two NHS services. Brook Cornwall has reviewed all the data available to them on the quality of care in both 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 Cornwall for 2012/13. Participation in clinical audits During 2012/13, no national clinical audits and no national confidential enquiries covered NHS services that Brook Cornwall provides. During that period Brook Cornwall was not eligible to participate in any national clinical audits or any national confidential enquiries of the national clinical audits. As Brook Cornwall 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 Cornwall 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 four local clinical audits were reviewed by the provider in 2012/13. Brook Cornwall intends to take the following actions: all clinical staff will receive refresher training on standards of record keeping all clinical staff will receive refresher training to implement best practice guidance to offer IUD during emergency contraception consultations. Quality account 16 2012/13 Participation in clinical research The number of patients receiving NHS services provided or sub-contracted by Brook Cornwall 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 Cornwall’s income in 2012/13 was not conditional on achieving quality improvement and innovation goals through the Commissioning for Quality and Innovation payment framework. Statements from the CQC Brook Cornwall 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 Cornwall had an unannounced CQC inspection on 13 March 2013 and was found to be fully compliant against all inspected outcomes. Brook Cornwall has no conditions on registrations. The Care Quality Commission has not taken enforcement action against Brook Cornwall during 2012/13. Brook Cornwall 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 Cornwall will be taking the following actions to improve data quality. Implementing an improved database for collection of client data. Introducing the database into additional clinics to improve the amount and quality of client and service data that they submit. Implementing the Brook organisation guidelines on recording client activity within the service. NHS Number and General Medical Practice Code Validity Brook Cornwall 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. Quality account 17 2012/13 Information Governance Toolkit attainment levels Brook Cornwall’s Information Governance Assessment Report overall score for 2012/13 was 74% and was graded Green (satisfactory). Clinical coding error rate Brook Cornwall 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 2 2012/13 4 Brook Cornwall 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. We do not consider this number of incidents disproportionate or unreasonable given the number of clients we see (less than 1%) Brook Cornwall 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. Quality account 18 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. Quality account 19 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. Quality account 20 2012/13 The Clinical Director completed a programme of visits to all services. All services were found to be providing safe and effective care. The Clinical Director noted the Brook ethos and commitment of staff to ensure that young people get a friendly and positive experience of health care at all our services. Four Brook wide clinical audits were coordinated during the year and the findings were reviewed by the Clinical Director. A number of recommendations were made to improve consistency in good practice across the organisation, all of which were accepted and endorsed for implementation by local services. Note keeping audit - it was recommended Brook switches to electronic patient records wherever possible. In the interim services with paper records were instructed to obtain a stamp with staff name and designation, saving time and improving accountability. Implant fitting and removal audit - it was recommended to ‘quick start’4 an implant where possible and to undertake and document that an STI screen has been done for all women with irregular bleeding. Sexually transmitted infection audit - it was recommended that Brook asks about and documents the sexuality of the client; determines STI risk by asking about previous infections; provides a test of cure for clients with gonorrhoea and works with partner services to improve partner notification. Emergency contraception audit - it was recommended that all women are offered an Intrauterine Device as the first line option and referral to local providers is facilitated as required; Brook offers ‘quick start’ contraception at presentation and advises all women to have a pregnancy test at three weeks. This latter offer should be combined with an STI screen if the woman had a new partner. The Clinical Director and Head of Nursing used the Pan-London Patient Group Directions as the basis for developing a suite of Brook Patient Group Directions. These aim to ensure that young people using Brook services receive a consistent, safe and high quality service. These will be finalised following the appointment of a pharmacist who will provide medicines management support across the organisation and will be integral in enabling Brook to move closer to becoming an authorising body for PGDs in its own right. If a health professional is reasonably sure that a woman is not pregnant or at risk of pregnancy from recent unprotected sexual intercourse, contraception can be started immediately unless the woman prefers to wait until her next period. 4 Quality account 21 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 Cornwall 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 All clinical staff received refresher training on standards of record keeping and on the Faculty of Sexual and Reproductive Healthcare Clinical Effectiveness Unit’s best practice guidance of offering clients an IUD during emergency contraception consultations. Client safety Through the implementation of the staff training schedule, all staff received initial and refresher training in line with good practice recommendations and local requirements. This included safeguarding training at appropriate levels for all staff and clinical update training for nurses improving staff skills and helping to ensure improved levels of service for clients. Client experience By introducing new ways to measure client satisfaction and gather client feedback, we are ensuring that more clients have an opportunity to provide feedback about our service. This enables us to monitor and improve the quality of service whilst also ensuring it meets the needs of young people. Responses to the Counter Measures survey were overwhelmingly positive. 100% of clients who responded answered yes to the question ‘Did Brook help you today?’ (72% response rate). 97% of clients who responded answered yes to the question ‘Would you recommend Brook to a friend?’ (48% response rate). From our local client satisfaction surveys which were carried out in all of our service locations we received the following feedback. All aspects of the Pool clinic received an average rating between good and excellent apart from the privacy in the waiting area, which received a rating between ok and good. We are currently planning changes which will improve privacy. Most aspects of the Newquay Brook clinic received an average rating between good and excellent. The area with the lowest rating was opening times and comments from participants indicated that clients want the clinics to be open for more hours and on more days of the week. Current funding is Quality account 25 2012/13 only sufficient to open on two days a week but we will use this feedback to inform funders of the evidence of demand for more clinics. We will also share this feedback within the clinic using a “you said, we did” poster to explain to clients why services are more limited than they would like. Quality account 26 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 27 2012/13 Brook Cornwall 60 Station Road Pool Redruth Cornwall TR15 3QG www.brook.org.uk Registered Charity Number: 1024390 Limited Company Registered in England & Wales Number: 2826211 Brook is a trading name of the charities in the Brook Advisory Group