Brook London
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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Brook London
Brook has been providing services in London since 1964 and is a specialist
provider of sexual health and education services offering services to under
25s across London. We are now part of the London and South East Area.
We have thee core activity areas.
Provision of clinical and support services via five confidential sexual health
clinics offering contraception, counselling, pregnancy support, infection
testing and treatment. In 2012/13, 23,372 visits were made by 12,305 young
people.
Relationships and sex education and training in schools and youth-based
education settings to groups of young people, condom distribution schemes
as well as professional training. In 2012/13 26,390 contacts were recorded
within this activity area.
Lobbying, campaigning and advocacy to represent the voices of young
people to decision makers.
Brook is a trusted and popular brand with young people across London, and is
associated with high quality, easily accessible services. Most young people
who use our services state that Brook was recommended to them by friends.
Brook in Euston has been awarded You’re Welcome status by the
commissioner. Both Brook in Southwark and Brook in Lambeth have been
externally assessed against You’re Welcome criteria and recommended for
accreditation by You’re Welcome Consultancy Services.
Brook works closely with local agencies to deliver work jointly where this
improves outcomes for young people.
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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 London. 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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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 Head of Area Operations 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 London.
Jacqueline Parris
Eve Martin
Simon Blake
Head of Area Operations Chair of the Board of Trustees Chief Executive
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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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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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Progress against our 2012/13 local priorities
Clinical Effectiveness
Priority 1 Service re-evaluation
We said that we would undertake re-evaluation of the service design we
introduced in 2011/12, focusing on activity levels, finance, staff and client
feedback. We said that progress would be monitored by evaluation findings
and feedback, and that this would be reported within the local Senior
Management Team, with updates circulated internally and to the national
Executive Team.
Data was gathered from staff via an online evaluation questionnaire during
September 2012. Owing to capacity issues, we have yet to analyse the data
thoroughly and produce a report. However, early indications suggest that
most feedback from staff concerning the service redesign is positive. This has
been shared within the local Senior Management Team. Once the report is
produced, this will be shared internally and with commissioners as
appropriate.
Owing to changes in finance personnel, there has been a delay in obtaining
information required to evaluate the service redesign in financial terms.
However, this information is imminent, and a financial evaluation of the new
structure is planned. This will be shared internally and with commissioners as
appropriate.
We are in the process of recruiting a Data and Impact Officer. One of the
priorities for the new post holder will be to report on activity levels to allow us
to evaluate this aspect of the new clinic structure. Once again, this report will
be shared internally and with our commissioners as part of our quarterly
monitoring process.
Priority 2 Training and Refresher Programmes
We said we would maintain training and refresher programmes for
contraceptive methods and sexually transmitted infections. We said that
progress would be monitored by training plans and certification, and that this
would be reported within the local Senior Management Team, with updates
circulated internally and to the national Executive Team.
All new Sexual Health Counsellors and Client Support Workers have received
training on contraception and STI’s. This is recorded in training and personnel
records. All attendees receive a certificate, and training plans are discussed
as part of the local Senior Management and Operational Management Team
meetings.
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Priority 3 Patient Group Directions
We said we would review Patient Group Directions, via newly developed panLondon PGDs, and that this would be monitored by agreed PGDs. We said
that this would be reported within the local Senior Management Team, with
updates circulated internally and to the national Executive Team.
Pan London PGDs have been prepared by the London Sexual Health
Programme, and these are now being used in all of our London clinic sites.
This has been shared and discussed as part of the Senior and Operational
Management Team meetings.
Client Safety
Priority 4 Care Pathways
We said we would develop care pathways to improve client safety, in
accordance with CQC outcomes and regulations. Progress would be evident
in the pathways, and this would be reported within the local Senior
Management Team, with updates circulated internally and to the national
Executive Team.
We have developed a number of clinic pathways. This is evident by the
presence and implementation of the pathways in the clinics. All pathways
have been approved via the Senior and Operational Management Team
meetings and shared internally.
Priority 5 Incident and Safeguarding Reporting
We said we would continue to audit and report all safeguarding issues and
incidents in accordance with national and local policy and incident reporting
procedures and that progress would be monitored by review. We said this
would be reported within the local Senior Management Team, with updates
circulated internally and to the National Executive Team.
We continue to report all safeguarding issues and incidents to the national
Executive Team and trustees on a quarterly basis. All incidents and
safeguarding issues are discussed and updated at six-weekly local Senior
Management Team meetings.
Priority 6 Health and Safety and Infection Control Records
We said we would record periodic infection control and health and safety
checks on all Brook premises and that progress would be monitored by
review. We said that this would be reported within the local Senior
Management Team, with updates circulated internally and to the national
Executive Team.
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We carry out annual infection control audits which are circulated internally,
discussed by the local Senior Management team and reported to our
national Executive Team. We carry out monthly health and safety checks of
our premises. Brook has commissioned an independent company to carry out
annual health and safety audits of our premises including recommendations
for improvement. This will be shared internally and reported to our national
Quality and Safeguarding Directorate.
Client Experience
Priority 7 Feedback
We said that we would increase the rate of client feedback, reporting results
and trends. We said that progress on this would be measured by collating all
feedback, complaints and incidents, reporting in KPI reports and to the
National Executive Team via quality reports. We said that this would be
reported within the local Senior Management Team, with updates and KPI
reports circulated internally and to the national Executive Team.
We have gathered client feedback as follows:
feedback cards which are collated on Survey Monkey
complaints
Counter Measures survey
mystery shoppers.
The results of all of these feedback methods are used to plan improvements,
and are discussed by the local Senior and Operational Management Teams
and circulated internally. Findings and resulting developments are included in
KPI reports to commissioners, to the national Quality and Safeguarding
Directorate and shared with young people.
Priority 8 Recruitment
We said that we would involve young people on all interview panels and
maintain records of this to monitor progress. We said that this would be
reported to the local Senior Management Team, with updates and KPI reports
circulated internally and to the national Executive Team.
We involve young people in all local interview panels in Brook London. This is
recorded via the interview notes, as well as being evidenced on the invitation
letter to candidates. We ran a training course for young people in Brook
London, on interview skills in September 2012. Certificates were issued to
attendees.
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During the recent national review of Middle Management and Administration
positions throughout Brook, a record of all young people’s involvement in the
process was kept by Brook’s national Participation Lead who also gave
feedback from young people on the process to senior managers leading the
process.
Priority 9 Volunteers
We said that we would work with the national and London volunteers to
make effective use of this resource across services and keep records of this to
monitor progress. We said that this would be reported within the local Senior
Management Team, with updates and KPI reports circulated internally and to
the national Executive Team.
During 2012, Brook London hosted two cohorts of young volunteers via the
V2424 scheme, who were actively involved in supporting services and
campaigns at a local level. Where funded, our education programmes
include young volunteers and peer educators. Young People are trained to
develop resources, submit applications for small project funding and codeliver some of Brook’s education work.
Priority 10 You’re Welcome
We said that we would complete ‘You’re Welcome’ self-assessment and
engage with mystery shopping initiatives, and that this would be measured by
mystery shop reports and You’re Welcome accreditation. We said that this
would be reported within the local Senior Management Team, with updates
and KPI reports circulated internally and to the national Executive Team.
During 2012, we completed and submitted You’re Welcome toolkits for our
sites in Euston, Southwark and Brixton. We have subsequently been
accredited with You’re Welcome status in Euston and this is evident in the
certificate displayed in the centre. Both Brook in Southwark and Brook in
Brixton have been inspected by an external verifier and, at the time of writing,
have been recommended for accreditation. This has been planned and
reported as part of local Operational and Senior Management Team
meetings and shared internally once accredited. Successes are shared with
commissioners as part of quarterly monitoring arrangements and KPI
reporting.
All three main sites were visited by mystery shoppers. Findings and
improvement plans are shared internally.
Priority 11 Web based Communication
We said that we would maintain effective use of web based communication
tools such as the Brook website and approved social networking sites. We said
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that this would be reported within the local Senior Management Team, with
updates and KPI reports circulated internally and to the national Executive
Team.
We make use of the Brook website to promote our services and to provide
service updates. We use Twitter and Facebook at a national level to
communicate to young people about campaigns and lobbying.
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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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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 London local priorities for improvement in 2013/14 are:
Clinical Effectiveness
Priority 1 Clinical Audits
Brook London will undertake clinical audits and analyse local data and
findings. A service specific recommendation and action plan will be created
to be completed within three months. Implementation plans will be fed back
to the national clinical team and learning shared across services.
Client Safety
Priority 2 Patient Group Directions
Brook London will adopt the Brook PGDs by the end of March 2014. All
relevant clinical staff will complete update training on the Brook PGDs and be
signed up to their use using a common assessment framework.
Progress will be evident in the adoption of Brook PGDs and reported via the
local and national Executive Team. Staff update training will be evident in
training records.
Priority 3 Safeguarding Audit
Brook London will undertake a twice yearly safeguarding audit to review and
assess all safeguarding incidents.
Progress will be evident in the completion of the report, which will be shared
internally.
Client Experience
Priority 4 Alcohol Screening
Brook London will run training for staff in the use of an alcohol screening tool in
partnership with Alcohol Concern. We will pilot introduction of the screening
tool in our three main clinics and in education work where appropriate.
Progress will be evident in training records and monitoring reports. Evaluation
of use of the tool will be carried out by Alcohol Concern. This will be reported
back to the local SMT and circulated to commissioners and the Quality &
Safeguarding Directorate.
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2012/13
Priority 5 Participation in local authority structures
Brook London will develop a pilot project to support young people’s
involvement in new commissioning structures. This will take the form of young
volunteers’ voices being heard via local community engagement bodies,
such as Healthwatch, and directly within local council meetings, where
relevant.
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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 London provided and/or sub-contracted 12 NHS
services.
Brook London has reviewed all the data available to them on the quality of
care in 12 of these NHS services.
The income generated by the NHS services reviewed in 2012/13
Represents 98% of the total income generated from the provision of NHS
services by Brook London for 2012/13.
Participation in clinical audits
During 2012/13, no national clinical audits and no national confidential
enquiries covered NHS services that Brook London provides.
During that period Brook London was not eligible to participate in any
national clinical audits or any national confidential enquiries of the national
clinical audits.
As Brook London 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 London,
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 4 local clinical audits were reviewed by the provider in
2012/13 and Brook London intends to take the following actions to improve
the quality of healthcare provided:
measures to improve termination of pregnancy follow up rates
measures to improve the uptake of long acting methods of contraception
measures to improve infection control procedures
review of client clinical pathways and policies.
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2012/13
Participation in clinical research
The number of patients receiving NHS services provided or sub-contracted by
Brook London 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
A proportion of Brook London’s income in 2012/13 was conditional on
achieving quality improvement and innovation goals agreed between Brook
London and any person or body they entered into a contract, agreement or
arrangement with for the provision of NHS services, through the
Commissioning for Quality and Innovation payment framework.
Further details of the agreed goals for 2012/13 and for the following 12 month
period are available electronically at harriet.gill@brook.org.uk.
Statements from the CQC
Brook London 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 London had unannounced
CQC inspections on 12 August 2012 at Brixton, 14 January 2013 at Euston and
7 March 2013 at Southwark and was found to be fully compliant against all
inspected outcomes at all three locations. Brook London had no conditions
on registration.
The Care Quality Commission has not taken enforcement action against
Brook London during 2012/13.
Brook London has not participated in any special reviews or investigations by
the CQC during the reporting period.
Data quality
Brook London will be taking the following actions to improve data quality.
We will appoint a Data & Impact Coordinator to manage the production and
circulation of high quality, accurate and useful data to better understand
service impact and reach. We will work with new commissioners in Local
Authorities to ensure that data continues to be relevant and reliable.
NHS Number and General Medical Practice Code Validity
Brook London did not submit records during 2012/13 to the Secondary Uses
service for inclusion in the Hospital Episode Statistics which are included in the
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latest published data.
Information Governance Toolkit attainment levels
Brook London Information Governance Assessment Report score for 2012/13
was 76% and was graded Green/Satisfactory.
Clinical coding error rate
Brook London 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
3
2012/13
4
Brook London 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 that we see (less than 1% of client visits).
The overall grading of the incidents remains low risk and of low impact to
client experience or safety.
Brook London has taken the following actions to improve this number, and so
the quality of its services by:
issuing clear instructions on the dispensing of new medicines by doctors
and on rules regarding the accompaniment of clients to A&E services
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.
Quality account
23
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
24
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
25
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
26
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
27
2012/13
Review of local performance 2012/13
Brook London 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
Brook London took measures to improve termination of pregnancy follow up
rates, as well as measures to improve the uptake of long acting methods of
contraception. We also took measures to improve infection control
procedures. We increased and improved upon the clinical pathways that we
have in place, as well as our referral pathways to specialist external agencies.
We also undertook a review of our clinical policies.
Client safety
Brook London’s clinical services have adopted the pan London PGDs. All
Brook London staff have attended level 1 Safeguarding training. Our three
main clinical services have undergone an unannounced CQC inspection and
have been found to be fully compliant.
Client experience
Brook London completed and submitted the You’re Welcome assessment
toolkit for the three main centres. The Euston Centre has subsequently been
accredited, and the centres in Lambeth in Southwark have been externally
verified and recommended for accreditation at the time of writing. All three
main centres have undergone mystery shop visits and received positive
reports. Recommendations resulting from these mystery shop reports have
been actioned. Young people in education and training programmes have
actively participated in the running and development of Brook London
through volunteering and placement opportunities.
Quality account
28
2012/13
Supporting statements
Commissioning Primary Care Trust
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. However,
Brook London received the following statements from current local authority
commissioners.
Brook has held the contract for Condom Distribution in Hackney for more than
5 years and it is the largest of its kind within the integrated scheme for London.
The reason it has been so successfully scaled up has been two-fold: the care
and attention to the dimension of quality in the preparation and planning
that was undertaken at the start of the scheme and the unswerving
commitment to assuring the highest possible standards of quality in every
single aspect of the scheme today. In particular, the supported involvement
of young people in the quality assurance processes combined with the
acceptance of the scheme by the wider population of young people in the
borough and the key stakeholders mean I can have every confidence, as a
commissioner, that the service Brook provides is the envy of my peers across
London.
Adrian Kelly
Senior Strategist - Sexual Health
Public Health Team
Children and Young People's Service
London Borough of Hackney.
As a Commissioner for young people’ sexual health and contraceptive
services in Camden, I have found Brook’s services to have been of a
consistently high standard. All elements from the staffing to the range of
services provided have been maintained to a good standard and Brook
have consistently looked at how they can improve their services to meet the
needs of the clients. A You’re Welcome assessment and known and mystery
shops facilitated by a team of local youth health ambassadors has given very
positive feedback about the Brook Euston service and monitoring data and
audits of aspects of the service have been conducted to a high standard
and driven development to meet the needs of client group.
Dionne Campbell
Senior Commissioning Officer, lead for Teenage Pregnancy & Young People's
Sexual Health
Strategy and Resources
Children Schools and Families
London Borough of Camden
Quality account
29
2012/13
Brook services are of a consistently high quality and are constantly improving
through working collaboratively with other organisations and commissioners.
Martha Stafford
Sexual Health and HIV Commissioner
Lambeth, Southwark and Lewisham
Healthwatch
Healthwatch Lambeth response to Brook London & South East Quality Account
for 2012/2013
Response to statement on quality from the board of trustees and chief
executive
We welcome the emphasis on incident and safeguarding and note that a
permanent Executive Director of Quality and Safeguarding was appointed in
April 2012 as part of the new Executive management team and that a new
structure has been created for Quality & Safeguarding work. We also
welcome the finalisation of the sexual health outcomes star and the intention
to measure the extent of change that Brook services make in enabling young
people to enjoy their sexuality without harm during 2013/14.
Quality Priorities and Objectives for 2012/13
In general, the format setting last year’s quality priorities is helpful and clear.
The narrative places work to achieve the priorities within a changing
organisational context, which is also useful. We have restricted our comments
below to those priorities which seek to measure client experience of the
service.
It would be useful to read more about the Patient Group Directions and any
learning reported to the Senior and Operational management team
meetings.
We welcome the accreditation of the Euston service with Your Welcome
status and the recommendation for accreditation to the Southwark and
Brixton services. We note that on page 19, following a programme of visits to
all services by the Clinical Director ‘all services were found to be providing
safe and effective services and staff were young people friendly’.
We welcome the mystery shop visits and the participation of young people in
Education and Training programmes via volunteering and placement
opportunities and would welcome more information on the
recommendations resulting from these processes.
However, we think that more information on the key indicators used to
evaluate the staff in terms of delivering a ‘young people friendly’ service and
the indicators/standards assessed by the mystery shoppers and the young
Quality account
30
2012/13
volunteers would be helpful. Perhaps these could be listed as a ‘key to
standards’ similar to that provided for Client Safety on page 21 of the report.
Quality Priorities for 2013/14
We support all the Quality Priorities for 2013/14.
We note the planned review of the organisation’s complaints and
compliments process in line with the Office of the Children’s Commissioner’s
common principles for child friendly complaints processes and note that the
revised process will be rolled out in 2014/15.
We also welcome Priority 4 Alcohol Screening including the evaluation of the
alcohol screening tool by Alcohol Concern.
We particularly welcome Priority 5 Participation in local authority structures
and look forward to working with Brook to support young people’s
involvement in new commissioning structures.
Quality account
31
2012/13
Brook London
374 Brixton Road
London
SW9 7AW
www.brook.org.uk
Registered Charity Number: 1013037
Limited Company Registered in England & Wales Number: 2705091
Brook is a trading name of the charities in the Brook Advisory Group