Brook Luton
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).
IIn 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 Luton
Brook Luton is one of three Brook services within the East of England, the
others being Brook Bedford and Brook Milton Keynes. Brook Luton is currently
in its fifth year and provides a contraceptive and sexual health service
commissioned by Luton Borough Council Public Health. This service includes
both clinical and non-clinical services to under 25 year olds in Luton and the
surrounding areas. Brook Luton engages with approximately 16,000 young
people every year through a combination of clinical and non-clinical
services.
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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 Luton. As part of the nationwide Brook organisation we
welcome the opportunity to demonstrate our commitment to continuously
improving the quality of our services for young people.
Brook is committed to delivering high quality, young person centred services
which are welcoming to all young people in venues that they are
comfortable in, wherever possible in their own communities.
We are committed to:
providing consistently high quality services and support for young people
supporting staff to ensure they are equipped to deliver continuously high
standards of service
involving young people in decision making across Brook so they can
influence the design and delivery of services
measuring and demonstrating the impact we make.
2012/13 was a transformative year for Brook. Having become a unified
organisation with a single accountability and governance structure in 2011
we have designed and implemented a new structure for the organisation.
An important part of this transformation is the establishment of a Quality and
Safeguarding Directorate which is designed to ensure strong professional
leadership, innovation and knowledge exchange across Brook to underpin
the delivery of safe and high quality services to young people.
Brook’s internal transformation ran parallel to significant change within the
national health system. We are immensely proud of the way Brook staff
focused determinedly on meeting the needs of the young people we work
with throughout this process.
We encourage staff, clients, partners and commissioners to look at our quality
accounts to get a snapshot of what we do well and what we intend to
improve in the coming 12 months. To provide further assurance the service
commissioner for each contract, the local authority overview and scrutiny
committee (OSC) and the local Healthwatch have been offered an
opportunity to comment on the account. Given the major restructuring in the
health system in England this year it is unsurprising that in many cases a
comment has not been received. We will continue to actively seek feedback
from clients, commissioners and other partners as the new structures take
shape over the coming year.
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2012/13
We are looking forward to remaining resolutely focused on the needs of
young people and supporting continued quality improvement during
2013/14, ensuring all our services remain of the highest standard and
accessible to all young people.
The board of trustees is accountable for ensuring the accuracy of the
information within this quality account. The local Service Manager is
responsible for the preparation of this report and its contents. To the best of
our knowledge, the information reported in this quality account is accurate
and a fair representation of the quality of healthcare services provided by
Brook in Luton.
Carolyn Benjamin
Service Manager
Quality account
Eve Martin
Chair of the Board of Trustees
7
Simon Blake
Chief Executive
2012/13
Part Two Priorities for improvement
Progress against our 2012/13 organisation wide priorities
Clinical effectiveness
Priority 1 Brook wide clinical audit programme
We said that all clinical delivery services would take part in a Brook wide
programme of four clinical audits. We set a benchmark for all services to
select a minimum of 40 sets of client notes for each audit.
Four Brook wide clinical audits were completed in the following areas:
note keeping
contraceptive implant fitting and removal
sexually transmitted infection(STI) screening
emergency contraception.
All services took part and submitted data from at least 40 sets of client notes
with the exception of two services who submitted fewer.1 The
recommendations from the audits are described in Part Three of this account.
Priority 2 Clinic support worker training and development programme
We said a standard induction, training and development programme would
be developed for Clinic Support Workers (CSWs) and implemented by all
services. We said that all newly appointed CSWs would have access to a
standard induction programme and that all existing CSWs would have access
to a standard ongoing professional development programme.
During the early part of the year Skills for Health was asked by the Department
of Health to develop a Code of Conduct and Minimum Training Standards for
Health Care Support Workers2.
Brook welcomed this development. Once the Code of Conduct and
Training Standards are published, we will review them for their relevance to
Brook’s specific sexual health work with young people. If appropriate these
will become the foundation of Brook’s CSW competency framework and
adopted across the organisation.
These two services did not see sufficient clients during the audit period to meet the inclusion
criteria.
2 The scope of a Clinic Support Workers role falls within this definition
1
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Client safety
Priority 3 Review of Incident reporting procedures
We said that we would review the organisation’s incident reporting
procedures to ensure there is a consistent approach to the management of
serious incidents across the organisation so that risks can be scale rated,
trends identified and action plans implemented to mitigate risks and improve
client safety.
Organisational wide quarterly reporting requirements were revised to improve
categorisation of incidents. Categories included incidents relating specifically
to information governance, medicines management and other clinical
incidents. This has enabled high risk incidents and trends to be easily
identified and cross organisation learning to be shared.
A sub-committee of the board receive and review these quarterly reports to
ensure continuous improvement.
During 2013/14 we will review organisation wide incident reporting procedures
to ensure consistent reporting of patient safety incidents.
Client experience
Priority 4 Development of a client experience questionnaire
We said we would develop a client experience questionnaire to evaluate
clients’ experience of the clinical consultation and the quality of care
provided. Our benchmark was that 40 client satisfaction surveys should be
completed for 50% of clinicians in all locations.
Following the successful pilot of Counter Measures in 2011/12 we decided to
use this kinaesthetic approach to gathering client feedback instead. This is
an effective method of taking an exit survey that requires a minimum of
materials and is accessible to most, if not all young people. Clients are
given a counter and asked to drop it into one of two containers in response
to a closed survey question to elicit a ‘yes’ or ‘no’ response.
Two Counter Measures survey were carried out, each for two weeks. The first
ran from 20 August 2012, with the question ‘Did Brook help you today?’ The
second ran from 18 February 2013 with the question ‘Would you recommend
Brook to a friend?’. The results are presented in Part Three of this account.
The Counter Measures surveys were relatively successful in engaging clients.
We therefore intend to continue using this survey methodology for measuring
client experience.
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2012/13
Progress against our 2012/13 local priorities
Clinical effectiveness
Priority 1 Clinical audit and measurable outcomes
We said that we would monitor our clinical effectiveness via a local and
national clinical audit cycle to highlight areas of underachievement, the
development of subsequent actions plans and timely re-audit to ensure
service improvement. The results for the audits are disseminated to all clinical
staff and necessary improvements implemented.
Four national audits have been undertaken in the areas of screening for
sexual transmitted infection, emergency contraception, contraceptive
implant fitting and removal and record keeping.
Locally we are currently working on improvements to our audit templates and
plan to undertake local audits over the next 12 months commencing with
Implant insertion and removal by the end of April 2013.
Client safety
Priority 2 Developing a culture of client safety
We said that client safety is at the centre of our service provision and we aim
to build a safety culture where clinical leads guide and support staff to
provide a safe experience that focuses on safeguarding young people and
clinical safety.
To achieve this we follow the Brook Protecting Young People Policy and
ensure all staff have had appropriate safeguarding training and understand
the referral pathways for vulnerable young people to internal safeguarding
leads and external providers (ie social services, sexual assault referral units
and police).
We also have local flowcharts in working order for the safety of young people
attending following domestic violence, sexual assault and forced marriage.
Furthermore we have a monthly meeting for the case management of clients
identified as ‘Cause for Concern’ and experience and knowledge learned
from these are shared with the team at Brook Luton.
Clinical risk management is integrated into the quarterly medical meetings
with review of critical and untoward incident reports and dissemination of
outcomes and service improvements to all staff. A traffic light system for
escalation of critical incidents is in place and all reports are fed back to both
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local service commissioners and Brook’s Quality and Safeguarding
Directorate.
Brook Luton ensures staff performance levels are conducive to a safe client
experience through competency assessment, one-to-one and group clinical
supervision, performance management and annual appraisal.
Brook Luton is registered with the Care Quality Commission and works within its
framework to provide risk assessment, triggers for service analysis and
reporting of critical or untoward incidences.
Client experience
Priority 3 Feedback tools and focus groups
We said that we would measure client experience through the use of
feedback tools to include quarterly client satisfaction questionnaires and
focus groups with young people to help improve and develop our services.
We undertook quarterly client satisfaction questionnaires and in total
surveyed 200 young people throughout the year. On average 98% of clients
said Brook was easy to find, 94% were happy about the staff at Brook, 100%
would come back to Brook and 100% were happy with the services Brook
provided.
Three focus groups took place from January 2012- February 2013:
Improving the clinic environment
Eight young people attended a focus group to look at how Brook Luton could
improve the environment of the clinic for young people. The group
recommended that a new TV in waiting area would improve the waiting area
as the current one was too small. This has now been replaced by a new TV.
The focus group also suggested that there should be more up to date
magazines to read whilst waiting to be seen. Staff members have now been
regularly bringing in magazines and newspapers for the waiting area.
Clinic refurbishment
10 young people attended the focus group and made recommendations on
how the clinic waiting area could be improved, such as wall displays, furniture
as well as the overall layout of the waiting area. The young people helped
design user questionnaires and distributed them to other young people.
A-Z of Sexual Health Leaflet
Six young people attended a group to review and revise this leaflet formerly
published by Luton Primary Care Trust. The overall feedback was that the
leaflet was good but could be slightly improved with some minor changes to
the design of the leaflet (ie colours, layout and pictures). All the young people
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thought the language was good and easy to understand particularly for
younger people (under 16s).
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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 Luton’s local priorities for improvement in 2013/14 are:
Clinical Effectiveness
Priority 1 Clinical audit
We will undertake the organisation wide audits within our audit cycle and
analyse the local data for all audits. Undertaking these audits will enable
Brook Luton to identify areas for improvement in clinical practice.
Audit will be undertaken by all staff who work in clinic (as appropriate) to aid
best practice and the results will then be reported back to the Nurse
Manager to formulate plans to address any areas identified for improvement.
Once results are disseminated to staff and recommendations are adopted
into regular practice, re-auditing will be undertaken after 12 months to
demonstrate how change in practice has led to improvements.
Client Safety
Priority 2 Guide to assessing sexual behaviours
Brook has developed an innovative resource to help professionals who work
with children and young people to identify, assess and respond appropriately
to sexual behaviours. It uses a 'traffic light’ system to categorise sexual
behaviours, to increase understanding of healthy sexual development and
distinguish this from harmful behaviour.
Brook Luton will ensure that all members of staff are fully trained to use the
traffic light resource. We will also incorporate this into our training for
professionals programme across Luton.
Progress will be reported via senior management meetings. Measurement of
progress will be via members of staff receiving training and monitoring
delivery to clients. We will endeavour to incorporate at least one training
session to professionals working across Luton.
Client Experience
Priority 3 Young people’s participation
We will ensure an active and meaningful partnership through the
participation of young people, based on choice, shared decision-making
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and respect. We believe that participation is a process through which young
people can be heard, influence decisions and, importantly, effect real
change. Brook Luton plans to undertake two young people focus groups
during 2013/14. We want to improve the client experience from the
perspective of the young people who use our services. We have already built
up a bank of young volunteers through our Peer Education programme and
we will use these young people to deliver peer led focus groups.
We will measure this through the actual delivery of two focus groups and
ensure that we meet at least one outcome from each focus group to affect
positive change within our service. We are committed to providing a service
with input from the young people that use it to ensure changes are relevant
and practical.
Progress will be reported via senior management team meetings and all team
meetings and the implementation of agreed outcomes.
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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 Luton provided and/or sub-contracted one NHS service.
Brook Luton has reviewed all the data available to them on the quality of
care in this one NHS service.
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 Luton for 2012/13.
Participation in clinical audits
During 2012/13, no national clinical audits and no national confidential
enquiries covered NHS services that Brook Luton provides.
During that period Brook Luton was not eligible to participate in any national
clinical audits or any national confidential enquiries of the national clinical
audits.
As Brook Luton 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 Luton 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 and Brook Luton intends to take the following actions to improve the
quality of healthcare provided:
documentation regarding options available to clients attending for
emergency contraception was highlighted as an area for improvement. A
pro forma has been developed and implemented into practice which
prompts staff to consider and document that all options have been
discussed with clients and outlines plans for subsequent follow-up.
Participation in clinical research
The number of patients receiving NHS services provided or sub-contracted by
Brook Luton 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 Luton’s income in 2012/13 was not conditional on achieving quality
improvement and innovation goals through the Commissioning for Quality
and Innovation payment framework because payment is via a block
contract.
Statements from the CQC
Brook Luton 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 Luton had an unannounced
CQC inspection on 25 October 2012 and was found to be fully compliant
against all inspected outcomes. Brook Luton has no conditions on
registration.
The Care Quality Commission has not taken enforcement action against
Brook Luton during 2012/13.
Brook Luton 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 Luton will be taking the following actions to improve data quality
Brook Luton aims to ensure that all data collected, recorded and reported is
accurate, valid, reliable, timely, relevant and complete to ensure quality of
the data:
we will work with electronic data programmers to integrate a fully
electronic medical notes system to the centre to improve access to client
medical information and legibility of information;
we will review and integrate a robust note taking policy and training
framework into the employee induction and training programme;
we will implement the Brook organisation guidelines on recording client
activity within the service.
NHS Number and General Medical Practice Code Validity
Brook Luton did not submit records during 2012/13 to the Secondary Uses
service for inclusion in the Hospital Episode Statistics which are included in the
latest published data.
Information Governance Toolkit attainment levels
Brook Luton’s Information Governance Assessment Report overall score for
2012/13 was 84% and was graded green.
Clinical coding error rate
Brook Luton was not subject to the Payment by Results clinical coding audit
during 2012/13 by the Audit Commission.
Patient Safety Incidents
Year
2011/12
2012/13
Number of
incidents
7
8
Brook Luton considers that this number requires reduction. Of the incidents
reported in 2012/ 13, 12.5% were due to faulty clinical supplies not resulting in
misdiagnosis or injury. 25% were non clinical issues. The remaining incidents
were discussed at our regular medical and team meeting to identify areas
which will be addressed with an ongoing audit and training program to
ensure all staff are striving to achieve clinical excellence.
Brook Luton intends to take/has taken 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.
continuing to report issues with medical suppliers to enable dissemination
of faulty equipment.
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.
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)
Regional
Education Lead
(South)
Quality and
Safeguarding
Manager
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.
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
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
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
Standards
6
7
8
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%.
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.
Review of local performance 2012/13
Brook Luton 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 Luton engaged with approximately 8,000 young people through its
clinical services. All Brook Luton’s nurses are dual trained (in both
contraception and sexual health) and are supported by our Information and
Advice Workers who undertake early intervention and prevention work with
young people. Our audits enable us to establish our clinical effectiveness and
utilise findings to facilitate training and on-going development of the service.
There has been a slight rise in the reporting of clinical incidents and we will
continue to raise incidents as they arise and through our medical meeting
structure. This will enable us to identify staff training issues and reduce the reoccurrence of incidents.
Client safety
Brook Luton is registered with the CQC and this year, successfully passed an
unannounced inspection.
All Brook Luton staff have undergone Level 1 safeguarding training.
A robust clinical audit timetable ensured that all necessary steps to ensure
client safety were reviewed and changes have been implemented. We
have maintained levels of staff training, professional updates and regularly
support staff through our appraisal and supervision processes. We ensure all
staff have a full working knowledge of our confidentiality policy, that our
complaints policy is clearly visible within our clinics and ensure we follow our
complaints procedure when complaints arise. All staff follow the Brook
protocol for the assessment of risk when in contact with clients and staff work
to a separate flowchart to assess the risk on clients under the age of 14.
Client experience
Client experience is at the forefront of our work at Brook Luton and we are
keen to engage clients to review our services and learn from them how to
improve our services. Our Peer Education programme has been the main
driver in securing volunteers to deliver peer led workshops and school
assemblies. We understand that peer delivery increases clients’ experience
and their willingness to engage with us to drive the quality of our service. We
have successfully undertaken a number of focus groups with client volunteers
to improve our services.
We have offered the services of our young people’s focus groups to Luton
Link to share their views on other areas of local healthcare within Luton and
we hope to continue to build on this with the new Healthwatch board in the
future.
We regularly ask our clients to complete client questionnaires so we can
monitor how our services are perceived by our clients and affect the
necessary changes. We have undertaken the same questionnaire for the last
few years and will endeavour, with the input of clients, to amend the
questionnaire to engage around subjects they have recommended we look
at.
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.
Health Watch
It is extremely positive to see the new developments and changes that have
taken place throughout the previous year and we are pleased to see Brook
Luton developing new models and structures to ensure that the changes to
Public Health do not disrupt services.
We are pleased to see the use of an interactive website and text messaging
service as a communication tool. We would like to see the inclusion of
statistics that outline the number of service users that have taken advantage
of this service as this may highlight to other service providers the benefits of
utilising a range of communication methods.
Some further information in relation to the Clinical Governance Board subcommittee, such as its members and where it convenes (eg locally or
nationally) would provide greater assurances to members of the public and
would further clarify the expertise involved in designing such critical
governance.
Healthwatch Luton would like to thank Brook Luton for outlining proposals to
include the appointment of a Pharmacist in preparation for the changes
outlined in the Public Health Act 2012. However it would be of greater
assistance if additional details were provided around the impact this would
have on service users. Specifically, how would services change with the
appointment of a pharmacist? What practical impact would this have on
service users?
Following comments in last year’s quality accounts regarding the need for the
Care Quality Commission (CQC) to conduct a visit, Healthwatch Luton is
pleased to note that the CQC conducted an unannounced inspection at
Brook Luton. We are pleased to note that the results from this unannounced
visit are exceptionally positive.
We would like to commend the young persons and service user focus groups
that Brook Luton has developed to help shape the organisation. We have
worked closely with these groups and have seen the positive impact their
input and suggestions have had around shaping services. We look forward to
working closely with Brook Luton and their service users in the coming year.
Finally, Healthwatch Luton would like to take this opportunity to congratulate
all the staff at Brook Luton for their continued success and for providing a
highly valuable service for the people of Luton.
Luton Borough Council Scrutiny:
Health and Social Care Review Group
The Luton Scrutiny: Health and Social Care Review Group (HSCRG) welcomes
the opportunity to comment on Brook Luton’s Quality Account 2012-13.
HSCRG is pleased to note Brook Luton continued to meet the CQC standards,
having successfully passed an unannounced inspection in 2012. It
commends the service’s ongoing commitment to staff training, particularly
relating to safeguarding of young people and clinical safety, believed to be
critical areas to enhance quality of service and clients’ experience.
Brook Luton has not given the HSCRG cause for concern. Quite the opposite,
Members are pleased to hear from the Council’s Public Health commissioners
that Brook Luton continues to provide a quality service for young people and
hence had been awarded a further 3 year contract. They are also content
with the service’s commitment to continuous improvement in response to
clients’ feedback, e.g. changing opening hours to improve access, and with
the significant fall in under 18 conception rates, since Brook Luton set up their
service in Luton.
In conclusion, Members of the HSCRG are content with the quality
improvement reported by Brook Luton in 2012-13 and support its priorities and
general direction of travel for 2013-14. HSCRG looks forward to see the
service continuing to meet the needs of young people in Luton in the
forthcoming year and beyond.
Brook Luton
1st Floor St Nicholas House
15-17 George St
Luton, LU1 2AF
www.brook.org.uk
Registered Charity Number: 1038372
Limited Company Registered in England & Wales Number: 2916478
Brook is a trading name of the charities in the Brook Advisory Group