Brook Milton Keynes
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 Milton Keynes
Brook Milton Keynes is part of the East of England cluster of services within the
nationwide organisation of Brook.
Brook Milton Keynes first opened a service in Milton Keynes in October 1989.
Today, we have a main centre in Central Milton Keynes and three
community-based satellite clinics in Bletchley, Wolverton and Buckingham
town centre. We ensure that our services are delivered in a range of locations
that best meet the needs of the young people we work with.
In our main centre we provide fully integrated sexual health services delivered
by dual trained sexual health nurses, offering a full range of contraception
and both testing and treatment for sexually transmitted infections.
Brook has two Outreach Nurses that deliver contraception and advice,
through planned appointments and ad-hoc responsive services in eight
schools, two education and training provider locations and four hostels. Our
Outreach Nurses focus their work on supporting the most vulnerable young
women in Milton Keynes who would not normally access sexual health
services and are provided with advice and contraception in settings they feel
comfortable accessing or in their own home.
Brook Milton Keynes has an Education and Training team of six workers. The
team and the young volunteers that support Brook ensure that all young
people in Milton Keynes have access to accurate and consistent relationships
and sex education and information, empowering them to make positive
choices with their relationships and sexual health. This is achieved locally in a
number of ways:
our professionals training programme is designed to develop the skills of
professionals working with young people so that young people are given
accurate and consistent information and have access to appropriate
referral pathways;
delivering a wide range of relationships, sex and emotional well being
sessions in mainstream schools, education and training providers and other
youth settings;
delivering three 12-week courses in small groups of young people with a
higher level of need around, for instance, grooming/internet safety, self
esteem and body image, domestic violence, alcohol and risk taking;
intensive one to one interventions for vulnerable and at risk young people
including building self confidence and self esteem, consent and
appropriate behaviour.
Over the last 12 months we have seen 7,440 young people making 16,136
visits at our clinics plus 6,044 during our education and training work.
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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 Milton Keynes 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 Milton Keynes.
Maxine Beilby
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
As well as saying we would complete all of the Brook wide clinical audits
which would assure delivery of quality client care at Brook Milton Keynes it
was our aim to undertake a local review of audit practice to ensure that there
was a robust learning and improvement cycle in place to promote best
practice.
Brook Milton Keynes successfully took part in all four audits and submitted 40
records for each audit.
We reviewed audit practices and through this, identified areas for
improvement. Recommendations included implementing a more robust and
qualitative auditing practice and sharing changes with all clinical staff to
achieve a greater knowledge and involvement in audits in 2013/14.
Client safety
Priority 3 Implementation of the Sexual Behaviours Traffic Light Tool
We said that we would engage and involve all Brook staff working with young
people in Milton Keynes in a pilot of the sexual behaviours traffic light tool kit
developed by Brook. We aimed to roll out training to support staff to use the
toolkit within their everyday practice.
We also said we would engage professionals from other agencies in Milton
Keynes who work with young people to use the toolkit. The benefit of doing
this would be that all agencies would then be working within the same criteria
when making decisions about client safety and protecting young people.
We intended to measure progress through reviewing safeguarding cases
within Brook and seeking staff feedback to determine whether and how the
tool assisted them in identifying and managing client safety and safeguarding
issues.
We have achieved this priority and have made progress in delivering training
to professionals across the Milton Keynes area. Staff found the toolkit easy to
use and useful in their day to day role.
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Client experience
Priority 3 Improve access to sexually transmitted infection testing
We said that we would enrich client experience by improving access to
sexually transmitted infection testing services. We would ensure that sufficient
trained staff were available to meet service demand for testing and we
would measure progress through service user feedback.
We have achieved progress against this priority. We have increased the
number of sessions where screening is available to three a week. We
facilitated and supported additional nurse training in screening for sexually
transmitted infections and trained our Clinic Support Worker to support
screening processes.
We also reviewed the way appointments are booked, resulting in same day
appointments being introduced which reduced the number of nonattendances for appointments.
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2012/13
Priorities for organisation wide improvement 2013/14
Brook’s organisational priorities for improvement in 2013/14 are set out below.
Progress on all priorities will be monitored by and reported to the quality and
safeguarding team and the clinical governance sub-committee of the board.
Clinical Effectiveness
Priority 1 Brook wide clinical audit programme
In 2013/14 all services will take part in six audits covering:
abortion referral
emergency contraception
implant fitting and removal
infection control
note keeping
sexually transmitted infection screening.
All services will be expected to participate in the audit programme. A
minimum of 40 sets of client records will again be included in each audit. By
comparing results with the 2012/13 audits we will be able to evidence
improved practice and identify areas where further improvement is required.
We will be able to assess how effectively the recommendations have been
implemented at service level and where remedial action is required. Services
will be expected to use the comparison information to assess how effectively
their local recommendations have been implemented. Where
recommendations fall below the expected improvements an agreed process
for addressing this has been agreed.
Client Safety
Priority 2 Appointment of a pharmacist
Brook has historically been commissioned to provide clinical services by the
NHS. From April 2013 sexual health services are commissioned through Local
Authorities in their public health role. In the new health system medicines
management support will no longer automatically be available to Brook
through its commissioning body.
We will employ our own pharmacist who will lead the development of Brook
Patient Group Directions (PGDs) and advise on medicines management. By
the end of March 2014 we intend that 90% of our services will be using Brook
developed PGDs.3
3
Achieving this will be subject to Brook being able to authorise its own PGDs.
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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 Milton Keynes’ local priorities for improvement in 2013/14 are:
Clinical Effectiveness
Priority 1: Increase the offer of IUD as emergency contraception
Brook Milton Keynes will develop a clear and robust pathway to offer female
service users an IUD as the first option when requesting emergency
contraception, documenting uptake and declines by clients.
The aim of this is to promote IUD uptake which is proven to have better
efficacy rates, thus reducing the risk of unintended pregnancy. The benefit to
all services users in the long term will be to reduce repeated use of
emergency hormonal contraception (EHC) in single use pill form which will
reduce the necessity for repeat visits to services and increase service
capacity for other users.
We will measure progress against this priority through undertaking four
Emergency Hormonal Contraception audits throughout 2013/14 and analysis
of site visit data.
Progress against this priority will be reported to the Regional Nurse Lead in the
format of an audit summary, to the Head of Area Operations and Area
Director to ensure the sharing of best practice and to staff through staff
meetings and target boards in staff areas to support the tracking of progress.
Client Safety
Priority 2: Increase staff awareness of drug interactions
Brook Milton Keynes plans to increase staff awareness of drug interactions
which can reduce the efficacy of hormonal contraception.
We will achieve this by ensuring that staff receive regular training around
recreational, complementary, prescription and illegal drug interactions, that
staff have increased access to a senior supervisor and easy access in their
workplace to the most up to date medical information through the British
National Formulary (BNF).
We will measure progress by ensuring that drug interactions are a standing
item for discussion within staff supervision and monitoring the number of
clinical incidents as a result of drug interactions.
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2012/13
Progress will be reported to the Regional Nurse Lead, Head of Area
Operations for the East of England and Quality Directorate through a
quarterly quality reporting process.
Client Experience
Priority 3: Access to services
Brook Milton Keynes plans to integrate a web-based clinic into our core offer
of services. We will enable young people to access advice and information,
have some contraceptive supplies posted to their home, have preappointment consultations and make appointments to attend the clinic for
specific services online with an Advice and Information worker based in Brook
Milton Keynes main clinic. Brook’s aim is to reduce the requirement for young
people to make repeat visits to the service for pre-appointment consultations,
increase access to condoms, encourage an increase of male service users
and decrease waiting times in the main clinic.
We will measure progress through a critical evaluation process of the online
clinic tool, gathering client feedback of those using the tool and visiting
services, analysing take up/did not attend rates of appointments booked
online and analysing visit data to monitor impact.
Progress will be reported to Brook’s clients through online and clinic feedback
channels, the Online Clinic Project Manager, Area management team and to
the Executive Director of Business Development and Operations for the
region.
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2012/13
Statement of assurance from the board
The following are a series of statements that all providers must include in their
quality account. Many of these statements are not directly applicable to
providers of community sexual health services.
Review of services
During 2012/13 Milton Keynes provided and/or sub-contracted two NHS
services.
Brook Milton Keynes has reviewed all the data available to them on the
quality of care in two of these NHS services.
The income generated by the NHS services reviewed in 2012/13 represents
70% of the total income generated from the provision of NHS services by
Brook Milton Keynes for 2012/13.
Participation in NHS national clinical audits
During 2012/13, no national clinical audits and no national confidential
enquiries covered NHS services that Brook Milton Keynes provides.
During that period Brook Milton Keynes was not eligible to participate in any
national clinical audits or any national confidential enquiries of the national
clinical audits.
As Brook Milton Keynes 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 Milton
Keynes 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 seven local clinical audits were reviewed by the provider in
2012/13 and Brook Milton Keynes intends to take the following actions to
improve the quality of healthcare provided:
we intend to reduce the quantity of oxygen (O2) canisters on site to
reduce safety risks. We will increase the safety and mobility of O2 units to
ensure oxygen can be delivered safely and quickly in emergency
situations;
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2012/13
decrease risks to staff and service users by improving clinical waste
disposal. This will include introducing clear visual aids to indicate correct
disposal pathways and creating a more robust pathway for the disposal of
out of date medicines;
undertake monthly stock rotation and a quarterly stock audit to reduce risk
of out of date medicines being issued and overstocking of clinical supplies.
Participation in clinical research
The number of patients receiving NHS services provided or sub-contracted by
Brook Milton Keynes 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 Milton Keynes’ income in 2012/13 was in part conditional on achieving
quality improvement and innovation goals through the Commissioning for
Quality and Innovation payment framework. Contracting arrangements with
Buckinghamshire Primary Care Trust included CQUIN requirements. The CQUIN
requirement within the contract for 2012/13 was met.
Statements from the CQC
Brook Milton Keynes 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 Milton Keynes
received an unannounced inspection on 3 July 2012 and a follow up
inspection on 10 November 2012. Brook Milton Keynes was found to be fully
compliant against all inspected outcomes. Brook Milton Keynes has no
conditions on its registration.
The Care Quality Commission has not taken enforcement action against
Brook Milton Keynes during 2012/13.
Brook Milton Keynes 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 Milton Keynes will be taking the following actions to improve data
quality:
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2012/13
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 with the service.
NHS Number and General Medical Practice Code Validity
Brook Milton Keynes 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 Milton Keynes Information Governance Assessment Report overall score
for 2012/13 was 92% and was graded Green (satisfactory)
Clinical coding error rate
Brook Milton Keynes 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
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31
Brook Milton Keynes considers that this number is as described for the
following reasons. Having reviewed these numbers to determine their
accuracy we found that of the incidents reported 15% of those across the
two periods were incorrectly recorded as clinical incidents.
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 Milton Keynes has taken the following actions to improve this number,
and so the quality of its service by:
reviewing the recording procedure for clinical incidents including
definitions including the grading of clinical incidents,
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sharing learning from clinical incidents and near misses with service staff.
undertaking a quarterly clinical waste audit to improve monitoring and
compliance with clinical waste guidelines
reviewing stock rotation systems and disposal of out of date clinical
supplies
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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Part Three Review of quality assurance
Review of Brook organisational performance 2012/13
On 1 April 2011 Brook changed from a Network of 17 independently
constituted Brook charities to one nationwide organisation. In becoming ‘One
Brook’ the organisation committed to achieving excellent quality, the best
clinical governance framework and the highest standards for all our services.
In 2012/13 following a transition year the new organisational structure was
established and the Executive and Management teams were appointed.
There are five directorates:
Policy and Communications
Quality and Safeguarding
Business Development and Operations South
Business Development and Operations North
Finance and Corporate Services.
All Brook services are organised within one of six areas:
South West and Wales
London and the South East
East of England
Midlands
Greater Manchester
Northern England and Scotland
Brook Northern Ireland was legally established as a subsidiary of the Brook
parent company In April 2012.
The formation of a Quality and Safeguarding Directorate, with professional
leadership in clinical governance, as well as centralised IT, finance, and
human resources functions will help drive quality and standards, streamline
operations, and improve efficiency and knowledge exchange.
The management structure will support staff more effectively, minimise and
manage risk, and respond to changes. The full benefit of this change will
continue to be realised in 2013/14.
Brook took the following organisation wide specific actions to improve quality
and performance during 2012/13.
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2012/13
Establishing a Quality and Safeguarding Directorate
An Executive Director of Quality and Safeguarding was appointed in April
2012. The Executive Director of Quality and Safeguarding is Brook’s
appointed Caldicott Guardian.
The Quality and Safeguarding Directorate team is set out below:
Executive
Director, Quality
and
Safeguarding
Executive
Assistant
Head of
Education
Head of Nursing
Regional
Nursing Lead
(North)
Regional
Nursing Lead
(South)
Regional
Education Lead
(North)
Quality and
Safeguarding
Manager
Regional
Education Lead
(South)
Clinical Director
Head of
Counselling
Quality and
Safeguarding
Administrator
Data and
Impact
Coordinator
Participation
Lead
The Clinical Director was appointed in September 2011. The Head of Nursing
was appointed in August 2012. Two part-time Regional Nurse Leads were
appointed in January and February 2013 to promote efficient and effective
professional leadership for all nursing and clinical staff within their regions.
These posts will be pivotal in working with clinicians and support staff who
work within our clinical environment to drive ongoing improvement and
quality.
Clinical effectiveness
Clinical governance
Brook’s clinical governance standard was reviewed to ensure it was up to
date with regulatory and best practice requirements and reflected the new
organisational structures. All services will re-assess themselves against the
standard during 2013/14.
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2012/13
The Clinical Director completed a programme of visits to all services. All
services were found to be providing safe and effective care. The Clinical
Director noted the Brook ethos and commitment of staff to ensure that young
people get a friendly and positive experience of health care at all our
services.
Four Brook wide clinical audits were coordinated during the year and the
findings were reviewed by the Clinical Director. A number of
recommendations were made to improve consistency in good practice
across the organisation, all of which were accepted and endorsed for
implementation by local services.
Note keeping audit - it was recommended Brook switches to electronic
patient records wherever possible. In the interim services with paper
records were instructed to obtain a stamp with staff name and
designation, saving time and improving accountability.
Implant fitting and removal audit - it was recommended to ‘quick start’4
an implant where possible and to undertake and document that an STI
screen has been done for all women with irregular bleeding.
Sexually transmitted infection audit - it was recommended that Brook asks
about and documents the sexuality of the client; determines STI risk by
asking about previous infections; provides a test of cure for clients with
gonorrhoea and works with partner services to improve partner
notification.
Emergency contraception audit - it was recommended that all women
are offered an Intrauterine Device as the first line option and referral to
local providers is facilitated as required; Brook offers ‘quick start’
contraception at presentation and advises all women to have a
pregnancy test at three weeks. This latter offer should be combined with
an STI screen if the woman had a new partner.
The Clinical Director and Head of Nursing used the Pan-London Patient Group
Directions as the basis for developing a suite of Brook Patient Group
Directions. These aim to ensure that young people using Brook services
receive a consistent, safe and high quality service. These will be finalised
following the appointment of a pharmacist who will provide medicines
management support across the organisation and will be integral in enabling
Brook to move closer to becoming an authorising body for PGDs in its own
right.
If a health professional is reasonably sure that a woman is not pregnant or at risk of
pregnancy from recent unprotected sexual intercourse, contraception can be started
immediately unless the woman prefers to wait until her next period.
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2012/13
Sharing knowledge and good practice
A fortnightly briefing for Brook’s local clinical leads was introduced in July 2012
to share evidence, updates, provide advice and improve communication.
The fifth annual Clinical Leaders’ Conference for Nurse Managers and Senior
Doctors was held in March 2013 to facilitate sharing of best practice and
quality improvement. Two regional meetings for clinical leads were held in
September and October 2012.
Staff support and development
Senior doctors from across Brook met in February 2013 to begin work on
determining how to maximise the skills and talents of doctors within Brook.
The Clinical Director was successfully revalidated and confirmed as Brook’s
Responsible Officer.
Progress was made towards developing a standard appraisal system for Brook
doctors and nurses and a national training programme for appraisers which
will be rolled out 2013/14.
Client safety
Quality and risk reports
The Quality and Risk report completed by all services on a quarterly basis was
reviewed. The report now provides a more detailed analysis of clinical
incidents and safeguarding referrals to provide enhanced assurance that
appropriate actions are being taken to ensure the safety of Brook clients.
Safeguarding
Following the annual review of Brook’s Protecting Young People Policy a
programme of refresher training for all staff was delivered by the Executive
Director of Quality and Safeguarding. All services were provided with an
‘essentials of safeguarding’ folder to ensure contact details for Brook’s
safeguarding leads and information about local safeguarding services are
available to all staff at all times and consistent escalation pathways are in
place within Brook.
Infection control audit
All services participated in the second Brook Infection Control Audit to ensure
compliance with infection control standards. There was an overall
improvement on 2011/12. 100% of services achieved a green rating on each
Quality account
23
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
24
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
25
2012/13
Review of local performance 2012/13
Brook Milton Keynes 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 Milton Keynes reviewed their audit practices in 2012/13 and identified
areas that required improvement.
Brook Milton Keynes identified a need to implement a more robust and
qualitative audit practice that would achieve improved audit compliance
against both local and Brook wide audits. In particular this was seen in the
improvement of audit practice when carrying out the infection control audit.
Evidence was more robust, practice more consistent and learning was shared
across the service.
We assessed how we involved staff in audits, including feedback, review and
monitoring systems that support consistent clinical standards. We increased
staff involvement in undertaking audits to promote ownership and
accountability, and we reviewed ways that we could improve
communication and feedback to staff on improvements required in practice.
We also redesigned our paper based client notes to ensure a more user
friendly format, make reporting essential information easier and include
prompts to report information critical to client care.
We worked closely with our electronic medical database programmers
attending focus groups to appraise current electronic systems and feeding in
to a redesign of the program with a longer term aim to integrate a fully
electronic and fit for purpose patient care system.
Client safety
Brook Milton Keynes built on the introductory Traffic Light Tool training through
the development of case studies for staff training. Young people’s views were
sought on how behaviours should be categorised (red, amber or green)
depending on age group. This enhanced staff confidence in using the toolkit
in everyday practice.
The Education and Training team is currently working with the Milton Keynes
Safeguarding Children Board to deliver sessions on child sexual development
and the traffic light tool to local professionals.
Quality account
26
2012/13
Client experience
Our clients told us that our waiting times were too long. We established that
the average waiting time, from a client walking into Brook to the time they
left, had increased to 50 minutes. Following a detailed assessment of staff skill
mix versus activity we identified a need for more clinically trained staff. We
increased the number of nurses available in clinic from two to three per day.
In addition, we increased the capacity of the clinic support worker role to
better manage the increase in infection testing results, partner notification
rates, availability of chaperoning for clients and triaging for sexual history.
We undertook an assessment, through staff and client feedback, to establish
potential benefits of providing less invasive dual testing for Chlamydia and
Gonorrhoea when undertaking full infection screening. We found that dual
screening could provide a less invasive experience for clients who are victims
of sexual assault and reduce the need for speculum trained nurses.
Quality account
27
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.
Milton Keynes Clinical Commissioning Group
Thank you for forwarding a copy of the Brook Milton Keynes Quality Account
which has been read with interest, and which will be helpful, informative and
provides a high level of assurance to a range of stakeholders.
The review of quality improvements 2012/13 documents the position in
relation to a number of quality indicators including completion of four
national clinical audits, development of clinical support workers in line with
national training standards, strengthening of incident reporting, reviews and
links with the risk register, the introduction of a client experience questionnaire
and the piloting of a sexual behaviours traffic light tool.
The team are to be commended for the hard work and commitment this
achievement represents.
The CCG can confirm that the information in the Quality Account is accurate
and fairly interpreted and that the range of services described and priorities
for improvement is representative.
The CCG is pleased to see that there are a number of priorities for
improvement going forward including:
participation in six further national clinical audits;
the appointment of a pharmacist to take responsibility for the
development of patient group Directives (PGDs) and advising on
medicines management procedures;
the review of complaints and compliments processes;
pathway improvements to support reductions in repeat services;
increased awareness of drug interactions and
improved access to services.
All developments support the CCG priorities and address continuous
improvements in patient safety, clinical effectiveness and public and patient
experience.
The CCG welcomes the opportunity to work collaboratively with the Brook
Milton Keynes and further strengthen the relationship to support continuous
Quality account
28
2012/13
improvement in quality of care provided to the local population. We hope
that you find the above comments useful and look forward to viewing the
published account.
Jill Wilkinson
Director of Quality & Safeguarding
Milton Keynes Clinical Commissioning Group
HealthWatch
Healthwatch Milton Keynes welcomes the opportunity to review and
comment on the Brook Milton Keynes Quality Accounts for 2012/13.
Brook’s quality accounts provided a comprehensive report with clear
strategy for improvement where there have been less than good audits.
Healthwatch Milton Keynes thanks Brook for providing its services to the
people of Milton Keynes and supports its commitment to continually
improving the services.
Overview and Scrutiny Committee
Buckinghamshire County Council’s Health Overview and Scrutiny Committee
(HOSC) has been invited to submit views on the Brook Milton Keynes Quality
Account 2012/13. The HOSC does not wish to comment on the Account and
we are satisfied if the need arises we have direct methods of raising any
concerns or discussing issues with the provider.
Milton Keynes Council’s Health Overview and Scrutiny Committee (HOSC) has
been invited to submit views on the Brook Milton Keynes Quality Account
2012/13. On the whole the Panel felt that Brook East of England should be
commended for producing a readable Quality Account which would be of
interest to, and understood by, the general reader.
Quality account
29
2012/13
Brook Milton Keynes
624 South Fifth Street
Milton Keynes
MK9 2FX
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