Brook Wirral
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 Wirral
Since opening in 1992 Brook Wirral, now part of the Northern England and
Scotland Area, has grown significantly and provides free and confidential
sexual health information, advice, sexually transmitted infection testing,
counselling, and education services. Locally and nationally, the organisation
is highly regarded for its innovative and effective approach. We are a trusted
and recognised brand amongst many thousands of young people, and we
work successfully in partnership with other organisations to improve young
people’s lives. During 2012/13 Brook Wirral’s clinical and education services
were commissioned by NHS Wirral with some additional financial support for
targeted youth support from the Rank Foundation.
In 2012/13 Brook Wirral had contact with 22,802 young people: 11,694 at our
main clinic site (including counselling) and our Education and Outreach team
had contact with 11,108 young people.
Brook Wirral’s education team works within most of the secondary schools in
Wirral delivering our unique ‘BiteSize Brook’ events, ‘All Different, All Beautiful’
and ‘Greater Expectations’ personal development programmes. The team
also delivers outreach work with young men and young women and runs a
weekly lesbian, gay and bisexual group.
The centre opens six days a week as a drop-in service, offering young people
contraception, condoms, emergency contraception, pregnancy testing and
referral for pregnancy advice and abortion.
Brook Wirral is part of a network of services providing a range of additional
health services in Wirral schools as part of a two year pilot programme.
Specifically, Brook Wirral delivers additional contraceptive clinics in schools
and youth settings across the Borough, we are responsible for the
governance of the mental health training and are responsible for the
development of a classroom resource and training for teachers on mental
health and resilience. Brook’s services are delivered by nurses, counsellors,
education workers and receptionists.
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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 Wirral. As part of the nationwide Brook organisation we
welcome the opportunity to demonstrate our commitment to continuously
improving the quality of our services for young people.
Brook is committed to delivering high quality, young person centred services
which are welcoming to all young people in venues that they are
comfortable in, wherever possible in their own communities.
We are committed to:
providing consistently high quality services and support for young people
supporting staff to ensure they are equipped to deliver continuously high
standards of service
involving young people in decision making across Brook so they can
influence the design and delivery of services
measuring and demonstrating the impact we make.
2012/13 was a transformative year for Brook. Having become a unified
organisation with a single accountability and governance structure in 2011
we have designed and implemented a new structure for the organisation.
An important part of this transformation is the establishment of a Quality and
Safeguarding Directorate which is designed to ensure strong professional
leadership, innovation and knowledge exchange across Brook to underpin
the delivery of safe and high quality services to young people.
Brook’s internal transformation ran parallel to significant change within the
national health system. We are immensely proud of the way Brook staff
focused determinedly on meeting the needs of the young people we work
with throughout this process.
We encourage staff, clients, partners and commissioners to look at our quality
accounts to get a snapshot of what we do well and what we intend to
improve in the coming 12 months. To provide further assurance the service
commissioner for each contract, the local authority overview and scrutiny
committee (OSC) and the local Healthwatch have been offered an
opportunity to comment on the account. Given the major restructuring in the
health system in England this year it is unsurprising that in many cases a
comment has not been received. We will continue to actively seek feedback
from clients, commissioners and other partners as the new structures take
shape over the coming year.
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We are looking forward to remaining resolutely focused on the needs of
young people and supporting continued quality improvement during
2013/14, ensuring all our services remain of the highest standard and
accessible to all young people.
The board of trustees is accountable for ensuring the accuracy of the
information within this quality account. The Area Director is responsible for the
preparation of this report and its contents. To the best of our knowledge, the
information reported in this quality account is accurate and a fair
representation of the quality of healthcare services provided by Brook in
Wirral.
Julie Brierley
Area Director
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 Motivational interviewing techniques
We said we would provide training in motivational interviewing techniques to
all staff working with young people.
All eligible staff members attended the four day training in June and July. The
training was incredibly powerful and has given the Brook Wirral team a range
of tools and approaches which can be implemented across the disciplines
within Brook, supporting us to maximise our combined efforts with young
people. This builds on the work we did the previous year to establish better
links between our counsellor, the education team and clinical staff. We will
implement the techniques by all staff taking the same approach with young
people, the education team increasing one to one work, offering dedicated
coaching sessions and adding specific motivational techniques into clinical
consultations. The counsellor has extended her ‘Toolkit’ by adding some
more detailed techniques to the interventions she offers young people.
Priority 2 Wirral wide implant audit
We said that we would take part in an NHS led Wirral wide audit and analysis
of implant fitting and removals in order to identify any issues which impact on
young people retaining their implant.
Brook Wirral participated in this audit in partnership with other services. The
audit looked at clients who have this method removed after a short period,
and what support they had received before they made the decision. The
conclusions of this will help us to improve client information and support when
they opt for this long acting reversible contraceptive method.
Priority 3 Health services in schools
We said we would take part in an external evaluation of the pilot of health
services in schools programme.
The service now runs in seven schools during the lunch period, and in two
Further Education establishments and one hard to reach client venue.
The service is extremely successful and is well attended. Relationships with
school nurses are positive, often contact is made with the centre outside of
the delivery times of this service.
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Client safety
Priority 4 Sexual bullying and social media
We said we would extend the provision of an education programme
exploring the impact of social media and mobile technology on young
people.
Brook Wirral developed a Bitesize zone to raise awareness of sexual bullying
and social media. This zone was developed for the youth offenders
association and is delivered during our Education Bitesize sessions. This
intervention focuses on safety and is designed to inform and educate young
people on how to keep themselves safe.
Priority 5 Local audits
We agreed with our Commissioner to undertake an audit for each quarter of
2012/13.
Quarter 1
Quarter 2
Quarter 3
Quarter 4
Audit of all safeguarding issues, concerns and actions in Q1
Audit of contraceptive method pre and post termination referral
Audit of contraceptive method used prior to transfer to LARC
method
Audit of Chlamydia positives tested on outreach programmes
and treated in clinic
Two audits were undertaken due to changes in management priorities and
workload to ensure that Brook Wirral could focus on the tendering process for
the integrated sexual health contract.
The outcomes of the two audits will be used to inform planning and training
schedules. However the successful award of the integrated contract now
means that clinical governance, processes and planning will be part of the
partnership clinical governance board plans. These will be included in
improvement priorities in 13/14 and are not yet formulated or agreed within
the partnership model.
Client experience
Priority 6 Research views of vulnerable young people not using Brook
We said we would commission research, led by a group of peer mentors to
seek out the views and experiences of hard to reach and vulnerable young
people who do not use services.
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Owing to changes of personnel at Brook Wirral during the management
restructure and the focus on tendering for the integrated sexual health
contract the research was not completed.
However, during the tender process Brook Wirral participated in market
research in Birkenhead with young people to identify their views on the
location of sexual health clinics and the services they wanted. This information
was used to inform the design of the new service model and resulted in the
dedicated young people’s clinics being located in five locations across
Birkenhead. This was designed to promote easier access for vulnerable and
disadvantaged young people who were identified as not previously
accessing services.
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2012/13
Priorities for organisation wide improvement 2013/14
Brook’s organisational priorities for improvement in 2013/14 are set out below.
Progress on all priorities will be monitored by and reported to the quality and
safeguarding team and the clinical governance sub-committee of the board.
Clinical Effectiveness
Priority 1 Brook wide clinical audit programme
In 2013/14 all services will take part in six audits covering:
abortion referral
emergency contraception
implant fitting and removal
infection control
note keeping
sexually transmitted infection screening.
All services will be expected to participate in the audit programme. A
minimum of 40 sets of client records will again be included in each audit. By
comparing results with the 2012/13 audits we will be able to evidence
improved practice and identify areas where further improvement is required.
We will be able to assess how effectively the recommendations have been
implemented at service level and where remedial action is required. Services
will be expected to use the comparison information to assess how effectively
their local recommendations have been implemented. Where
recommendations fall below the expected improvements an agreed process
for addressing this has been agreed.
Client Safety
Priority 2 Appointment of a pharmacist
Brook has historically been commissioned to provide clinical services by the
NHS. From April 2013 sexual health services are commissioned through Local
Authorities in their public health role. In the new health system medicines
management support will no longer automatically be available to Brook
through its commissioning body.
We will employ our own pharmacist who will lead the development of Brook
Patient Group Directions (PGDs) and advise on medicines management. By
the end of March 2014 we intend that 90% of our services will be using Brook
developed PGDs.3
3
Achieving this will be subject to Brook being able to authorise its own PGDs.
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2012/13
Client Experience
Priority 3 Review of complaints and compliments process
We will complete a review of the organisation’s complaints and compliments
process. This will be in line with the recommendations from the Office of the
Children’s Commissioner in their Common Principles for Child Friendly
Complaint Processes:
1. All organisations working with children and young people should value
and respect children and young people, as well as develop positive and
trusting relationships with them
2. Complaints from children and young people should be seen as positive
and valuable service user feedback and considered from a safeguarding
perspective
3. Children and young people should be involved in the development and
implementation of the complaints process they may wish to use
4. All children and young people should have access to information about
complaints processes. This should be provided in a variety of formats
including online. It should be age appropriate and take account of any
additional needs that a young person may have
5. All children and young people should be able to make complaints in a
variety of ways
6. Written responses to complaints should be timely and where possible,
discussed with the young person. The young person should always be
given an opportunity to provide feedback.
7. Staff should be well trained and have access to training in listening to and
dealing with complaints from children and young people.
8. Children who need additional support to make a complaint should have
access to an independent advocate.
The revised process will be rolled out across Brook through 2013/2014. The
review will involve young people and users of Brook services and will result in a
more accessible and better used complaints and compliments process.
Complaints and compliments will be shared with staff and services to share
learning across the organisation.
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2012/13
Priorities for local improvement 2013/14
Brook Wirral’s local priorities for improvement in 2013/14 are:
Clinical Effectiveness
Priority 1 Implementing integrated policies and practice
Brook Wirral is now part of an integrated sexual health model in Wirral and is
operating in partnership with Wirral Community Trust and Wirral University
Teaching Hospital. The model has a clinical governance board that is
represented by managers from all three organisations that will direct
improvement plans and priorities for the partnership. Brook Wirral will be
working with our partners to ensure that integrated clinical practices and
policies are implemented across all parts of the service.
Progress will be monitored by and reported to the clinical governance board
and to the Brook Area Director and Brook Executive Director of Operations.
Client Safety
Priority 2 Reviewing and implementing integrated client safety systems
We will be contributing to the partnership approach to client safety by
undertaking a holistic review of client safety systems including client records,
safeguarding procedures and clinical governance to ensure that the new
service model is operating under a single set of policies and procedures and
that client safety and confidentiality is protected and ensured throughout the
hub and satellite services.
Progress will be monitored by and reported to the clinical governance board
Brook Area Director and Brook Executive Director of Quality and
Safeguarding.
Client Experience
Priority 3 Young People led Counter Measures surveys
Building on the success of the simple and effective Counter Measure surveys,
we will introduce two young people led Counter Measure surveys. The
questions for both surveys will be decided on by young people with the
support of our outreach staff.
We will review client feedback and client data to identify how we can
improve the client experience when visiting Brook Wirral. This review will
include client waiting times, access to the relevant consultant, outcomes of
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consultation. This will enable us to deploy the resources we have in the most
efficient way to manage clinic flow and service delivery.
The results will be shared with our staff teams and regionally and nationally if
relevant. We will also report the results within the waiting rooms via the ‘You
said, we did” board.
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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 Wirral provided and/or sub-contracted one NHS service.
Brook Wirral has reviewed all the data available to them on the quality of
care in this service.
The income generated by the NHS services reviewed in 2012/13 represents
100% per cent of the total income generated from the provision of NHS
services by Brook Wirral for 2012/13.
Participation in clinical audits
During 2012/13, no national clinical audits and no national confidential
enquiries covered NHS services that Brook Wirral provides.
During that period Brook Wirral was not eligible to participate in any national
clinical audits or any national confidential enquiries of the national clinical
audits.
As Brook Wirral 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 Wirral 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 Wirral intends to take the following actions to improve the
quality of healthcare provided:
quick start contraception where possible
undertake and document that an STI screen has been done for all women
with irregular bleeding
ask about and document the sexuality of the client
determine STI risk by asking about previous infections
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2012/13
provide a test of cure for clients with gonorrhoea
work with allied services to improve partner notification
offer all women an IUD as the first line option of emergency contraception
and facilitate referral where required
advise all women to have a pregnancy test three weeks. after emergency
contraception
offer an STI screen to woman with new partners requesting emergency
contraception.
Actions from audits led by NHS Wirral are not yet formulated or agreed within
the integrated partnership model.
Participation in clinical research
The number of patients receiving NHS services provided or sub-contracted by
Brook Wirral 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 Wirral’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 this was not available.
Statements from the CQC
Brook Wirral 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 Wirral had an
unannounced CQC inspection on 20 November 2012 and was found to be
fully compliant against all inspected outcomes. Brook Wirral has no
conditions on registration
The Care Quality Commission has not taken enforcement action against
Brook Wirral during 2012/13.
Brook Wirral 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 Wirral will be taking the following actions to improve data quality:
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2012/13
we will implement all actions indicated as a result of completion of the
Information Governance Toolkit
guidelines for recording client activity are being developed and will be
implemented within the service in 2013/14.
NHS Number and General Medical Practice Code Validity
Brook Wirral 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 Wirral’s Information Governance Assessment Report overall score for
2012/13 was 84% and was graded Green.
Clinical coding error rate
Brook Wirral was not subject to the Payment by Results clinical coding audit
during 2012/13 by the Audit Commission.
Patient Safety Incidents
Year
2011/12
Number of
incidents
1
2012/13
1
Brook Wirral considers that this incident rate is because there is a focus on
client safety at all times and this is underpinned by procedures relating to
premise safety, client records and information as well as clinical governance
procedures.
We do not consider this number of incidents disproportionate or unreasonable
given the number of clients that we see (less than 1% of client visits).
The overall grading of the incidents remains low risk and of low impact to
client experience or safety.
Brook Wirral 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
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2012/13
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
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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%.
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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.
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2012/13
Review of local performance 2012/13
Brook Wirral 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.
In the autumn of 2012 Wirral PCT and Public Health Commissioners tendered
for a fully integrated sexual health service. Following a very robust open
competitive bid process the contract was awarded to the consortia of Wirral
Community Trust, Brook Wirral and Wirral University Teaching Hospital. This
means that Brook Wirral is now part of a new exciting integrated service. The
new service model is branded as Sexual Health Wirral and merges the Genito
Urinary Medicine, Contraception and Sexual Health and Young People’s
services. It offers clients a one stop shop for all their sexual health needs
including contraception, emergency contraception, pregnancy testing, STI
and full GUM screening. The service is available seven days a week in various
locations and venues with five dedicated young people’s clinics.
Clinical effectiveness
Regular clinical meetings have been held alongside one to one supervision
and appraisals. Separate meetings for nurses and clinic support workers have
been held regularly as have cross discipline meetings which include
reception, administration and counseling staff. These regular meetings allow
staff the opportunity to raise issues which are pertinent to their own discipline
and to reflect on the complete client experience we offer.
Client safety
Brook Wirral reviewed all procedures and documentation for safeguarding
decision making and is in the process of introducing a new Decision Making
and Recording Form and monitoring system. This is to ensure that staff are
guided and supported in making safeguarding assessments, that all
vulnerable young people are monitored and safeguarding referrals are of the
highest standard possible.
All Brook staff received safeguarding training in 2012/13.
Client experience
Brook Wirral undertakes regular client satisfaction surveys and reviews the
outcomes in management and team meetings to implement appropriate
actions. In 2012/13, young people told us that;
staff were helpful and supportive
they didn’t feel judged
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2012/13
confidentiality is very important
they didn’t like having to wait a long time to be seen.
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2012/13
Supporting statements
Primary Care Trusts ceased to operate on 31 March 2013 so it was not possible
for the commissioning PCT to comment on this quality account.
No supporting statements were received from Healthwatch or the local
authority Overview and Scrutiny Committee by the time of publication.
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2012/13
Brook Wirral
Whetstone Lane
Birkenhead
CH41 2QR
www.brook.org.uk
Registered Charity Number: 1015488
Limited Company Registered in England & Wales Number: 2727971
Brook is a trading name of the charities in the Brook Advisory Group
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2012/13