Section 1
What is a Quality Account?
Statement from the Chair
Statement of Directors’ responsibilities in respect of the Quality Account
About our services
Gloucestershire Care Services NHS Trust: Our Visions and Values
Where our services are provided
Section 2
Our priorities for clinical improvement in 2013-14
Clinical effectiveness – improving the quality of our care pathways
Learning from experience
Putting patients first
Section 3
Review of quality priorities for 2012-13
Using the expertise of staff through the Top 100 Ideas scheme
Quality Improvements
Infection Prevention and Control
Medicines Management
Gloucestershire Care Services Volunteer Programme
Working with Communities – “Your Care, Your Opinion”
Listening, learning and improving
Patient’s stories
Care Quality Commission 2012-13
Our compliance with Care Quality Commission standards
Complaints and our learning
Incident reporting 2012-13
Valuing our staff
Quality and performance
Same sex accommodation: declaration of compliance 2013-14
Our information governance (IG) toolkit attainment level
Data quality
NHS number and general medical practice code validity
Financial statement
How to contact us
Amendments and additions to the document following feedback from our
Appendix A - Statement from Gloucestershire County Council - Health and
Overview and Scrutiny Committee
Appendix B – Statement from Gloucestershire LINk
Appendix C – Statement from Gloucestershire Clinical Commissioning Group
Section 1
Page 5…….
What is a Quality Account?
Page 6…….
Statement from the Chair
Page 7….…
Statement of Directors’ responsibilities in respect of the Quality
Page 8……
About our services
Page 12……
Gloucestershire Care Services NHS Trust: Our Visions and
Page 13……
Where our services are provided
‘Gloucestershire Care Services NHS Trust is committed to working with
you to provide high quality, local, health and social care’
What is a Quality Account?
A Quality Account is provided to support openness and transparency across the NHS regarding the
quality of services provided.
This document may be used by patients and carers, stakeholders, the public and our staff, to
assess the level of quality care we provide. Comparisons to other organisations may be made
utilising some of the quality performance data within the document.
Statement from the Chair
On behalf of Gloucestershire Care Services NHS Trust (the Trust), the
Trust Board and our staff I am delighted to present our annual Quality
Account. This provides us with an opportunity to restate our
commitment as an organisation to continue to improve the quality of
the services that we provide and to demonstrate the achievements of
our staff. Throughout this reporting period (1st April 2012 to 31st March
2013), we have continued to focus on quality improvement across all
our services.
During 2012-13 the Trust operated as an arm’s length provider within NHS Gloucestershire as
progress to establish a Community Interest Company met with legal challenge. In considering the
future of the organisation, Commissioners called for a response that did not dilute the market for
care in Gloucestershire and that would deliver its strategic vision. The plan to establish
Gloucestershire Care Services (GCS) as an NHS Trust was agreed and the transition to
Gloucestershire Care Services NHS Trust took place on the 1st April 2013, following significant
preparation and staff involvement. The reflective “look back” aspects of this document relate to our
predecessor organisation (NHS Gloucestershire Care Services), whilst the “look forward” sets out
our objectives and commitment for Gloucestershire Care Services NHS Trust.
Despite the significant organisational change and period of uncertainty for the future, staff have
continued to be focussed and work hard, especially in the area of quality and performance. They
are to be congratulated and should be proud of the high standards they have achieved.
Continuously improving the quality of our services remains our primary focus for the Trust, through
a growing portfolio of quality improvement initiatives aimed at enhancing the safety, experience and
outcomes for all our patients. Our Board ensures that matters relating to care quality remain high
on its agenda and will throughout the coming year ensure that lessons learnt from the concerns
raised regarding Mid Staffordshire NHS Trust, are used to review our practices.
We recognise the importance of providing assurance to our partners and users of our services, that
the care we deliver is of a high standard, as safe as possible and achieve good clinical outcomes.
We welcome the comments and interest we have received from our partners and stakeholders and
wherever possible have incorporated these into this final draft. To the best of our knowledge, the
information presented to you in this Quality Account is accurate and provides a fair representation of
the quality within our organisation.
Ingrid Barker – Chair
The Directors of the Trust are required under the Health Act 2009, National Health Service (Quality
Accounts) Regulations 2010 and National Health Service (Quality Account) Amendment Regulation
2011 to prepare Quality Accounts for each financial year. The Department of Health has issued
guidance on the form and content of annual Quality Accounts (which incorporate the above legal
In preparing the Quality Account, directors are required to take steps to satisfy themselves that:
the Quality Accounts presents a balanced picture of the Trust’s performance over the period
the performance information reported in the Quality Account is reliable and accurate;
there are proper internal controls over the collection and reporting of the measures of
performance included in the Quality Account, and these controls are subject to review to
confirm that they are working effectively in practice;
the data underpinning the measures of performance reported in the Quality Account is
robust and reliable, conforms to specified data quality standards and prescribed definitions,
is subject to appropriate scrutiny and review; and the Quality Account has been prepared in
accordance with Department of Health guidance.
The directors confirm to the best of their knowledge and belief they have complied with the above
requirements in preparing the Quality Account.
By order of the Board
28.6.2013……….Date............................................................Deputy Chief Executive
About our services
Gloucestershire Care Services NHS Trust (the Trust) provides high quality accessible and
responsible community and specialist NHS services across Gloucestershire and employs in excess
of 2,800 staff. Staff include Nursing, Medical, Dental, Allied Health Professionals, Support Staff,
Administrative And Clerical Workers. Having worked closely with colleagues in social care for many
years, we have now integrated adult health and social care services and manage approximately 800
staff – Social Workers and Reablement Workers on behalf of Gloucestershire County Council.
We deliver community-based health and social care to people of all ages across Gloucestershire
covering a population of approximately 600,000 people.
These services are delivered in a variety of settings including people’s homes, community clinics
and community hospitals.
Throughout 2012-13 a total of 54 different healthcare services were provided by the organisation.
Each year the organisation’s staff engages in more than two million contacts with patients and other
service users.
Providing Services across Gloucestershire
1. Children and Young Peoples’ Services
Brings together all the specialist community services for children and young people across
Gloucestershire and offers a co-ordinated approach for child health as well as delivering the
universal childrens’ services of Health Visiting, School Nursing and the Neonatal hearing
screening service.
2. Locality Based Services for Adults
Provides a range of services for the local communities within the county including community
based care and hospital admission avoidance, District Nursing, Adult Social Care, Community
Podiatry and therapy services for older people. Our services also provide care within seven
community hospitals which includes minor injury units, outpatient and inpatient care.
3. Specialist Services
Community Dental Services
Provide a range of specialist dental services across Gloucestershire
Sexual Health Services
Provide a range of sexual health and genito-urinary medical services across the county.
Specialist Nursing including Tuberculosis, Parkinson’s Disease and Heart Failure.
The clinical services are supported by a range of corporate functions such as Human
Resources, Finance, Performance, Governance And Risk Management.
Patient Advocacy and Liaison Service (PALS) and the Patient Experience Service
provide liaison with users, their families and carers.
4. Integrated Community Teams
GCS and GCC have worked hard to integrate services being delivered across Gloucestershire,
based on our joint commitment, as set out in the July 2012 Concordat and Business Case to the
integration of health and social care services in Gloucestershire.
The intentions have been:
To improve health and social care outcomes for adults in Gloucestershire
To deliver operating efficiencies across the County against challenging economic and
demographic trends
Evidence from national studies provide a consensus that integration between health and social
care provides significant benefits to service users, staff and organisations including:
Improved overall access to services
Shortened time from identification of need to delivery of community service
Simplified decision-making processes
Increased efficiency of processes of assessment
Reduction of communication failures by reduction of patient handover
Community based workers who deliver health and social care to adults in the community,
including Social Workers, Physiotherapists, Occupational Therapists, District Nurses and
support staff for each profession, are now integrated and largely co-located into integrated
community teams (ICTs) organised within three locality structures; Gloucester & Stroud,
Cotswold and Cheltenham; Forest of Dean & Tewkesbury to ensure a local focus is maintained.
An Integration Programme has been in place since 2011, including six work streams that are
responsible for providing our Integrated Care Teams with the ability to work across
organisational and professional boundaries. These workstreams include HR and Workforce
Development, Finance, Performance, IT, Accommodation, and Governance. Their plans have
focused on looking at what practical changes are required to the way our organisations work to
allow integrated working, with significant change already delivered.
In addition to this, there have been a number of service improvement projects, aligned to and
enhancing integration. These have included:
Referral Management Centre developments
The Customer Journey Project
Living Well
Review of the Self Directed Support process
South Cotswold and Gloucester pilots with the intention to enhance Integrated Community
Teams and to support the work of avoiding inappropriate hospital admissions.
Benefits to patient/service user:
 Faster recovery at home with support
 Patient is back in the community with their local support network ie. Family friends, carers, GPs
and the voluntary sector.
 Increased independence and quality of life.
Benefits to care provider
 Less duplication through integrated care.
 Bringing care closer to home.
 Make best use of hospital based
(left) Senior reablement worker and community
therapist working with a patient in his home
Full independence through co-ordinated care
After a stay in hospital to recover from a fall,
Mrs B had been discharged home and was
receiving four calls per day for homecare
support. A social worker from the local
community team visited Mrs B to complete a
review to see how she was progressing and
whether or not additional support was needed.
Throughout her adult life, Mrs B has lived with
a disability where paralysis affects one side of
her body. An independent and resilient lady,
Mrs B raised her family and, in recent years,
nursed her first and her second husband
through long illnesses until they died.
Ashleigh Intermediate Care Centre Team
(back row) occupational therapist, senior reablement
worker, unit lead, care leader, community nurse
(front row) social worker, district nurse.
From the first assessments and learning about
Mrs B’s past, it became clear to the social
worker that Mrs B has developed good coping strategies over the years to solve the
challenges of daily living with a major disability.
Mrs B, however, had not been out of her home since her fall and she was fearful of driving
again. Her family expressed concerned about her catheter and its possible removal, and
Mrs B’s need for exercise and ongoing support.
After the social worker talked through the issues with Mrs B, the homecare agency and
occupational therapist, it was agreed that the reablement team would support Mrs B for the
morning and night calls, with the homecare agency continuing to support the lunch and
evening calls. Advice and support were given to make sure that Mrs B could move safely
around her home with adjustments to existing equipment.
Over a number of weeks, and through the work of the occupational therapist and
reablement workers, Mrs B was supported to become more independent and confident in
daily tasks, such as washing, dressing, meal preparation and cooking. The lunch-time visit
from the homecare agency was replaced with a reablement visit to support Mrs B in
regaining these skills further.
To help Mrs B better manage her catheter - with a view to removing the need for a catheter
altogether – the team’s district nurses became more closely involved in her care. Different
catheter equipment proved unsuccessful at home so, with the support of her social worker,
Mrs B was admitted to Ashley Intermediate Care Unit in Cheltenham. After three weeks of
close supervision by the Unit’s district nurse and other support staff, Mrs B was finally able
to have her catheter removed.
The impact on Mrs B’s quality of life has been dramatic, and she no longer needs any help
at home from carers.
Our Vision and Values
Our Strategic objectives
To secure, develop and deliver innovative, high quality community based services
meeting the needs of users
To integrate health and social services
To develop and strengthen partnerships with communities
To support, develop and involve our staff
To strengthen our excellent reputation
To deliver our contract commitments and provide value for money
Where our services are provided
“The Community Hospital
had a good friendly
supportive attitude and
that services
the ward manager
Where our
are provided
was leading it well and
that we wish to thank
them all for what they did
for my husband.”
“The Expert Patient
Programme made me
realise that people do
care and there is help
and they will help you to
deal with your
Section 2
Page 15……Our priorities for clinical improvement in 2013-14
Page 17…..Clinical effectiveness – improving the quality account of our care
Page 17….. Learning from experience
Page 18……Putting patients first
In order to identify our priorities for the coming year, in Gloucestershire Care Services NHS Trust
we have considered the four aspects of quality, safety, effectiveness and experience. We have
used the information available from patient feedback, incident reports and from our staff, to identify
the key workstreams for the coming year.
Our priorities for clinical improvement in 2013-14
The implementation of the Safety Thermometer has formed a key part of our patient safety plans
during 2012-13 and evidencing improvement will continue to be a priority during 2013-14. This is a
national programme aimed to reduce harm from:
Hospital and community-acquired pressure ulcers (also known as pressure sores)
Urinary tract infections (UTIs) in patients with catheters
Blood clots (deep vein thrombosis and pulmonary embolism)
The healthcare complications resulting from these issues are recognised across the NHS. Harm
from pressure ulcers, falls, urinary catheters and blocked clots, is estimated to affect over 200,000
people each year and the direct costs to the NHS estimated at over £430 million per year.
Gloucestershire Care Services is working with other NHS trusts to improve patient safety as part of
this national programme. We aim to eliminate all four causes of harm, for every patient, by
developing safer systems for in patient and community settings.
The programme encourages organisations to address safety issues from the patient’s perspective
and adopt an integrated approach across teams and departments to minimise the risk of the four
causes of harm.
Measuring for improvement
Measuring harm-free care from the patient’s perspective is ambitious and is supported by the use of
the safety thermometer which is a tool that measures, monitors and analyses causes of patient
harms and harm-free care. This enables frontline clinical teams to survey their patients every
month, measure the four causes of harm and will build evidence to enable monitoring of their own
safety improvement.
The use of the tool in 2012-13 has highlighted themes for further quality development including:
Catheter care
Antibiotic prescribing
Review of the escalation threshold for the Early Warning Trigger Tool (QuEST)
Data collected from incident reporting is also used to influence improvement work, especially for
patients who have fallen or who have pressure ulcers. As we repeatedly measure our patients for
harms, we will build a picture of improvement. We will monitor how rapidly this is happening to
establish ongoing patient safety work is making a difference to patient care and experience.
How this will be achieved
Establishing baseline information
Using the NHS Safety Thermometer (ST) to measure harms at the
point of care enabling clinical staff to know the number of:
• Pressure ulcers
• Falls
• Catheter-associated urinary tract infections
• Proportion of patients that are free from harm
• Blood clots
• Complete the ST for 100% of eligible patients every month for
the four harms to establish a baseline.
• Use that baseline line information from the safety thermometer
and triangulate with incident reporting and case note review.
Goal – where do we want to be?
We will use the work from the safety thermometer to support the
GCSNHST objective to deliver care free from avoidable pressure
ulcers, falls, urinary catheter infections and blood clots.
• Safety Thermometer data is reported in the quality and
performance part of the Trust Board, using the quality
dashboard to measure improvement.
• The patient safety report is presented to the Integrated
Governance Committee
• Groups that drive these improvements are: Falls; Pressure Ulcer
Group; Quality and Safety Group; Care Quality Forum.
• Progress is included in the locality monthly reports and shared
with local governance committees.
How the goal will be achieved
As part of the safety thermometer work, improvement will be
tracked over time. The clinical teams are committed to effectively
deliver care, free from harm to patients. This is not about starting
again but building on successes and integrating within current ways
of working.
• Completion of safety thermometer on a monthly basis.
• Use of the early warning trigger tool on all our inpatient areas.
• Risk assessment.
• Audit of catheter care plans.
• Audit of antibiotic prescribing compliance.
• Medicines review for all in patients.
• Nutrition and hydration including protected mealtimes in
inpatient areas.
Clinical effectiveness – improving the quality of our care
Our aim is that service users and their families are supported at home for as long as possible, are
well informed about how to best manage their health and have key contact details to access
responsive support and advice.
Clearly described pathways of care, developed in partnership with other providers within
Gloucestershire will support the delivery of compassionate care throughout the care journey by
reducing the number of handovers between teams and provides clear support and guidance to
patients and carers as to where to access support.
The focus for pathway development in collaboration with our partners for in the coming year will be:
• Support for those with dementia
• Respiratory care
• Care for the frail older person
• Reablement pathway
Our aim is that service users and their families are supported at home for as long as possible, are
well informed as to how to manage their health and care needs and have key contacts for support
and advice.
Monitoring and Reporting
The Transforming Local Care Committee will oversee and monitor the development of long term
condition pathways.
Learning from experience
Listening to and learning from the experiences of service users, their families and carers is critical if
we are to continue to improve the quality of our services.
The results from the “friends and family test” which forms part of our service user survey
programme will provide the baseline from which to develop our work programme.
• Together with the Your Care, Your Opinion Group develop our user experience strategy.
• Review the methods used to gain views from users and carers and develop a plan for gaining
the views of those who may not respond to traditional survey methods and consider for example
focus groups, use of technology.
• To add the friends and family tests within the staff survey.
Monitoring and Reporting
The Your Care, Your Opinion Group which includes in its membership the third sector partner
agencies and lay members, will monitor progress against our action plan and reporting will form part
of experience reports to the Integrated Governance Committee which provides assurance to the
Putting patients first
The Trust Board are committed to effectively learning from the Public Inquiry relating to the Mid
Staffordshire NHS Foundation Trust and supporting documents. We are committed to creating a
culture that puts patients at the centre of all we do and ensuring we support our staff to do so.
Whilst the reports focus on inpatient care and nursing, our staff are saying that ensuring patients
and their families are treated with dignity and respect is everybody’s business. We have reflected on
the issues raised and held a number of conversations with staff groups across the county to insure
our actions reflect the staff view of the impact of the learning on our organisation. We have
developed a plan that was discussed at our Board on the 14 May 2013, and addresses actions in
relation to the key aspects of:
Prevent problems
Detect problems quickly
Take action promptly
Ensure robust accountability
Ensure staff are trained and motivated
Our progress will be reported both to our Staff Forums and to the Integrated Governance
Committee and measured together with the feedback from both patient and staff surveys. This will
also be reflected in our Quality Strategy that is being prepared in partnership with clinicians and
stakeholders and will be reported in the Quality Account 2013 -14.
Section 3
Page 20…..Summary review of quality priorities for 2012-13
Page 25…..Using the expertise of staff through the Top 100 Ideas scheme
Page 26…..Quality improvements
Page 27…..Infection Prevention and Control
Page 28…..Medicines Management
Page 30…..Safeguarding
Page 31…..Gloucestershire Care Services Volunteer Programme
Page 32…..Working with Communities – “Your Care, Your Opinion”
Page 33…..Listening, learning and improving
Page 34…..Patient stories
Page 35…..Care Quality Commission 2012-13
Page 36…..Our compliance with Care Quality Commission standards
Page 37…..Complaints and our learning
Page 39…..Incident reporting 2012-13
Page 40…..Valuing our staff
Page 44…..Quality and performance
Page 46…..Same sex accommodation: declaration of compliance 2013-14
Page 46…..Our information governance (IG) toolkit attainment level
Page 47…..Data quality
Page 47…..NHS number and general medical practice code validity
Page 48…..Financial statement
Page 49…..How to contact us
Page 50…..Amendments and additions to the document following feedback from our
Page 51…..Appendix A - Statement from Gloucestershire Clinical Commissioning
Page 53…..Appendix B – Statement from Health and Care Overview and Scrutiny
Page 55…..Appendix C – Statement from Gloucestershire LINk
Page 57…..Glossary
Summary review of our quality priorities for 2012-13
Commissioning for quality and innovation (CQUINs)
What are CQUINS?
CQUINs are projects agreed between the Commissioners (who buy our services) and the Trust.
These projects are established to improve clinical care delivery or the processes that support
clinical care.
A proportion of Gloucestershire Care Services’ income (£1,952,975 in 2012-13) was conditional on
achieving quality improvement and innovation goals agreed between the Trust and our
commissioning through the CQUIN payment framework. The Trust received full payment of this
Patient experience in our community hospitals
In April 2012 we said….
Carrying out patient satisfaction surveys and monitoring the results helps to ensure that all service
improvements are driven by service user feedback and therefore focused on improving patient
Using the learning reported from the 2011-12 survey will be used to improve or maintain both the
quality of service reported and the response rate.
Reporting of our progress
Regular update reports have been provided to the Information Governance Committee and the
Achieving our goal
Implement of action plans based upon survey findings 2011-12.
Achievement by March 2013
The response rate increased to 420 from the baseline of 234 in 2011-12. The table shows the
percentage of positive responses to the five key CQUIN questions.
Did the service meet your expectations?
Were you involved as much as you wanted in
planning your treatment and care?
Were hospital staffs available to talk about
worries and concerns?
Yes 2010/11
Not asked
Yes 2011/12
Not formally asked 86%
How would you rate the privacy on the ward?
61% - very
27%- good
12% average
60% - very good
32% - good
8% - average
66% - very good
28% - good
5% average
How likely is it that you will recommend this
service to friends and family?
Not asked
Not asked
Reducing risk of Venous Thromboembolism (VTE)
In April 2012 we said….
Venous Thromboembolism (VTE) is a significant cause of death in hospitalised patients and
adversely affects the quality of life of patients. This initiative will support VTE prevention with the
aim of reducing the risk of patients developing the condition during and after their time as an
inpatient, building on the quality achievement in the previous year.
Our goal
By March 2013 90% of all inpatients will have been assessed for their risk of VTE and 90% of those
assessed as being at risk will have received appropriate prophylaxis.
How we monitored and reported our progress
We did this by monthly reporting as part of the quality and performance dashboard.
Achievement by March 2013
The practice of providing VTE risk assessment for patients has been successfully embedded into
the inpatient areas. The targets for both aspects of this CQUIN have been exceeded.
97.5% of patients had a risk assessed completed
95% of those at risk received prophylaxis
Zero attributable VTE’s were identified
Falls prevention
In April 2012 we said….
Falls have a major impact on quality of life, health and healthcare costs. Reducing falls in hospital
will reduce unnecessary increased length of stay.
Our goal
90% of patients will have a falls risk assessment within 24 hours of admission and where necessary
a care plan developed to detail how we will reduce the risk of falling.
How we monitored and reported our progress
Monthly update reports given through the quality and performance dashboard.
How we achieved our goal
We ensured that all the community hospital teams carried out falls risk assessment for all patients.
Where a patient is at potential risk, a care plan and patient information concerning falls prevention is
Achievement by March 2013
We exceeded the 90% target and evidenced that 98% of patients received a falls risk assessment
within 24 hours of admission. For those at risk of falls, 99% had a falls care plan in place within 24
hours of admission.
Improving care for those with Dementia
In April 2012 we said….
Improved screening for signs of dementia and then appropriate referral. This aides diagnosis and
the provision of early treatment and support.
Our goal
90% of all those aged 75 years and over admitted to a community hospital will have screening and
where appropriate be referred for further assessment.
How we monitored and reported our progress
This was actioned by monthly reporting through the quality and performance dashboard.
Achievement by March 2013
We exceeded the target and achieved initial screening assessment for 98% of eligible patients. Of
this group 90% had multi-disciplinary intervention within 3 working days.
Introduction of the Safety Thermometer
In April 2012 we said….
Safety Thermometer (ST) provides an effective measure and benchmarking of four key areas of
Our goal
By March 2013 all community hospital ward teams will be submitting data to the national database.
How we monitored and reported our progress
This was actioned by monthly reporting through the quality and performance dashboard.
How we achieved our goal
The clinical teams supported by a clinical lead, undertook a monthly census which resulted in
information collated by the Performance Team being submitted to the national database.
Achievement by March 2013
The target was exceeded with all inpatient and community teams undertaking the monthly census
and reporting on the national database by the end of the year.
Patient experience escalator
In April 2012 we said….
We want to ensure that services provided promoted shared decision making and ensured all were
treated with kindness, dignity and respect.
Data from quarter 1 (April-June) - we used the friends and family test to identify good practice.
Our goal
• To develop and implement a programme of observational audit.
• Evidence learning from the 2011-12 survey
• Demonstrate leadership from point of care to chair
How we monitored and reported our progress
This was actioned quarterly through reporting through the quality and performance dashboard.
Achievements by March 2013
• 93.2% of those that use our services would recommend us to their friends and family
• Action plan from 2011-12 audit agreed and monitored by the Contract Quality Group
• Observational audit in place
• The use of patient stories developed with the support of our expert patient programme
Improving maternal mental health
In April 2012 we said….
Ante and post natal screening offered to women can support early intervention and appropriate
Our Goal
That through the use of the maternal mental health pathway we improve outcomes for women with
mental ill health during pregnancy and for up to a year following birth
In quarter 1 (April- June) the baseline data was gathered and the number of staff requiring training
was identified.
How we monitored and reported our progress
Through quarterly reporting in the quality and performance dashboard.
Achievements by March 2013
• 75% of staff requiring training undertook the appropriate programme.
• 95% of women were offered screening.
• 83% had initial screening question
• 19% had onward referral at end of inpatient stay
Improve the number of referrals to the Single Point of Clinical Access (SPCA) from
In April 2012 we said….
Increasing the number of referrals to the SPCA will support effective care close to home and reduce
acute admissions.
Our Goal
By the end of the year we will have received 100 referrals to the SPCA from the Great Western
Ambulance Service (now South Western Ambulance Service NHS Foundation Trust), by developing
effective processes to work in partnership.
How we monitored and reported our progress
Through the quality and performance dashboard.
How we will achieve our goal
Working in partnership with the ambulance service will look at pathways to support patients as close
to home as possible and in doing so avoid unnecessary hospital admission
Achievements by March 2013
We achieved a total of 236 referrals to our SPCA therefore exceeding our target.
Provision of seven day services
In April 2012 we said….
We aim to firstly enhance the process in community hospitals throughout the week and by doing so,
support early discharge from acute hospitals, and secondly prevent unnecessary acute admissions
and enable discharge home or to care home seven days a week.
Our Goal
To develop effective processes supported by clinical teams to ensure where safe to do so patients
may be admitted or be discharged from community hospitals seven days a week.
How we monitored and reported our progress
By monthly reporting through the quality and performance dashboard.
How we achieved our goal
The goal was achieved through partnership working and our developing Integrated Community
Teams to ensure where safe to do so patients are cared for close to home and that unnecessary
admissions to acute services are avoided.
Achievements by March 2013
• 44% of patients admitted to a community hospitals came directly from home with a further 8%
admitted following initial assessment within an acute setting
• 17% of total admissions take place over the weekend
• 13.8% of discharges take place over the weekend
Improve care and support at end of life
In April 2012 we said….
That effective planning and communication can enable those at the end of life to be cared for in
their place of choice and better support their families and carers.
Our goal
To effectively utilise the Liverpool Care Pathway (LCP) to record conversations with patients and
their families, aiding communication and supporting joint planning and informed choice based on the
best evidence.
How we monitored our progress
Benchmarking data was collected through the clinical audit process in quarter one to establish the
number of LCPs in use and if preferred place of care at end of life was recorded
How we achieved our goal
The negative publicity surrounding end of life care and the LCP in particular brought considerable
challenge to this work. Nursing staff supported patients in understanding and ensuring informed
consent around care planning and respected choice where patients or families may opt not to use
an LCP to record care. Whilst the CQUIN measured LCP use the focus of staff remained on
improving care and enabling choice around preferred place of care, ensuring this was effectively
document whether or not the LCP was used.
Achievements in March 2013
85.5% had LCP in use and 62.15% had preferred place of care at end of life recorded.
Using the expertise of staff through the Top 100 ideas scheme
In April 2012 we said….
We would challenge staff to submit ideas and innovation that would benefit staff and patients.
Our goal
Identify the top three ideas then submit these to be supported to implement their plans.
How we achieved our goal
We worked in partnership with Bristol Business School who led workshops and helped prepare the
shortlisted to present to the “Dragon’s Den” panel. We involved our staff forums who undertook the
Achievements in March 2013
The joint winners were:Emma Cronin-Preece & Linda Knight
Text servicing for the community accessing the Public Health Nursing Service
Would help to ensure effective use of staff time as contacts will be requested by
clients. Text messaging enhances access in a rural area, those with poor reception and for
those who prefer text messaging. Teenagers and parents will have enhanced access to
Public Health Nurses and private and confidential advice at their convenience.
Ollie Crawford-Paul
Swap shop for surplus or stock approaching its use by date
Introduction of a swap shop for staff on the intranet would benefit staff, patients and the
organisation as a whole providing a means for efficiently redistributing unwanted stores
items. It would be particularly useful to the smaller units where the minimum unit of issue
of some stock is too large for all the items to be used within their use by date, this will
reduce wastage and costs.
James Clapp
Children’s physiotherapy smart phone app, enabling parents and medical
professionals to gain instant information
Children, parents, health professionals including GPs, Health Visitors, and Physiotherapists
would benefit. Parents and children will have instant access to information on common
conditions seen in childhood and the best forms of self-management or accessing
(left to right) Rob Graves Non-Executive Director, James Clapp, Linda Knight, Emma CroninPreece, Ollie Crawford-Paul
Next Steps
So many great ideas were developed which we would not wish to lose. Many of those are being
supported by managers of the teams that submitted their ideas, to trial their ideas in practice. The
top three finalists will be supported to develop their ideas and plan the implementation and have
identified mentors identified to support them in this process.
Quality improvements
Gloucestershire Care Services NHS Trust aims to embed the four key aspects of quality, safety,
effectiveness and experience, in every day practice. Each member of staff takes all opportunities to
consider how they can ensure care provided is safe, effective and delivers a positive experience
and where we do not get that right we are open and honest and learn from feedback.
Infection Prevention and Control
Infection prevention and control is a critical part of patient safety across all services and aspects of
care. The commitment demonstrated by our care and hotel services staff, has enabled the Trust to
evidence excellent progress in this important area exceeding our targets in each of the following
three areas.
Number of C.difficle infections
Number of MRSA bacteraemia
Percentage of staff completing infection prevention and control
≤ 24
A comprehensive Infection Prevention and Control Annual Report will be presented to the
Trust Board in November 2013 and made public through our website.
Across our community services monthly audits of hand hygiene practice are undertaken
using the adapted Lewisham observational tool observing hand hygiene practice within a
clinical area over a period of 20 minutes.
Example of a hand hygiene report (based on percentages):
Annual average score for observational hand hygiene audits = 98% compliance
The Patient Environment Action Team (PEAT)
The annual programme of PEAT inspections focuses on the non-clinical aspects of care quality. The
results of the 2012 inspections are detailed in Table 2 below and evidence that hospital teams have
all maintained or improved on the score achieved in 2011.
Moreton District Hospital was not inspected at this time as the visits took place just prior to the move
to the new North Cotswold Hospital. This site will be part of the programme of visits for the coming
year. Environmental issues identified at The Dilke Hospital caused the team to assess privacy and
dignity as “good”. The PEAT team membership includes a member of the infection prevention and
control team, and the results clearly demonstrate continued improvement in quality standards.
Privacy & Dignity
Cirencester Hospital
Tewkesbury Hospital
Dilke Memorial
Lydney & District
Stroud General
The Vale Hospital
Moving from PEAT to Patient Led Assessments of the Care Environment (PLACE)
The ending of PEAT inspections and their replacement by new patient led inspections, to be known
as Patient-Led Assessments of the Care Environment or PLACE was announced by David
Cameron on the 6 January 2012.
The focus of the revised process will continue to be cleanliness, buildings/facilities, privacy and
dignity, and food, but there are a number of changes to the detail of the assessment, the scoring
methodology and the assessment process and crucially the number and responsibilities of the
patient representatives.
The Trust will be part of this new process in 2013 and will be reporting on the outcome within future
Quality Accounts.
Medicines Management
Prescribing medication is the most common healthcare intervention. Medicines management
governs the way in which medicines are selected, procured, prescribed, administered and
reviewed, in order to optimise the contribution made to producing informed and desired
outcomes of patient care. Getting the use of medicines right or optimising the use of medicines is
essential to improve the outcome for patients.
The Head of Medicines Management is a member of the Countywide Antimicrobial Stewardship
Group which has a clear work plan to improve antibiotic prescribing and reduce the risk of
resistance. A monthly antibiotic audit was introduced across all on inpatient wards to assess 5
key elements of antibiotic prescribing. The results of this audit are published on the monthly
dashboard and non-compliance followed up with individual prescribers. Prudent and appropriate
antibiotic prescribing will continue to be a focus through 2012-2013.
An Accountable Officer for Controlled Drugs has been appointed to meet the legislative
requirements of establishing an NHS Trust. This person has responsibility for the safe
and effective use of controlled drugs across the Trust.
A very successful Medicines Management Conference was held in November 2012. It was attended
by approximately 100 staff and covered key areas including the legal aspects of prescribing and
administration, the rights of medicines administration, record keeping and antibiotics. It is hoped to
repeat this in future years.
A Medicines Management training program for clinical staff is currently being run by the clinical
pharmacist at Cirencester Hospital. This event has been welcomed by staff and it is planned to roll
this out across all our services.
During this year a review has taken place of all medicines held as stock on the inpatient ward. The
purpose of the review was to ensure evidence based prescribing was being adhered to with the
countywide drug formulary and to provide continuity of care across all inpatient sites. The review
has reduced the amount of inappropriate stock being held on wards and reduced wastage. This
review has dovetailed with the introduction of bedside medicine lockers which supports a
personalised care and maintenance of independence during an inpatient stay.
The organisation continues to support non-medical prescribing to support service development and
improve patient and care experience. During 2012-2013 10 registered nurses started their
Independent non-medical prescribers through local Universities. We continue to provide a range of
educational sessions to support Non-Medical Prescribers programme across the organisation meet
their continuing professional development needs. In the future the use of e-learning will be
considered to allow a wider range of topics to cover.
Plans for 2012-13 include a focus on medicines management training and missed dose audits.
In line with both national and local drivers this last year has seen considerable movement towards a
more integrated approach to Safeguarding Adults and Children. This has culminated in the
formation of a joint operational group, and both named nurse leads are now co located to facilitate
closer working.
The Trust continues to increase the numbers of staff who have accessed training relevant to their
role and now has 16 trainers who have completed a train the trainer course hosted by GCC to
enable the delivery of foundation level training within our localities.
To increase the Safeguarding profile a Safeguarding Children’s newsletter has been developed,
which will be replicated for Safeguarding Adults and the first of a series of poster campaigns ‘No
Pressure Ulcers’ was run with positive feedback from clinical staff.
Both Adult and Children’s Services continue to fully participate in multi-agency meetings within the
The Named Nurse for Safeguarding Children and specialist safeguarding team provide supervision
to all health staff involved in child protection cases. Health visitors and school nurses as front line
practitioners working with children and families receive specialist safeguarding supervision. In
addition group supervision is provided to staff with Sexual Health Services and Minor Injury Units.
The Director of Nursing represents the Trust on both the Gloucestershire Safeguarding Children’s
and Adults Boards and key professionals attend the sub committees. There is an ongoing robust
programme of local and multi-agency safeguarding children training for staff caring for children and
vulnerable adults.
In April 2012 the Trust published a declaration about how the Board assures themselves that
safeguarding arrangements are in place. The Trust Board continues to take its safeguarding
responsibilities very seriously.
Gloucestershire Care Services NHS Trust meets the statutory requirement with regard to the
carrying out of criminal records checks (DBS) Disclosure Barring Service.
Child protection policies and systems are up to date and robust including a process for following
up children who miss outpatient appointments and a system for flagging children for whom there
are safeguarding concerns.
All eligible staff are required to undertake safeguarding training and attendance is monitored in
line with mandatory training policy and reported to the Trust Board. In addition, a review of other
training arrangements will be completed and will incorporate the emerging recommendations
from the national review of safeguarding training.
The named doctor, named nurse responsible for safeguarding are clear about their roles and
have sufficient time and support to undertaken them.
The Executive Director of Nursing is the Board level Director for safeguarding.
Safeguarding - Preventing Pressure Ulcers
2012 /13 marked the launch of several new initiatives to
support existing activity relating to Pressure Ulcer (sore)
prevention. As part of our participation in the South West
NHS Patient Safety forum a change in our risk
assessment and related clinical records resulted in much
clearer information relating to level of risk and prevention
strategies, that have been positively received by staff.
All pressure ulcers are reported via our electronic incident
reporting system, and are subject to an initial investigation
by the Named Nurse Safeguarding (Adults). The incidents
are reported on the performance dashboard, which
demonstrates a reduction in the number of pressure sores
acquired while an individual is in the care of GCS.
Linked to this was the development and launch of a
Safeguarding and Pressure Ulcers policy which clearly
described employee’s responsibilities and a countywide
multiagency approach to management. This policy is now
reflected in a countywide policy hosted by GCC and has
also been adopted by partner health agencies. The Tissue Viability Team also hold training and
education sessions.
Gloucestershire Care Services Volunteer Programme
Volunteers work across our organisation providing valuable support to improve the patient
experience in hospitals, clinics and within a patient’s own home. They help to build a stronger
relationship between members of the local community and our
services, helping to tackle health
inequalities and promoting healthy lifestyles. Patients benefit from improved well-being, higher selfesteem, lower levels of social inclusion and improved self-management skills.
The Trust Volunteer Service policy was written and published in April 2012, which included some
work collating a database of the volunteers in the organisation. Prior to this volunteering was
managed in each locality and there were no centralised records of the volunteers in the
organisation. The policy is due for review April 2013.
A volunteer co-ordinator was appointed on an 18 month secondment with the purpose of supporting
volunteers with induction and training as well as ensuring all essential employment checks were
undertaken to protect the patient.
A volunteer database was compiled which includes records of Disclosure Barring Service (DBS)
checks. Since September the Volunteer Coordinator has been working on updating this list of
volunteers and ensuring all those who need them have a current Disclosure and Barring Service
check (previously CRB checks).
Total Number of volunteers
September 2012
Children's services
Cirencester Hospital
Expert Patient Programme
Forest Hospital
North Cotswolds Hospital
Speech and Language Therapy
Stroud Hospital
Stroud Physiotherapy department
Tewkesbury Hospital
Vale Hospital
March 2013
Since September the following processes have been drawn up to help support those who wish to
offer their time to volunteering:
Recruitment (including Volunteer Agreement)
Person specification and task lists
Induction (including corporate and local induction, handbook and welcome pack)
Problem solving guidance
There is a volunteering page on the organisation website for the public to find out about
volunteering for the organisation and contact details for enquiries and to apply. The e-mail address
that has been set up to receive general enquiries and a point of contact for the service is:
[email protected]
Working with Communities – “Your Care, Your Opinion”
A “Your Care, Your Opinion” Committee has been established within the Trust that ensures active
two-way communication with local communities. The purpose of the committee is to raise
awareness of the services provided by the Trust and that service development is informed by
learning from user experience. In doing so it focuses on the elements of care that are critical to
service users and that underpin the delivery of the commitments made within the NHS Constitution
(March 2012).
The work of the Committee is informed by the key national and local drivers for patient experience,
with particular reference to the NHS Outcome Framework, the NHS Patient Experience Framework
and the Trust Vision and Values. They focus on the elements of care delivery that service users tell
us are important to them:
Care planned with the user that respects their values, preferences and expressed needs
Professionals ensuring care is coordinated and integrated
Clear information and communication
Care with compassion that supports physical and emotional comfort
Active involvement of family, carers and friends
Support through transition and ensuring continuity
Ease of access to care
Listening, learning, improving
User Experience Survey Programme
The patient experience programme has over the past year (2012-13) seen an increase in the use of
surveys to gain an understanding of the views of patients/service users regarding their care. More
than 50 patient experience surveys were carried out across the organisation during the year
including the in patients survey using “real time” electronic data collection. The overall responses to
the core questions included in each survey show a high level of satisfaction reported by those
receiving care.
Our patient experience surveys have shown that the majority of our patients feel that they are being
treated with respect and dignity and that they are involved with decisions about their care and
treatment. Patients tell us that they are being communicated with well; understanding what staff are
telling them, being able to ask questions and being listened to by staff. More than 90% of our
patients tell us they feel that they are being treated in a safe environment.
One of the re-occurring themes is that patients say they do not always know how to feedback about
the service they have received, in terms of offering compliments or making a complaint. To address
this a review is under way of the current Complaints, Concerns, Compliments and Comments (4Cs)
information leaflet, with a view to simplifying the content and renaming the leaflet so it is clear to
service users about how they can provide feedback.
Patient stories
During 2012/13 Gloucestershire Care Services (GCS) began work on Patient Stories; a new method
of involvement with our patients and their relatives or carers to strengthen our public and patient
Patient Stories provides a unique
method of gaining the views of
“I’ve learnt coping
service users as it does not rely on
strategies, communication
surveys or questionnaires which
skills alongside many other
useful techniques and to
organisation feels important, but
become a better selfallows the participant to tell their
manager and I still use many
story in their own words without
of the skills that I learnt from
direction or agenda from the
interviewer. Story telling in this way
is seen as a very powerful method
of gaining views and feedback of
the care and services received, the stories will provide us with valuable information
regarding the care provided by GCS.
We will be able to use this information to inform and support service development or improvement
initiatives and importantly to celebrate good news and promote where the experience and/or
outcome of the care received has been positive. The story can be in the form of a written transcript
of the conversation or an audio or video recording and there are various methods by which the
Patient Story can be shared all depending on the consent and wishes of the participant. We
anticipate sharing the story with the teams of the services involved, at our Trust Board meetings,
during staff induction and training and also on our internal and external websites.
Although this project has started on a
small scale, several patients and
“I write to bring your
attention the outstanding
experiences with us. GCS would like
care given to my husband.
to thank all those people who have
Their visits were reassuring
taken the time to work with us to
and comforting. We built up
improve our services. To date the
a good rapport and
majority of our Patient Stories have
friendship with the nurses
been provided by members of the
Expert Patient Programme, five
members of the group have given
very positive feedback about the
skills, strategies and strengths they
gained during the programme and
the overwhelming message has been about how this has enabled them to feel more fulfilled and
independent with better management of their condition.
“The excellent service was
provided efficiently and
professionally. Staff were
consistently on time and provided
appropriate support, guidance
and information at a time when it
was most needed.”
We have also received two
stories from relatives of patients
who have had inpatient stays at
our Community Hospitals; the
common theme running through
these stories is around the
importance of clear and reliable
communication between not only
the clinical staff and the patient
and family but also between
members of the multidisciplinary
team. As an organisation we
have been able to review some
of our processes, we have put in
place training and updates for
staff and have also introduced a
new role of Care Communication
Co-ordinator at one of our
Community Hospitals. These
measures will be reviewed and
assessed in due course.
Care Quality Commission 2012-13
The Care Quality Commission (CQC) is the regulator for all care provided with hospitals, care
homes and within people’s own homes.
During 2012-13 the CQC undertook three inspections of services provided by the Trust. The full
reports of these inspections are available via the CQC website www.cqc.org.uk.
Visits from the Care Quality Commission (CQC)
The North Cotswold Hospital
The North Cotswolds Hospital was inspected by a team from the Care Quality Commission (CQC)
on the 26 July 2012. During the inspection care was observed, staff were interviewed and records
reviewed all supported by conversations with patients and families. The following essential
standard of care where assessed and the hospital considered fully compliant.
Consent to care and treatment
Cooperating with other providers
Safeguarding people who use services from abuse
The following essential standards were also assessed during that visit and some improvement
noted as required.
Clinical records
• Care and welfare of people who use services
The learning from this visit was shared across all our community hospitals and as a result, the
following actions are being implemented:
• Review of clinical record keeping by our internal auditors
• Review of clinical records to develop a single record used by all professionals
Locally the visit led to significant service changes taking place including extended documentation
auditing, updating of staff on the resuscitation policy and adaption of the intentional rounding
process. The Matron is monitoring the actions underway to ensure full compliance be evidenced
when CQC next visit the site.
The Dilke Hospital
The Dilke Hospital was reviewed by the Care Quality Commission on the 30th August 2012 in
response to a previous visit. The review was intended to provide assurance that action had been
taken to ensure compliance against the following essential standards:
Respecting and involving people who use services
Care and welfare of people who use services
Meeting nutritional needs
Safeguarding people who use services from abuse
Supporting workers
The review found the Dilke Hospital to be meeting all essential standards.
The initial visit led to a number of service changes including introduction of care coordinators from
within the multi-disciplinary team, regular review meetings with patients and relatives, including a
daily “ward round” for relatives and a review of communication processes. The Trust were delighted
that these actions evidenced improvement when reviewed.
Hope House
Hope House, Sexual Health Services were inspected by the Care Quality Commission on the 20th
March 2012 and were found to be compliant within the essential standard assessed.
People's personal records, including medical records, should be accurate and kept safe and
confidential. This review was undertaken as part of a national programme of inspection relating to
assurance with practice associated with termination of pregnancy. The inspection found that the
Trust met the part of the regulation which was the subject of this review in relation to the use of the
HSA1 forms by doctors.
Our compliance with Care Quality Commission standards
Gloucestershire Care Services NHS Trust is required to register with the CQC and its current
registration status is unconditional.
The CQC has not taken enforcement action against Gloucestershire Care Services during 2012-13.
Complaints and our learning
In 2012 - 13 the Trust received a total of 88 formal complaints. This compares to 76 formal
complaints in the previous year.
Figure 1: Complaints by Quarter
Given the relatively low numbers of formal complaints received, trend analysis is difficult, of note,
however is:
Of the complaints received, approximately 30% related to community hospital inpatient and
minor injury unit services and 25% related to Out of Hours Services.
Just fewer than 40% of formal complaints received in 2012/13 related to ‘treatment issues’.
Approximately 14% related to complaints about the doctors attitude and the treatment received
or prescribed by the Out of Hours Service.
Key to the Trust’s approach to the management of complaints is ensuring that lessons are learnt
and appropriate actions are taken where improvement is needed. The Integrated Governance and
Quality Committee have a role in overseeing this. Some examples of the learning from complaints
and the investigations undertaken are summarised below.
Example of Learning from Complaints
Stroud General Hospital discharge planning and arrangements:
• Formal contact meetings are now held with patients and families within the first 48
hours of admission to improve and aid communication and enable families to be a part
of the care planning process
 Unitary multi-disciplinary team notes have been developed to include Occupational
Therapy records
Communication and information sharing with the Community Nursing teams
following discharge:
Referral protocols have been reviewed to ensure that the community nursing teams
have adequate information regarding patients clinical needs prior to discharge from
The Community Nursing teams now make routine telephone contact with all patients
known to have new/short term catheter in situ as soon as possible in order to advise
them how and when to make contact if they need support or advice
The Community Nursing teams have implemented changes to their practice in
recording messages and actions taken
Communication between the Health Visiting Teams and service users where referral
to Gloucestershire County Council (GCC) is required:
The Health Visiting teams now ensure that parents are given the referral guidelines
and correct information for any services they refer into
The Health Visiting Service has implemented action to ensure that telephone
messages are dealt with in a timely manner
Addressing delays in specialist assessment involving Children’s’ Occupational
The service has used the feedback to instigate a complete review of the service to
create a fully integrated team with a single point of access. To ensure improved
communication with service users, the team have worked in partnership with
Gloucestershire Carers Association and agreed a series of update letters to be sent to
families, keeping them fully informed of their case progress.
Timeliness of our response to Complaints
We make contact with individuals making a complaint and agree the review process and the
timeframe in which they can expect to receive a response. For the year 2012-13, 97.7% of
response letters were sent to the complainants within the agreed timeframes. This represents a
significant improvement on 2011/12.
Q1 2012
Q2 2012
Q3 2012
2012/2013 2011/12
No %
No. %
No. %
No %
No %
> by 1-3
>4 days
No %
100% 18
100% 27
93.1% 13
100% 86
97.7% 54
100% 18
100% 29
100% 88
Incident Reporting 2012-13
It is the Trust policy that staff report all adverse incidents using our Datix database which is a
computerised system for logging and analysing all incidents across the organisation. An adverse
incident is any event which affects a patient, member of staff, visitor or contractor which could have,
or actually has caused harm while he or she is under our care or on the Trust premises. A high
reporting rate within an organisation is evidence of a positive reporting culture, especially when this
is linked with a low level of serious harm incidents in the Trust. The level of serious harm sustained
as a result of an incident is approximately 0.29% of the total number of incidents reported.
Our incident reporting processes have enabled us to develop a comprehensive quarterly
governance report which provides data on trends in relation to patient and staff safety incidents and
provides reporting at team, locality and Board level. The Trust has a duty to report all patient related
safety incidents and near misses to the national database – the National Reporting and Learning
System. As incidents are investigated, the learning from such is shared widely and used to inform
changes to policy or work practice across the organisation.
Incident Types 2012/13
Clinical incident
Records, Information, Confidentiality
Discharge, Transfer, Appointment
Estates, staffing, infrastructure
Fire incident
Personal Accident
Security incident
Violence, Abuse or Harassment
Vehicle incident
Waste Environmental Incident
The analysis of incident type mirrors the national picture that falls and pressure ulcers are the
highest recorded concerns as reported by the National Reporting and Learning System
(NRLS). The category ‘clinical incident’ includes ‘pressure ulcers’ and the category ‘personal
accident’ includes patient falls. These figures also include pressure ulcers which are inherited from
other care providers.
This year has seen the development of a new process to monitor the management of pressure
ulcers. The nature of this new process has meant that management of this category of incident is
discussed and shared as well as monitored. The Trust is confident that this proactive approach will
see the number of acquired pressure ulcers fall in the future, working with other agencies to look at
a reduction across the care pathway. This approach also ensures that any safeguarding concerns
associated with a patient developing a pressure ulcer are identified and acted on.
Serious Incident Requiring Investigation (SIRI) reported via STEIS
The Trust has continued to develop its learning from Serious Incidents Requiring Investigation
(SIRIs) reported via the Strategic Executive Information System (STEIS) database. Management of
these incidents is monitored to ensure they are investigated in a timely manner to ensure learning is
shared with the service as quickly as possible. All incidents classified as SIRIs must have to be
reported to our Commissioners within 24 hours of being notified, require an interim report, which is
submitted to the commissioner within three days and, depending on the grade of the incident, a final
report and action plan submitted to the commissioner within either 45 or 60 working days.
Monitoring of the action plan also occurs to ensure correction actions are undertaken and learning is
During 2012‐2013, 14 of the 5343 reported incidents were classified as serious. These required
more detailed investigation and were reported on the STEIS database. The majority of these
incidents relate to pressure ulcers. As part of our quality drive to reduce the incidence of pressure
ulcers, all acquired grade 3 and 4 pressure ulcers are treated as serious incidents requiring
Valuing our staff
The Trust appreciates that its success is built on its workforce and it recognises how important it is
for staff to feel valued and to enjoy their work.
We know that highly performing, highly productive staff that are happy and feel supported in their
roles will ensure that we continue to provide the highest quality care to our patients.
We are committed to supporting our staff to achieve their potential and to develop their skills,
providing access to training and appropriate development opportunities.
Our Staff
We have a diverse, highly skilled and experienced workforce that helps us provide the highest
quality care to our patients. As of March 2013, the Trust employed in excess of 2500 staff
(excluding bank staff).
Age profile
The majority of staff (64%) are aged between the ages of 40-60 years with a further 8.5% aged over
60. This is reflective of the age profile of the NHS as a whole. Generally, the age profile of staff
becomes older as the pay bands get higher.
Gender profile
By gender, 92% of staff are female reflecting the traditionally female bias in caring roles. The
proportion of men in the organisation is greater in higher pay bands.
Ethnicity profile
95% of the workforce is White British, 2% are White non-British, and 3% are from a BME
background. The ethnic profile of the staff is not quite reflective of the county profile, where 90% of
people are White British.
Disability profile
0.8% of staff are listed on the Electronic Staff Record (ESR) as having a disability. However, 12% of
staff disclosed a disability in the 2011 staff survey compared to a national average of 16%.
Religion/ Belief profile
Just over half the staff have not disclosed their religion/belief in the ESR. Of those who have
disclosed, the majority (38%) are Christian. There are small numbers of staff with other beliefs 4%
are atheist, and 3.5% cite their religion/belief as ‘other’.
Sexual orientation profile
Half the staffs have not disclosed their sexual orientation on the ESR. Of those who have disclosed,
49% are heterosexual, 0.2% are gay, 0.2% lesbian and 0.25% bisexual.
Marriage/ civil partnership profile
63% of staff are married, 0.14% are in a civil partnership and 24% are not married or in a civil
partnership. The remainder have not disclosed their marital status.
Supporting our staff
The Trust has a comprehensive set of Human Resources policies which clearly set out equal
opportunities for employment and promotion, based on abilities, qualification and abilities for the
post. This includes a clear whistleblowing policy called “It’s Okay to Ask Why” reflecting the
commitment of the organisation to seek feedback from staff on any concerns and issues they
From April 2013 the Trust has been accredited as meeting the Investors In People Standard (IIP).
The principle strengths noted within the assessment were the:
Clarity of vision and values.
Sound and visible business planning.
Engagement with members of the team and recognising and affirming their contributions.
Good practice in appraisal and performance management provides a sound base for
Senior leaders and many in local and specialist service senior roles are effective role models.
Ideas and suggestions are being sought from around the organisation and evaluated.
There is much encouragement for career development at all levels.
Mandatory training.
Support for sound practice and positive behaviours across the whole team provide a bedrock for
delivering effective performance
There is a commitment for analysis, evaluation and honest reflection
The organisation is also registered as a ‘Mindful Employer’ and has been accredited as a two tick
employer. The Two Tick accreditation means that all those applying for positions within the Trust
with a disability, are guaranteed an interview, if they meet the minimum requirements of the role. In
addition, the organisation is developing an action plan to support its intention to sign the “Time for
Change” pledge.
Stress-awareness training is available for all staff through our ‘Lighten Up’ programme. This is a
holistic approach to rebalancing life and work, with practical tools for managing pressure. We
particularly encourage staff who have raised stress as an issue (or have been absent from work due
to stress), to enrol on the programme. In addition to the nationally recognised Lighten Up
programme, The Trust provides access to an employee assistance programme (EAP) and
Occupational Health Service for all our staff. The EAP is provided by an external company and
offers staff and their families a free 24 hours helpline and counselling service. The Occupational
Health Department, “Working Well” provides a free confidential health advice service to staff.
Advancing Diversity
The Trust is in the process of implementing the NHS Equality Delivery System (EDS).
Working on a series of peer reviews and internal assessments, the EDS provides a comprehensive
method for meeting the requirements of the Equality Act (2010). This truly participative approach will
provide the basis for stronger links with our communities. We now have a clear direction for how we
can strengthen our performance to raise the quality of our services for all our service users and
particularly more disadvantaged and vulnerable people in Gloucestershire. Based on this the Trust
has developed its equality objectives, focused around four goals:
To mainstream equality in business development processes
To improve the quality of evidence on equality in the organisation
To improve our dialogue with external stakeholders especially those with protected
characteristics or in vulnerable groups
To ensure we have a diverse workforce who actively promote equality in their work and beyond
Engaging with Staff
To increase staff engagement across the organisation nine staff forums have been set up across
the organisations business units, which are open for all staff to attend. Staff from each of the forums
are elected by their colleagues to sit on the organisation’s staff council. The staff council which is
attended by a Non-Executive Director has strong links to the Trust Board and they meet together on
a bi-annual basis. The terms of reference for both the staff forums and staff council have been
determined by staff in order to encourage as much participation has possible. The terms of
reference of the Staff Council include:
Highlighting issues of particular concern to staff and make proposals on how to address these
Consulting upon proposed organisational objectives
Reviewing the performance of the organisation
Commenting upon key organisational decisions
Making proposals on how to improve the services of GCS
Influencing and constructively challenging the Board
The Trust has a Joint Negotiating and Consultative Forum (JNCF) that meets at least bi-monthly,
where terms and conditions of employment and Human Resources policies are negotiated and
discussed. The Chief Executive, Director for Adult Services along with the Head of human
resources are members of this forum. The following trade unions are represented: Unison, Unite,
Chartered Society of Physiotherapy (CSP), Royal College of Nursing (RCN), British Dental
Association (BDA), Society of Chiropodists and Podiatrists (SCP), and the British Medical
Association (BMA).
Staff Development
Building the skills and competencies of our workforce is key to unlocking potential and efficiencies,
improving quality and efficiency for the future.
As an employer, we are committed to developing a flexible and productive workforce through
effective skills utilisation of the existing workforce. In the coming year we plan to:•
Further expand our apprenticeship and work experience schemes
Review our succession planning/ career pathways
Develop the capacity and capability of the volunteer workforce.
Further develop management and leadership skills, competencies and behaviours
Continue to invest in developing the clinical skills of our workforce to meet local need
Further develop the roles of Integrated Support Workers
Develop a more flexible and responsive Contingent Workforce
Staff survey
The Trust is an active participant of the National staff surveying programme but we did not actively
survey our staff in 2012 because we were still part of the Primary Care Trust who were exempt from
participating in the survey during that year. We have however undertaken an internal survey of staff
at the beginning of 2013 and will be reporting the findings to the Board in July 2013. The survey did
incorporate the “Friends and Family” test, so we look forward to hearing what our staff have to say
about working for this organisation.
Quality and Performance
Quality and Performance achieved within our Adult Services
Out of hours
Primary Care Centre emergency face to face consultation within
60 minutes
Adult Community Services - % treated within 8 weeks
Adult Speech And Language
Adult Physiotherapy
Adult Occupational Therapy
Special Nurses: Percentage treated within 8 weeks
Parkinson’s nurses
Diabetes nurses
Bone Health Service
Musculoskeletal Service
Cancelled operations for non-clinical reasons not offered a
binding date within 28 days
Cancelled operations
Minor Injury Units (MIUs)
% seen waiting less than 4 hours
% seen waiting less than 2 hours
Bed Occupancy: All Community Hospital medical beds
Average wait of for access to service
Adult Physiotherapy
Combined Specialist and Non Specialist Wheelchair Service
2 weeks
2 weeks
2 weeks
The red status declared for Adult Physiotherapy and adherence to the locally agreed access target
of 2 weeks, is predominantly due to waiting list pressures within a specific locality which was
worsened by difficulties with recruiting. This has since been resolved with a successful recruitment
into the locality.
Quality performance achieved within our children’s’ services
Community Services - % treated within 8
Paediatric speech and language
Paediatric physiotherapy
Paediatric occupational therapy
Prevalence at 6 – 8 weeks
Neo-Natal Hearing Screen
Screens offered
Completed by 5 weeks
Average wait for access to service
Occupational Therapy
Speech and Language Therapy
2011-2012 YTD
2 weeks
2 weeks
2 weeks
1.5 weeks
1.1 weeks
1.9 weeks
2012-2013 YTD
1.7 weeks
1.9 weeks
The prevalence of breast feeding at 6-8 weeks fell significantly during 2012-13 to 50% from the
previous year’s 52%. The inherited 2 week prevalence rate was 74.1% at 2011/12 outturn but had
reduced to 60% by 2012/13 outturn (a fall of 14.1%). Collaborative work with Gloucestershire
Hospitals, Children’s Centres and Public Health Commissioners is addressing this public health
problem. Targets for 2013-14 will include a minimum drop off rate between 2 weeks and 8 weeks for
the Trust, specific targets for poor performing children centre areas, and countywide joint-provider
prevalence targets.
Same sex accommodation: declaration of compliance 2013-14
The Trust is pleased to confirm that we are compliant with the government’s requirement to
eliminate mixed-sex accommodation, except when it is in the patient’s overall best interest, or
reflects their personal choice.
Every patient has the right to receive high quality care that is safe, effective and respects their
privacy and dignity. Gloucestershire Care Services NHS Trust is committed to providing every
patient with same sex accommodation, because it helps to safeguard their privacy and dignity when
they are often at their most vulnerable.
We have the necessary facilities, resources and culture, to ensure that patients who are admitted to
our hospitals will only share the room where they sleep with members of the same sex and same
sex toilets and bathrooms will be close to their bed area. Sharing with members of the opposite sex
will only happen when clinically necessary (for example where patients need specialist equipment),
or when patients actively choose to share.
This achievement is regularly monitored and if our care should fall short of the required standard,
we will report it. We will also set up an audit mechanism to make sure that we do not misclassify
any of our reports. The review of compliance forms part of our annual audit programme and for the
reporting period 2012-13 there were no breaches of compliance.
Our Information Governance (IG) toolkit attainment level
Information Governance is the way by which the NHS handles all organisational information, but
particularly personal and sensitive information about patients and employees.
It allows
organisations and individuals to ensure that personal information is dealt with legally, ethically,
confidentially, securely, efficiently and effectively, in order to deliver the best possible care.
In the information Governance Toolkit there are three levels of assessment across 41 requirements,
these cover the way in which organisations ‘process’ or handle information. The attainment levels
are cumulative starting with Level 1 and rising to Level 3.
In 2012-13, NHS Gloucestershire (including Care Services), achieved 69% compliance against the
requirement of the annual Information Governance Toolkit (version 10) assessment with 40 out of
the 41 requirements achieving Level 2 statement of compliance for Connecting for Health. This
compares to 67% compliance against the annual Information Governance Toolkit (version 9) in the
previous year. 69% is the upper point of Level 2 which shows very good processes in place across
the organisation.
The Trust has developed an Information Governance improvement plan for 2013-14 for submission
to Connecting for Health. This lays out plans to deliver to Level 2 on all 41 requirements during
2013-14. This will be supported by a data mapping programme and the collation of a detailed
information asset register.
The Information Governance Management and Technology Steering Group oversee the progress of
this work and provide assurance through to the Integrated Governance Committee.
Participation in clinical audits
During 2012-13 no national clinical audits and no national confidential enquiries covered NHS
services that Gloucestershire Care Services NHS Trust provided. However a number of services
contributed information to national audit programmes where the participation was then by
Gloucestershire Hospitals NHS Trust. These are as follows:
Parkinson’s Disease – Specialist Nursing
Parkinson’s Disease – Speech and Language Services (SALT)
National Hip Fracture database
National Clinical Audit
No. Of
Parkinson’s Disease audit:
participation by specialist
nursing service
Parkinson’s Disease audit:
participation by speech
and language therapy
National hip fracture
patient outcomes at 120,
365 days post-surgery
% Of Total
Actions taken as
a result of the audit
On-going participation to
Yes by
be confirmed by
Consideration being
given to participation in
more relevant National
Fracture Liaison database
Data Quality
Good quality information underpins the safe and effective delivery of patient care and is essential to
support improvements in care quality. TPP SystmOne has recently been selected under a national
procurement process as the new community system. This will allow clinicians to collect clinical data
and enter data directly into the system. This will improve both the data collection and quality.
Deployment is planned to commence in June 2013.
NHS Number and General Medical Practice Code Validity
The Trust submitted records throughout the reporting period to the secondary uses services (SUS)
for inclusion in the hospital episode statistics which are part of the latest published data. The
percentage of records in the published data, which included a valid NHS number, are detailed below
and measured against the national average.
Admitted patient care
Outpatient care
Accident and Emergency care
National Average
The percentage of records in the published data which included the patients’ valid general medical
practice code is measured against the national average as detailed in the following table.
Admitted patient care
Outpatient care
Accident and Emergency care
National Average
Clinical Coding Error Rate
The Trust will not be reporting on the clinical coding error rate as GHNHSFT undertakes this activity
on our behalf. GHNHSFT monitor and report the clinical coding error rate as part of the national
audit requirements.
Our Participation in Clinical Research
The number of patients receiving NHS services provided or sub-contracted by the Trust in 2012-13,
that were recruited during that period to participate in research approved by a research ethics
committee was 47.
Financial Statement
During 2012-13 Gloucestershire Care Services Trust provided and/or sub-contracted 54 NHS
Gloucestershire Care Services NHS Trust has reviewed all the data available to them on the quality
of care in all of these NHS services.
The income generated by the NHS services reviewed in 2012-13, represents 100% of the total
income generated from the provision of NHS services by 2012-13.
How To Contact Us
We really value your feedback so if you have any questions or comments about the content of this
report please write to:
Mrs E J Fenton
Director of Nursing
Gloucestershire Care Services NHS Trust
Edward Jenner Court
1010 Pioneer Avenue
Gloucestershire Business Park
Email [email protected]
If you have any comments, concerns, complaints or compliments about the services we provide,
please do not hesitate to contact the:
Patient Advice & Liaison Services (PALS) on: 0800 151 1508.
Amendments and additions to the document following feedback from
our Partners
Gloucestershire Care Services NHS Trust values the feedback we have received from our partners
on the Quality Account (Draft for Consultation). This document has now been finalised with the
following amendments and additions as a result of the feedback received.
Quotes from patients and carers included
Tables reviewed and data presented in a format to aid understanding
Section added regarding the value of volunteers
Gloucestershire Clinical Commissioning Group
Comments on the Gloucestershire Care Services Quality Account 2012/13
Gloucestershire Clinical Commissioning Group (CCG), on behalf of its predecessor NHS
Gloucestershire, has taken the opportunity to review the Quality Account prepared by
Gloucestershire Care Services (GCS)
for 2012/13.
We are pleased that GCS has been working closely alongside NHS Gloucestershire and
the shadow CCG during 2012/13 to maintain and further improve the quality of
commissioned services. GCS has co-operated in building new clinical and managerial
relationships in preparation for the CCG to take over commissioning responsibility from 1st
April 2013.
GCS has been receptive to challenges and concerns, engaged with the development of
initiatives such as the Joint Formulary, Map of Medicine and Your Health, Your Care
strategy – our shared vision for the future. They have demonstrated commitment to further
improvement of the safety, effectiveness and patient experience of services across a wide
range of services, particularly in falls reduction in Community hospitals.
The CCG welcomes GCS’s strong focus on patient experience and quality of care, which
demonstrates a joint commitment to delivering high quality compassionate care. We look
forward to developing a whole health and social care community clinical programme
approach towards commissioning and delivering services, with a strong emphasis on
clinical leadership and engagement. Integrated care will be delivered according to agreed
pathways and standards, with strong user and carer involvement being evident from
prevention to end of life.
There are robust arrangements in place with GCS to agree, monitor and review the quality
of services. The Quality Review Group continues to meet monthly and brings together
managers and clinicians from both GCS and Gloucestershire CCG. We have received
assurance throughout the year from GCS in relation to key quality issues, both where
quality and safety has improved and where it occasionally fell below expectations with
remedial plans put in place and learning shared wherever possible.
The priorities for 2013/14 have been developed in partnership and Gloucestershire CCG
endorses and supports proposals set out in the Quality Account to increase staffing levels
in Community Hospitals and will fund recruitment into vacant nursing posts. Gloucestershire
CCG would like to see a more ambitious programme to improving the quality of the services
provided by GCS for 2014-15, which is reflected in the Quality Account.
GCS are in a strong position to manage both present and future challenges, and to work
with Gloucestershire CCG to deliver best value effective care for the people of
Gloucestershire CCG can confirm that we consider that the Quality Account contains
accurate information in relation to the quality of services that Gloucestershire Hospitals
NHS Foundation Trust provides to the residents of Gloucestershire and beyond.
Dr Charles Buckley
Clinical Commissioning Lead for Quality
Marion Andrews-Evans
Executive Nurse and Quality Lead
Health and Care Overview and Scrutiny Committee
Comments on the Gloucestershire Care Services NHS Trust
Quality Account 2012/13
The county council has restructured its overview and scrutiny committee structure to better
fit with the commissioning structure in place within the council. Therefore the Health,
Community and Care OSC was decommissioned in April 2013, and from the start of the new
council in May 2013 the Health and Care Overview and Scrutiny Committee (HCOSC)
became effective. It is important to note that this new committee, with predominantly new
membership, has not yet had much opportunity to engage with the GCS NHS Trust. However
as Chairman of the HCOSC I am happy to offer some comments on this Quality Account.
I am aware that it is difficult within the prescriptions of this type of report to achieve a
balance between sufficient information such that the report is readable and informative
(too little information and it is meaningless; too much and it is unwieldy and ultimately
uninformative). The structure of this QA is much improved on last years and offers a good
insight into the work of the Trust. However, despite the improvement, it is still difficult to
get an impression of how the Trust’s overall performance can be measured against
outcomes, i.e. what difference has this made to the patient/service users?
Given the importance of the reablement and telecare/health agendas, I would have
expected their contributions/impact to be explicit within the QA, and it was disappointing to
see that this was not the case.
It is good to note that staff input is valued and I welcome the Top 100 ideas scheme and
look forward to hearing how these ideas are being progressed.
It is also good to note that the number of (community hospital) patients engaging with the
patient survey has increased; and that the Trust is taking forward the learning opportunities
identified though the complaints process. Learning from customers is a valuable tool in
understanding how the patient experience can be improved; but it will be important to
understand whether this learning is improving patient outcomes.
I welcome the integrated approach that the Trust is taking to safeguarding issues.
The Great Western Ambulance Service (GWAS) was acquired by the South Western
Ambulance Service NHS Foundation Trust (SWAST) in February 2013 and I would have
expected to see this reflected in the commentary of the report.
I am aware that the Single Point of Clinical Access (SPCA) is an effective resource to ensure
that the patient receives the right care in the right place, and aims to reduce admissions to
the Acute Hospitals. However, the QA only refers to GWAS in this regard and, whilst it is
good to see that the number of referrals from the ambulance service has increased, it would
have been helpful to see the number of referrals from across the wider health professional
community, e.g. GPs.
To give the Incident Reporting section more context it would be helpful to know the number
(percentage) of incidents against the overall patient and staff throughput across the Trust
through the year.
I look forward to working with the Trust and would like to take this opportunity to thank the
Trust for engaging with the Health, Community and Care OSC in the last council.
Cllr Steve Lydon
Health and Care Overview and Scrutiny Committee
Gloucestershire Local Involvement Network’s (LINk) Response on NHS Gloucestershire
Care Service’s DRAFT Interim Quality Account 2013
Gloucestershire LINk welcomes the opportunity to comment on the draft NHS
Gloucestershire Care Service’s 2013 Quality Account. The following comments have been
compiled by a number of LINk members.
Although we are able to comment on a number of areas within this draft report, we are
limited in other areas as Quarter 4 data was not available. It is likely that a number of these
comments are not relevant in relation to the final version of the Quality Account, but the
cessation of LINk on 31st March 2013 made further comments impossible.
We do not feel that this draft report gives sufficient information for the average lay reader
to appreciate the full extent of the quality of the services provided by Gloucestershire Care
Services. It would benefit from more details about the services, such as the community
hospitals, and some quotes from patients and carers about the care they have received
during 2012/13.
The layout of the report has a number of tables to illustrate the data information, however,
the lack of any graphs makes it difficult to visually see the relevant trends and prevalence
rates that appear over time/will further enhance the understanding of the data information.
In this draft there is an absence of qualitative information and including such information
would significantly increase the quantitative and qualitative mix that reflects patient
experiences and stories (good and bad) of your services.
There is no reference to use of volunteers although we are aware that volunteers are
welcomed by the trust and used in a number of venues.
We were concerned to notice a rising number of clinical incidents Q1-Q3. It is possible this is
due to a different method of recording but if so this should be clearly stated in the text.
Throughout the report there is a clear need to expand on areas so as to give a full and
comprehensive picture. We think that the report would benefit from expanding the
narrative statements, in particular to cite how identified actions would be taken forward.
We know that GCS works with a wide range of partners including the voluntary and
community sector to deliver services to the public at large but there is no indication of this
in the draft report.
We would like to see a little more detail on how the GCS Quality objectives will be delivered
in 2013/14 in the final report, including the engagement and involvement of people and
There is no mention of the use of the National Institute for Health and Care Guidance (NICE)
or implementing NICE guidance within the report and we would feel there should be to
measure quality of GCS (i.e. against NICE Quality Standards).
Barbara Marshall
Chair of Gloucestershire LINk
28th March 2013
Black and Minority Ethnic Communities
Clostridium difficile
Care Quality Commission - The CQC regulates care provided in Hospitals, Care Homes
and people’s own homes.
This is the National Commissioning for the Quality and Innovation Payment
framework which links part of the organisation’s income to quality improvement
Employee Assistance Programme
Electronic Staff Record
Gloucestershire Clinical Commissioning Group
Gloucestershire Care Services NHS Trust
Gloucestershire Hospitals NHS Foundation Trust
Great Western Ambulance Service
Health and Care Overview and Scrutiny Committee
Joint Negotiating and Consultative Forum
Liverpool Care Pathway for end of life care
Local Involvement Network
Memory Assessment Service
Minor Injuries Unit
Meticillin resistant Staphylococcus aureus
Malnutrition Universal Screening Tool
National Institute for Health and Care Guidance
National Health Service
Occupational Therapy
Patient Advice and Liaison Service helps the NHS to improve
services by listening to what matters to our patients, their families and carers,
answering questions and helping to resolve concerns as quickly as possible
Patient Environment Action Team
Patient Led Assessments of the Care Environment
Quality Account
Strategic Health Authority
Serious Incident Requiring Investigation
Speech and Language and Therapy
Single Point of Clinical Access
NHS National Safety Thermometer
Strategic Executive Information System which monitors serious incidents
Venous-Thromboembolism (Deep vein thrombosis or pulmonary embolism)
Quarter 1 – 1st April - 30th June
Quarter 2 – 1st July – 30th September
Quarter 3 – 1st October – 31st December
Quarter 4 – 1st January – 31st March