Quality Account
2012/13
Contents
Chief Executive’s statement
3
Our priorities for improvement for 2013-14
5
• Improving patient safety
6
• Improving clinical effectiveness
10
• Improving patient experience
12
• Monitoring progress throughout the coming year
14
• Other areas of quality improvement
15
Review of services
16
Our quality improvements in 2012-13
24
• Patient safety
24
• Clinical effectiveness
28
• Patient experience
32
• Other areas of quality improvements
34
Statements from Healthwatch, Overview and
Scrutiny Committees and Commissioners
38
Chief Executive’s statement – Quality Account
Our mission is to provide care
and services that we and our
families would want to use. Our
commitment to this is embedded
in our four areas of focus:
• Preventing illness, improving health and
wellbeing
• Maintaining independence, preventing
deterioration in health
• Preventing avoidable hospital admissions /
extended stays in hospital
• Providing high quality end of life care
Over the past year we have demonstrated excellent
care and high quality services across the Trust. This
report outlines what we have done over the past
12 months and our continued commitment to
improving the quality and safety of the care we
provide to our patients.
Community services are at the heart of a modern
and flexible NHS. Our staff, which includes
nurses, occupational therapists, consultants
and physiotherapists, to name just a few, play a
significant role in the health of people in both
Hounslow and Richmond, impacting and making a
difference every single day to hundreds of people.
As the local community healthcare provider, it’s
important that we are committed to continuous
improvement in the quality of all the services we
provide. Our focus on providing the right care, at
the right time, in the right place sees our patient
contacts take place in health centres across both
boroughs, local hospitals and also in people’s
homes. We are committed to delivering high
quality, safe and effective care within a variety of
settings.
Over the past year we have achieved many things
that we are rightfully proud of. Our new birth visits
by our health visiting team are vital in providing
important health promotion and safety advice to
families. Last year we set ourselves an ambitious
3
target of 95% for these initial visits by day 14,
which we have not only met but exceeded,
achieving 98.4%. This compares to an average
of 76% during the previous year. The team has
achieved this by proactively working together in
innovative ways; it’s a real success story for us.
Another area that demonstrates our commitment
to providing high quality care is the creation of
a rapid response and early discharge support
programme for our patients who need end of
life care and those with long term conditions.
Improved partnership working and delivery of
seamless, joined up care is making a difference to
many of our patients.
Over the past year we have received a positive
report from the Care Quality Commission (CQC)
and also achieved NHS Litigation Authority
(NHSLA) Level 1, providing further assurance that
we have safe and effective policies and procedures
in place. We have also seen excellent results in
areas such as reporting of incidents, evidencing
changes in practice and in our systems to support
staff to report and learn from incidents, complaints
and compliments. Next year we will focus on
building on all of these, following up, learning
and encouraging service improvements, led by our
frontline staff.
During this year we also received the Francis
Report. As a Trust we have carefully considered
the findings of the Francis report into the failings
of care at Stafford Hospital. We are confident that
such things could not, and would not, happen at
Hounslow and Richmond Community Healthcare
NHS Trust (HRCH), however we must ensure we
take all opportunities to learn from what happened
at Stafford and review all the recommendations of
the report. We will be holding staff events over the
next year to discuss the findings and implications
for us.
Everyone has the right to safe and effective care
and we want our patients to feel happy and
confident with the care they receive from us. While
4
we have clearly progressed in many areas, there
is still more to do and challenges for us. These are
described in the priorities outlined for the year
ahead.
Our priorities have been directly influenced
by feedback from our patients, carers, staff,
commissioners and stakeholders, and by the
requirements of our regulatory bodies.
I would like to thank all of our staff for their
continued hard work and commitment. I am proud
of the work that we are achieving here and the
continued focus on patient care that I can see
running through all our services.
Finally, I can confirm on behalf of the Trust’s Board
that to the best of my knowledge and belief, the
information contained in this Quality Account
is accurate and represents our performance
in 2012/13 and our priorities for continuously
improving quality in 2013/14.
Richard Tyler
Chief Executive
Our priorities for improvement 2013-14
How we decided our priorities
for improvement for the next
12 months
In determining the areas the Trust should focus
on for our quality improvements in 2013/14, we
sought the views of our patients, carers, staff and
other stakeholders in a number of ways:
After careful consideration of the main themes
emerging from this feedback, our Trust Board also
reviewed our performance against indicators which
measure the safety and quality of our services and
agreed four priorities for 2013/14. All four priorities
are about delivering better outcomes and an
improved experience for our patients.
• We undertook an analysis of patient safety
incidents to identify key themes and trends
The priorities for improvement we have
chosen for 2013/14:
• We implemented an online survey for our staff
Improve patient safety:
• We promoted this survey to our local
community through the network of contacts
held by the Patient Experience & Involvement
Team, including Hounslow and Richmond
Local Involvement Networks (LINks) and patient
groups.
• We made presentations to local groups
including the London Borough of Hounslow’s
Older People’s Group and Richmond Council
for Voluntary Service’s Users and Carers Group
• We presented and sought views from our
Patient and Public Involvement (PPI) Committee
• We spent time capturing face to face feedback
from patients, carers and the public when they
attended West Middlesex University Hospital
and the Heart of Hounslow Health Centre.
• We sought feedback from our staff through
our internal communication bulletins, team
and management meetings and our clinical
leaders forum.
• Ensure a consistent, high quality standard
for safeguarding vulnerable adults is
delivered across the organisation
• Minimise risk of preventable healthcare
associated infections
Improve clinical effectiveness:
• To ensure consistent, high quality care
is maintained through effective clinical
supervision
Improve patient experience:
• Deliver the right care, at the right time, in
the right place
Two of these priorities build on progress made last
year; priority 2 and priority 4 are new for 2013/14.
5
Our priorities for improvement for 2013-14
Improving patient safety
increase the number of clinical staff who complete
training in the Mental Capacity Act 2005 (MCA)
and Deprivation of Liberty Safeguards (DoLS);
this specialist training equips them with the skills
to provide safer and better patient-centred care
for people who are not able to make their own
decisions about their health needs.
PRIORITY 1
Ensure a consistent, high quality
standard for safeguarding
vulnerable adults is delivered
across the organisation
We are committed to our duty of safeguarding
patients who may be least able to protect
themselves from harm (No Secrets, Department
of Health 2007). We want to prevent harm from
occurring and also to ensure our staff provide an
effective, patient centred response where harm has
occurred.
This priority area will build on the progress we
made last year to safeguard vulnerable adults.
Our staff need to have a full understanding of the
principles of safeguarding vulnerable adults. It is
important that they have received training that is
appropriate to them and their role.
Last year 89.4% of staff received training in
safeguarding vulnerable adults by 31 March 2013;
this year we will build further on this. We will also
The ‘Safeguarding Adults Self-Assessment and
Assurance Framework (SAAF) for Health Care
Services’, was developed by Strategic Health
Authorities in collaboration with the Department
of Health (DH), commissioners and clinicians. It will
help us to review and measure our safeguarding
adults arrangements and to develop action plans
to address any gaps we identify.
The assessment we undertook in 2012/13
showed we achieved amber or green (working
towards/effective) in 17 out of 21 areas. During
2013/14 we want to achieve a green rating, as a
minimum, in 19 out of 21 areas. This will show
we are progressing in all of the areas that we are
currently assessed as not effective or working
towards. We will strive to achieve a ‘blue’ rating
(exceeding requirements) in the area of strategy
and workforce.
Performance against each area in SAAF – 2012-13
6
Area
No of questions
Not effective
Working
towards
Effective
Exceeding
requirements
Strategy
2
0
1
1
0
Systems
9
2
4
3
0
Workforce
6
0
2
4
0
Partnerships
2
0
0
2
0
Additional information
2
(one question not
applicable to HRCH)
1
0
0
0
Total
21
3
7
10
0
We will continue to work with other agencies such
as adult social care and the police to ensure that
safeguarding remains a priority.
Our aim
“
Throughout the months that (our friend)
spent on your ward, she spoke highly of the
care, kindness, consideration and respect,
which you all gave her.
Ms S, Surrey
”
To achieve a ‘green’ rating against 19 out
of 21 applicable actions required within the
Safeguarding Adults Self-Assessment and
Assurance Framework (SAAF).
Measures we will report to our Board
Measures we will report to our Board
Position as of 31 March 2013
Target for 31 March 2014
Number and percentage of questions in SAAF
where we have reported a green (effective) or
blue (exceeding requirements) status
10 out of 21
19 out of 21
48%
90%
Percentage of staff who have attended
safeguarding adults awareness training
89.4%
95%
Percentage of clinical staff required to attend
MCA and DoLS training who have completed
this training
5.3% (36) clinicians
completed MCA & DoLS
training
40%
1
1
Other measures we will use to track progress
Number of serious incidents relating to
safeguarding adults
7
Our priorities for improvement for 2013-14
PRIORITY 2
Minimise risk of preventable
healthcare associated infections
Reducing healthcare associated infections (HAIs)
is a priority and integral part of HRCH’s patient
safety agenda. We will continue to embed a
zero tolerance approach for meticillin-resistant
staphylococcus aureus (MRSA) bloodstream
infections whilst maintaining reductions in
Clostridium difficile and other preventable
healthcare-associated infections (HAIs) within the
Trust and across the local health economy.
All patients admitted to our inpatient unit are
screened for MRSA in line with national screening
requirements and all patients are assessed for
8
their risk of acquiring an infection so that the right
measures to reduce this risk can be put in place.
All of our clinical staff are required to undertake
the Trust’s mandatory annual infection prevention
and control training to optimise patient safety
and meet clinical standards. Their high standards
of practice are evidenced through audits of hand
hygiene and compliance in line with our Infection
Prevention and Control Policies.
We will improve our learning from incidents
of HAIs by reviewing any community acquired
infections, making sure improvements and
recommendations are made and embedding High
Impact Interventions* within our nursing teams.
*High Impact Interventions are evidence-based guidelines which
must be applied every time a clinical procedure is carried out. They
form part of the programme to deliver Saving Lives: Reducing
Infection, Delivering Clean Safe Care (DH, 2007) and reduce the risk
of infection to patients when used consistently.
Our aim
To minimise the risk of preventable healthcare
associated infections through a comprehensive
programme of training and audit against
infection prevention and control policy.
Measures we will report to
our Board
Our performance has increased throughout the
year, from a low baseline. We have agreed these
measures to make sure our excellent performance in
Q4 2012/13 is maintained and embedded across all
services.
Measures we will report to our Board
Q1 12/13
performance
Q4 12/13
performance
Target for 31 March 2014
Percentage of services completing a
hand hygiene audit quarterly
72.5%
97%
90%
Percentage compliance with hand
hygiene policy
98%
98%
95%
Percentage of teams submitting High
Impact Interventions
35.3%
100%
90%
Percentage of clinical staff who have
completed their annual Infection
Prevention and Control training
Not available
91.16%
90%
Other measures we will use to track progress
Number of healthcare associated
infections
0 MRSA
0 MRSA
2 Clostridium difficile
1 Clostridium difficile
9
Our priorities for improvement for 2013-14
Improving clinical effectiveness
PRIORITY 3
To ensure consistent, high
quality care is maintained
through effective clinical
supervision
Clinical supervision is an activity that brings skilled
supervisors and practitioners together in order
to reflect upon their practice, identify solutions
to problems, improve practice and increase
understanding of professional issues.
This priority area will build upon the progress we
made last year.
HRCH continues to be committed to providing
effective clinical supervision across all our services.
10
During 2012/13 we engaged front line staff in
reviewing and revising our current supervision
policy and identifying what documentation is being
used. We undertook an audit which found that
supervision was not always recorded and was not
always structured consistently.
Over the next year we will further develop this
and launch a revised, evidence based policy which
includes an agreed model of supervision and
standard documentation. We will develop a project
plan which will include all the key actions required
to ensure we achieve this.
Our aim
For our clinical staff to report that they access
clinical supervision which complies with the
Clinical Supervision Policy.
Measures we will report to our Board
Measures we will report to our Board
Position as of 31 March 2013
Target for 31 March 2014
Implementation of a revised Clinical
Supervision Policy
Not available
Full implementation
Percentage of clinical staff who report
they are receiving clinical supervision
and are complying with the Trust’s
policy
30.2%
70%
(audit of health visitors only)
Other measures we will use to track progress
Progress against project plan
Not available
100% actions to be green
Exception reporting of any amber
actions
11
Our priorities for improvement for 2013-14
Improving patient experience
PRIORITY 4
Deliver the right care, at the
right time, in the right place
We want to ensure better outcomes for all of
our patients. This means listening to our patients,
carers, service users and local communities’
experiences of our services and agreeing changes
to how we deliver them as a result of this
feedback. We asked our local communities, who
agreed this priority was important to them and
their families.
We already undertake patient surveys in every
service throughout the year. However, we
recognise we need to increase opportunities to
gather real time feedback and we are introducing
comment cards across all services which specifically
ask whether patients feel they have received
care in the way that is right for them. We will
implement the Friends and Family Test* across
all of our services and are confident this will act
as a further opportunity for patients to provide
feedback on their experience of our services and
allow us to become more responsive to the needs
of those who use our services.
We will continue to work with our partners to
ensure that discharges from our inpatient unit are
planned and safe and patients do not receive care
as an inpatient for longer than is right for them.
We will continue to support patients to manage
their long term conditions with advice about
making changes to any lifestyle or behaviours that
may be increasing their risk of ill health.
*The Friends and Family Test is a question that is asked of all
patients who use services, the response to which can then be used
to drive change and continuous improvements in the quality of
the services provided. Patients will be asked how likely they would
be to recommend the service they have received to a friend or
relative based on their treatment and experience. The results will be
published nationally. More information can be found here: www.
nhs.uk/NHSEngland/AboutNHSservices/Pages/nhs-friends-andfamily-test.aspx
12
“
You and all the staff do a magnificent
job. To maintain such high standards, to
coordinate people with such a wide range of
abilities and disciplines and to generate such
a quietly positive atmosphere for the patients
shows good teamwork.
Ms B, Richmond
”
Our aim
For 80% of patients to report they received care in the way that was right for them.
Measures we will report to our Board
Measures we will report to our Board
Position as of 31st March 2013
Target for 31st March 2014
Patient reported ‘do you feel you have
received care in the way that is right for you?
Not currently recorded
Establish a baseline
% of patients reporting they were involved in
decisions about their care and treatment as
much as they wanted to be
82%
86%
% of patients reporting they see their GP,
Consultant or health care professional less
as a result of completing the Expert Patient
Programme (EPP)
64%
50%
NB self-reported evaluation
NB This is a self-reported
evaluation; we do not seek
to discourage patients
from seeking advice from
their health professional
appropriately.
(2011/12 local patient survey)
National research shows
that A&E attendances are
reduced by 16% for patients
who have completed the
EPP.
Other measures we will use to track progress
Number of patients who have had their
discharge from our inpatient unit delayed.
10
8
13
Our priorities for improvement for 2013-14
Monitoring progress throughout
the coming year
We have a dedicated committee focussed
on reviewing the quality of our services. This
committee, known as the Integrated Governance
Committee (IGC), will monitor our progress
throughout the year. The IGC is chaired by a
non-executive director and membership includes
the Chair of the Trust Board and representation
from Healthwatch. The Safeguarding committee,
Infection Prevention and Control committee and
Quality and Safety committee report to the IGC.
In addition, our Patient and Public Involvement
committee is specifically tasked with monitoring
our performance against our Quality Account.
They will review progress and hold us to account
for its delivery.
Priority for improvement
Responsible director
Implementation committee
Ensure a consistent, high quality standard
for safeguarding vulnerable adults is
delivered across the organisation
Siobhan Gregory
Safeguarding committee
Minimise risk of avoidable healthcare
associated infections
Siobhan Gregory
Infection Prevention and Control
Committee
Ensure consistent, high quality care is
maintained through effective clinical
supervision
Jo Manley
Quality and Safety Committee
Deliver the right care, at the right time, in
the right place
Jo Manley
Quality and Safety Committee
How will we report progress throughout the year to the Trust Board and to the public
Progress in all four priority areas will be monitored by our Trust Board through the IGC. We have agreed
a Board level sponsor for each priority and the same at service level. Where possible we have selected
indicators that can be compared across the Trust and with other similar trusts. These quality indicators
will be reported through the Quality and Performance scorecard which is published every month and is
available on our website within Trust Board papers for staff and the public to view. Our commissioners
will also receive reports as part of our contracts with them.
14
Additional quality indicators
chosen for 2013/14
In addition to the four Priorities for Improvement
we will also deliver the quality improvements
outlined in our Quality Framework (our overriding
strategy to improve quality of our services), in
our contracts and in our Commissioning for
Quality and Innovation schemes (CQUINs). Further
information about our CQUINs is on page 19.
The additional quality indicators we will monitor
align with local, regional and national targets and
focus on learning and implementing change. They
are spread across the three domains of quality.
Targets are being agreed for each indicator;
progress will be reported to the Board in the
monthly scorecard.
• Patient safety
- A reduction in the number of inpatient falls
-Safety Thermometer – patients receiving harm free care
• Clinical effectiveness
- Proportion of services completing a re-audit
-Proportion of completed clinical audits with an action plan
• Patient experience
-Proportion of complaints with completed action plans
-Number of patients completing the Friends & Family Test
-Net Promoter Score - percentage of respondents classified as promoters
15
Review of services
During 2012/13 Hounslow and Richmond
Community Healthcare NHS Trust (HRCH) provided
and/or sub-contracted 57 NHS services.
HRCH has reviewed all the data available to them
on the quality of care in all of these NHS services.
Performance management is embedded
throughout the Trust with reporting processes
from ‘Patient to Board’. During 2012/13, HRCH
has continued to develop its Integrated Finance
and Performance Report. This report has indicators
which measure the safety and quality of services
alongside measures on finance, workforce and
performance. The report is scrutinised by the
Finance and Performance Committee every month
which reports to the Trust Board. An exception
reporting system ensures that there is focus on
areas of unsatisfactory performance, with clear
accountability for delivery of action plans within
agreed timetables.
The performance of services is monitored through
use of a ‘heat’ map which shows those areas
where a service may not be providing consistently
high quality services. This information is gathered
16
from a wide range of sources including complaints,
incidents, serious incidents and patient feedback.
We are developing an ‘early warning’ system in
Teddington Memorial Hospital which will support
front line staff to identify risks and take early
action to retain high levels of patient safety and
ensure a positive patient experience is maintained.
We expect this to be fully implemented during
2013/14.
Services
HRCH provides a combination of specialist and
local healthcare services across Hounslow and
Richmond in a wide variety of settings including
health centres and clinics, schools, hospitals and
in patients’ homes. We also provide services
at Teddington Memorial Hospital and run the
Hounslow Urgent Care Centre at West Middlesex
Hospital.
Further information about all of our services can be
found on the Trust’s website:
www.hrch.nhs.uk/our-services
Participation in clinical audit
During 2012/13, one national clinical audit covered
NHS services that HRCH provides; no national
confidential enquiries applied to our services.
During 2012/13, HRCH participated in all of the
national clinical audits which it was eligible to
participate in. We were not eligible to participate in
any national confidential enquiries.
The national clinical audit that HRCH participated
in is listed below; data collection for this audit has
now moved to 2013/14.
National
Clinical Audits
Participation
Number of cases
submitted or
reason for
non-participation
Chronic
Obstructive
Pulmonary
Disease (COPD)
Yes
Registered for
National Clinical
Audit.
Data collection
moved to 2013/14
Clinical Outcome Review Programme (formerly
known as National Confidential Enquires)
None covered services provided by HRCH
Whilst we registered for the National Clinical
Audit of COPD, the Clinical Effectiveness and
Audit Group review National Clinical Audits which
we have participated in during previous years
to ensure learning from audit findings directs
continued improvement in our services.
HRCH participated in the National Falls and Bone
Health audit in 2010, which was published in
2011. This was further reviewed by the Trust in
2012/13 and we have taken the following actions
to improve the quality of healthcare provided:
• National Falls and Bone Health 2010
(Published 2011)
The Trust’s inpatient rehabilitation unit is now
implementing the national Fall Safe bundle
which assists in reducing the number of falls
for patients receiving care from our services.
A falls working group has been developed to
monitor the Fall Safe bundle. The group has
created links with the Community Falls Liaison
Service and the rehabilitation inpatient unit to
share good practice and facilitate continuity of
care once a patient has been discharged into
the community.
128 local clinical audits were undertaken by
HRCH in 2012/13; six of these local clinical audits
had outcomes and learning that would affect a
substantial number of services across the Trust.
17
Review of services
The reports of these six local clinical audits were formally reviewed by HRCH in 2012/13 and we have
taken the following actions to improve the quality of healthcare provided.
Title of local clinical audit
Actions taken to improve quality of healthcare provided
Clinical Records Management Audit
Developed and implemented local action plans to improve
records management.
Improve the quality of care for patients
with dementia on a district nursing
caseload by enhancing the generalist
community nursing knowledge base about
dementia and dementia screening tools
This project has been taken to the Clinical Leaders Forum and a
strategy formulated to ensure there is sufficient knowledge base
for the district nursing team and appropriate dementia screening
tools are available.
Antimicrobial Stewardship Audit
A learning tool will be provided to reinforce the importance of
appropriate antibiotic prescribing. A re-audit has been scheduled
to provide assurance of continuous improvement.
Breast Feeding Nightingale Project
To continue with the success of implementing the Chiswick
Breast Feeding Clinic model in Brentford. Ensure all applicable
services mirror this model.
Records Folders for Families with
Additional Needs Audit
An action plan is in place to improve on the allocation of
coloured records folders which will ensure care provided to
families with additional needs is reviewed regularly.
Responding to Needs (2013 to 2015) –
patients with disabilities
To continue to monitor audit findings produced in this two year
programme and ensure all services are providing reasonable
adjustments to individuals who have a disability. This may include
making patient information available in larger fonts or promoting
the use of British Sign Language interpreters.
Participation in clinical research
The number of patients receiving NHS services
provided or sub-contracted by HRCH in 2012/13,
that were recruited during that period to
participate in research approved by a research
ethics committee was 36.
HRCH has been involved in six clinical research
studies during 2012/13 which were approved by a
research ethics committee. These were:
• Interprofessional working in teams around the
child
18
• The DESMOND programme, a national
diabetes education programme
• Speech perception for people with a hearing
impairment
• Healthy Eating Lifestyle Programme for
adolescents
• Life after stroke
• Autism spectrum disorder
We have provided training to encourage and
support staff to participate in clinical research.
The Trust is a member of the South West London
Sector Research Governance Consortium.
Use of CQUIN payment framework
A proportion of HRCH’s income in 2012/13 was conditional on achieving quality improvement and
innovation goals agreed between HRCH, NHS Richmond and NHS Hounslow through the Commissioning
for Quality and Innovation payment framework (CQUIN).
Our achievements against CQUIN goals for 2012/13
Goal
Commissioner
Achievement
Status (RAG)
Community nursing-end of life care
NHS Richmond
Fully delivered
Green
Dementia and mental health competencies
NHS Richmond
Fully delivered
Green
Long term conditions-self care
NHS Richmond
Not fully met
Red
Safety Thermometer
NHS Richmond
Fully delivered
Green
Immunisation
NHS Richmond
Partially met; will be
achieved by Q1 13/14
Amber
Falls and bone health
NHS Richmond
Fully delivered
Green
Integrated care & reablement transitions
NHS Richmond
Fully delivered
Green
Safety Thermometer
NHS Hounslow
Fully delivered
Green
Delivering the Out of Hospital strategy
NHS Hounslow
Fully delivered
Green
End of life
NHS Hounslow
Fully delivered
Green
19
Review of services
Our long term conditions and self-care CQUIN
was not achieved. Whilst we trained staff and
implemented self-management plans for patients
with a long term condition, we were not able to
complete a required audit to evidence that self-
management plans were in place. We are now
exploring an electronic system to enable audit.
We have worked with our commissioners to agree
our CQUIN schemes and goals for 2013/14; these
are detailed below.
Goal
Commissioner
Dementia
NHS Richmond
•
Reduce non-elective bed days in hospital
NHS Hounslow
•
Reduce length of stay by improving management of patients with dementia
Patient reported outcome and experience measures
•
Design, develop and implement a tool that allows the effective reporting on Patient
Recorded Outcome and Experience Measures
Integrated whole systems
•
•
Develop and promote best use protocols
•
A reduction in emergency hospital admissions
Catheter management
To quantify the total number of referrals going through SPA, from West Middlesex
University Hospital. Use of the SPA will deliver improved, appropriate and timely
discharges.
Targets will be agreed during Q1 of 2013/14.
The CQUIN payment framework enables commissioners to reward excellence by linking a proportion
of healthcare providers’ income to the achievement of local quality improvement goals.
20
NHS Hounslow
NHS Hounslow
A reduction in hospital admissions due to blocked catheters
Single point of access (SPA)
•
NHS Hounslow
The Safety Thermometer is a local improvement tool for measuring, monitoring, and
analysing patient harms and harm free care. Data will be collected against the harms of
pressure ulcers, falls, urinary tract infections and venous thromboembolism
Care homes
•
NHS Richmond
Support greater integration and joint working between acute and community providers to
deliver better outcomes for patients. Acute and community providers are required to work
in partnership to deliver joint goals, with a focus on older people and vulnerable adults.
Safety thermometer
•
NHS Richmond
NHS Hounslow
Registration with the Care Quality
Commission
Hounslow and Richmond Community Healthcare
NHS Trust is required to register with the Care
Quality Commission (CQC) and its current
registration status is ‘registered without
conditions’.
The CQC has not taken enforcement action
against the Trust during 2012/13.
We have not participated in any special reviews or
investigations by the CQC during 2012/13.
As is standard, the CQC undertook one review of
compliance within our services during 2012/13.
Hounslow Urgent Care Centre
An unannounced inspection was undertaken in
December 2012 as part of the CQC’s scheduled
programme of inspections. The CQC found that
Hounslow Urgent Care Centre is meeting all the
essential standards of quality and safety.
Patients interviewed as part of the inspection
reported:
“Staff are professionals, they know what they
are doing, I trust their judgements.”
“I’ve got no complaints; staff do an excellent
job here.”
“Staff took time to explain things thoroughly.”
“You get good treatment here and the staff are
kind and really care about what they are doing.”
21
Review of services
The CQC noted the following positive initiatives
undertaken to improve our services:
• We have developed patient pathways with
our multidisciplinary team. This means
patients with specific conditions can expect
or anticipate their care to take place within an
appropriate time frame.
• We have designed comment cards to enable
people to feedback their experiences of staff
communication and professionalism, standards
of care, and cleanliness.
The report, produced by the CQC, can be found at
www.cqc.org.uk
Data quality
Reliable information is a fundamental requirement
for HRCH to conduct its business efficiently
and effectively. We need accurate, timely and
comprehensive data to deliver high quality services
and to account for our performance. Producing
data that is fit for purpose is a key element of
our operational performance management and
governance arrangements.
The Trust will be taking the following actions to
improve data quality:
• Apply the standards of data quality as outlined
in our Data Quality Policy
• Continue to develop a culture of high data
quality within the Trust and involve clinical
staff in reviewing data as we move increasingly
towards more patient care being recorded
electronically
• Continue to run reports to assure ourselves
and our commissioners of the accuracy,
timelines and quality of our data.
HRCH has been working in conjunction with
other London trusts, developing reporting of
a Community Information Data Set. We have
achieved a completion rate exceeding 95% against
22
a 50% target for the main community information
systems, and have exceeded 60% coverage on
service specific systems.
The Trust will continue to focus on data
completeness during 2013/14 through inter-system
comparisons and a range of reporting functions
that identify particular areas for improvement.
Particular emphasis has been placed in the past
year on improving data quality in the area of
childhood immunisations as we have a transient
population in some areas where we provide
services.
The patient NHS number is the key identifier
for patient records. We report the percentage
of electronic patient records which include the
patient’s NHS number; we achieved in excess of
98% during 2012/13 on our main electronic care
record (RiO) which is linked to the National Spine*,
with in excess of 750,000 appointments for
approximately 225,000 patients.
HRCH also submitted information about the
percentage of records for patients admitted to our
inpatient wards at Teddington Memorial Hospital
which included the patients NHS number to the
Secondary Uses System (SUS) for inclusion in the
Hospital Episode Statistics. We reported that 99%
of records included the patient’s NHS number and
99% included their General Medical Practice.
*The National Spine is part of the national infrastructure that
supports the delivery of healthcare services and provision
in the UK. It supports a single NHS Number as a unique
identifier facilitating the safe, efficient and accurate sharing
of patient information across organisational and system
boundaries within the NHS.
Information Governance Toolkit
Information governance supports clinical
governance, service planning and performance
management. It gives assurance to the Trust and
to individuals that personal information is dealt
with legally, securely, efficiently and effectively.
The Information Governance Toolkit is an online
system which allows us to assess ourself against
Department of Health information governance
policies and standards.
The Trust’s Information Governance Assessment
Report overall score for 2012/13 was 68% and
was graded green, i.e. satisfactory. This is a
significant improvement from our overall score of
56% in 2011/12, which received a red, i.e. not
satisfactory, rating. This has been achieved through
a variety of actions taken throughout the year:
• Development of an information governance
action plan which was monitored by the
Information Governance Committee
• Development of a data quality strategy and
policy
• 95.8% of our staff have completed
information governance training
• We reviewed the information flows into and
out of the Trust, confirming that we use the
NHS number and assess the risks associated
with the moving of information.
Progress during 2013/14 will continue to be
monitored by the Information Governance
Committee, which reports to the Quality and
Safety Committee.
The Trust was not subject to the Payment by
Results clinical coding audit during 2012/13 by the
Audit Commission.
23
Our quality improvements for 2012/13
How we performed in the ‘priority
for improvement’ areas we set
ourselves
Patient safety
PRIORITY 1
To ensure a consistent, high
quality standard for
safeguarding vulnerable
adults is delivered across the
organisation.
Our aim
To achieve our mandatory training target
for 95% of all staff to have completed
safeguarding adults awareness training as per
policy.
We wanted our staff to be confident and
competent in identifying safeguarding adult
concerns and the organisation to have systems and
processes in place to manage these concerns safely
and effectively.
The outcomes we achieved:
• We are pleased that we have significantly
increased the percentage of our staff who have
completed safeguarding adults training from
30% (31 March 2012) to 89.4% (31 March
2013) against a target of 95%
• Patients with learning disabilities who attend
the Urgent Care Centre or Walk In Centre are
identified early in their care so that appropriate
adjustments are made
24
• We have identified a training programme
for our staff so they have the right level of
knowledge about the Mental Capacity Act
(MCA) and Deprivation of Liberty Safeguards
(DoLS)
• 36 (5.3%) clinicians attended MCA and DoLS
training during 2012/13; we know there is
more work for us to undertake to improve this
• We assessed our safeguarding adults
performance using an approved tool, and
found we scored amber/green i.e. working
towards or effective in 17 of 21 (81%) areas.
How we supported these achievements:
• We provided an e-learning programme which
increased access to training and our managers
promoted this at team meetings
• Our Trust Board supported an organisationwide promotion of safeguarding adults
training and monitored the uptake throughout
the year
• A Patient Passport, currently being used for
patients who have a learning disability, will be
reviewed and rolled out to other vulnerable
patients during 2013/14
• We developed a range of practice guidelines to
support staff working with patients who lack
mental capacity to make their own decisions
about their health
• We are working with the Local Safeguarding
Adult Boards and local authorities to consider
the impact of recommendations from the
Government’s review of Winterbourne View
Hospital.
Measures we reported to our
Board
Baseline position as of
31 March 2012
Position achieved by
31 March 2013
Percentage of staff who have
attended safeguarding adults
awareness training
30%
89.4%
Percentage of clinical staff required
to attend MCA and DoLS training
who have completed this training
Not available
NB Our Quality Account 2011/12 reported
a target of 85%; this was subsequently
reviewed and increased to 95%
5.3% (36) clinicians completed MCA &
DoLS training
Other measures we used to track progress
Number of safeguarding adults referrals made by our staff
Data not available
NB Systems were not put in place for staff
to report referrals internally
All incidents, including serious incidents relating to safeguarding
adults cases
3 incidents
1 serious incident
We recognise that there is more for us to do and we will continue to focus on this as a priority for
improvement in 2013/14. We will also invest in a new safeguarding adults at risk nurse post who will
support us to continually improve in this area and be compliant with anticipated legislation.
25
Our quality improvements in 2012-13
PRIORITY 2
Ensure all patients are fully
informed and supported to
make an informed consent for
all their treatment options.
Our aim
To be able to evidence through a patient
survey undertaken by every service that
consent was gained appropriately for all
patients surveyed.
We want our staff to have the guidance they need
to support patients to give informed consent for all
their treatment options.
How we supported these achievements:
• We launched our Consent Policy, to support
staff in taking effective action to seek consent
from all patients, which has been externally
reviewed and approved
• We have developed a range of briefing notes
which related to consent and the Mental
Capacity Act
• We have developed a ‘resource page’ on our
website to help us to work in partnership with
our patients
• We recognise that consent is a particularly
complex issue for patients with learning
difficulties and have developed good practice
guidelines to assist staff who work with this
patient group
• Staff attended external consent training
• Our consent forms have been standardised
across appropriate services.
The outcomes we achieved:
• We were judged to be meeting the standard
regarding consent to examination, care,
treatment or support by the Care Quality
Commission during an inspection of our
Urgent Care Centre in December 2012.
• Clinical records management audit showed:
-80% of clinical records included
documentation that consent to share
information with other providers had been
sought
-Consent to treatment was sought and
recorded in 84% of records
-72% of staff reported that their service
used our approved consent forms.
“
26
I found (my physio) to be absolutely
brilliant…her attitude towards patients should
be bottled. I am a very happy patient.
Miss J, Whitton
”
Measures we reported to our Board
Baseline position as of
31 March 2012
Position achieved by
31 March 2013
Any incidents or complaints relating to
consent issues
Not available
0
Annual report from completed patient
surveys across all services on consent
compliance
Not available
85% consent compliance
reported
(HRCH patient surveys asking if
consent was obtained prior to
treatment)
Other measures we used to track progress
Reports following any CQC unannounced inspections where issues of consent
are reviewed
1
Percentage attendance of clinical staff on MCA and DoLS training
5.3% (36) clinicians completed
MCA & DoLS training
Number of applications for DoLS assessments made by our staff
0
During 2013/14, we will continue to review our consent forms and guidance. We will undertake an audit
of compliance with the Consent Policy and implement actions following the findings from that.
27
Our quality improvements in 2012-13
Clinical effectiveness
How we supported these achievements:
PRIORITY 3
To continue progress made
towards reducing the number
and severity of pressure ulcers
developed by patients in our
care.
A 30% reduction in category 3 and 4 pressure
ulcers compared to 2011/12.
We wanted fewer patients to develop a pressure
ulcer whilst in our care, whether they were being
cared for on one of our inpatient wards or in their
own home, and where a pressure ulcer did develop
that our staff provided the right care to prevent
deterioration and promote healing.
The outcomes we achieved:
• A reduction of 64% in the number of grade 3
and 4 pressure ulcers acquired whilst patients
were receiving care from our services, from 87
(2011/12) to 31 (2012/13)
• A reduction of 7% in the number of all
pressure ulcer incidents (grades 2,3 and 4)
reported, from 291 in 2011/12 to 270 in
2012/13.
28
• We formed a clinically led, multi-disciplinary
task force to address the themes identified in
investigations into pressure ulcers.
178 members of our staff attended training led by
our Tissue Viability nurse in how to identify, assess
and manage pressure ulcers.
Our aim
“
• We undertook detailed investigations into the
31 grade 3 and 4 pressure ulcers acquired
whilst patients were receiving care from us and
shared the learning from them across the Trust
I wish to express my sincere thanks to all
the District Nurses…I’m sure their expertise in dealing with my wound helped me get
better more quickly.
Mrs M, Teddington
”
Measures we reported to our Board
Baseline position as of
31 March 2012
Position achieved by
31 March 2013
Pressure ulcers (grade 3 and 4) developed in our
care and reported as serious incidents
87
31
Reported pressure ulcers grade 2 and above
291
270
Percentage of all reported pressure ulcers which
are severe (grade 3 and 4)
30%
11.5%
Other measures we used to track progress
Percentage of pressure ulcers that deteriorate in our care
*
Percentage of patients assessed for risk of pressure damage on admission to our
services
*
Percentage of patients with pressure damage with a care plan in place
*
*We recognise that we did not put robust systems in place to record progress against these measures
however our policy requires staff to assess all patients with reduced mobility, whether temporary or
permanent, for their risk of developing pressure damage and for care plans to be in place for those
patients who have sustained pressure damage. Investigation of patients with pressure ulcers acquired in
our care indicates staff are working to our policies.
29
Our quality improvements in 2012-13
PRIORITY 4
To ensure consistent, high
quality care is maintained
through effective clinical
supervision.
Our aim
For 95% of clinical staff to receive clinical
supervision as per Trust policy.
We wanted all of our clinical staff to receive clinical
supervision to support them to develop their skills,
knowledge and professional values which will
improve the quality of health care provided to our
patients.
The outcomes we achieved:
• We undertook an audit which showed that
30.2% of health visitors reported they were
receiving supervision
• The audit found that supervision was not
always recorded and was not always structured
consistently
We reviewed our existing Clinical Supervision
Policy and found that it did not meet the needs
of the Trust. A multi-disciplinary working group,
which will ensure progress is monitored on actions
required to implement a new Clinical Supervision
Policy, has now been implemented.
30
Measures we reported to our Board
Baseline position as of
31 March 2012
Position achieved by
31 March 2013
Percentage of clinical staff who have
received clinical supervision as per policy
Not recorded
30.2%
Completed annual audit of clinical
supervision participation
Not recorded
(audit of health visitors only)
Audit completed for health
visiting staff
Other measures we used to track progress
All incidents and complaints relating to clinical performance
86
(incidents reported in the
‘diagnosis/treatment’ category)
We recognise that we have not made sufficient progress in this area and have agreed this as a priority for
improvement for 2013/14.
31
Our quality improvements in 2012-13
Patient experience
PRIORITY 5
To demonstrate changes in
services as a result of patient
feedback.
Our aim
30% of services will show real changes based
upon feedback from patients.
We wanted more patients to be able to see and
experience services which are delivered in ways
that they have told us best meet their health needs
and wishes. We wanted to learn more about the
experiences of patients and their families/carers
who use our services to enable us to make changes
in how we deliver our services.
We made changes to services as a result of patient
feedback; some examples of this are:
• We have reviewed how we follow up patients
with long term conditions in the podiatry
service
• We have increased availability of patient advice
leaflets, particularly related to care following
treatment
• We reviewed the consistency of care over both
day and night shifts at our inpatient unit
• We ensure all patients receive information and
a point of contact when referred from our
inpatient unit to West Middlesex University
Hospital
• We revised the ‘sign in’ sheet at our baby clinic
to ensure it is clearer about when the service
closes.
32
The outcomes we achieved:
• 63% of services conducted at least one service
evaluation
• 94% of all patient experience surveys have an
action plan which is currently in progress; 6%
have completed action plans
• 93% of patients using Hounslow Urgent Care
Centre would be confident that friends and
family would receive a high standard of care
from the Urgent Care Centre
• 88% of all complaints receive a full response
within 25 days; in cases where we did
not meet this target, we contacted the
complainants to advise of the delay and to
agree a reasonable extension.
How we supported these achievements:
• 169 staff members undertook a Customer
Care Awareness training programme provided
by an external learning company. It is planned
for this to become an annual event to allow
staff to refresh their customer care skills
• We share learning from audits of patient
experience, complaints and PALS enquiries
through our intranet site and our ‘Learn and
Share’ newsletter
• Our official Twitter account,
@HRCH_NHS_Trust, gives patients, carers and
their families the opportunity to contact us
directly about their experiences of our services.
The Trust also monitors what is being said
about our services on the site. Examples of
‘tweets’ from the last year include:
-“Second trip to #Teddington Memorial
Hospital in a week (for me this time) and
staff & nurses still just as lovely. Thank u.”
-“Why doesn’t the Phlebotomy dept answer
phone? 7 emails to arrange a blood test!!”
-“@HRCH_NHS_Trust Hi, your ‘Heart of
Hounslow’ Clinic are not picking up the
phone, been calling half an hour... are they
actually open?”
All tweets are monitored and responded to in a
timely manner.
“
I write to express my gratitude and
appreciation…everyone I met was helpful and
friendly and I was impressed by the kind and
sympathetic attitude.
”
The Trust also uses twitter to share our good news
stories and information, so that they directly reach
those people and organisations that have chosen
to follow us. These are often re-tweeted, further
increasing the scope and reach of these tweets.
We encourage our staff, patients, visitors, carers
and other stakeholders to follow us
@HRCH_NHS_Trust
Measures we reported to our Board
Baseline position as of
31 March 2012
Position achieved by
31 March 2013
Percentage of patients surveyed rating their
overall experience as good or excellent
82%
Survey results not available until
June 2013
Percentage of patients surveyed who would
recommend the service to a relative or
friend
91%
Staff that would be happy with the
standard of care at the Trust if friends or
family needed treatment
66% of staff said they strongly
agree or agreed with this
statement
(local patient survey)
(local patient survey)
Survey results not available until
June 2013
93%
(Urgent Care Centre onlyremaining services data being
collated)
Other measures we used to track progress
Percentage of services in which patient feedback has resulted in
specific change
94% of patient experience
surveys have action plans in
progress
Number of different ways services are seeking patient’s views and experiences
•
•
•
•
•
Complaints & PALS
Patient surveys
Being Open meetings
User groups
Quality Account
consultation
33
Our quality improvements in 2012-13
Other areas of quality improvement
Patient safety
Reporting and learning from incident
reporting
The National Reporting and Learning System
(NRLS) reported 180 patient safety incidents
for HRCH during the first half of 2012/13. This
equates to 23.1 per 1,000 bed days. This puts us in
the middle 50% of reporters, within a group of 19
primary care organisations with inpatient provision.
The median rate of reporting per 1,000 bed days
was 41.1. The National Patient Safety Agency is
clear that organisations that report more incidents
usually have a better and more effective safety
culture.
During this period, the Trust reported one (0.6%)
incident resulting in the death of a patient and
three (1.7%) resulting in severe harm. The
incident resulting in the death of a patient was
subsequently found to be unrelated to HRCH
services. Our reporting system has since been
updated to reflect this. The three incidents
resulting in severe harm related to patients who
had acquired grade 4 pressure ulcers - all were fully
investigated as serious incidents and learning has
been implemented.
During 2012/13 we wanted to make sure all
incidents were reported promptly to support
timely actions being taken to prevent a risk of
re-occurrence and improve learning. National
benchmarking information from the National
Research and Learning System (NRLS) for the
period April 2012 to September 2012 showed
that we reported 50% of our incidents outside of
expected reporting times. We set ourselves a target
of 85% of all incidents to be reported within 24
hours of the incident occurring. We have made
significant progress against this target - in April
2012, 42.7% of incidents were reported within 24
hours and in March 2013 this had risen to 77.6%.
34
We achieved this through the following actions:
• We implemented Datix, a web-based incident
reporting system for staff to report incidents
and for managers to review in a more efficient
way
• We developed a ‘Learn and Share’ newsletter
for all staff which reinforced the importance of
reporting incidents promptly.
Learning from serious incidents
A serious incident requiring investigation is
defined as an incident that occurred in relation
to NHS funded services and care resulting in
unexpected or avoidable death or serious harm.
A Root Cause Analysis investigation is undertaken
for every serious incident to enable lessons to be
learnt, implemented and disseminated across the
organisation. All investigations include an action
plan, key messages from which are shared widely.
Completion of action plans is monitored, however
this is identified as an area where we need to
strengthen our systems and processes. Actions
we have taken as a result of learning from serious
incidents include:
• We launched a pressure ulcer ‘task force’ to
review standards of care for patients with, or at
risk of developing pressure ulcers, to ensure all
care was evidence based and patient focussed
• We have ensured all of our staff undertake
information governance training so that they
understand their responsibility to keep patient
information safe.
Hand hygiene compliance
We know that hand hygiene is the most important
factor in the prevention of healthcare associated
infection. We ask clinical staff to undertake an
audit of their hand hygiene every quarter; in March
2013, 97% of clinical teams submitted a hand
hygiene score, a substantial increase from 74% in
March 2012 and exceeding the target we set for
ourselves of 85%.
The average hand hygiene compliance score the percentage of staff complying with the hand
hygiene policy across the Trust in March 2013 was 98%, a slight increase from 96% in March
2012 but continuing to exceed the 90% target we
set ourselves.
We have supported staff to achieve this through
the following actions:
• Scores are reviewed by the Infection Prevention
and Control team as they are submitted, with
support given to teams as required
• We send positive communications across the
organisation to commend and thank teams for
their efforts
• Real time feedback and support is given to
teams to address non-compliance
• Infection Control Link Practitioners attend
quarterly meetings where they receive training
and support from the Infection Prevention and
Control team which is shared with their teams.
Clinical effectiveness
Clinical audit
Clinical audits and service evaluations have become
an integral part of quality assuring and improving
clinical practice in all local services. Linking audits
which demonstrate achievement of performance
indicators with clinical audit forward planners has
resulted in a number of services exceeding their
expected target of completing at least two clinical
audits and one service evaluation.
• 100% of services participated in some form of
clinical audit or service evaluation
• 63% of services conducted at least two clinical
audits and one service evaluation
• 36% of services exceeded the minimum clinical
audit activity target and on average conducted
five or more service improvement projects.
We achieved this progress by taking the following
actions:
• We developed a trust-wide clinical audit
programme which linked in with our key work
streams and evidence for regulators
• We promoted the use of an audit forward
planner; 65% of local services submitted
a forward planner to the clinical audit
department, a 25% improvement from
2011/12
• We established a monitoring system to allow
tracking and facilitation support for all service
improvement projects being conducted at a
local level.
New birth visits within 10-14 days
We recognise the importance of parents receiving
a new birth visit from a health visitor within 14
days of the birth of their baby. This enables an
early assessment of need and care planning to take
place; thereby ensuring families receive the support
they require.
Staffing levels within the health visiting service are
challenging. Strengthened clinical leadership within
teams has significantly improved the performance
against the target we set ourselves of 95% of all
new birth visits to be completed by day 10-14. We
are now achieving 98.4% of all new birth visits by
day 14 as compared to an average of 76% during
2011/12.
• We have implemented monthly operational
meetings with staff in children’s services to
review pressures and risks across the service
and individual teams and to put in place
appropriate support including flexible use of
bank and agency staff
• We use a team of staff with a range of skills to
ensure the core service is provided
• We support student health visiting and Return
to Practice health visiting programmes
35
Our quality improvements in 2012-13
• We have introduced a red/amber/green ‘RAG’
rating within health visiting teams to identify
performance issues and ensure new birth visits
are prioritised.
Urgent Care Centre activity
Hounslow Urgent Care Centre opened in March
2012 and provides care and treatment for patients
with non-life threatening injuries and illnesses that
require immediate attention.
We planned for the Urgent Care Centre to treat
60% of all non-emergency department patients.
In March 2013, the Urgent Care Centre treated
and discharged 60.4% of all patients coming
to the site. This is a significant improvement on
performance in April 2012 of 44.5%. This year
99.7% of all patients were seen and treated within
4 hours. Actions to achieve this include:
• Close working with the West Middlesex
University Hospital Emergency Department to
ensure integrated and seamless care pathways
for patients
• Using clinician appraisals to improve the quality
of triage and our communication with patients
• Undertaking audit to assess the quality of our
service and pathways referrals.
• Using performance indicators to improve
performance in our services.
Average daily attendance has increased from 141
in April 2012 to 212 in March 2013.
Patient experience
Complaints
We recognise that complaints are a valuable part of
patient feedback. We are committed to ensuring
that all complaints or concerns are resolved
quickly and simply and that information gained
from them is used to improve our services. We set
ourselves a target of 100% of all complaints to be
responded to within 25 days. In 2012/13, 88% of
36
all complaints received a full response within 25
days; in cases where we were not able to respond
within this target, we contacted the complainants
to advise of the delay and to agree a reasonable
extension.
To support this we implemented the following
actions:
• We launched our Policy for the Management
of Complaints and Concerns
• We have provided training for staff on how to
respond to a complaint
• We implemented a Complaints Scrutiny Panel
with representation from LINks who provide an
objective scrutiny of the quality of complaints
responses and identify learning.
Mixed sex accommodation
The Trust Board makes an annual declaration
of compliance with the national definition ‘to
eliminate mixed sex accommodation except where
it is in the overall best interests of the patient, or
reflects their patient choice’ and we publish this
declaration on our website. During 2012/13, HRCH
reported no mixed sex accommodation breaches
in our inpatient unit and have therefore declared
compliance.
Staff sickness levels
In recognition of the relationship between highly
performing and engaged staff and the delivery of
high quality services to our patients, we have set
a target of 3.2% staff sickness rate. Performance
is monitored monthly by the Trust Board. This was
a challenging target which was not consistently
met throughout the year; the average for 2012/13
being 4.0%; while in March 2013 the rate was
4.2%.
In order to ensure a more robust approach to
managing sickness absence a comprehensive
plan was agreed by the Trust’s Human Resources
Committee in January 2013. The key actions we
are taking include:
• Agreement of a revised Sickness Absence
Policy with clear trigger points and a staged
process for dealing formally with persistence of
long term absence.
• Training on the new Trust Sickness Absence
Policy that emphasises the following areas
currently identified as factors militating against
good management of sickness absence:
- Return to work interviews
- Management of short term absence
- Management of long term absence
- Managing disability related sickness absence
• Rolling out the training programme to line
managers
• Including the management of sickness absence
in every job description.
NHS staff survey
As part of the national staff survey, our staff are
asked if they would recommend the Trust as a
provider of care to their family or friends. This
information is provided by the Health and Social
Care Information Centre.
The 2011 staff survey reported that 64% of staff
would recommend HRCH as a provider of care to
their family or friends; this equals the average of
all community trusts. There was no change in the
2012 rating.
We have taken the following actions to improve
this percentage, and so the quality of our services,
by the following actions:
• We have developed an action plan to address
all the issues raised in our staff survey of
2012, which will be monitored by the Human
Resources Committee and reported to the
Board
Organisational Readiness Self-Assessment
(ORSA) – preparedness for revalidation of
doctor’s license to practise
Revalidation is the process by which doctors in
the UK will have their license to practise renewed.
The purpose of revalidation is to assure patients
and the public, employers and other healthcare
professionals that licensed doctors are up to
date and fit to practise. Revalidation started in
December 2012.
The ORSA tool is a self-assessment tool, which
captures data to help designated bodies determine
their readiness for revalidation. The ORSA tool
is based on The Medical Profession (Responsible
Officers) Regulations 2010 and associated
guidance and additional criteria suggested by the
GMC. The full ORSA exercise is an annual process,
supplemented by interim progress reporting.
Following the ORSA submission in April/May
2012, the Trust was RAG rated as ‘red’, and in the
lowest 20% of organisations in the same sector.
In September 2012, HRCH was required to submit
an action plan for addressing this. All actions
have now been completed and in January 2013
we submitted a ‘green’ rating (i.e. ‘prepared’ for
revalidation status).
Equality and Diversity
We want to ensure that we recognise and deliver
culturally sensitive, inclusive, accessible and fair
services which make a difference to the individuals
we serve. We are also committed to providing
employment practices which are fair and accessible
for the diverse workforce we employ. Equality and
diversity is at the heart of the NHS and investing in
a diverse workforce enables us to deliver a better
service and improve patient care.
In 2012, we implemented the NHS Equality
Delivery System (EDS) framework to help support
improvements in patient access, experience and
outcomes and to improve our workforce practices
and be seen as an inclusive organisation. The EDS
is a developmental tool and will help us to assess
our performance annually with local partners.
Further information can be found on our website:
www.hrch.nhs.uk/equality-diversity
37
Statements from Healthwatch, Overview and
Scrutiny Committees and Commissioners
We would like to thank those who have reviewed and provided
comments on our 2012/13 Quality Account.
We have considered all of the comments received; the majority
of which are responded to within this Quality Account. There
are additional comments which will be helpful as we seek to
continually improve the quality of our services.
Richmond LINks
(now Healthwatch Richmond)
experience throughout the patient journey to
demonstrating and promoting how using patient
experience has improved patient care.
The Quality Account of Hounslow and Richmond
Community Healthcare presents a positive
account of the organisation’s performance during
2012-2013 and we are content that this is a fair
reflection on the organisation’s performance.
We particularly welcome the involvement of
patients and staff in the setting of priorities for
2013-2014 as described in Part 2 - How we
decided our priorities for improvement for the
next 12 months. The inclusion of patient reported
measures in monitoring progress is also welcomed
and this is something we would like to see further
developed.
Overall it is encouraging that the majority of
priorities chosen for the year 2012-2013 were
achieved. We were disappointed to learn that the
priority “for 95% of clinical staff to receive clinical
supervision as per Trust policy” had not been met.
Ensuring staff have clinical supervision routinely
and consistently is very important to ensuring
patients receive safe and effective care and that
staff are able to continually develop professionally.
Whilst this is disappointing, it is positive that it
is candidly admitted and that this priority will be
pursued again for the year 2013-2014.
The achievement of the patient experience priority
was positively received and we acknowledge the
importance of using patient experience to drive
care quality. We encourage HRCH to strive to
create further improvements in this area and as
a result we welcome the inclusion of Priority 3 Deliver the right care, at the right time, in the right
place as a priority for 2013-14. We encourage the
Trust to develop this further by tracking patient
38
Paul Pegden Smith
Acting Chair
Healthwatch Richmond
30 April 2013
London Borough of Hounslow
London Borough of Richmond
The Health & Adults Care Scrutiny Panel in
Hounslow have had a busy work programme
this year and due to other priorities we have
not carried out detailed scrutiny work in relation
to services provided by Hounslow & Richmond
Community Healthcare Trust during 2012/13. The
general comments we provide below are therefore
based solely on the information provided in this
draft Quality Account:
Following on from the meeting held on Tuesday
7th May 2013, to discuss Hounslow and Richmond
Community Healthcare Trust‘s (HRCH) Quality
Account, we welcome the opportunity to provide
additional input, as the London Borough of
Richmond upon Thames (hereinafter ‘LBRuT’)
is determined to champion the interests of its
residents by playing a full and positive role in
ensuring that the people living and working in the
LBRuT have access to the best possible healthcare
and enjoy the best possible health.
We welcome the time taken to seek patient
and carer views in identifying the improvement
priorities and are pleased to see the continued
inclusion of a specific priority in relation to
safeguarding. Whilst the draft Quality Account
indicates that 36 clinicians have attended MCA
(Mental Capacity Act) and DoLS (Deprivation of
Liberty Safeguards) training, it would be helpful
to know what percentage of all clinicians this
represents.
Given the focus the Trust has placed on gathering
data from a range of sources in relation to the
performance of services, we would have liked to
see some of the key themes captured from this
data included within the body of this report. We
believe this is important in providing transparency
on how identified priorities and any related action
plans and measures “fit” with patient views and
other data gathered.
Cllr Poonam Dhillon
Chair, Health & Adults Care Scrutiny Panel,
London Borough of Hounslow
The Report:
We congratulate HRCH on this document. We
are pleased to see measures and data have been
included and feel as confident as we can about
its accuracy and conclusions drawn on the quality
of healthcare provided. However, we say this with
some reservation: firstly because we were unable
to see a finalised version with all the data that will
be presented and secondly because whilst data
and figures were included the source of the data
was not adequately referenced. Referencing is key
to maximising confidence in those reading Quality
Accounts. Without it, service users and members
of the public may have no trust in what they are
reading.
We welcome your priorities. However, we would
have liked greater transparency in and more
information about your rationale for selecting
these as your key priorities over other areas.
Given the current economic climate, the national
changes to health and social care and a number
of high profile operational health-related issues,
many users will be aware - albeit in a broad-brush
manner- of them. We therefore suggest that more
detail and links to the evidence you based these
priorities on are added to the QA.
Under the heading “Additional Quality Indicators
2013/14”, the QA states that you will “monitor
[to] ensure alignment with local, regional and
39
Statements from Healthwatch, Overview and Scrutiny Committees and Commissioners
national targets and are focused on learning and
implementing change” but it does not explain how
this will be done and what, if any, mechanisms
will be put in place if targets are not met. We feel
that the level of detail afforded to the ‘priorities’
should also be afforded to the other ‘key areas’
as this would show a firm level of commitment
to these other ‘key areas’ as well as providing
specific measureable and actionable targets whose
progress can be monitored and evaluated.
We do not feel that the section ‘Priorities for
2013/14’ is as accessible or easy for members of
the public to read or follow as it could be.
Improving Patient Experience:
The report mentions the methodology used
to engage with patients, carers, staff and
stakeholders however you do not mention the
number of respondents to surveys and how many
surveys were distributed. It would be helpful if a
sentence setting this context was included, as it
would be sufficient to cast aside possible doubts
about the levels of engagement in this process. By
not providing this context it made the committee
question how well the groups were engaged
with and whether this is an accurate reflection of
patient experience.
We are pleased to see that in your priorities for
this year you have widened and extended your
category for ‘Vulnerable Adults’ to include more
than just adults with learning disabilities. We are
pleased that you have / will have specialist nurses
and a Head of Safeguarding.
Whilst we appreciate that you are a healthcare
provider and that the QA requires you to report
back on purely ‘health’ matters, we nevertheless
suggest that going forward, more is made of
the multi-disciplinary team around the person
to ensure that there is an effective working link
between health and social care. We feel that issues
which boarder ‘heath’ and ‘social care’ should not
be silo-ed to one discipline but taken on board by
40
both as the distinction is not as clear cut as it is
often made out to be; it is in the best interests of
the patient and will provide the best outcome for
patients.
The following suggestion should be used to form
part of the future evidence base and inform
future priorities for QAs as it would better capture
patient and carer experience. The suggestion is the
creation of a ‘person centred book’ where patients
and carers have access and can input their views,
suggestions and experience of what has worked
well and what has not. This can be in addition to
patient notes. It should be left in the home and
should in some way be incorporated into patient
notes. This would help to improve their delivery
and quality of care. The rationale is that it will help
identify areas which may need extra resource/
input and as stated above can be used as evidence
for spotting trends and in deciding priorities for
2014/15.
Conclusion:
Our aim is to ensure that your Quality Account
reflects the local priorities and concerns voiced
by our constituents as our overall concern is for
the best outcomes for our residents. We are, in
general, happy with the quality account and agree
with your priorities. However, in light of the events
both nationally (Mid-Staffordshire) and closer to
home (Lewisham) the need for more transparency
and better referencing of evidence cannot be
stressed enough. We hope that our views and
the suggestions offered (in relation to the QA and
the wider context of operational quality care) are
taken on board and acted upon. We wish to be
kept informed of your progress throughout and
thereafter.
Health, Housing and Adult Services Overview
and Scrutiny Commitee,
London Borough of Richmond upon Thames
Hounslow Clinical Commissioning
Group
NHS Hounslow Clinical Commissioning Group
(CCG) Quality, Patient Safety and Equality
Committee have reviewed the Hounslow and
Richmond Community Healthcare NHS Trust’s
Quality Account (QA) for the year 2012-13
with support from the North West London
Commissioning Support Unit (CSU) quality,
contracting and performance teams. In our view,
the QA complies with guidance as set out by both
Monitor and the Department of Health (DH).
The priorities for quality improvements in 2013-14
are mainly accepted by Hounslow CCG. However,
it is felt that some targets are not setting a high
enough aspiration for achievement or descriptions
of what achievement looks like does not
appropriately reflect a quality outcome. Hounslow
CCG will work with the Trust to develop more
effective quality outcomes and challenge the Trust
to strive to achieve beyond their set targets.
As priority 1, to ensure a consistent, high quality
standard for safeguarding vulnerable adults is
delivered across the organisation, is a continued
priority it is expected that training attendance
for the Mental Capacity Act 2005 (MCA) and
Deprivation of Liberty Safeguards (DoLS) will be
high, despite the Trust starting from a low baseline.
Hounslow CCG notes that this target would be
unnecessary for the Adult Community Nursing
Service given the MCA and DoLS guidance.
Hounslow CCG fully endorses the Trust looking
to achieve a ‘green’ rating (effective) for all areas
of the Safeguarding Adults Self-Assessment and
Assurance Framework (SAAF) for Health Care
Services. We commend the Trust for striving to
achieve a ‘blue’ rating (exceeding requirements) in
the areas of strategy and workforce. It would have
been helpful to have some context around the
current ‘red’ ratings to help the reader understand
areas for improvement. The priority 1 initiatives
help to support Hounslow CCG’s out of hospital
strategy, specifically our frail elderly work stream.
Priority 2, to minimise the risk of preventable
healthcare associated infections, whilst important
is not felt to be a priority area for the Trust as
they already have low infection rates for 201213. In addition to this, the targets set by the Trust
appear not to be challenging as they are below
current levels of performance. Hounslow CCG
would expect the Trust to at least maintain current
standards of preventing healthcare associated
infections. Hounslow CCG would also encourage
the Trust to develop other areas for patient safety
improvement, such as, medication error incidents.
In order to strengthen priority 3, to deliver the right
care, at the right time, in the right place, Hounslow
CCG would recommend involving patients and
the public in the resultant service improvement
initiatives derived from the patient feedback
received. We also suggest incorporating recurrent
complaint themes into this priority.
Hounslow CCG fully endorses the Trust continuing
to support patients to manage their long term
conditions with advice about making changes
to their lifestyle and behaviours which may be
increasing their risk of ill health. This initiative helps
to support our out of hospital strategy. However,
the current target set for this indicator is too low
and below current practice. We would expect this
target to at least maintain current performance.
Although disappointing that the supervision
priority from 2012-13 was not fully implemented,
Hounslow CCG are glad to see that the Trust also
see this area’s importance and have continued
to develop and implement it as a priority for
2013-14. The measure for priority 4, to ensure
a consistent high quality of care is maintained
through effective clinical supervision, would be
more robust if compliance with the policy is taken
as sub-measure for demonstrating that the policy
was implemented.
41
Statements from Healthwatch, Overview and Scrutiny Committees and Commissioners
Hounslow CCG recognises the achievements
that the Trust has made in their new birth visits
in spite of a nationally recognised Health Visitor
shortage and high retirement rates. The CCG also
recognise their quality priorities achievements for
2012-13 in the areas of safeguarding vulnerable
adults, informed consent, the reduction in pressure
ulcers and making changes as a result of patient
feedback. We support the continued focus
on safeguarding vulnerable adults and clinical
supervision for 2013-14.
The improvements made in the patient safety
culture of the Trust are encouraging and Hounslow
CCG would urge the Trust to continue developing
this area. Hounslow CCG would also like to note
the improvements made around communication
and monthly patient centred meetings between
GPs, Health Visitors and District Nurses and
supports this relationship development.
In 2013-14, Hounslow CCG is expecting
to see improvements in quality reporting in
terms of indicators reported on as well as the
quality or completeness of the data. The use of
benchmarking data can also be further utilised
to help showcase improvements. The CCG will
continue to work with the Trust in developing,
monitoring and benchmarking these quality
improvement areas via the contract and quality
meetings for the Trust.
Hounslow CCG hopes that Hounslow and
Richmond Community Healthcare NHS Trust
have found these comments helpful and we
look forward to continuous improvements and
productive collaborative working in 2013-14.
Dr Nicola Burbidge Dr Annabel Crowe
Chair
Quality, Patient
Hounslow CCG
Safety and Equality
Chair
Hounslow CCG
42
Richmond Clinical Commissioning
Group
Richmond Clinical Commissioning Group (CCG)
were pleased to receive HRCH’s Quality Account.
The members felt that the areas of improvement
were relevant, in particular the emphasis on
continuing to improve the care provided to adults
at risk. The areas would appear to align with
our future direction and commitment to providing
care closer to home. Richmond CCG would expect
to see how the provider demonstrates how it has
implemented the learning and outcomes from
the Francis report. We look forward to receiving
updates on progress.
Dominic Wright
Chief Officer
Richmond CCG
Feedback
We hope you find this Quality Account a useful, easy to understand document that gives you meaningful
information about Hounslow and Richmond Community Healthcare NHS Trust and the services we
provide.
This is our third Quality Account. If you have any feedback or suggestions on how we could improve our
Quality Account, please let us know by emailing communications@hrch.nhs.uk or calling 020 8973 3143.
For comments or questions about our services please contact our Patient Advice and Liaison Service (PALS)
on 0800 953 0363 or email: pals.hrch@nhs.net
The information in this report is available in large print by calling 0800 953 0363.
If you would like a summary of this document in your own language, please call
0800 953 0363 and state clearly in English the language you need and we will
arrange an interpreter to speak to you.
43
Hounslow and Richmond Community Healthcare NHS Trust
Thames House (Trust headquarters)
180 High Street
Teddington TW11 8HU
www.hrch.nhs.uk