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CONTENTS
Section 1
Section 2
Section 3
Glossary
Introduction
Priorities for 2013/14
2.1 Priorities for improvement
2.2 Statements of assurance from the Board
2.3 Statements to review services
2.4 Participation in clinical audits
2.5 Measuring participation
2.6 Measuring coverage/recruitment
2.7 Reviewing reports of national clinical audits
2.8 Reviewing reports of local clinical audits
2.9 Research
2.10 Goals agreed with commissioners
2.11 What others say about MKCHS
2.12 Data quality
Review of 2012/13
3.1 Patient safety
3.1.1 Transfer of care
3.1.2 Infection prevention and control
3.1.3 Patient Environment Action Team (PEAT) audits
3.1.4 Safeguarding children
3.1.5 Safeguarding adults
3.2 Clinical effectiveness
3.2.1 High quality workforce
3.2.2 Patient safety thermometer
3.2.3 Patient experience
3.3 National Quality Board mandatory reporting
3.3.1 NHS Outcomes Framework Domain 4 –
Ensuring people have a positive experience of care
3.3.2 NHS Outcomes Framework Domain 5 –
Treating and caring for people in a safe environment
and protecting them from harm
3.4 Partners’ statements
3.5 How to provide feedback on the account
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SECTION ONE
Introduction
High quality care is what we all want to receive. Here at Milton Keynes Community
Health Services (MKCHS), maintaining high quality services is our top priority,
underpinned by patient safety, clinical effectiveness and good patient experience. We
aspire to excellence in all of our services which include: Adult Services, Older
People’s Services, Children’s Health Services and Mental Health and Learning
Disability Services.
Milton Keynes Community Health Services is very proud to
provide a number of services in partnership with Milton Keynes
Council. These integrated services include Mental Health,
Learning Disability, Intermediate Care and Community
Equipment. Both organisations are committed to ensuring
quality is a priority and Milton Keynes Council has supported
the development of the quality initiatives within this Quality
Account.
In November 2011, MKCHS transferred under the legal
umbrella of Bedford Hospital but as an autonomous division
where our branding and identity remain intact.
We believe the integrated nature of our service provision supports improved
experience for the person receiving the service. More joined up care means less
duplication, better co-ordination and a faster response. We hope to build further on
our integrated way of working with social care and also with primary and hospital
care.
The quality agenda is a key component of our Quality, Innovation, Productivity and
Performance (QIPP) programme and is threaded through the work that has been
undertaken during the last year to transform community services.
The quality of services is now more robustly monitored by ourselves and by our
commissioners (who receive funding from the government to purchase health
services locally) through monthly data interrogation and reporting. This gives us the
ability to reduce any variation in standards of practice and, through the work we are
progressing to improve experience feedback and engagement, it ensures increased
accountability to the people of Milton Keynes.
We understand that the community we serve must have confidence in the services
we provide. From first contact through to discharge, the patient journey must be a
positive experience. We strive to work with patients, users and their carers in
identifying where patient experience has not been as good as it should have been
and ensure that learning and changes to services and practices occur as a result.
One of our units, the Campbell Centre, was subject to an inspection by the Care
Quality Commission during 2012/13 and a number of areas were highlighted as
needing further improvement. An on-going programme is underway to ensure the
standards we, and more importantly, our patients expect are reached.
We make sure that quality includes equality and inclusion and implements the
principles contained in the Equality Act, which became law in October 2010.
The patient experience strategy we have produced is “a partnership between the
people who use our services, the Milton Keynes community, clinical staff and service
managers. The strategy comprises of a series of ‘Campaigns’ designed to make real
and lasting improvements in areas which matter to our service users”.
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We have used our Patient Experience Working Group and our Equality and Human
Rights Committee to give initial feedback on this Quality Account and established a
working group which includes senior clinicians, managers and Local Involvement
Network (LINk – now Healthwatch) representatives in its membership, to develop the
report together. This input, along with feedback from the National Staff Survey and
Commissioners Quality visit feedback, helped us to determine where we have done
well and areas that need improvement. In using this approach, we are assured that
this report gives a true and accurate picture of Milton Keynes Community Health
Services and the issues that are important to the local community and our staff.
This Quality Account, in its draft format, was discussed and approved by the
Leadership Management Team, the Patient Experience Working Group, the Joint
Negotiating and Consultative Committee and our Equality and Human Rights
Committee. The draft document was also circulated to the Clinical Commissioning
Group, the Health and Adult Social Care Select Committee, Learning Disabilities
Partnership Board and Milton Keynes Local Involvement Network (LINk MK – now
Healthwatch). Once feedback was received the report was finalised and then
formally presented to the MKCHS Board before final publication.
Within this Quality Account we have highlighted areas of importance to people who
use our services; under Patient Safety we have included; Transfer of Care, infection
prevention and control (IPC), as well as safeguarding children and vulnerable adults.
The Clinical Effectiveness section gives assurance that we have a high quality
workforce; we are taking forward the national programme of the Patient Safety
Thermometer. Under Patient Experience we have focused on our six patient
experience campaigns (The Family & Friends questionnaire, Mental Health
Transformation, Pressure ulcers – how does it feel to be a patient, Children’s
Services consistency in communications, access to podiatry and collecting feedback
from people with learning disabilities).
This year there is also a new compulsory part of section three that has been
determined by the National Quality Board, introducing mandatory reporting against a
core set of quality indicators. For MKCHS this includes: responsiveness to patients’
needs, staff recommendations of the organisation to family and friends, Venous
Thromboembolism (blood clot) treatment, Clostridium Difficile infection monitoring
and patient safety incidents that have resulted in harm or death.
This report looks at the organisation’s performance between April 2012 and March
2013. From April 1st 2013, MKCHS was acquired by Central and North West London
NHS Foundation Trust, a high performing NHS Foundation Trust which already offers
a wide range of community and mental health services across London and Southern
England. Our organisations are a natural fit and we are confident our joint approach
will strengthen the services we provide.
We hope you find the report interesting and that it gives you an understanding of how
seriously we take quality – it’s at the heart of everything we do.
Statement on quality from the Managing Director of Milton Keynes Community
Health Services
I confirm that the information provided in this document is a true and accurate
reflection of Milton Keynes Community Health Services.
Managing Director, Milton Keynes Community Health Services
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SECTION TWO
Priorities for 2013/14
2.1
Priorities for improvement
We consulted with our stakeholders throughout the year to develop our quality
priorities for 2013/14. Leading up to the finalisation of our priorities for
improvements next year, we consulted:
LINks (now Healthwatch) Patient Participation Group
Commissioner Quality Review Group
Our senior managers via a workshop
Patient Experience Strategy Working Group
Health Overview & Scrutiny Committee
We identified three areas as priorities for improvement in 2013/14:
Transfer of care
Responsiveness to patients’ needs and improving patient experience
NHS safety thermometer - organisational ambition of zero avoidable
pressure ulcers
Priority 1: Transfer of care
When people transfer from one clinical setting to another, we need to have
effective systems in place to ensure that they are transferred safely. This is of
particular importance for some of our most vulnerable service users who need
complex arrangements to be put in place involving many different health and
social care professionals.
Incidents relating to poor transfer of care between services are reported
regularly by our services; most relate to the transfer into our services, and
many have resulted in harm. We have analysed trends to understand the
impact on service users and their carers and have shared the findings with
relevant partner organisations.
Whilst there have been some positive developments in care pathways for
people with complex needs, progress has fluctuated because of the difficulties
in working across different organisations, and to date there has been no
measurable improvement in the frequency or severity of the incidents. It is
important therefore to maintain our focus on this serious patient safety issue
in 2013/14.
Target
We will work in partnership with other local health and social care providers to
reduce the number of transfer of care incidents over the next 12 months in
order to reduce the potential for preventable harm. This target will be
measured as follows:
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Milton Keynes Community Health Services will forward 100% of transfer of
care incidents reported by our staff to the relevant organisation for
investigation.
The proportion of transfer of care incidents originating from Milton Keynes
Community Health Service that result in moderate or major harm or death,
will fall to below 15% of the total number of incidents by August 2013, to
below 10% of the total number of incidents by October 2013, and to below
5% of the total number of incidents by the end of March 2014.
Why have we set these targets?
The nature of transfer of care incidents and their impact on service users and
carers in Milton Keynes is well understood because incident trends and
complaints have been analysed. Poor transfer of care affects:
the safety and wellbeing of service users
access to appropriate and timely treatment, care and rehabilitation
service user and carer confidence in local health services
relationships between service users and health care professionals and
between staff in different settings.
Although this is not a national or local quality (CQUIN) target, it is of high
importance to the people of Milton Keynes. This area has also been raised
through the recent Mid Staffordshire NHS Foundation Trust Public Inquiry –
The Francis Report as an essential area to get right.
How are we going to achieve and monitor them?
With advice from the Milton Keynes Safeguarding Adults Board we will ensure
the adoption and implementation of a Transfer of Care Strategy. This will
ensure that there is a ‘board to ward’ approach to transfer of care with strong
leadership, accountability and engagement by all staff.
We will continually monitor adverse events (complaints, safeguarding referrals
and incidents) and carry out regular audits to highlight areas for improvement.
Quarterly reports will be produced which will be presented to the Milton
Keynes Adults Safeguarding Board and this will be a standing agenda item at
our Quality Committee. Progress will also be discussed via the Quality
Assurance Report which is presented to the Board on a bi-monthly basis.
Priority 2: Responsiveness to patients’ needs and improving patient
experience
An organisation’s responsiveness to a patient’s need is central to the quality
of patient experience.
Annually each NHS health organisation is assessed based on the answers to
five questions within the CQC national inpatient survey. For Milton Keynes
Community Health Services this survey is only relevant to our mental health
units as community care services are not included.
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During the last 12 months we have worked to improve overall scores for our
mental health units and have also gathered baseline information on these five
questions for all our services.
Another measure of patient experience is being gathered via the new friends
and family test. It asks all patients who have been discharged from an
inpatient setting if they would recommend the service to their friends and
family. The test is only compulsory for acute trusts, although in 2012/13 our
commissioners set a quality (CQUIN) target using it. The target focused on
inpatients that had been discharged.
However, this meant the majority of our community patients (who remain with
us indefinitely owing to the nature of their health problems) were not included.
To include them, we decided to target a percentage of each service’s
caseload to get a benchmark to work from and to enable us to collect
standardised data across the whole of the organisation.
The friends and family test is not a national quality (CQUIN) target for
community, learning disabilities or mental health providers. However, we are
committed to collecting this data so we are able to benchmark progress
against local and national NHS organisations. The test will however, become
a requirement for us in 2014/15.
Target
Friends and family test: to deliver the friends and family test across all
MKCHS services (including discharged inpatients, and a sample of our
community caseload), and achieve a year-end position within the top 50%
of the national result.
Friends and family test national staff survey results: to improve on the
2012 national staff survey result of 3.76 out of 5 for this measure in the
2013 national staff survey.
Why have we set these targets?
Putting patients first is a priority for us as an organisation and it is at the heart
of the NHS Constitution. Over the years we have built on this value and are
seeing real and positive changes in the way we deliver services. This has
increased patient satisfaction and the satisfaction
and pride of our staff in the services and care they
deliver.
We know there is still much to do. We understand
that improvements should be continuous, this
agenda is still evolving and we are committed to
maintaining the momentum already achieved. Our
targets enable us to further demonstrate and embed
a culture of putting the patient first.
How are we going to achieve and monitor them?
We will continually monitor feedback from patients about their experience of
our services through patient stories, complaints, locally agreed patient
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experience campaigns, focus groups, the family and friends test, and the
national patient and staff surveys.
This information will be reviewed, acted on and fed back to staff and service
users. Monitoring will take place via our Patient Experience Strategy Working
Group, our Quality Committee as a standing agenda item and through the
quality assurance report that is presented to the Board bi-monthly.
Priority 3: NHS safety thermometer - organisational ambition of zero
avoidable pressure ulcers
The NHS safety thermometer is a national tool
that was developed for acute hospital settings.
The tool has now been included in the national
quality (CQUIN) targets for all NHS
organisations (apart from ambulance services)
and is used to monitor falls, urinary infections in
patients with catheters, pressure ulcers and
venous thromboembolism (blood clots).
Compliance with the NHS safety thermometer is a requirement for Milton
Keynes Community Health Services as a national quality (CQUIN) target.
Using the data that is collected on a monthly basis a percentage of harm free
care can be calculated for each organisation. On the basis of national data, it
is likely that most organisations will find that the majority of their harm is
represented by pressure ulcers.
At Milton Keynes Community Health Services we have been actively working
towards zero avoidable pressure ulcers for a number of years. However,
working with the Strategic Health Authority on the pressure ulcer ambition
programme has enabled us to take a more targeted approach.
Target
Milton Keynes Community Health Services is to:
undertake a survey once a month using the NHS safety thermometer tool
improve on the 2012/13 baseline data for collection of pressure ulcer data
achieve a year end baseline for the number of recorded avoidable
pressure ulcers to be measured against in the following year.
Why have we set these targets?
We know from the information collected through serious incident reporting and
the collection of monthly data via the NHS safety thermometer, pressure
ulcers are a problem for patients in Milton Keynes. Pressure ulcers cause
considerable distress and pain to patients so if they can be avoided it must be
our priority this is achieved. It has taken us time over the last year to achieve
an accurate system of identifying avoidable and unavoidable pressure ulcers.
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How are we going to achieve and monitor them?
Working from six months’ worth of data we will monitor and target effective
pressure ulcer education, avoidance and care. Monthly service level
monitoring will be overseen by our Clinical Quality Manager via the Zero
Pressure Ulcer Ambition Group. Results will be reported via the quality
assurance report on a bi-monthly basis for further scrutiny and assurance by
the Quality Committee and the Board.
2.2
Statements of assurance from the Board
One of the aims of this Quality Account is to give information to the public
which will be common across all Quality Accounts in the country. In order to
do this our Quality Account has a number of statements that must be
included.
Performing to essential standards
Milton Keynes Community Health Services currently has unconditional
registration with the Care Quality Commission (CQC). Last year, we reported
that we had de-registered with the CQC as the provider-arm of the Primary
Care Trust and registered instead with Bedford Hospital NHS Trust; our host
organisation. We are now in the process of transferring our registration to
Central and North West London NHS Foundation Trust in preparation for our
merger.
In August 2012, we had an unannounced visit by the CQC to our mental
health inpatient unit, the Campbell Centre; the findings from the visit
highlighted some significant areas for improvement. We were very concerned
about this and took immediate steps to make the improvements and have
implemented an action plan to continue to develop the service and to ensure
that the improvements are sustained. We are also sharing the lessons learnt
from this experience across all our services.
Measuring clinical processes and performance
We measure the delivery of high-quality care through a programme of audits
and other investigative projects including surveys and analysis of incidents
and complaints trends.
All services have an audit plan which is established at the beginning of the
financial year. This includes topics identified as priorities for each service
through reviews of NICE guidance and through identifying trends from the
analysis of adverse events. It also includes audits deemed mandatory by the
organisation, for example care records and infection control. The audit plan is
facilitated by clinical governance and led by a nominated clinical lead from
each service.
Incidents and complaints trends are analysed quarterly and provide a useful
indicator of clinical processes and performance. Improvement plans are
developed for trends and these feed through to the patient experience
campaigns. This ensures service users and carers are involved, and
improvements are sustained.
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Involvement in national projects and initiatives aimed at improving
quality
Milton Keynes Community Health Services is an active participant in
nationally driven quality improvement initiatives. We implemented the patient
safety thermometer this year to check the effectiveness of our management of
major clinical risks to patients including falls, pressure ulcers, urinary
infections for patients with catheters, and venous thromboembolism (blood
clots).
We reviewed the findings from the Winterbourne View Serious Case Review
to identify any recommendations which might apply to our services. These
have been included in our Safeguarding Adults Action Plan so that we can
continue to monitor compliance with all standards which safeguard our service
users.
We undertake a regular review, jointly with the Local Authority - at the
Safeguarding Adults Board sub-group – to review all national enquiries and
reports to see how they apply to our services and to learn from the findings.
Our Patient Experience Manager is an active member of a regional
development group for patient experience initiatives and has helped to
establish the policy and priorities for this group.
2.3
Statements to review services
During 2012/13 Milton Keynes Community Health Services provided and/or
sub-contracted 43 NHS services.
Milton Keynes Community Health Services has reviewed all of the data
available to them on the quality of care in 43 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
Milton Keynes Community Health Services for 2012/13.
2.4 Participation in clinical audits
During the period April 2012 to March 2013, six national audits and one
confidential enquiry covered NHS services that Milton Keynes Community
Health Services provides.
During that period Milton Keynes Community Health Services participated in
one (11.76%) national clinical audit and 100% national confidential enquiries
of the national clinical audits and national confidential enquiries which it was
eligible to participate in.
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National Clinical Audits
The Department of Health has identified a list of national clinical audits and
enquiries for inclusion in all Quality Accounts.
These national clinical audits are a set of centrally funded national projects
that provide healthcare providers with a common format to collect audit data.
The projects analyse the data centrally and feedback comparative findings to
help participants identify necessary improvements for patients. Most of these
projects involve services in England and Wales; some also include services
from Scotland and Northern Ireland.
There are 51 national audits identified for inclusion in the Quality Account for
the period April 2012 to March 2013 and Milton Keynes Community Health
Services is eligible to participate in the following audits:
Epilepsy 12 (childhood epilepsy)
Falls and bone health
Parkinson’s disease
Psychological therapies
Prescribing observatory for mental health
Schizophrenia
National Confidential Inquiries
The purpose of a National Confidential Inquiry is to detect areas of deficiency
in clinical practice and devise recommendations to resolve them. Enquiries
can also make suggestions for future research programmes.
To date, most confidential enquiries are related to investigating deaths to
establish whether anything could have been done to prevent the deaths
through better clinical care. Confidential enquiries are “confidential” in that
details of patients/cases remain anonymous, though reports of overall findings
are published.
Milton Keynes Community Health Services is eligible to participate in the
suicide and homicide by people with mental illness confidential inquiry.
2.5 Measuring participation
The national clinical audits and national confidential inquiries that Milton
Keynes Community Health Services participated in, and for which data
collection was completed during 2012/13, are listed below alongside the
number of cases submitted to each audit or inquiry as a percentage of the
number of registered cases required by the terms of that audit or enquiry.
During the period April 2012 to March 2013, six (11.76%) of 51 national
clinical audits were relevant to Milton Keynes Community Health Services.
The table below details the audits that the organisation participated in and
reasons for non-participation where applicable.
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National Clinical
Audit
Epilepsy 12 (childhood
epilepsy)
Falls and bone health
MKCHS
Participation
Yes No
x
Parkinson’s disease
x
Data not being collected during this
year. Participated in previous years.
The audit was undertaken by the
Specialist Parkinson’s Nurse last year
and although the National Parkinson's
Audit takes place every year, it is
recommended that services take part
every other year to give time for them to
respond to the findings.
Data not being collected during this year
–previously participated
Vacancy in the Pharmacy Team - keen
to participate during 2013-14 now
vacancy has been filled.
Data not being collected during this
period. May consider participation next
year.
x
Psychological
therapies
Prescribing
observatory for mental
health
Schizophrenia
Reason for non-participation
x
x
x
In the same period, Milton Keynes Community Health Services participated in
all national confidential enquiries which were relevant to the services we
provide. The table below details participation.
National confidential
inquiry
Suicide and homicide by
people with mental illness
MKCHS
participation
Yes No
x
Cases Submitted
six cases were submitted in
2012/13 to the Centre for Suicide
Prevention.
2.6 Measuring Coverage/Recruitment
National clinical audit
Epilepsy 12 (childhood epilepsy)
Falls and bone health
Parkinson’s disease
Psychological therapies
Prescribing observatory for mental
health
Schizophrenia
Participation
Yes
No
No
No
No
% cases submitted
50 sets of notes
No
2.7 Reviewing reports of national clinical audits
The reports of the national clinical audits undertaken by our services were
reviewed by the organisation in 2012/13 and MKCHS intends to take the
actions described in the table below to improve the quality of healthcare
provided.
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AUDIT
Epilepsy12 (childhood epilepsy)
Summary of Actions
Epilepsy 12 is a UK-wide multi-centre
collaborative audit which measures the
quality of health care for childhood
epilepsies. The ‘12’ refers to the 12
measures of quality applied to
The first 12 months of care after the initial
paediatric assessment. Care was
compared to National Institute of Clinical
Excellence (NICE) epilepsies guideline
recommendations. The Epilepsy 12
national audit described the care using
three domains:
1. Service descriptor: paediatric services
described the details of their service for a
specific census day in 2011.
2. Clinical audit: a retrospective case note
analysis for all children meeting the
project inclusion criteria, having their first
paediatric assessment during a particular
6 month period before census day was
undertaken.
3. Patient Related Experience Measure
(PREM): carers and young people with
epilepsy were invited to describe their
experiences of their health care.
An action plan has been put in place to
ensure the continuing improvement of
outcomes for those children, young
people and their families.
2.8 Reviewing reports of local clinical audits
The annual clinical audit plan reflects local and national priorities for service
improvement and there is an expectation for all services to engage fully in the
audit process to ensure continual review of current practice against specific
objectives.
All services complete an audit of their record keeping practice each year to
demonstrate that adequate information is recorded for each patient to ensure
safe and effective treatment and care. Health and safety audits, security
audits, hand hygiene and infection prevention audits are also carried out in all
services annually and are of great value in terms of ensuring safety of patients
and staff and minimising the spread of infection.
The reports of 94 local audits were reviewed by Milton Keynes Community
Health Services in 2012/2013 and the recommendations outlined from these
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will be acted upon in order to improve the quality of the service offered to
patients.
Clinical audit is not an isolated quality improvement activity, it is one of a set
of tools and organisations can use to improve the quality of care that is
delivered to service users and their families.
In addition to mandatory audit requirements, the annual audit plan is an
integral part of the service improvement process for all services. Topics relate
to service objectives that support local and national priorities. Included in the
plan are projects to identify level of compliance with a range of national quality
and best practice indicators. These include NICE guidelines, the Care Quality
Commission’s standards for equality and safety, as well as locally applicable
patient satisfaction surveys or audits relating to emerging themes in incidents
or complaints.
As part of our audit cycle clinical services undertake a consent audit every
three years. This measures how our services involve service users and,
where relevant, their families or carers in making decisions about all aspects
of their care and treatment. The implementation of the consent audit has
delivered noticeable improvements in practice.
We have highlighted two examples of good practice from consent audits this
year, below:
Within the Early Stroke Rehabilitation Team (ESRT) which was established
in April 2010 to work across the acute, community, health and social care
settings to provide intensive rehabilitation and support stroke survivors being
discharged home from the Acute Stroke Unit (ASU), Milton Keynes
Foundation Trust Hospital. The aim of the ESRT is to facilitate earlier
discharge from hospital, and to provide home based assessment,
rehabilitation and support for those who have suffered a recent stroke.
During the audit, the auditor identified several examples of good practice
relating to ensuring informed consent to treatment. These included:
The development of laminated cards which act as visual aids to
communication with patients in support of the consent process
Regular multi-disciplinary meetings where a patient’s capacity to
consent is discussed. The social worker is highly involved in these
discussions and in undertaking capacity assessments. An
independent Mental Capacity Advocate (IMCA) is also involved.
Assurance regarding staff being trained in supported conversation
techniques with patients, and repeat visits to patients at which
previously held conversations are reiterated with time lapses inbetween these visits in support of the patient’s decision-making
processes.
The ESRT Speech and Language Therapists were pivotal in the
language choice and design of the ESRT Information Leaflet,
alongside stroke survivors themselves.
Milton Keynes Priority Dental Services provides specialist dental services
within Milton Keynes and is responsible for the provision of dental care to
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patients who have difficulty accessing that care from a general dental
practitioner due to their special needs. These needs include physical
disability, learning disability, mental health problems, severe anxiety/phobia or
a complex medical history. Looked-after children and HMP Woodhill also
receive dental care from this service.
Within the Milton Keynes Priority Dental Service, ’Consent’ relates to
engaging the service user and relevant family members or carers as fully as
possible in care-planning and making decisions about all aspects of dental
health and welfare.
During the audit clinical notes were reviewed which covered four aspects of
consent. These areas were: cases involving sedation or anaesthesia of an
adult; cases involving parental consent for the sedation or anaesthesia of a
child; cases involving adults who were unable to consent to their own
treatment; and cases involving no requirement for formal consent. The audit
found:
Clear evidence that the service users’ ability to give informed
consent is part of a routine process of assessment leading either to
formal or informal consent to treatment. In all cases, it is apparent
that, where mental capacity was deemed to be missing or where
the service user was not adult, relevant steps were taken to gain
appropriate levels of consent.
The process of decision-making appears to be so well understood
and applied that there was no evidence of any implied consent: all
consent is either formal or verbal (or otherwise specifically
indicated), and is well evidenced in the record in both cases. The
attendance of the service user for an appointment, for example, is
not taken as implied consent for going ahead with treatment.
What was seen and described on the day of the review indicated a
high level of service user involvement and a commitment to
engagement.
2.9 Research
We recognise the value of participation in research as an activity which drives
up standards of care. It is therefore embedded in our Innovation Strategy.
MKCHS is a member of the Thames Valley Comprehensive Local Research
Network and participates in high-quality research and development in order to
promote best practice. We are compliant with the Research Governance
Framework, which ensures all research studies are conducted safely.
Over the past 12 months, we have agreed to participate in 11local and
national research projects, working in partnership with staff, the Research
Network and universities.
The table below gives an overview of research studies we have been involved
with in the last 12 months in various categories.
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SPECIALITY
Child health (recruitment to vaccination
studies)
Child and Adolescent Mental Health
Health Visiting
Mental Health
Psychology
NUMBER OF STUDIES
4
2
one
2
2
The number of patients receiving NHS services provided or sub-contracted by
Milton Keynes Community Health Services during April 2012 to March 2013 is
not able to be provided as these figures are collected for all Thames Valley
primary and community settings as a group; however the Thames Valley
Research Network Board reported a good level of recruitment from the
partner organisations.
2.10
Goals agreed with commissioners
A proportion of Milton Keynes Community Health Services income in 2012/13
was conditional upon achieving quality improvement and innovation goals
agreed between Milton Keynes Community Health Services and any person
or body they entered into a contract, agreement or arrangement with for the
provision of relevant health services, through the Commissioning for Quality
and Innovation payment framework. In 2012/13 we fully achieved all our
standards by quarter four, resulting in an additional income of £461,840 which
spent on improving patient care. Outlined below are the 2012/13 CQUIN
standards and a summary of our achievement against them:
2012-13 QUALITY (CQUIN) STANDARDS
COMMUNITY SERVICES (CS) & MENTAL HEALTH SERVICES (MH)
Clinical Quality Indicator (CQUIN)
National 1:NHS patient safety
thermometer – community and
mental health contracts
Improve collection of data in relation to
pressure ulcers, falls, urinary tract
infection in those with a catheter, and
VTE
2012-13 Performance
We started our data collection using the Patient
Safety Thermometer tool in February 2012 for
three areas - Windsor Intermediate Care Unit, the
Older People’s Assessment Service and district
nursing; with HMP Woodhill being included from
September 2012 onwards. From 1 April 2013 we
extended PST reporting to the intermediate care
teams - early stroke rehabilitation team, rapid
intervention and assessment team and the home
to stay team.
Our main goal in the last year has been to
develop robust and easy systems for collecting
data around four key patient harms - falls,
pressure ulcers, urinary catheter infections, and
venous thrombo emobolism (VTE) or blood clots.
Now with 12 months data to work with we are able
to more effectively monitor harm and this will be a
17
starting point to begin a programme of harm free
care for our service users.
Local 1:High impact innovations –
community and mental health
contracts
During 2012/13 providers should have
developed and agreed with
commissioners a plan for the
implementation of the high impact
innovations as set out in ‘Innovation,
Health and Wealth’. MKCHS will be
required to demonstrate
implementation of the high impact
innovations relevant to them as a
provider as set out in ‘Innovation,
Health & Wealth’.
Local 2: Patients with long term
conditions are identified and receive
care in the most appropriate place
dependent on clinical care
To identify those patients with long
term conditions most at risk of hospital
admission. To personalise and improve
the care, safety and experience for
people with defined long term
conditions through the use of case
management and joint working across
health and social care. Leading to a
reduction in emergency admission and
readmission of patients with long term
conditions.
Care of patients with long term
conditions is currently managed by
community matrons. It is anticipated
that from September 2011 that a long
term condition case management team
will be established. Once established
the team will replace community
The MKCHS position statement and action plan
for the implementation of the high impact
innovations in mental health and community
services has been approved by the MKCHS
Leadership Team. This was also submitted to the
Head of Quality and Standards at NHS MK and
Northants.
MKCHS has registered with the NHS Institute for
Innovation and Improvement to keep up to date
with the implementation support packages they
are working on. This will help with the successful
spread and adoption of high impact innovations.
A steering group was established in January 2013
to oversee innovation across the organisation.
This will progress the implementation of this
CQUIN going forward.
Community matrons have been providing case
management for over 300 patients with long term
conditions who had been identified as at a high
risk of requiring hospital admission due to their
condition.
A new self-care plan was introduced and rolled
out during the year. The aim was for all patients to
have a personalised self-care plan in place by the
end of quarter four. This has been achieved in
advance of the end of the quarter.
The target set is to have no more than 225
patients on the community matrons caseload
admitted to hospital as an emergency by the end
of March 2013. At the end of quarter three, 169
patients had been admitted to hospital. In addition
the target for attendances at A&E for patients on
the community matron caseload is no more than
137. At the end of quarter three, this was 103.
These are challenging targets and achievement
has been supported through a range of activity
within the service such as reviewing oxygen
requirement and provision, checking inhaler
technique, medication reviews, use of telehealth
to monitor and respond during an acute
exacerbation of condition, linking with other
services and agencies to ensure the right level of
support is provided to address individual needs
18
matrons within this CQUIN.
and concerns
Local 2: Dementia prescribing
Prescribing guidance
Guarantee appropriate prescribing of
antipsychotic medication for people
with dementia and behavioural and
psychological symptoms of dementia
(BPSD) through the development and
implementation of best practice
prescribing guidance.
Developed and gained approval for antipsychotic
medication process in line with national guidelines
for use in treatment of BPSD in dementia.
Discharge planning
Embed good practice in the discharge
of patients with dementia and BPSD
who are prescribed antipsychotic
medication through the development
and implementation of discharge
processes that lead to routine / timely
review of antipsychotic medications.
All new prescribing is in accordance with new
guidance.
Initial check list completed for all patients
All patients who are prescribed antipsychotic
medication are reviewed on a 12 weekly time
frame.
Prescribing review 1
Review all current prescribing of
antipsychotic medications in patients
with dementia and BPSD.
Patients prescribing audit was completed and
submitted within requested time frames.
Prescribing review 2
Review antipsychotic prescribing
patterns within older people’s mental
health unit in patients with dementia
and BPSD.
Regional 1:Patient revolution – net
promoter
To establish ‘net promoter (or friends
and family) question’ and ensure that
this is used within all local patient
experience/satisfaction surveys.
To establish a system for collating
patient stories.
To establish a baseline net promoter
(friends and family) score for each
service/directorate.
To report quarterly to board and
The net promoter (friends and family) question
has been established across all services areas
and is collected on a quarterly basis. To enhance
the level of information collected we also included
five questions from the national inpatient survey
which focuses on an organisation’s
responsiveness to patient’s needs.
Patient stories are routinely collected and bimonthly a patient story DVD is presented to the
Board for discussion.
Baselines have been set for each service and
19
commissioner at organisational,
speciality and service level, including
how patient experience and stories
have impacted/will impact on changes
to service.
Directorate.
Reporting is done on a bi-monthly basis to the
Board using the quality assurance report and
dashboard. This is then presented to
commissioners at their Commissioning Quality
Achieve a ten point improvement in Net Review Group meeting. Reporting demonstrates
Promoter (friends and family) score
learning and how services have changed as a
from quarter one to quarter four.
result.
A ten point achievement was not achieved.
However it has been agreed with commissioners
this is due to the way the tool is set and should
not negatively reflect on MKCHS’s achievement of
the CQUIN.
2.11
What others say about Milton Keynes Community Health Services
Milton Keynes Community Health Services is required
to register with the Care Quality Commission and its
current registration status is ‘Unconditional
Registration’.
Milton Keynes Community Health Services has participated in one special
review (unannounced visit) by the Care Quality Commission during 2012/13.
The review took place at the Campbell Centre, which is an acute adult mental
health inpatient unit. The outcome of the review showed compliance with
CQC standards, however moderate concerns in relation to six areas were
raised, as follows:
Outcome 1 - Respecting and involving people who use the service
Outcome 4 – Care and welfare of people who use the service
Outcome 7 – Safeguarding people who use services from abuse
Outcome 10 – Safety and suitability of premises
Outcome 13 – Staffing
Outcome 16 – Assessing and monitoring the quality of the service.
Improvement actions were identified and these have been progressed. At the
end of March the CQC revisited the unit and we are waiting for detailed
feedback against the above areas to understand where we have improved
and where further work is necessary.
The CQC have also completed Mental Health Act compliance assessments
which are carried out annually. These reviews took place at the following
sites:
The Older People’s Assessment Service (TOPAS), older people’s
mental health
The Campbell Centre, acute adult mental health service
The Linden Unit, adult mental health rehabilitation unit.
20
This highlighted some areas for improvement at the Campbell Centre which
are presently being addressed.
An OFSTED and CQC Inspection of safeguarding and looked after children
services was completed between 9th -20th July 2012. The CQC provided its
own report that included findings from the overall inspection report with more
detailed evidence and feedback on the findings from the CQC component of
the inspection. Within the report there were no recommendations relating
specifically to MKCHS safeguarding children arrangements. However, there
were three recommendations requiring action by MKCHS. Two related to
children in care. The other recommendation related to ensuring provision of
equipment for children with disabilities and life limiting conditions does not
impede their discharge from hospital and that a comprehensive maintenance
programme is in place. Milton Keynes Clinical Commissioning Group has
overall responsibility for the plan.
2.12
Data Quality
Outlined overleaf are the actions that Milton Keynes Community Health
Services will be taking to improve data quality.
We recognise that good quality information is critical in providing effective and
prompt services. It is needed by patients in our community and is also
required for effective management, clinical governance and service
agreements.
We have continued our programme of work to improve both the completeness
and validity of the data that is captured across the organisation. Opportunities
to further enhance data quality are routinely identified and our information and
performance team sets clear priorities every month for development and
improvement.
We manage data quality in a comprehensive and systematic way, aiming to
ensure substantial assurance ratings to our systems and processes. This
should give everyone confidence that data reported in these accounts, and
routinely in our performance reports, is reliable and based on solid
information.
During 2012/13 we made considerable progress to enable the internal and
external reporting of performance data required as a result of increased
contractual requirements. We achieved this by continuing our implementation
and enhancement of the RiO system (Rivers of Information, a clinical records
data collection system) and various data collection tools across services, and
by increasing the capacity and capability of staff within services with regard to
data recording, reporting and analysis.
For 2013/14 Milton Keynes Community Health Services will continue this
programme of work and will take the following actions to further improve data
quality.
We have set business objectives to make sure that all services are in
a position to record, report and analyse their activity and
performance data. This information will enable our services to
21
manage capacity and demand, ensure delivery of contractual
requirements, measure the outcomes from service improvement
initiatives and ultimately, improve the quality of services provided to
patients.
Our information and performance team review and validate data to
ensure records are accurate and captured in a timely manner. We
will design and implement data quality dashboards and service
portfolios as part of a robust framework to collect and report meaningful
and measurable information. These will help us to drive service
improvements and contribute to a better patient experience.
To further enhance how we can benefit from information we will
continue to implement a comprehensive business intelligence reporting
system so information is available to staff on demand. This
innovation will support service decision making and make a real
difference to the quality of our care.
NHS number and general medical practice code validity
Milton Keynes Community Health Services submitted records during April
2012 to December 2012 to the
Secondary Uses service for inclusion in
the Hospital Episode Statistics which
are included in the latest published
data.
Based on published data in the SUS
data quality dashboard from the
Information Centre for coverage
between April 2012 and December
2012 (latest release at time of writing).
The percentage of records which included the patient’s valid NHS number
was: 100% for admitted care and 99.8% for outpatient care.
The percentage of records in the published data, which included the patient’s
valid General Practitioner Registration Code, was 100% for admitted care and
100% for outpatient care.
Information governance toolkit
Milton Keynes Community Health Services (MKCHS) Information Governance
Assessment Report overall score for 2012/13 was 70% and was graded
‘green’.
The ‘Information Governance Toolkit’ is a set of standards which describe
how we should look after people’s information safely and effectively. The
standards are very wide-ranging and examples of the topics in the toolkit
include:
all the arrangements which need to be in place to safeguard data about
people; service users and staff, including training
expectations for appropriate use of computer systems
procedures for handling problems
22
all the policies which govern the quality of information
procedures to ensure that information is available constantly and where
needed, and contingency plans in place.
The Information Governance Committee is responsible for monitoring
compliance with the standards and under its guidance we have:
reviewed all policies and procedures and have a rolling programme of
review and updating in place
trained 92% of staff in safe-handling of information.
As a service provider, MKCHS offers assurance of its compliance with the
Information Governance Toolkit to the Bedford Hospital NHS Trust Board.
Milton Keynes Community Health Services was not subject to the Payment by
Results clinical coding audit during the reporting period by the Audit
Commission
23
SECTION THREE
Review of 2012/13
This section of our Quality Account highlights the positive work that has
been progressed through the last 12 months. It follows the areas we
highlighted in the 2011 /12 Quality Account which we had prioritised for
work in the coming year and also notes the new mandatory reporting on
quality indicators set down by the NHS National Quality Board.
3.1 Patient Safety
3.1.1 Transfer of Care
When people transfer from one clinical setting to another or to home, we need
to have effective systems in place to ensure that they are transferred safely.
This is of particular importance for some of our most vulnerable service users
who need complex arrangements to be put in place involving many different
health and social care professionals. Though there has been considerable
progress in this area, reviews of incident reports and feedback from service
users show that there is still work to be done and in 2012-13 we will be
building on the initiatives described below.
How do we achieve progress?
Over recent years there has been an emphasis on supporting people to
remain at home to receive care and treatment and for those admitted to
hospital to return home as soon as possible. This can often result in reduced
time for discharge planning to take place. To counter any risks associated
with this, we are working with our partner organisations, Milton Keynes
Council and Milton Keynes Hospital, to develop a joint policy and protocols
which will set standards for good practice. We will be running more multiagency training events and workshops to share good practice and improve
understanding.
Listed below are just some of the initiatives Milton Keynes Community Health
Services provides in partnership with other local organisations:
Home to Stay team – Provides care co-ordination and support for
people with complex needs being discharged from hospital for the first
30 days after leaving the hospital.
Rapid Assessment and Intervention Team (RAIT) – Works with
GPs, community teams, A&E and admission units to support people to
remain at home or discharge back home as soon as medically
appropriate. In 2012, additional funding was received and three key
aspects of intermediate care services have been developed to provide;
o Additional Admission Avoidance Activity
o Extension of the Stroke Pathway
o Psychological support for people living with Long Term
Conditions
24
Intermediate Care – Provides a range of multi-disciplinary, community
or inpatient re-ablement support for people to regain as much
independence as possible by learning, or re-learning the skills
necessary for daily living following an episode of illness, injury or crisis
Intravenous Treatment – Community nursing provides support for
people to return home to continue with a course of intravenous therapy
in the home
End of Life Care Team – Provides training, advice and support to
services and organisations across Milton Keynes to improve end of life
care and support for patients and their relatives. In 2012, this function
was moved across to the CCG. MKCHS are currently working with
commissioners to design the future model of care for Milton Keynes.
Diabetic Specialist Team – Works with hospital consultants to
support self-management for people with unstable or newly diagnosed
diabetes
Community Matrons and Telecare – Working with Milton Keynes
Council to provide support for people with complex long-term health
conditions to monitor and proactively manage their condition.
Throughout 2012 further funding has been agreed to deliver a rolling
programme for the replacement of equipment into the future and new
pathways of care developed.
How are we monitoring and measuring?
We will continue to include Transfer of Care as a campaign in the Patient
Experience Strategy and will seek the views of people who have used our
services and their carers.
We will monitor adverse events (complaints, safeguarding referrals and
incidents) and carry out regular audits to highlight areas for improvement.
One of the key methods for monitoring how well discharges are being planned
and supported is through the incident reporting process. Milton Keynes
Community Health Services staff have confidence in this system of reporting
because of the cycle of feedback to them which provides assurance that:
1. Each incident is acted on in the area where the failure occurred so that
remedial action can be taken to reduce the risk of recurrence
2. The investigation and outcome is fed back to the service which raised
the incident
3. Reporting contributes to an overall picture of key risks to patients each
quarter
How will progress with this be reported?
Progress against the Patient Experience campaign will be reported by the
Strategy Steering Group to LINkMK (now Healthwatch) and to the Clinical
Governance Committee. Recent examples of actions to improve transfer of
care processes include:
Whole System Transfer of Care Workshop led by Milton Keynes
Community Health Services held February 2012 to identify key actions
required to improve transfer of care across the system
25
Formal agreement to work across health and social care organisations
to jointly resolve issues impeding effective transfer of care
In August 2012, an inter-agency operational group (MKCHS, MKC &
MKHFT) to address issues with transfer of care was established called
the SPOT Action Group. The group is working on a number of
initiatives to improve joint working. This work is supported by quarterly
focus groups with the local public, coordinated by LINk MK to ensure
local experience and feedback influences the work plan.
3.1.2 Infection prevention and control
Effective infection prevention and control standards and avoidance of
healthcare associated infections (HCAI’s) are essential to ensuring the safety
of patients in our care, wherever their care is provided. We know from
speaking with patients and the public during the last year that good infection
control and the cleanliness of all of our facilities is really important to them.
We are proud of our infection control achievements, some of which are set out
below.
What are the outcomes from the work developed?
Hand Hygiene
Studies show that infection rates can be reduced by 1050% when healthcare staff regularly clean their hands. In
the past twelve months we have continued to focus
heavily on ensuring staff are using effective techniques
when cleaning their hands. We have done this through
educational sessions and by facilitating staff to audit each
other’s hand hygiene practices.
Each year, we undertake an organisation-wide audit in
December. This year we saw a further increase in most
aspects of hand hygiene practice. The graph below shows the improvements
over the last five years.
Organisation wide hand hygiene audit
100
80
60
%
40
20
0
Before pt contact
2008
After pt contact
2009
Correct Technique
2010
2011
Bare Below
Elbows
2012
26
In addition, monitoring that staff are adhering to the ‘bare below the elbows’
principle is now part of our on-going hand hygiene auditing in inpatient
settings. This, together with raising staff awareness about the need for ‘bare
below the elbow’ principles, will help to ensure the safety of all of our patients
whilst they are in our care.
Meticillin-resistant staphylococcus aureus (MRSA) bacteraemia
We continue to play a significant role in maintaining low numbers of patients
admitted to hospital with MRSA bacteraemia (MRSA in the bloodstream). We
do this via a whole system approach. Our community Infect Prevention and
Control Team not only works with our own services, but also GP Practices
and residential nursing homes.
In 2012-13 Milton Keynes Community Health Services was given an individual
target of no more than one MRSA bacteraemia case attributed to our
services. We achieved this target with zero cases attributed to us.
Data from the MRSA patient pathway project has been used to consider how
patients diagnosed with MRSA can be better supported. Patients with MRSA
access all parts of the health economy so these issues are being considered
through a system wide Milton Keynes Infection Prevention and Control
Committee.
Clostridium difficile
Incidence of clostridium difficile is also monitored very closely and reported as
a key performance indicator on a monthly basis. In 2012/13, our target was to
ensure no more than two clostridium difficile cases were attributed to our
services. We achieved this target with zero cases attributed to us.
Proactive and innovative work around clostridium difficile continues to reduce
the overall number of cases across the whole health economy to the absolute
minimum possible.
Clean environments
Improvement of infection prevention and control standards requires a multifaceted approach. It is widely recognised that environmental cleanliness is a
key component in the provision of safe, clean care. Milton Keynes Community
Health Service is unusual in having integrated the domestic services fully with
the infection prevention and control team. This means much closer working
and the ability to provide a much more responsive service in relation to
infection prevention and control.
Cleanliness quality control audits are conducted every month across the
organisation. The graph below combines all monthly quality control scores
and compares them against the combined monthly quality control targets to
show an overall compliance position.
27
Graph - Overall Cleanliness Score (By Month) for April 2012-March 2013
Using the scores in the chart above it is possible to identify an annual
cleanliness performance score for the organisation against an overall annual
target. This information can be found in the table below.
MKCHS 2012-13 Target Score
88.6
MKCHS 2012-13 Score Achieved
91.6
3.1.3 Patient Environment Action Team (PEAT) audits
Every year all NHS providers in the UK are
required to undertake an in-depth assessment
of qualifying inpatient settings as part of a
national programme managed by the NHS
Information Centre. The results from this
programme are published as an official
statistic and are used as a performance tool
by the Care Quality Commission, contributing
to five outcomes on a trusts quality risk profile.
Within Milton Keynes Community Health Services three premises qualify for
the assessment, the Campbell Centre, Windsor Intermediate Care Unit and
the Older People’s Assessment Service. The assessment programme
focuses on the patient perspective and patient journey, and we ensure that
patient representation is included on every assessment through LINk:MK
(now known as Healthwatch).
28
The patient environment action team audits will be replaced this year with a
new assessment system, patient led assessment of the care environment
(PLACE). The initial programme will take place between April and June 2013.
The following scoring details and information relate to the 2012 patient
environment action team programme. It was undertaken between January
and March 2012 and the scores were released in June 2012.
Table: PEAT scores 2012 with national comparison
PEAT
Section
National
Average
Campbell
Centre
Environment
Food
Privacy &
Dignity
Good
Excellent
Good
Acceptable
The Older
People’s
Assessment
Service
Good
Excellent
Excellent
Excellent
Excellent
Windsor
Intermediate
Care Unit
Good
Excellent
Excellent
The environment score for PEAT has remained good across all three sites for
2012. This section of the assessment is diverse, covering a wide range of
factors, and therefore it was difficult to achieve the 96% required for an
excellent. Good was the average nationally for environment.
Windsor Intermediate Care Unit retained its excellent score for food, and The
Older People’s Assessment Service improved from good to excellent.
The Campbell Centre’s food score reduced in 2012 following a change to the
lunchtime catering arrangements which did not reach the same standards.
Significant work was undertaken following this audit to improve the lunchtime
catering and it is anticipated improvements will be clearly visible against the
new assessment requirements of the Patient Led Assessment of the Care
Environment.
The privacy and dignity score has remained excellent across all three sites for
2012.
3.1.4 Safeguarding Children
Why is this a priority?
Safeguarding children is the action we take to promote the welfare of children
and protect them from harm. It is everyone’s responsibility and everyone who
comes into contact with children and their families has a role to play. The
national media often reminds us of the devastating outcomes that can happen
when systems to protect vulnerable children fail.
Working Together to Safeguard Children (2013) is the Government’s statutory
multi -agency child protection guidance which sets out how organisations and
individuals should work together to safeguard and promote the welfare of
children and young people.
29
What are the outcomes from the work developed?
Milton Keynes Community Health Services has a small team of nurses and a
doctor who are specially trained to offer advice, support and training to staff
about safeguarding children.
In the past year the Safeguarding Children Team has continued to:
deliver a comprehensive training programme for staff to make sure
they are all up-to-date with what they need to know about
safeguarding children
undertake audits of practice and review safeguarding children cases
so we can learn lessons for improving practice
ensure a robust governance structure within the organisation to
monitor safeguarding activity
be an active partner in supporting the work of the Milton Keynes
Safeguarding Children Board (MKSCB) - a multi-agency board - which
requires all organisations that work with children to co-operate to keep
children safe from harm
contribute to the Milton Keynes Children and Families Partnership,
which ensures better partnership working between local agencies, to
improve the lives of children and young people and their families in
Milton Keynes
We are confident that because of this ongoing work, ensuring staff have the
required skills and competencies; they will be able to identify and take
appropriate action when there are safeguarding concerns. This, therefore,
ensures staff are better able to safeguard and promote the welfare of
vulnerable children within Milton Keynes.
3.1.5 Safeguarding Adults
MKCHS has maintained its strong presence in multi-agency Safeguarding
Adults fora in Milton Keynes over the last year, with consistent representation
on the local Safeguarding Adults Board and on all four of its sub-groups.
Internally, there have been significant changes to our Safeguarding Adults
response. As mentioned in last year’s Quality Account, we now have our own
Safeguarding Adults Assurance Group (SAAG), consisting of senior staff from
clinical teams as well as senior managers. This group leads on the
organisational response to both internal and external safeguarding adults
work, such as the Safeguarding Adults Assurance Framework (SAAF) which
monitors our work in this work area and is sent to our commissioners.
The SAAG is also responsible for work which has seen Safeguarding Adults
basic awareness training becoming mandatory for all staff. This reflects the
same level of compliance as that for Safeguarding Children. Work is still ongoing to update the electronic staff record so that attendance can be properly
reported on. The SAAG has overseen the development of an internal
Safeguarding Adults strategy, which reflects the local joint policy but clearly
defines the internal structures to manage compliance.
Why is this a priority?
30
The Francis Report into Mid Staffordshire Hospital and the successful
prosecutions of staff from Winterbourne View have kept the theme of
Safeguarding Adults firmly in the public eye over the past year. Public interest
has never been greater, and it is vitally important that MKCHS can show a
robust response to these and similar issues.
What are the outcomes from the work developed?
This year saw a particular challenge to our Safeguarding Adults
response with the Care Quality Commission (CQC) visit to the
Campbell Centre in August. Their report highlighted, amongst other
things, the need for work to raise awareness about Safeguarding
Adults at the Campbell Centre. This has led to a programme of training
and incident monitoring that has seen 95% of staff given training to
support them in their role and to ensure that concerns are more
appropriately raised. Alerts sent to the Adult Social Care Access Team
(ASCAT – the Local Authority team that deals with Safeguarding Adults
alerts) have, since the commencement of the training programme,
increased markedly. Furthermore, a new post of Safeguarding Adults
Lead Investigator has been created within Mental Health services, and
a team of specialist investigators will be created around it to manage
investigations in a more structured and transparent way.
Safeguarding Adults basic awareness training has, from January 2013,
now been made a mandatory training session for all MKCHS staff. This
brings the subject into line with requirements for Safeguarding
Children. Work is on-going to ensure that staff compliance can be
monitored: this involves not just providing appropriate training
opportunities, but also updating the Electronic Staff Record system so
that attendance can be recorded in line with other mandatory courses.
Two further developments are the benchmarking exercises where
Clinical Governance staff and colleagues from social care jointly
monitor clinical incidents to ensure that Safeguarding Adults alerts are
being raised appropriately by staff across MKCHS. These have shown
a good degree of consensus and indicate that the thresholds for raising
alerts are understood by both parties: this is important in ensuring that
advice given to clinical staff reflects good practice.
Finally, we are in the process of setting up a Safeguarding Adults
Champions group to promote the integration of the Safeguarding
Adults agenda into all clinical workstreams.
3.2 Clinical Effectiveness
3.2.1 High Quality Workforce
Milton Keynes Community Health Services employs around 1000 staff,
around two thirds of whom hold professional qualifications, either as doctors,
nurses, therapists or other technical staff.
31
Why is this area a priority?
The key to providing excellent care to those who use our services is to ensure
that we recruit and retain a skilled and competent workforce. Most of the
healthcare budget is spent on staff. Therefore the quality of our staff, how
motivated and committed they are to their jobs, can really affect the standard
of care provided to patients and service users. It is important to ensure that
staff are effectively trained, given opportunities for development and feel
engaged in the work they are doing.
Staff Charter
We implemented a ‘staff charter’ this year, which sets out the
values of the organisation. These centre around treating people
with dignity and respect, working in partnership and being
committed to high quality, person-centred care. To make this
real for people we set out our commitment to staff and our
expectations of them in all our job descriptions and policies.
This helps to ensure that we can deliver health care in ways that meet the
needs of the people who use our services.
Training
We have been working hard to ensure that our staff receive all the training
defined as mandatory – this covers issues such as infection control, load and
patient handling and safeguarding children. Currently over 80% of staff have
undertaken the training and we continue to work towards increasing this. In
addition, we have been developing the use of e-learning across a range of
subjects and this has increased staff access to training, as borne out by the
staff survey results shown below. In addition, staff have accessed training to
develop their skills in a wide range of areas – for example, we held a
conference on sharing best practice around dementia and over 100 of our
staff attended.
Staff Survey 2012
We are pleased that the Staff Survey 2012, which benchmarks us against
similar organisations, indicates that staff motivation and ability to contribute to
improvements at work are above average and that the overall staff
engagement score is one of the best in the country and has improved
significantly since last year. Indeed, in seven areas of the staff survey, such
as quality of work and patient care, receiving job relevant training and staff
motivation we had the highest score of all community services organisations.
The table below highlights some results from the survey, which benchmarks
us to similar organisations. We are pleased to see that staff generally enjoy
their work, are well trained and are able to contribute to making improvements
at work.
32
Issue
2011
2012
Similar
organisations
Quality of work and patient care
74%
76%
Staff receiving training and development
in last 12 months
Staff receiving an appraisal
82%
85%
82%
(best)
86%
(best)
90%
Fairness and effectiveness of incident
reporting procedures
Staff able to contribute to improvements at
work
Staff job satisfaction
3.57
3.69
3.54
65%
68%
3.54
76%
(best)
3.78
Staff recommendation of the trust as a
place to work or receive treatment
Staff motivation at work
3.50
3.76
3.58
3.92
3.98
(best)
3.82
Staff reporting good communication
between senior management and staff
35%
46%
(best)
28%
82%
88%
3.61
(summary scale)
Recruitment and Retention
Although there are a few occasions when it is difficult to recruit staff, we have
had no major recruitment issues this year, despite the year of organisational
uncertainty. We have been able to reduce the use of temporary and agency
staff in the clinical areas, which saves us money as well as ensuring a good
quality service for patients. As our staff turnover rate increased during the
year, we carried out a review of leavers and as a result have made some
improvements to the way we capture information from those leaving the
organisation.
Sickness absence rates have risen slightly during the year, reflecting
pressures that staff are under, but we have put in place additional targeted
support and the absence rate now shows signs of reducing.
All new staff are subject to employment checks on commencing employment,
which continues to ensure a safe and effective workforce.
3.2.2 Patient Safety Thermometer
The NHS Safety Thermometer is a national tool which the Trust uses to
measure the rate of patient harm occurring form the 4 harms identified in the
tool; it is essentially a survey which is carried out on those patients receiving
care on a given day every month. The tool looks at the whole patient pathway
and as such captures harm which may have happened even before the
patient was admitted to our services (in the case of pressure ulcers, UTI &
VTE) as well as harm that may have happened whilst receiving care from our
services. MKCHS has implemented the Safety Thermometer since its
introduction in February 2012 initially using it to measure harm on pilot sites
only. The Thermometer has been rolled out across relevant community
33
services and is now being used to measure harm across areas in the
organisation where harms may occur.
Why is this area a priority?
Previously, scrutiny of ‘harms’ has concentrated on the individual harm itself and
has not looked for links between them. This new approach provides a richer
picture of organisational safety and quality. It also allows us to be clear about
what we mean by ‘harm free care’, as shown by the table below.
The harmfreecare programme is looking at all four harms with an overarching
ambition to deliver harm free care defined by the absence of pressure ulcers, harm
from falls, catheter acquired urinary tract infections and blood clots in 95% of our
patients. The VTE element has not been measured to date in MKCHS, however
there is a roll out programme in place to be able to implement this element starting
at Windsor Intermediate Care Unit from May 2013.
What are the outcomes from the work developed?
Milton Keynes Community Health Services currently collects data from four service
areas - HMP Woodhill in-patient area, Windsor Intermediate Care Unit, The Older
People’s Assessment Service and all of the District Nursing teams. Each month,
approximately 320 patients are included in the assessment.
From April 2013, additional teams will be formally collecting data: Early Stroke
Rehabilitation Team, Rapid Access and Intervention Team and the Home to
Stay Team.
Results over the last year demonstrate a steady and continuous decrease in
harm from pressure ulcers and falls. The focus for the coming year is to
maintain this trend and to share improvements in practice and learning across
the services and teams that are participating in the programme.
Table 1 shows the number of patients per month who have developed ‘new’ harms.
These are categorised as harm that the patient has developed whilst in our care
e.g. pressure ulcer or within the last 72 hours. When looking at Table 2, we can
see the gradual but continuous improvement in relation to numbers of all ‘harm.
34
Table 1 - New ‘harms’
Table 2 – All ‘harms’
35
Perhaps the most significant data is shown in the table 3 below, this identifies
the number of patients per month that have been ‘harm free’, gradually rising
from 84.4% in March 2012 to 95.5% in March 2013.
Table 3 – Harm Free
Over the next 12 months we will use this data in a meaningful way to continue to
improve practice and provide safer care to our patients. We will use this data to
complement other methods of measurement used within the organisation to ensure
that trends are analysed to inform improvement work.
3.2.3 Patient Experience
Our aim for 2012/13 was to embed our Patient Experience Strategy ensuring
our patient experience campaigns prioritised the needs of our most vulnerable
service users, including people with characteristics protected under equality
and diversity law, mental health service users, those who access our
children’s services and people with learning disabilities. We worked with the
services to ensure they were using a range of methods to engage with their
service users, providing feedback to them and making improvements within
year.
Through the Patient Experience Steering Group, services were invited to
submit campaign ideas that would improve the patient experience. Group
members were asked to take into account national initiatives and/or local
areas of concern, including complaints and incidents to decide which
campaigns to support. The campaigns chosen for 2012-13 were:
36
The introduction of the friends and family questionnaire
Mental health service transformation – engagement during transition
Pressure ulcers – how does it feel to be a patient?
Achieving consistent, directorate wide feedback in children’s services
Access to podiatry clinics
Collecting user experience feedback from people with learning disabilities
Each campaign has made considerable progress in 2012/13 which has
significantly contributed to the patient experience agenda.
Campaign 1: The introduction of the friends and family questionnaire
Background
This year’s patient experience agenda was heavily influenced by a local
quality (CQUIN) target, which required Milton Keynes Community Health
Services to:
establish the friends and family question and ensure it is used within all
local patient experience/satisfaction surveys
establish a system for collating patient stories
establish a baseline score (for the question) for each service/directorate
report quarterly to the Board and Commissioner at organisational,
speciality and service level, including how patient experience and stories
have impacted or will impact on changes to services
achieve a ten point improvement in the score (for the question) from
quarter one to quarter four.
The friends and family question was developed to measure the local
population’s perception of the health care they received. It asks how likely a
service user would be to recommend the service to friends and family with the
responses ranging from extremely likely to not at all. The campaign’s aim was
to ensure that every service undertook a survey which included the friends
and family question to get baseline results. The results were discussed and
fed back to patients and the Board and there was a commitment to achieve a
ten point improvement in the score within year. The campaign also included
establishing a system for collecting patient stories.
What happened?
The friends and family test question has
been rolled out as standard across all
services, along with seven additional
questions to measure experience. Services
had the choice of using the original or an
easy read version of the questionnaire.
They could use a variety of methods for
collecting the results, including patient
experience trackers, paper based surveys, postcards and a more recent
addition of an online survey. The results were collated by the patient
experience team on a monthly basis and fed back to services to share with
their teams and service users.
37
The process of implementation has been a challenge for some of our
services, particularly those who did not have an existing survey in place.
However, theorganisation’s response rate has increased substantially over
the three quarters from 185 respondents in quarter one to 1,641 respondents
in quarter three.
Services are making changes based on the feedback they receive and are
providing feedback about these changes to service users using ‘You said, we
did’ posters. The changes include:
more visible name badges for the health visiting team
better patient information within the district nursing service
the introduction of a quiz afternoon and ‘film Friday’ at Windsor
Intermediate Care Unit
additional speech and language therapists at ‘drop in’ clinics to reduce
waiting times and to reduce the need for additional follow up
appointments.
In addition, the qualitative feedback is being used on the homepage of our
website so that staff and service users can see what people using our
services think of us.
Raising the profile of the patient experience has delivered another major
benefit, a subtle change in culture. Although we have seen a drop in our
family and friends test score, the number of responses has increased. This
will make it difficult for us to meet our ten point improvement by quarter four
but the changes seen and reported by patients are a great success.
Our quality (CQUIN) target also required us to develop a system for collecting
patient stories. We did this through the friends and family questionnaire,
focus groups and the complaints process.
Five patient stories have been collected from district nursing, Windsor
Intermediate Care Unit, mental health and the health visiting team. The
stories have been filmed and presented to the Board and Patient Experience
Steering Group. They have also been placed on the home page of our
website, where consent was given.
The patient stories have made the most impact on staff. Where actions were
identified, follow up work has been completed. Additionally, staff watching the
films have reported taking the lessons away from the session and applying
them in their own areas. Services are also using them as part of their staff
training programmes.
What next?
The friends and family question will not be a national requirement in 2013/14
for community health services; however it is likely to be set as a local quality
(CQUIN) target.
Irrespective of the target, as an organisation, we will continue with the process
of surveying our service users and will adapt the questions accordingly. We
may consider surveying discharged patients in line with the national target
38
and taking a different approach for our services that do not frequently
discharge patients.
Campaign 2: Mental health service transformation - engagement during
transition
Background
The Mental Health Joint Services campaign aimed to establish a strong
service user and carer feedback process to support the mental health service
change (transformation) programme.
What happened?
The feedback process was developed through a series of informal service
user and carer forums, which were widely advertised. The forums covered
patient’s experiences of the Access and Short Term Intervention service
(ASTI), dementia and care planning. Although the number of attendees
varied, we gained valuable insight into how it felt to be a patient. Following
each forum, a summary of the meeting and associated actions were
distributed to all the service users who attended. A few months later this was
followed up with an update of the changes that had taken place as a result of
the feedback.
Changes that took place at the ASTI service included an increase in the
number of customer liaison officers, improved call handling equipment and
longer opening hours.
What next?
The forums were successful so they will continue throughout 2013. We have
received feedback from service users, carers and LINk:MK (now Healthwatch)
on the planning, timing and topics for this year’s programme. Taking this
feedback, national targets, local initiatives and any areas of concern into
account, this year’s forums will be based on:
Planning care, understanding the care planning approach
Support for carers
Meeting the needs of young people
Dementia care
Support during recovery
Campaign 3: Pressure ulcers – how does it feel to be a patient?
Background
Research has shown that a patient’s experience of the care they receive can
be negatively impacted upon if they also have a pressure ulcer.
The pressure ulcer campaign aimed to eliminate avoidable grade two, three
and four pressure ulcers by December 2012. The key elements of the
campaign included the development of supporting information for patients and
carers on pressure ulcer prevention and early detection; involving patients in
39
selection of pressure relieving equipment and patient feedback on living with a
pressure ulcer.
What happened?
A patient information leaflet has been developed, printed and distributed. It is
being translated into an easy read version with the support of the learning
disabilities team and the ‘Check it out’ service user group.
A month’s trial of pressure relieving mattresses took place at Windsor
Intermediate Care Unit. Patients were asked to provide feedback on them
taking into account noise, comfort and if they found themselves more prone to
slipping. The mattress that was most popular has been purchased and it now
replaces all 19 our mattresses in the Unit and is complemented by the
installation of new beds.
Two patient stories relating to pressure ulcers have been filmed and one has
been used for a dedicated staff training day on pressure ulcers.
What next?
The campaign met its objectives. However, we will continue using the videos
for staff training and the pressure ulcer leaflet will be evaluated at the end of
the year.
Campaign 4: Achieving consistent, directorate wide feedback in children’s
services
Background
The objective of the campaign was to develop a more consistent approach
across the directorate to securing feedback from children and young people,
and their parents and carers about their experiences of using our services. It
was recognised that some teams had good mechanisms in place to do this
and others did not.
What happened?
In June 2012, service leads undertook a mapping exercise, agreed the next
steps for the campaign and developed an implementation plan.
In August 2012, a set of standard questions for use in the Directorate were
agreed and an easy read version was developed for use with younger service
users. A LINk:MK (now Healthwatch) representative was identified to support
the campaign, though most services identified service representatives suitable
for their specific service areas too. The use of electronic trackers to collect
patient feedback in line with national guidance was trialed and a number of
services found these beneficial.
The feedback from services users has been largely positive and where
change was identified action has been taken. Examples include:
40
The purchase of clearer name badges (in addition to identity badges)
where service users reported that they did not know the member of staff
treating them
The development of ‘You said, we did’ posters which have also been put
on a Facebook page for speech and language therapy service users.
From January, a post diagnostic parent support group is being piloted in
the community paediatric service. This is to support parents who have
reported long waits to access the parent training programme.
The parent training programme has been amended to facilitate and allow
more time for discussion.
Parents can now return assessment questionnaires directly to the service,
rather than via the GP practice. A stamped address envelope is provided
to do this.
What next?
The main objective for this campaign has been achieved as each service now
takes part in monthly feedback. Next steps are to ensure all services
consistently provide feedback to their service users in an appropriate way. In
2013, the Directorate will review the feedback twice a year to be aware of and
to address common themes.
Campaign 5: Access to podiatry clinics
Background
The aim of the campaign was to explore the access
issues service users faced when they attended podiatry
clinics in Milton Keynes. Concerns had been raised both
internally and via LINk:MK (now Healthwatch) about the
lack of reception staff to greet or to book in with when
they attend appointments, poor lighting and signage, and
inadequate facilities to support service users with
sensory impairments.
Three podiatry clinics were identified (Eaglestone Health Centre, Neath Hill
Health Centre and Bletchley Therapy Unit) and a working group was
established in conjunction with LINk:MK (now Healthwatch) to discuss with
service users the problems faced by them when attending these sites and
what improvements could be made.
What happened?
A survey was developed and conducted from 20 November 2012 to 30
November 2012. It asked questions about the information in appointment
letters, internal and external signage, designated drop off points and disabled
parking bays, getting to the clinic, presence of podiatry reception desks and
receptionists, and accessibility to the clinic room. A total of 80 responses were
collected across all three clinics.
Discussion with service users found they reported apprehension and
frustration but also praise for the service and staff. All routine patients
(including patients with sensory impairment) have “got used to” the process
41
and procedures of the service and know their route; whereas, new patients
cited difficulties in accessing the service at the beginning of their care
pathway and found the signage inadequate.
The survey and discussions highlighted a number of areas for improvement
which has resulted in the following actions:
New patient information leaflets (a different one for each of our six clinics)
have been introduced. They provide information on what to expect at the
first appointment, what to wear and bring with you, a map, and what to do
on arrival at the clinic.
Improvements to physical signage and maintenance of clinics, these are
currently being organised by our Estates and Facilities department.
Some of the actions identified were beyond our capacity and remit to
change as MKCHS does not own the facilities it uses.
What next?
The action plan and recommendations will be monitored by podiatry team
leads; they will provide feedback on progress to the Patient Experience
Strategy Group and Patient Experience Team.
Outcomes will be fed back to staff at team meetings, and service users
through “You said, we did” posters.
The work supports the findings of a similar project undertaken by our
Communications Department to improve access to buildings across all our
services.
Campaign 6: Collecting user experience feedback from people with learning
disabilities
Background
The aim of the campaign was to establish a way of collecting user experience
feedback from people with learning
disabilities.
People with a learning disability in Milton
Keynes need to be able to access health
services and have their needs effectively
met. The Health Action Team (within the
community team for adults) has done a lot of
work to improve access for this client group
and to help address health inequalities.
However, there had been limited feedback
from people with a learning disability.
What happened?
An easy read questionnaire, suitable for the client group to understand, was
developed in an electronic format. The ten questions were primarily about
health appointments and how adults with a learning disability found their
42
experience when attending their appointment. The survey covered
attendance by this client group at one of eight different services we offer.
The feedback for this project was collected at the ‘Big Health Day’ in May
2012. In total, 61 people took part in the survey.
The results of people’s experiences were then converted into easy read bar
charts for the client group to understand. The results were discussed at the
‘Check it out’ subgroup, a subgroup of the Learning Disability Partnership
Board. The overall feedback response indicated that our services were rated
as good.
What next?
The ‘Check it out’ subgroup felt that GPs and pharmacies were the most
important people to send the information and feedback gained from the
survey to as they are the first point of contact with the health service for many
people. The Group offered to do some training with them to show them how to
use an easy read version of the tracker. They also asked for the survey to be
circulated to all our senior managers so best practice could be shared across
the organisation. The team aims to repeat the survey in 2013 and will collect
carers’ views this year too.
Summary
In 2012/13 all campaigns have achieved their aims to involve service users
and to improve their experience of our services.
The implementation of the friends and family questionnaire brought about
real change for our service users and has led to a change in staff attitudes,
increasing morale for many services.
We have been able to show our service users that we are listening to their
experiences at every level from the Board to the ward using the patient
stories. This will continue to be a powerful training tool for the coming
year.
Our work with our mental health service users as part of our change
programme has provided us with a valuable insight into how it feels to be a
service user and a carer in our inpatient units and in the community. We
have also had the opportunity to provide feedback to those who took the
time to tell us about their experience, informing them of changes that have
been made as a direct result of their input.
Working with our learning disability service users and their carers has
highlighted the importance of taking the time to engage with those service
users whose voice is often not heard. Learning from this work is being
shared across the organisation in a variety of areas from children’s
services to patient transport.
We have been able to show that we are acting on local concerns with our
access campaign. The feedback will be considered when we are planning
changes to some of our buildings and a change to our patient information
has provided service users the information they have asked for prior to
their appointments.
43
Developing a systematic approach to gathering feedback from our younger
service users and their carers has enabled us to better plan the services
we offer in line with what they need.
Our aim for 2013/14 will be to build on this year’s success. We will continue
to look for new ways to engage with our service users, particularly those
whose voices are not often heard. We will also continue to ensure that
feedback from service users is used to develop and improve our services and
that we respond with news of changes we have made quickly and effectively.
3.3 National Quality Board Mandatory Reporting
In February 2012 the Department of Health published new Quality Account
reporting requirements for 2012/13. In the past local flexibility in the content of
the Quality Account gave a strong local ownership to the document which
allowed reflection of local priorities and circumstances. However this meant
that comparable performance with other organisations was not always
possible. The new mandatory sections have been introduced in order for the
local population to assess if an organisations performance is good or poor
against other NHS Organisations.
Out of the 10 new mandatory indicators 5 are relevant to MKCHS. These are
as follows:
Domain 4: Ensuring that people have a positive experience of care.
Responsiveness to in patients personal needs.
Percentage of staff who would recommend the organisation to
friends and family needing care.
Domain 5: Treating and caring for people in a safe environment and
protecting them from avoidable harm.
Percentage of admitted patients risk –assessed for Venous
Thomoembolism ( blood clots)
Rate of Clostridium difficile infection
Rate of Patient Safety incidents and percentage resulting in sever harm
or death.
3.3.1 NHS Outcomes Framework Domain 4 -Ensuring people have a
positive experience of care
Responsiveness to inpatients’ personal needs
This score is based on the average of answers to five questions in the CQC
national in patient survey. Each question is scored on a scale of 1-10, where
10 represents the best possible response, therefore, the higher the score for
each question, the better the performance.
1. Were you involved as much as you wanted to be in decisions about
your care and treatment? Of those patients surveyed, the average
scored for Milton Keynes was 7.5 for the questions that related to
44
2.
3.
4.
5.
involvement in care. This is comparable to the average national score
in this category.
Did you find someone in the hospital staff to talk to about your worries
and fears? Of those patients surveyed, the average scored for Milton
Keynes for those questions that related to listening and responding to
concerns was 8.0; this is slightly below the national average for this
category which was 8.5.
Were you given enough privacy when discussing you condition or
treatment? Of those patients surveyed, the average scored for Milton
Keynes for those questions that related to privacy and dignity was 9.0,
this is comparable to the national average.
Did a member of staff tell you about medication side effects to watch
for when you went home? Of those patients surveyed, the average
scored for Milton Keynes for the question relating to medication side
effects was 5.1, which is slightly below the national average of 5.7.
Did hospital staff tell you who to contact if you were worried about your
condition? Of those patients surveyed, the average scored for Milton
Keynes was 6.0, which was slightly below the national average of 6.5.
Per cent of staff who would recommend MKCHS to family and friends
The 2012 national staff survey asked respondents to rate the following
statement: Would you be happy for your friends and family to be treated by
your organisation. Sixty-seven per cent of MKCHS staff either agreed or
strongly agreed with this statement, which was an increase of 11% on the
previous year. When comparing MKCHS with other similar NHS trusts using
the scale score of zero to five, the organisation scored 3.76 against a national
average of 3.58.
3.3.2 NHS Outcomes Framework Domain 5 - Treating and caring for
people in a safe environment and protecting them from harm
Per cent of admitted patients risk assessed for VTEs (blood clots)
Throughout 2012/13, the organisation reviewed how it could best adopt the
NICE guidance in its in-patient units. During the year no risk assessments
were carried out for VTEs. However, the NICE guidance will be fully
implemented at the Windsor Intermediate Care Unit, our community in-patient
unit, before the end of May 2013. A review of our other in-patient units will be
conducted later in 2013/14.
Rate of Clostridium difficile
Clostridium difficile can cause symptoms including mild to severe diarrhea
and sometimes inflammation of the bowl, but hospital associated C. difficile
can be preventable. There is a ‘zero tolerance’ approach to infections
acquired in health care settings.
For MKCHS we have three main in patient settings, with only one that this
indicator would be appropriate to. Therefore historically we have not collected
the 2 indicators required. However we can note that for 2012/ 13 there have
been no C.difficile cases in any of our in-patient settings.
45
Rate of patient safety incidents and % resulting in severe harm or death
MKCHS are not at this present time able to report on the required information
for this section which is:
-
The rate of patient safety incidents per 100 admissions.
However the second set of indicators ‘the proportion of patient safety
incidents reported that has resulted in severe harm or death’ is noted below.
Patient safety incidents reported during 2012-13 is provided in the table
below.
Insignificant
Minor - Minimal Harm
Moderate - Short Term Harm
Major harm
Death
Incident Prevented
Near Miss
Number Percentage
626
42.76%
638
43.58%
173
11.82%
2
0.19%
7
0.48%
6
0.41%
10
0.68%
Milton Keynes Community Health Service staff are alert to the need to report
incidents. This is considered very positive by the National Patient Safety
Agency and the Care Quality Commission as it demonstrates vigilance and
transparency.
Two incidents this year involved major harm; in both these cases the person
was a mental health service user and the incident involved self-harm.
These incidents, and the deaths of service users, were reported and
investigated as serious incidents. The outcome of the investigations showed
that two people died of natural causes and five people, who were receiving
outpatient mental health services, died following self-harm.
All serious incidents are properly investigated (using root-cause analysis
methodology) and all recommendations are included on an action-plan which
is implemented by the service. Implementation of the action plan is monitored
at commissioner-led review meetings and learning points are shared with our
3.4
Partners’ statements
Healthwatch Milton Keynes
Healthwatch Milton Keynes (formerly LINk:MK) welcomes the opportunity to
review and comment on the Milton Keynes Community Health Services
Quality Accounts for 2012/13.
We would like to acknowledge the efforts of Milton Keynes Community Health
Service in producing a comprehensive, open and wide ranging report on
Quality Accounts as well as take this opportunity to thank them for involving
LINk:MK and its members in its work for that year. The document is clear and
46
comprehensive, but may have benefitted from the inclusion of information on
how Central North West London will bring expertise that will enhance the
efforts of MKCHS in the coming year, particularly as LINk:MK Executive
Committee Members had involvement in the tendering and procurement
process.
LINk:MK enabled the voice of the patients and the public to be heard and
taken into account in the design and delivery of health and social care
services and will continue to do so as Healthwatch Milton Keynes, the new
independent consumer champion for health and social care. We are pleased
to note that Patient Experience once again been prioritised by MKCHS,
relying on feedback from service users to help make service improvements
and patient satisfaction.
We are also pleased to note the inclusion of Transfer of Care, underlining a
commitment to multi-agency working to improve an area that has been of
concern to Healthwatch Milton Keynes, which we have worked on throughout
the previous year with MKCHS.
Healthwatch Milton Keynes wishes to congratulate MKCHS on the “Access to
Services” project undertaken in a number of services last year as a result of
LINk:MK issues, and for involving LINk:MK members in the practical part of
that project. Healthwatch Milton Keynes would have liked to have seen this
included in the Quality Accounts.
MKCHS Quality Accounts shows dedication in involving patients and the
public in the design, development and delivery of health and social care
services including continuous efforts in making service improvements. We are
equally committed in extending our help and support to MKCHS in the future
to enable the citizens of Milton Keynes to participate and influence the
commissioning and delivery pathways across all of their services and look
forward to receiving and reviewing a local report next year.
Milton Keynes Clinical Commissioning Group
The CCG can confirm that the information in the Quality Account is accurate
and fairly interpreted, and that the range of services described is
representative.
The document describes achievements in 2012/13 including:
1. Improvement s in transfer of care to support people to stay and home
or for those admitted to hospital to be transferred home as quickly as
possible. Successful initiatives include establishment of a home to stay
team, development of the Rapid Access and Intervention Team,
support for intravenous treatment , support for end of life care, diabetic
specialist team and community matrons and telecare;
2. Improvement in infection prevention and control resulting in an overall
cleanliness score of 91.6% against a target of 88.6%;
3. PEAT scores in the Campbell centre, the Older Peoples Assessment
Service and the Windsor Intermediate Care Unit in line with national
average comparators The dignity and privacy score remained excellent
across all three sites;
47
4. Improvements in safeguarding adults arrangement including training
and incident monitoring;
5. Strengthening of advice available for staff in relation to safeguarding
children;
6. Above average staff survey results with overall staff engagement score
being one of the best in the country;
7. The roll out of the patient thermometer tool across all relevant
community services resulting in a steady and continuous decrease of
harm from pressure ulcers and falls;
8. Embedding of the patient experience strategy.
All CQUIN’s were achieved and details of participation in national and local
clinical audits included. The hard work and commitment this achievement
represents is to be commended.
The CCG fully supports the priorities for improvement for 2103/14 including:
1. Improving patient safety through ensuring safe transfer of care by
working in partnership with local health and social care providers to
reduce the number of care incidents and the potential for preventable
harm;
2. Improving clinical effectiveness through achievement of zero avoidable
pressure ulcers;
3. Improving patient experience by prioritising responsiveness to patient’s
needs. The impact will be measured by exceeding the national average
score on the CQC national inpatient survey for the MKCHS Mental
Health Services; achieving the friends and family test across all
services and achieving a year end position within the top 50% of the
national result; and improving on the 2012 national staff survey result.
The CCG welcomes the opportunity to work collaboratively with MKCHS and
further strengthen the relationship to support continuous improvement in
quality of care provided to patients. We are confident that MKCHS will
continue to deliver improvements in quality for all patients who access
services.
Milton Keynes Health and Adult Social Care Select Committee
Having scrutinised the Account, the Panel then commented specifically on the
following points:
1. On page 7 reference was made to the Milton Keynes Safeguarding Adults
Board. The Panel felt that the Account needed to be clear that the
Safeguarding Adults Board did not adopt strategy itself, but was there to
advise other organisations on how to develop their own strategies;
2. The Panel thought that for clarity, more information on the transfer to the
Central North West London (CNWL) NHS Foundation Trust would have
been helpful but acknowledged the Quality Account covered the period
prior to the transfer on 1 April 2013 and that there would be more
information about the transfer in the 2013-14 Account;
3. The Community Health Service saw the Transfer of Care as the start of a
journey. It was a big issue in Milton Keynes and had been for a number of
48
years. Due to the large remit it covered it continued to be a priority for the
Community Health Service and included a current discussion of
community based care and the use of personal health budgets;
4. The HealthWatch representative commented that HealthWatch received a
lot of queries about the transfer of care and the priority given to it by the
hospital. Ms Weetman agreed that the transfer of care process was not as
good as it should be in Milton Keynes and that hopefully, by treating this
as a priority issue, a marked improvement would be seen by the end of the
year;
5. The Panel noted what appeared to be a lack of involvement in clinical
audits during 2012-13. Ms Weetman agreed that the Community Health
Service had struggled with these in the past year although it should be
noted that clinical audits did not have to be carried out every year. She
acknowledged that they had not done as many during the year as they
would have liked and will ensure that the issue is addressed in the future;
6. The Panel noted with approval that the spend on home based care was
rising whilst the spend on hospital based care was going down. It was
hoped that there would be a sustained investment in home care across the
health service in the future;
7. The Panel expressed concern as to whether the Community Health
Service was in a strong enough position to deal with mental health issues
in Milton Keynes and whether enough was known about the services
provided at the Campbell Centre. Ms Weetman felt that following the
transfer to CNWL the Community Health Service was now in a very good
position to deal effectively with the provision of mental health care in Milton
Keynes;
8. The Panel recommended that the Director included a brief statement
about the work being done / services provided by the Campbell Centre in
her introduction in order to re-assure the general reader;
9. In the Director’s introduction “the Health And Community Wellbeing Select
Committee” should be changed to read “the Health and Adult Social Care
Select Committee”;
10. Once again the section in the Quality Account dealing with the patient
experience was deemed to be excellent.
The Panel’s final assessment was that based on last year’s successful format,
this was a very thorough account which contained all the information about
the Milton Keynes Community Health Service anyone was likely to need. It
was a readable Account which would be understood and appreciated by the
general reader.
3.5
How to provide feedback on the account
Your comments and feedback are always welcome and will help us to shape
the future healthcare provision in Milton Keynes.
If you wish to comment or provide feedback on any aspect of this report
please contact us on 01908 243933 or communications@mkchs.nhs.uk
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Glossary
Throughout this document we have fully explained abbreviations, here are the
few exceptions.
CCG
CNWL
COPD
CQC
CQUIN
DoH
E4E
EMSHA
FNP
HCAI
IPC
IV
JNCC
LINk:MK
LMT
MKCHS
MKSCB
MMSE
MRSA
NHSLA
NICE
NPSA
PCT
PEAT
QA
QC
QIPP
QRP
RAIT
RCA
R&D
RiO
SpCAMHS
TOPAS
UTI
VTE
WICU
Clinical Commissioning Group
Central and North West London NHS Foundation Trust
Chronic Obstructive Pulmonary Disease
Care Quality Commission
Commissioning for Quality and Innovation
Department of Health
Energising for Excellence
East Midlands Strategic Health Authority
Family Nurse Partnership
Healthcare Acquired Infections
Infection Prevention and Control
Intravenous
Joint Negotiating Consultative Committee
Milton Keynes Local Involvement Network (now Healthwatch)
Leadership Management Team
Milton Keynes Community Health Services
Milton Keynes Safeguarding Children’s Board
Mini Mental State Examination
Meticillin-resistant Staphylococcus Aureus
National Health Service Litigation Authority
National Institute of Clinical Excellence
National Patients Safety Agency
Primary Care Trust
Patient Environment Assessment Team
Quality Account
Quality Control
Quality, Innovation, Productivity and Performance
Quality Risk Profile
Rapid Access and Intervention Team
Root Cause Analysis
Research and Development
Clinical records data collection system (Rivers of Information)
Specialist Child and Adolescent Mental Health Service
The Older People’s Assessment Service
Urinary Tract Infection
Venous Thrombo Embolism
Windsor Intermediate Care Unit
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© Milton Keynes Community Health Services (Part of Central and North West London NHS Foundation Trust)
MKCHS Headquarters, Hospital Campus, Eaglestone, Milton Keynes, MK6 5NG
Telephone: 01908 243933
Email: communications@mkchs.nhs.uk
Date: June 2013
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