Quality Report
2012 - 2013
oxleas.nhs.uk
Contents
Glossary of Abbreviations
AOT – Assertive Outreach Teams.
BMI – Body Mass Index
BP – Blood Pressure
CAMHS – Children and Adolescent Mental Health Services
1.0
Chief Executive’s Statement on Quality
2.0
Quality Priorities for Improvement4
2
2.1 Review of our how we did (Performance) against 2012/13 priorities 4
CDiff – Clostridium Difficile
2.2 Patient Experience
CLRN – Comprehensive Local Research Network
2.3 Patient Safety
10
2.4 Clinical Effectiveness
14
2.5 Our Quality Improvement Priorities for 2013/14
22
2.6 Statements of Assurance from the Board
27
CORC – Child and Adolescent Mental Health Services Outcomes Research Consortium
CPA – Care Programme Approach
CQC – Care Quality Commission
CQUIN – Commissioning for Quality and Innovation
HCI – Healthcare Quality Improvement Partnership
HPV – Human Papilloma Virus
HQIP – Healthcare Quality Improvement Partnership
ICT – Intermediate Care Teams
3.0
6
Other Quality Performance Information42
3.1 Changes to Quality Indicators
43
3.2 Quality Highlights and Case Studies
43
MH – MH – Mental Health
3.3 National Staff Survey
54
Monitor – Foundation Trust Regulatory Body
3.4 National Patient Survey
56
3.5 Oxleas Complaints Report 2012
58
Annex 1
Feedback from our Stakeholders
60
KPI – Key Performance Indicator
LD – Learning Disabilities
LTC – Long Term Conditions
MRSA – Methicillin Resistant Staphylococcus Aureus
OPEQ – Oxleas Patient Experience Questionnaire
POMH – Prescribing Observatory for Mental Health
QOF – Quality and Outcomes Framework
QSIP – Quality and Safety Improvement Plan
RCA – Root Cause Analysis
RiO – Electronic Clinical System
VTE – Venous Thromboembelism*
Annex 2
Statement of directors’ responsibilities in respect of the Quality Report 65
Annex 3
Criteria applied to mandated indicators
67
Annex 4
Independent Auditor’s Limited Assurance Report
69
1
Oxleas NHS Foundation Trust
Quality Report 2012/13
Quality report
Part 1
Specific examples of these actions include the
introduction of values based recruitment and
the use of multisource (360-degree) feedback
in staff appraisals.
Chief Executive’s
Statement on Quality
The National Patient Survey is a valuable source
of patient feedback and one of the measures
used by CQC to rate our performance. Our 2012
results showed that we have improved in many
areas when compared to the results of the
2011 survey. The report also showed that there
are some areas that still require further focus,
such as giving information about medication
to people who use our services. We have put a
robust plan in place for these areas and have
explained this in more detail in the report.
Welcome to our annual Quality report for
2012/13. Through the following pages, we
will demonstrate how we have fulfilled our
commitment to providing high quality NHS
services to all of our patients by setting out:
•our approach to quality improvement,
performance against the quality priorities
•oweurset
for ourselves,
•our priorities for 2013/14.
The National Patient Survey is only one way in
which we gather information. We use a variety
of methods across our services to ensure that
we collect, analyse and act on the feedback of
the people in our care. This information is now
published on our website www.oxleas.nhs.uk in
our newly-developed patient experience section.
In addition to these systematic approaches
to gathering feedback from our patients, the
executive and non- executive directors of the
trust will continue their practice of visits to
services; to listen to patients and staff. These
visits ensure that the most senior members
of the trust never lose sight of our essential
purpose as a trust, and provide patients and
front-line staff with opportunities to give
feedback.
We will also highlight some of the quality
initiatives that have been undertaken across
Oxleas this year.
This has been a busy year for us and our services
have operated in a demanding environment,
including the unique challenges presented by
London hosting the Olympic and Paralympic
games.
The publication of the Francis Report findings
on Mid Staffordshire Hospital provided shocking
reading and sobering reflection in Oxleas, as
no doubt it did in many NHS organisations. In
response to the report’s recommendations,
we have redoubled efforts across the trust to
ensure we continue to put patients first, provide
safe care and offer effective treatments that will
lead to positive health outcomes. Furthermore,
we ensure that we treat patients, their friends
and family members with compassion, dignity
and respect, and give people every opportunity
to have a say about our services.
Our on-going focus on the implementation
of the Productive Series continues to improve
quality and to demonstrate the effectiveness
and productivity of teams. This along with
the use of newer technologies in clinical care
ensures that our staff have more time to care.
Furthermore, both the Medical Director and the
Director of Nursing and Governance provide
assurance that our efficiency savings do not
adversely affect the quality of the services we
provide.
We are delighted to have ended the year with
very high approval ratings for the quality of our
services from both Monitor and the Care Quality
Commission. Our 2012 staff survey was the best
in London and the South of England and we are
very proud that colleagues in Oxleas are more
likely than staff in any other trust in the country
to say they are satisfied with the quality of care
being delivered to patients. We are determined
to maintain these high standards throughout
2013/14.
We continue to have quality meetings with
our local clinical commissioning groups on a
quarterly basis. These meetings provide local
GPs commissioners with the opportunity to
monitor the quality of our services by reviewing
information related to the three quality domains
of patient experience, patient safety and clinical
effectiveness.
I hope the following pages give you an insight
into what we have done to make this a reality
for our patients, carers, and staff. Our Quality
report is based on information gathered both
within the trust and externally; the contents
have been reviewed by our Governance and
Quality Boards and are to the best of my
knowledge accurate.
Signed
Stephen Firn, Chief Executive
29 May 2013
Oxleas NHS Foundation Trust
Annual Report and Accounts 2012/13
2
3
Oxleas NHS Foundation Trust
Annual Report and Accounts 2012/13
Quality report
Part 2
And
ave our stakeholders (staff, patients,
•Gcarers,
our members, the wider public and
2. Quality Priorities for
Improvement
local Primary Care Trusts) an opportunity to
comment on the areas we needed to focus
on in the coming year 2012/13.
This section forms Part 2 of our Quality report
and will provide an update on our priorities for
improvement and statements of assurance from
our board.
Our compliance framework, patient experience
surveys, incident reporting, engagement
meetings with staff, our service users, our
Council of Governors and quality meetings with
our commissioners also contributed to this
process.
Oxleas NHS Foundation Trust (Oxleas) is
committed to delivering quality services and we
have worked in partnership with staff, patients,
carers, our members, commissioners, GPs and
others to identify areas for improvement.
As an NHS healthcare provider, we aim to ensure
that quality is at the forefront of everything
we do and are aware that certain goals may
take more time to achieve or embed. Tables
1-10 below gives a summary of what goals we
achieved at the end of the financial year, 31
March 2013.
Our Quality report gives us an opportunity to
share with you our performance against our
priority areas for 2012/13, describe our priority
areas for 2013/14 and showcase notable and
innovative practice.
This section also highlights in detail our
performance against some of the quality
goals outlined in the table summaries. We will
highlight areas we have done particularly well
in and areas that require further focus to ensure
improvement in future. The detail is provided
in three domains: patient experience, patient
safety and clinical effectiveness.
2.1 Review of how we did
(Performance) against
2012/13 priorities
Last year, we had 45 improvement goals for
focus spanning the three quality domains of
quality: patient experience, patient safety
and clinical effectiveness. Our progress was
monitored through the year by our trust quality
board. We utilised a number of sources to help
determine the 45 quality priorities for 2012/13.
Where available, we have included data
from previous years’ quality reports, for
comparison and to evidence progress. This
includes published national audit results from
the Prescribing Observatory for Mental Health
(POMH) and national surveys of patient care
and satisfaction. With the exception of national
patient surveys, we use information from our
electronic patient record, RiO, our staff training
database and local audits or surveys to measure
achievement of these priorities. We have also
included what performance data is determined
by local or national definitions
In January and February 2012, as in previous
years, we held 3 borough based (Bexley, Bromley
and Greenwich) focus groups to ensure that:
gave feedback on how we were
•We
progressing in delivering the priorities set out
for 2011/12;
Oxleas NHS Foundation Trust
Quality Report 2012/13
Our performance has been compared to the
national average for POMH UK audits in the
following pages however all other data has not
been compared to other Trusts. Comparable
data for national priorities are presented in
section 2.6.11. For ease of reference, a glossary
of all terms and acronyms used is provided at
the end of the report.
4
5
Quality report
We have used the following symbols to denote how well we performed against the quality priorities:
Increase the
proportion of patients
who say they were involved in their care plans
66%
88%
86%
87%
Ensure care plans
are in the patients RiO - Local
electronic record (RiO)* 98.6% 99.2% 98.7% 98.5% 99.3%95% definition
Increase the
proporation of patients Improvement
National
who say they were on Patient
listened to (survey)
83% 98%* 94%
previous year
Survey
Patient Experience
Data
Source
2012/13
Target
Table 3: Summary of Kent Prison Mental Health services’ performance against quality
improvement goals
Quality
Improvement Goal
ImprovementNational
onPatient
previous year
Survey
RiO - Local
46%50% definition
To ensure the service user defined CPA
standards are an essential part of
the CPA process
15 standards 15 standards
Systm One* implemented
Local definition
Patient
Experience
Patient Experience
Ensure care plans are in the patients electronic record (RiO) - District nursing 15%
RiO - Local
81%90% definition
Data
Source
Increase the
proportion of patients
who say they were
given information ImprovementNational
on medication onPatient
side effects (survey)
38%
82%
72%
62%
previous year
Survey
Ensure care plans are in the patients
electronic record (RiO)
- Long Term Conditions
80%
87%
2012/13
Target
RiO - Local
definition
Experience Survey: Patients reporting
they have received enough Improve
Local
information about their care and
population patient
treatment
45% 83% 86%coverage coverage
2012/13
Achievement
To offer registered
carers of patients on CPA* a carer’s assessment
284
469
631
841
984
898 (60%)
Data
Source
2012/13
Target
2012/13
Achievement
2011/12
2010/11
2009/01
Quality
Improvement Goal
2008/09
Table 1: Summary of mental health and learning disability services’ performance against quality
improvement goals
2012/13
Achievement
Quality
Improvement Goal
2.2 Patient Experience
2011/12
This means the target set has been achieved
This means our 2012/13 performance is 5% or less below the target set
This means our 2012/13 performance is 6% or more below the target set
2010/11
2011/12
Achieved:
Mostly Achieved:
Not achieved:
Table 2: Summary of Community Health services’ performance against quality improvement goals
*Systm One – Prisons electronic patient record
Increase the
proportion of patients
who say they were
Improvement National
treated with dignity on Patient
and respect (survey)
88% 99%* 96%
previous year
Survey
* CPA – Care Programme Approach
Oxleas NHS Foundation Trust
Quality Report 2012/13
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7
Oxleas NHS Foundation Trust
Quality Report 2012/13
Quality report
2.2.1 The detail of how we have performed
– Patient Experience
We would like to highlight the following patient experience quality improvement goals:
of carer’s assessment to registered carers of people with severe and enduring mental illness
•Offer
on CPA
in the proportion of patients who say they were given information on side effects of
•Increase
their medication (based on the national patient survey results)
in the proportion of patients who use community health services with care plans in the
•Increase
electronic patient record, RiO.
2.2.2 Carers offered a carer assessment
This has been a priority for us since 2008 and remains an area of interest to our patients, members,
carers and commissioners. We have sought to increase the numbers of carers who have been
offered an assessment and are therefore delighted that we have consistently met this goal (see
below). We acknowledge the role of carers in supporting people with long term conditions like
severe and enduring mental illness and consider it important that they receive support through an
assessment of their needs. The next stage in our Carers strategy is to provide support to carers of
people who use our community health services.
2.2.3 Increase in the proportion of patients who
say they were given information on the side effects
of their medication
Each year, Oxleas participates in a national patient survey of users of community mental health
services and we have three quality improvement goals linked to the feedback from this survey:
increasing the proportion of surveyed patients who report that they were given enough information
about the side effects of their medication, felt listened to and were treated with dignity and respect.
The 2011/12 national patient survey showed that 6 out of every 10 patients that responded
reported receiving enough information about the side effects of their prescribed medication. This is
much lower than we expect as, it is important to us that our patients understand their prescribed
medications and the side effects that may arise from the medications. In response to the results,
we put in place a multi-faceted action plan which addresses the concerns about medication.
A checklist is to be used by doctors and other clinicians in teams to ensure the needs of patients
prescribed medication are met. This has been discussed in all mental health teams across the Trust.
In addition to ensuring clinicians offer face-to-face discussions, the checklist asks that posters,
printers, medication leaflets and medication groups, where possible, are available in teams. This
action plan has been endorsed by the Trust Quality Board and Clinical Effectiveness Group and will
be implemented across the organisation and monitored.
Chart 1: Registered carers of patients on CPA who have been offerred a carer’s assessment
1200
Number of carers
1000
800
600
400
200
0
2008/09
Oxleas NHS Foundation Trust
Quality Report 2012/13
2009/10
2010/11
8
2011/12
2012/13
9
Oxleas NHS Foundation Trust
Quality Report 2012/13
Quality report
Data
Source
2012/13
Target
2012/13
Achievement
Quality
Improvement Goal
2011/12
We continue to maintain a focus on recording all community patients’ clinical information in our
electronic patient records system RiO. Since the integration of Bexley and Greenwich Community
Health Services into Oxleas, we have looked at new ways of working to support clinical staff to
move from paper records held in patients’ homes to RiO. This year, we set ourselves a goal of 90%
of patients in long term condition teams and 50% of patients in district nursing teams to have an
electronic care plan on RiO. This has mostly been achieved however we will continue to work with
our community services using new technology such as remote access to RiO to ensure that clinical
information including care plans are recorded following home visits.
Table 5: Summary of Community Health services’ performance against quality
improvement goals
2010/11
2.2.4 Ensuring that the care plans of community health
patients are on RiO
Consenting girls aged 12-13 immunised for HPV Doses 1, 2 & 3
73%
RiO - National
75%80% standard
RiO - National
Maintain no new cases of MRSA* 0
00standard
Ensure all patients on
CPA discharged from
RiO - National
hospital are followed
100% (Monitor
definition
up within 7 days
100% 100% 98.8% 96.5% 99.6% target - 95%)
(MONITOR)
Ensure all patients
admitted to hospital
following self harm
are followed up within RiO - Local
48 hours of discharge
100% 100% 100% 100%100%100% definition
Patient Safety
Maintain no new cases of MRSA* 0
0
0
0
RiO - National
0 0definition*
Maintain no new cases of Cdiff* (threshold of 6)
1
0
0
2
0
0
RiO - National
(threshold of 6)
definition
Ensure staff are trained Local Oxleas
in level 1 safeguarding Training
children
89.0%
95.5%80% database
Ensure staff are trained
Local Oxleas
in level 2 safeguarding
Training
children
92.0%
87.8%80% database
Maintain no new cases of Cdiff* (threshold of 6)
0
Patient Safety
Data
Source
Quality
Improvement Goal
2012/13
Target
Table 4: Summary of mental health and learning disability services’ performance against quality
improvement goals
2012/13
Achievement
RiO - National
81%80% standard
2011/12
Consenting girls aged 12-13 immunised for HPV Doses1 & 2
82%
2010/11
2.3 Patient Safety
2009/01
RiO - National
85%80% standard
2008/09
Consenting girls aged 12-13 immunised
for HPV* Dose 1
83%
RiO - National
00standard
Improve collection of data to promote National
harm free care through reductions data
in falls, pressure ulcers, urinary tract Subission
collection
infections in people with indwelling of data to
tool catheters and venous DataNational national
thromboembolism (VTE)
submittedteam
definitions
Local Oxleas
Ensure staff are trained in level 1 Training
safeguarding children
84%
83% 95.4%80% database
Local Oxleas
Ensure staff are trained in level 2 Training
safeguarding children
71%
85% 87.1%80% database
Local Oxleas
Ensure staff are trained in level 3 Training
safeguarding children
72%
84% 84.0%80% database
* Human Papilloma Virus
Ensure staff are trained Local Oxleas
in level 3 safeguarding
Achieve Training
children
46.0%
87.0%trajectory database
Oxleas NHS Foundation Trust
Quality Report 2012/13
10
* MRSA – Methicilin Resistant Staphylococcus Aureus
* Cdiff – Clostridium difficile
* CPA – Care Programme Approach
* Monitor
11
Oxleas NHS Foundation Trust
Quality Report 2012/13
Quality report
CQUIN achieved.
Discharge planning
and pre-admission
processes agreed
To implement Agreed CQUIN
CQUIN
definition
requirements
with
and put
commissioners
robust process
in place
Patient Safety
To pilot and put in place
robust discharge processes
and support for patients
Data
Source
Quality
Improvement Goal
2012/13
Target
2011/11
2012/13
Table 6: Summary of Kent Prison Mental Health services’ performance against quality
improvement goals
2.3.1 The detail of how we have performed
– Patient Safety
We would like to highlight the following patient safety quality improvement goals:
• Ensuring that staff have completed their safeguarding children mandatory training
• Immunising consenting 12-13 year olds with the Human Papilloma Virus vaccine
• Putting in place robust discharge planning processes in Kent Prisons.
2.3.2 Safeguarding children – Level 3 staff training
In 2011, following the adoption of the Intercollegiate training guidance that requires all mental
health staff to undertake face to face level 3 safeguarding children training, we agreed a plan which
is shown in Table 7 below to achieve this by October 2014.
Our goal for 2012/13 was to have over 63% complete level 3 safeguarding children training and
we are pleased that 87% of staff completed this training across Mental Health and Community
Health services by the end of March 2013. We are committed to safeguarding children across the
organisation. This is reflected in our safeguarding children strategy which sets out the trust’s vision
for safeguarding children and ensures that safeguarding and promoting the welfare of children is
embedded across every directorate and in every aspect of our work.
2.3.3 Human Papilloma Virus Immunisations (HPV)
Some types of Human Papilloma Viruses (HPV) can cause cervical cancer and the HPV vaccine
helps protects girls from getting cervical cancer in the future (NHS Choices). Our goal therefore is
to immunise all consenting girls aged 12 to 13 years against HPV. This requires each girl to have a
course of 3 doses by the end of the academic school year July 2013. At the end of March 2013 we
had achieved the goal of immunising at least 80% of consenting girls with the first dose and also
the first and second doses. However, immunisation of identified girls with the 3 doses was achieved
in 75% and it is envisaged that by end of the academic school year we would achieve the target
of 80%.
2.3.4 Discharge Planning Processes in Kent Prisons
The purpose of this quality goal was to implement robust discharge and transfer processes in prison
that ensure that prisoners with mental health difficulties are safe. This required us to pilot a new
best practice approach for engaging patients and communicating with key stakeholders along the
patient’s journey.
The analysis of the discharge pilot showed that the mental health in-reach team’s initial assessment
along with subsequent CPA meetings were important in defining the patients’ needs and help the
development of a comprehensive discharge plan. As a result, we have reviewed our assessment and
discharge processes so that the in-reach team is more pro-active in identifying patients’ needs at
triage, using an enhanced screening tool and also during the initial assessment. Undertaking this
CQUIN initiative has improved this aspect of the patient pathway.
Table 7
Baseline
(October 2011 actual)
Target Year 1
(October 2012) Target Year 2 (October 2013)
Target Year 3
(October 2014)
25%
more than 44%
more than 63%
more than 80%
Oxleas NHS Foundation Trust
Quality Report 2012/13
12
13
Oxleas NHS Foundation Trust
Quality Report 2012/13
POMH UK*: Improve physical health checks and screening for metabolic side effects of medications in AOT
POMH National audit
Standard 2 - Standard of obesity/BMI*
45%
71%
80%
82%
POMH 78% Improvement National audit
Standard 3 - Standard of blood pressure
58%
82%
82%
90%
POMH 79% Improvement National audit
Standard 4 - Standard of plasma glucose
55%
70%
75%
81%
POMH -
74% Improvement National audit
Standard 5- Standard of lipid profile
52%
65%
70%
81%
POMH 61% Improvement National audit
Data
Source
POMH UK - 17: Ensure further reduction of antipsychotic medication use in patients with dementia through regular reviews
Standard 1 - Clinical
indications for
antipsychotic
treatment documented in patients records
100% 100% Improvement
POMH National audit
Standard 2 - Likely
factors that may
generate BPSD*
considered before
prescribing
antipsychotic medication
87%
100% Improvement
POMH National audit
Standard 3 - Risks
and benefits of
antipsychotic
medication considered
and documented prior to initiation
38%
100% Improvement
POMH National audit
Standard 4 - Risks and
benefits of antipsychotic
medication discussed
with patient/carer prior to initiation
50%
100% Improvement
POMH National audit
Clinical Effectiveness
Clinical Effectiveness
Ensure patients on CPA
have appropriate
physical health RiO - Local
checks/screening
71.6%* 65.4% 93.0%75% definition
Standard 1 - Patients
who smoke offered
help with smoking
cessation (or do not smoke)
97%
96%
98%
97%
96% Improvement
Ensure patients in
hospital have
appropriate physical health RiO - Local
checks/screening
71.6%* 97.6% 99.0%75% definition
2012/13
Target
RiO - Local
definition
2011/12
4076
(5% increase)
2010/11
Data
Source
5202
2009/01
20012/13
Target
Increase number of
patients in receipt of psychological therapies 3090 3149 3882 3306
Quality
Improvement Goal
2012/13
Achievement
2011/12
2010/11
2009/01
Quality
Improvement Goal
2008/09
Table 8: Summary of mental health and learning disability services’ performance against
quality improvement goals
2008/09
2.4 Clinical Effectiveness
2012/13
Achievement
Quality report
Standard 5 - Medication
reviewed and outcome
documented in POMH patients records
78%
85%ImprovementNational audit
* Behavioural and Psychological Symtons of Dementia
* Body mass index
Oxleas NHS Foundation Trust
Quality Report 2012/13
14
15
Oxleas NHS Foundation Trust
Quality Report 2012/13
Quality report
Clinical Effectiveness
To improve wound
care assessment by
ensuring patients
presenting with leg
ulcerations receive
a Doppler assessment
within 2 weeks of a referral to our services 50%
47%
Data
Source
Undertake a trustwide NICE Diabetes audit (Podiatry Services)
12/13
Target
Participate in
National audit of intermediate care
Achieved
2012/13
Achievement
2011/12
Quality
Improvement Goal
2010/11
Table 9: Summary of Community Health services’ performance against quality improvement goals
Achieved
Participate
in audit
National Audit
standards
Audit
completed
Undertake audit
in line with
NICE guidelines
RiO - NICE
Standards
RiO - NICE
77% 80%Standards
Clinical
Effectiveness
Oxleas NHS Foundation Trust
Quality Report 2012/13
Baseline = 39
Total for 12/13 = 1131
16
Data
Source
12/13
Target
2012/13
2011/12
Table 10: Summary of Kent Prison Mental Health services’ performance against quality
improvement goals
To set a baseline and
improve on the number of triage
assessments
We would like to highlight the following clinical effectiveness quality improvement goals:
• Screening for metabolic side effects of antipsychotic drugs
• Prescribing antipsychotic medications to people with dementia
• NICE Diabetes audit of foot care - Podiatry Services
• Use of Doppler assessment to Improve wound care – Doppler assessment audit.
2.4.2 POMH - Screening for metabolic side effects of
antipsychotic drugs
We have participated in this national audit run by the Prescribing Observatory for Mental Health UK
since 2008. This audit measures practice against 5 standards:
To ensure all young
people who attend
our Contraceptive
and Sexual Health Local
Service are offered audit Chlamydia screening local
kits
97%
98% 95%definition
Quality
Improvement Goal
2.4.1 The detail of how we have performed – Clinical
Effectiveness
1) Standard 1 - Patients who smoke are offered help to stop smoking
2) Standard 2 - measure of obesity/body mass index in all patients
3) Standard 3 - measure of blood pressure in all patients
4) Standard 4 - measure of plasma glucose in all patients
5) Standard 5- measure of lipid profile in all patients.
As a trust we have seen significant improvement in these standards over the last 5 years in the
performance of our Assertive Outreach teams who treat challenging and difficult to engage
patients with severe and enduring mental illness. Although there was a reduction in our 2012/13
performance against these standards we still did better than the average national performance
(Total national sample (TNS)) as seen in charts 2 -6 below.
In 2013/14 we will focus efforts to improve against these standards and a plan to do so has been
agreed with clinical teams.
10% improvement on Systm One baseline = 43
Local definition
17
Oxleas NHS Foundation Trust
Quality Report 2012/13
Quality report
Chart 4: Standard 3 - measure of blood pressure
100
100
90
90
80
80
70
60
50
40
97%
96%
98%
97%
96%
30
78%
20
Percentage of patients
Percentage of patients
Chart 2: Standard 1 - patients who smoke offerred help with smoking cessation (or do not smoke)
10
0
60
50
40
30
20
08/09
09/10
10/11
11/12
12/13
0
TNS 12/13
90
90
80
80
70
60
50
40
10
0
45%
08/09
Oxleas NHS Foundation Trust
Quality Report 2012/13
71%
80%
82%
78%
55%
Percentage of patients
100
20
82%
09/10
10/11
90%
79%
58%
08/09
11/12
12/13
TNS 12/13
Chart 5: Standard 4 - measure of plasma glucose
100
30
58%
82%
10
Chart 3: Standard 2 - measure of obesity/BMI
Percentage of patients
70
70
60
50
40
30
20
55%
70%
75%
09/10
10/11
81%
74%
57%
10
09/10
10/11
18
11/12
12/13
TNS 12/13
0
08/09
19
11/12
12/13
TNS 12/13
Oxleas NHS Foundation Trust
Quality Report 2012/13
Quality report
2.4.4 NICE Diabetes Audit – Podiatry Services
Chart 6: Standard 5 - measure of lipid profile
Compliance with National Institute for Health and Care Excellence (NICE) guidelines is important
in providing good quality care. We therefore undertook an audit of clinical practice in our podiatry
services against the NICE guideline for the prevention and management of foot problems in patients
with Type 2 diabetes.
100
Percentage of patients
90
80
70
The purpose of this audit was to establish whether the foot care team assess patients with type
2-diabetes for risks of neurological and vascular problems as 20 – 40% of diabetics suffer from
neuropathy and 20-40% suffer from peripheral vascular disease with 5% developing a foot ulcer
each year as a result and 0.5% requiring amputation (each year).
60
50
40
30
20
52%
65%
70%
81%
61%
55%
10
0
The audit reviewed the records of a sample of patients with a diagnosis of diabetes seen by the foot
care team in a 2-week period.
The Results showed that:
08/09
09/10
10/11
11/12
12/13
TNS 12/13
2.4.3 Prescribing antipsychotic medications to people
with Dementia
1 90% of the patients had been assessed in the last 12 months
2Of the 90% there was a record of feet examination for neuropathy, peripheral pulses and
deformity in 57% of cases (target 80%; a further 32% had a vascular assessment only and 1%
had only a neurological assessment)
3
A record of risk for developing neuropathy, vascular disease or ulcer (foot risk classification) in
those assessed in the last 12 months was found in only 30% of cases (target 80%).
Taking part in the national POMH UK audit on prescribing antipsychotic medicine for people with
dementia was a requirement for us under the CQUIN (Commissioning for Quality and Innovation)
Framework.
We acknowledge that there is more to be done to improve our compliance with the NICE guidelines
especially with foot risk classification (recording of risk) and have put in place a plan to do so with a
repeat of the audit in six months.
Behavioural and Psychological Symptoms (BPSD) are common in people with dementia, particularly
as the illness progresses. These symptoms, which include agitation, psychosis, verbal and physical
aggression are often managed with antipsychotic medications. However, antipsychotics are
associated with an increased risk of harm particularly strokes in older people with dementia. The
aim of this audit is therefore to reduce the prescribing of antipsychotic medications to dementia
sufferers.
2.4.5 Improving wound care – Doppler assessment
audit
This was our second year of participating in this national audit organised by the Prescribing
Observatory for Mental Health and we are pleased to note improvements in our results in
comparison to last year and the national average (Total National Sample (TNS)). Our results show
a reduction in the rate of antipsychotic prescribing from 16% to 9% (in comparison to national
average reduction from 16% to 13%).
Doppler is used to check for blood flow problems that cause (venous) ulcers in 1:500 people in
the UK (1:50 over the age of 80 years).To improve the care provided to people with leg ulcers it is
recommended that a Doppler assessment be carried out within two weeks of referral to our services.
We set ourselves a target of completing a Doppler assessment in 80% of patients and audited our
achievement of this target by auditing the clinical records of a sample of patients with leg ulcers
who have recently been seen by clinicians.
Although this has been a challenging area of practice over the last 2 years we have seen a
significant improvement in the results since 2010/11 and especially so in this 3rd year of undertaking
this audit (see chart 7). We will continue to maintain a focus on this quality goal.
Oxleas NHS Foundation Trust
Quality Report 2012/13
20
21
Oxleas NHS Foundation Trust
Quality Report 2012/13
Quality report
Chart 7: Doppler assessment completed within 2 weeks of referral
90
As in previous years, our public focus groups took place in January with Bromley and Bexley
boroughs, however due to adverse weather conditions the Greenwich focus group was cancelled.
As an alternative, questionnaires were sent out to confirmed attendees and other members to
comment on our trust priorities and make suggestions for 2013/14. The feedback we received
reinforced the need to continue our focus on the trust’s 4 must do priorities:
80
1 Increasing support for families and carers
Percentage of patients
100
70
2 Providing better information for our service users and carers
60
50
40
30
20
50%
10
0
10/11
47%
11/12
77%
12/13
80%
12/13 Target
In this section, we want to tell you about our chosen quality priorities for 2013/14. Our priorities
reflect the breadth of services we provide as follows: mental health and adult learning disability
services across Bexley, Bromley and Greenwich; community health services across Bexley and
Greenwich, adult musculoskeletal services to Kent and mental health in-reach to Kent Prisons.
2.5.1 How we agree our quality priorities
We have always endeavoured to work in partnership with, our service users; carers, members, staff
and commissioners to identify what our quality priorities should be each year. Every year we hold
a public forum in each of our boroughs of Bexley, Bromley and Greenwich to give feedback on our
progress against our quality goals and receive feedback about potential areas of priority in the
coming year.
22
4 Improving the way we relate to both our service users and carers.
These have therefore been chosen as the overarching quality improvement priorities for our patient
experience indicators.
2.5 Our Quality Improvement Priorities for 2013/14
Oxleas NHS Foundation Trust
Quality Report 2012/13
3 Enhancing care planning
Our priority areas for patient safety and clinical effectiveness domains are influenced not just
by contributions from the public forums but also by our engagement with our local health
commissioners, through our regular quality meetings, our Council of Governors, review of our
compliance framework, patient experience surveys and lessons learned from incident reporting.
We have also engaged with staff via quality away days, staff meetings and annual planning events;
their views have had input to our trust service development strategy and our internal quality
improvement initiatives.
Our quality improvement priorities for 2013/14 have been reviewed and agreed by our Quality Board
(a sub group of our Governance Board) and are broadly summarised as follows:
• Our 4 must do priorities (see above)
• Monitor key quality indicators
• Commissioning for Quality and Innovation goals agreed with our commissioners
• Current priorities where trend data is available to measure improvement year on year
• Are linked to the NHS Outcomes Framework and the 5 domains
o Domain 1 - Preventing people from dying prematurely
o Domain 2 - Enhancing quality of life for people with long-term conditions
o Domain 3 - Helping people to recover from episodes of ill health or following injury
o Domain 4 - Ensuring that people have a positive experience of care
oDomain 5 - Treating and caring for people in a safe environment and protecting them from
avoidable harm.
23
Oxleas NHS Foundation Trust
Quality Report 2012/13
Quality report
2.5.2 Patient Experience Quality Priorities 2013/14
2.5.3 Patient Safety Quality Priorities 2013/14
Table 11
Table 12
Quality Improvement
Goal for 2013/14
Area
applicable
to
How we will monitor,
measure and report progress?
Trust Must Do - Increasing support for families and carers
65% of registered carers of
patients on CPA have been
offered a carer’s assessment
80% of patients reporting that
their carer/family have been
supported
Mental
Health
All Oxleas
services
This will be monitored on a monthly basis by
the Trust Executive and bi-monthly by the
Quality Board as part of our QSIP*
This indicator will form part of all our patient
experience surveys. This will be monitored by
the Trust Patient Experience Group
Quality Improvement
Goal for 2013/14
Area
applicable to
100% of patients on CPA
discharged from hospital followed
up within 7 days
Mental
Health
Patients admitted to hospital
following self harm followed up
within 48 hours of discharge
Mental
Health
Maintain no incidences of MRSA*
All Oxleas
services
Maintain no incidences of Cdiff*
(threshold of 6)
All Oxleas
services
80% of staff are trained in level 1
safeguarding children
All Oxleas
services
80% staff are trained in level 2
safeguarding children
All Oxleas
services
80% of staff are trained in level 3
safeguarding children
All Oxleas
services
Trust Must Do - Providing better information for our service users and carers
All Oxleas
services
This indicator will form part of all our patient
experience surveys. This will be monitored by
the Trust Patient Experience Group
Trust Must Do - Enhancing care planning
80% of patients reporting that
they been involved in decisions
about their care and treatment?
All Oxleas
services
This measure will form part of all our patient
experience surveys. For Mental Health Services
- This will be reported from the results of the
National Patients Survey. This will be monitored
by the Trust Patient Experience Group
Trust Must Do - Improving the way we relate to patients and carers
80% of patients reporting that
staff have treated them with
dignity and respect?
80% of patients reporting that
they would recommend our
service to friends and family
if they need similar care or
treatment
Oxleas NHS Foundation Trust
Quality Report 2012/13
All Oxleas
services
All Oxleas
services
24
This measure will form part of all our patient
experience surveys. For Mental Health Services
- This will be reported from the results of the
National Patients Survey. This will be monitored
by the Trust Patient Experience Group
This indicator will form part of all our patient
experience surveys. This will be monitored by
the Trust Patient Experience Group
Patient Safety
Patient Experience
80% of patients reporting they
have been provided with enough
information about care and
treatment?
Participate in the NHS Safety
Thermometer to improve
collection of data to promote
harm free care through
reductions in falls, pressure
ulcers, urinary tract infections
in people with indwelling
catheters and venous
thromboembolism (VTE)
* MRSA - Methicillin Resistant Staphylococcus Aureus
* Cdiff - Clostridium difficile
How we will monitor,
measure and report progress?
Progress on these measures will be
monitored monthly by the
Trust Executive and bi-monthly
by the Trust Quality Board and
Patient Safety Group
Adult Community
Health Older People
Mental Health
25
Oxleas NHS Foundation Trust
Quality Report 2012/13
Quality report
2.5.4. Clinical Effectiveness Quality Priorities 2013/14
2.6 Statements of Assurance from the Board
Table 13
This section includes a number of nationally mandated statements of assurances from our
trust board.
Quality Improvement
Goal for 2013/14
Area
applicable to
How we will monitor,
measure and report progress?
During 2012/13, Oxleas NHS Foundation Trust provided and/or sub-contracted seven relevant health
services covering the following service lines:
Measures for the
following
services:
Ensure our patients have
a recorded care plan:
Mental Health and LD
- 95%
District Nursing
- 55%
This will be monitored on a
monthly basis by the Trust
Executive and bi-monthly by the
Quality Board as part of our QSIP*
Clinical Effectiveness
Community Services
LTC - 95%
95% of our patients on CPA
to have received a review in the
last 6 months
Mental Health and LD
Kent Prisons
This is an internal measure
and is different to the Monitor
target which states a review
is done in 12 months. Progress
on this measure will be
monitored monthly by the
Trust Executive and bi-monthly
by the Trust Quality Board
50% of patients with mental
health illness diagnosed with
hypertension and diabetes to
have an individualised care plan
in place to support them and
include lifestyle, diet, nutrition,
medication advice and ways
of accessing help within
primary care
Mental Health
This is one of our CQUIN goals for
13/14 and will be monitored bimonthly by the Trust Quality Board
and quarterly by our local mental
health commissioners
To record the smoking status of
patients and refer on to NHS stop
smoking services for support
All Oxleas Services
(Referral on
exclusions - Prisons
and Forensics)
This is one of our CQUIN goals for
13/14 and will be monitored bimonthly by the Trust Quality Board
and quarterly by our local mental
health commissioners
Children’s Mental
Health Adult Mental
Health Community
Paediatric Services
Kent prisons
This will be measured through
undertaking a national POMH
audit and monitored by the Oxleas
Clinical Effectiveness Group
Improving Practice in line
with NICE Guidance:
Prescribing for ADHD
Oxleas NHS Foundation Trust
Quality Report 2012/13
• Adult Mental Health (inpatient and community)
• Older Peoples Mental Health (inpatient and community)
• Adult Learning Disabilities
• Children and Young people (mental health, community and specialist children)
• Adult Community Health
• Specialist Forensic Mental Health
• Mental health in-reach to Kent Prisons.
Mental health and adult learning disability services are provided across the London boroughs of
Bexley, Bromley and Greenwich; in addition to this, our specialist forensic services also cover the
boroughs of Lewisham, Sutton and Merton. Community health services are provided across Bexley
and Greenwich and our mental health in-reach is to Kent Prisons only.
Oxleas has reviewed all the data available to them on the quality of care in all seven of these
relevant health services.
The income generated by the relevant health services reviewed in 2012/13 represents 100% of the
total income generated from the provision of relevant health services by Oxleas for 2012/13.
The data used to review our quality priorities cover the three dimensions of quality – patient safety,
clinical effectiveness and patient experience. Our review for 2012/13 has not been impeded by data
availability.
2.6.1 Participation in Clinical Audits
During 2012/13 six national clinical audits and 26 national confidential enquiries covered relevant
health services that Oxleas provides.
During 2012/13 Oxleas NHS Foundation Trust participated in 100% national clinical audits and
100% national confidential enquiries of the national clinical audits and national confidential
enquiries which it was eligible to participate in.
*QSIP – Quality and Safety Improvement Plan
26
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Oxleas NHS Foundation Trust
Quality Report 2012/13
Quality report
The national clinical audits and national confidential enquiries that Oxleas was eligible to participate
in during 2012/13 are recorded in table 14 below.
The national clinical audits and national confidential enquiries that Oxleas NHS Foundation Trust
participated in during 2012/13 are also included in table 14 below.
The national clinical audits and national confidential enquiries that Oxleas NHS Foundation Trust
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 enquiry as a percentage of the number
of registered cases required by the terms of that audit or enquiry.
Table 14
The reports of four national clinical audits were reviewed by the provider in 2012/13 and Oxleas NHS
Foundation Trust intends to take the following actions to improve the quality of healthcare provided.
These audits were reviewed at the Clinical Effectiveness Group (a sub group of the Trust Quality
Board) where the action plans were agreed. These action plans were then disseminated to the
local directorate Clinical Effectiveness Groups for implementation. The key actions for the reports
reviewed in 2012/13 were:
1
National audit of Intermediate care Yes
20
100%
(Royal College of Physicians)
Baseline
Prescribing for people with Borderline Personality Disorder (POMH UK re-audit)
Key action: To ensure that a clear pathway exists for regular review of medicines prescribed to patients
in psychotherapy services, who are not attached to a community mental health team.
2
National audit of psychological
therapies (Royal College of Psychiatrists)
Second round
Yes 1602100%
3
Prescribing for people with
Borderline Personality Disorder
Prescribing high dose anti-psychotics on acute inpatient and Psychiatric Intensive Care Unit
wards (POMH UK re-audit)
Key action: To continue prescribing anti-psychotics in line with national standards, and where high
doses or combination of anti-psychotics are prescribed, ensure that the rationale for this is clearly
documented in the patient’s records.
POMH* UK Audit – Topic 12 (re-audit)
4
Prescribing high dose anti-psychotics
on acute inpatient and Psychiatric
Intensive Care Unit wards
POMH UK Audit – Topic 1 (re-audit)
5
Prescribing anti-psychotics for
people with Dementia
POMH UK Audit – Topic 11 (re-audit)
6
Screening for metabolic side effects
of anti-psychotic drugs
POMH UK Audit – Topic 2 (re-audit)
National Confidential Enquiry into
Suicide and Homicide
Oxleas NHS Foundation Trust
Quality Report 2012/13
% of cases submitted
Oxleas uses clinical audit and participation in national confidential enquiries as a driver for
improvements in quality. The trust aims to ensure that all clinical professional groups participate in
clinical audit.
National Clinical Audits
(2012/13) 7
Number of cases
submitted
* N/A: means that the organising body did not stipulate how many cases must be submitted to meet
the audit requirements; therefore the number of cases submitted translates to 100%.
No.
No.
National Enquiries (2012/13)
Participation
Yes/No
*POMH – Prescribing Observatory for Mental Health
Yes
98
N/A*
Yes
211
N/A
Yes
366
Yes
407
Participation Yes/No
Number of cases
submitted
Yes
26
28
N/A
N/A
% of cases submitted
100%
Prescribing anti-psychotics for people with Dementia (POMH UK re-audit)
Oxleas met 4 out of 6 standards at 100%.
Key action: To maintain good practice for standards met and ensure that adverse effects continue to
be monitored in medication reviews, and documented clearly within the patient’s records.
Screening for metabolic side effects of anti-psychotic drugs (POMH UK re-audit)
Key action: To continue to build links with primary care to ensure that physical health is maintained in
line with NICE best practice guidance.
The reports of 35 local clinical audits were reviewed by the provider in 2012/13 and Oxleas intends
to take the following actions to improve the quality of healthcare provided. The trust wide and local
directorate Clinical Effectiveness Groups reviewed these. Recommendations and action plans are
agreed and disseminated as appropriate in line with our trust policy. Other clinician approved clinical
audits were reviewed at a local level. The key audit undertaken was the annual Care Programme
Approach (CPA) audit where we measure how well we adhere to standards of care planning for
patients with complex mental health difficulties. The key areas that require further improvements
are:
management
• Risk
Sharing
about medication, CPA and mental health
• Involvinginformation
service users in the development of their care plans.
•
29
Oxleas NHS Foundation Trust
Quality Report 2012/13
Quality report
The trust wide and local directorate clinical effectiveness groups reviewed the findings of the CPA
audit and agreed action plans to address the gaps within each directorate. A summary of key
actions to be implemented are as follows:
assessment to be added to standard checklists to ensure that all highlighted risks have
•Raiskcorresponding
risk management plan that is linked with the patient’s care plan
•Care plans to be added as a standing item at team meetings
•Information provided on standard care plan letters to be reviewed within directorates
dentify ways of providing information that is accessible and meaningful to service users from
•Idifferent
care groups
linicians to ensure all service users have the opportunity to contribute to and sign their care
•Cplan,
and all instances where the service user cannot or does not wish to sign are documented.
A clear process is in place to improve the quality of the healthcare provided to our patients through
monitoring the implementation of action plans and re-audit.
Copies of the completed audit reports (inclusive of recommendations and action plans) can be
requested from:
The Quality & Audit Team
Oxleas NHS Foundation Trust
Pinewood House
Pinewood Place
Dartford
Kent
DA2 7WG
Participation in clinical research demonstrates our commitment to improving the quality of
care we offer and our contribution to wider health improvement. It allows our service users and
carers access to novel treatments that are not available as routine NHS care and also provides an
opportunity for our clinical staff to be trained in providing them. We have hosted national research
in all of our services areas and are currently building our research capacity in community health.
Research activity is supported by a full time Research and Knowledge Manager funded by the
London South CLRN. The main duties are to promote research throughout the trust and to assist
clinicians with current trials and new projects in order to increase recruitment levels. Two clinical
studies officers are based at the trust and assist with study feasibility and setup, recruitment
screening and follow-ups. The ongoing development of the infrastructure required for successfully
hosting national research studies has contributed greatly to the vastly reduced study approval time
and continued increase in recruitment and the overall number of studies hosted.
Research and Development income for 2012/13 totalled £135,739.
2.6.3 Quality Goals Agreed with Commissioners
Since 2009/10, we have agreed quality goals with our commissioners under the Commissioning for
Quality and Innovation Framework (CQUIN) and as outlined above, commissioners have contributed
to the development of our quality and safety improvement plans.
Tel: 01322 625759, Email: Quality@oxleas.nhs.uk
2.6.2 Participation in Clinical Research
The number of patients receiving relevant health services provided or sub-contracted by Oxleas in
2012/13 that were recruited during that period to participate in research approved by a research
ethics committee was 409. This represents a 46% increase on the previous year.
We are a member of the National Institute of Health Research (NIHR) London South Comprehensive
Local Research Network (CLRN) and the Mental Health Research Network (MHRN). We work closely
with the London South CLRN to ensure our governance arrangements cover quality assurance, ethics
reviews, regulatory authorisations and that projects conducted by us adhere to the Department
of Health’s Research Governance Framework. Our Research and Development Office has fully
implemented and is compliant with the Research Support Services initiative and its Research and
Development Operational Capability Statement is available on the Trust’s website.
Oxleas NHS Foundation Trust
Quality Report 2012/13
Of the 15 member trusts of the London South CLRN, Oxleas is ranked joint first for the time taken to
issue NHS Permission for NIHR research studies, 2nd for recruiting to NIHR research studies to time
and target and 9th for overall recruitment. We are also ranked first for increasing the number of
newly-opened NIHR research studies.
30
A proportion of Oxleas income in 2012/13 was conditional upon achieving quality improvement
and innovation goals agreed between Oxleas and any person or body we have entered into a
contract, agreement or arrangement with for the provision of relevant health services, through the
Commissioning for Quality and Innovation payment framework. Further details of the agreed goals
for 2012/13 and for the following 12 month period are available from:
Quality and Audit Team
Oxleas NHS Foundation Trust
Pinewood House
Pinewood Place
Dartford
Kent DA2 7WG
Tel: 01322 625759, Email: Quality@oxleas.nhs.uk
Our total 2012/13 CQUIN income conditional on achieving all the quality improvement and
innovation goals was £3,912,992. The assumed provisional payment dependant on confirmation
from our associated commissioners on achieving the goals set by the end of March 2013 is
£3,912,992. Our total CQUIN income for the previous year 2011/12 was £2,016,192.
31
Oxleas NHS Foundation Trust
Quality Report 2012/13
Quality report
2.6.4 Summary of Oxleas 2013/14 CQUIN Goals
Mental Health and LD (BBG)
3
For Oxleas staff to receive training in brief advice on smoking cessation and refer patients who
smoke to local smoking cessation services
4
To improve and embed a learning culture within the organisation in line with the Francis Report
The CQUIN goals for our mental health LD services have been agreed with our commissioners. These
cover four specific areas, a summary of these are:
1 To Improve the physical health of patients with severe and enduring mental illness
to encourage patients to have an annual physical health check with their GP or to
•Continue
provide these health checks ourselves
Oxleas staff to receive training in brief advice on smoking cessation, hypertension and type
•For
2 diabetes (the commonest physical health problems in our patients)
•For Oxleas staff to refer patients who smoke to local smoking cessation services
patients with a diagnosis of hypertension and Type 2 diabetes, to ensure that their care
•For
plans reflect that appropriate advice and guidance has been given about lifestyle changes,
nutrition, and availability of targeted support from primary care services.
2 To improve dementia care and support
provide an assurance of dignity and nutrition on dementia wards by undertaking a survey
•Toof patients
and their families/carers
improve early detection and referral of patients with dementia by providing targeted
•Totraining
to GPs and staff in Bexley, Bromley and Greenwich boroughs.
3
To improve the collection of data to promote harm free care through reductions in falls, pressure
ulcers, urinary tract infections in people with indwelling catheters and venous thromboembolism
(VTE) – This is a national CQUIN goal
4Mental Health Payment By Results – To ensure that our staff cluster patients to the most
appropriate pathway of care for their needs in a timely manner and to high standards.
Community Health Services (Bexley and Greenwich)
5
To increase the number of women receiving an antenatal assessment from our health visitors
(Bexley only)
6To increase the numbers of patients on an end of life pathway dying at their preferred place of
death (Greenwich only).
Specialist Forensic Mental Health Services
We have been allocated 4 CQUIN goals for our specialist forensic mental health service, these are:
1Optimising care pathways – This is a CQUIN goal that is to help us understand the whole patient’s
care pathway and plan to optimise an individual’s length of stay in our forensic services
2Ensuring the effectiveness of the Care Programme Approach (CPA) to address unmet needs
3Improving the physical health and wellbeing of patients: This is a continuation of the 2012/13
CQUIN with an increase in the percentage of patients who have had a full physical health check
within timescales, have a physical health care programme, GP summary records received, timely
GP discharge letters and access to the National Screening Health Programme
4
Provision of resources to improve literacy, numeracy, IT and vocational skills within secure
services. This has been allocated to ensure we demonstrate an agreed increase in the number
and proportion of patients engaged in literacy, numeracy and vocational interventions.
Greenwich Improving Access to Psychological Therapies (IAPT)
1To identify patients who may benefit from IAPT services from the Greenwich Urgent Care Centre.
This will ensure collaborative working with the urgent care centre to promote the service; improve
the referral pathway of patients who have an underlining psychological condition that could be
managed/treated in the IAPT service.
At the time of writing our Quality Report, specific goals for our community services were still being
discussed. A summary of the proposals are as follows:
Musculoskeletal Service Provision Kent
1
To improve the collection of data to promote harm free care through reductions in falls, pressure
ulcers, urinary tract infections in people with indwelling catheters and venous thromboembolism
(VTE)
1 To improve numbers of referrals given appointments for urgent cases and non-urgent cases
2To improve cognitive impairment screening for patients aged 75 and over following admission to
hospital
Oxleas NHS Foundation Trust
Quality Report 2012/13
32
There are three CQUIN goals for this service
2 To improve waiting times for urgent and non-urgent patients
3 To improve the numbers of patients who have a signed individualised care plan.
33
Oxleas NHS Foundation Trust
Quality Report 2012/13
Quality report
Specialist Children Services
1 To contribute to the Special Educational Needs and Disabilities (SEND) Pathfinder pilot
2To improve the quality of care and support for patients and their carers on the end of life care
pathway
These inspections by the CQC formed part of their targeted programme of unannounced visits to
NHS providers.
The services that were inspected were found to be fully compliant with the reviewed standards.
3 To ensure that children with complex needs have a named key worker to co-ordinate their care
Oxleas intends to take the following action to address the conclusions or requirements reported by
the Care Quality Commission – no action plan has been put in place as the services inspected were
found to be fully compliant with standards.
4 To respond to requests for community paediatric input in a timely manner
Oxleas has made the following progress by 31 March 2013 in taking such action – no action required.
5To ensure children attending a diagnostic clinic have a correct diagnosis entered on the patient’s
record in a timely manner.
Further details of the agreed goals for 2012/13 and for the following 12 month period 2013/14 are
available on request from:
Quality and Audit Team
Oxleas NHS Foundation Trust
Pinewood House
Pinewood Place
Dartford
Kent DA2 7WG
2.6.6 Data Quality
Oxleas submitted records during 2012/13 to the Secondary Uses service for inclusion in the Hospital
Episode Statistics, which are included in the latest published data.
The percentage of records in the published data that included the patient’s valid NHS Number was:
• 98.9% for admitted patient care
• 99.8% for outpatient care
for accident and emergency care. (This is not applicable as Oxleas does not submit data in
•0%
relation to accident and emergency care. This is an acute trust indicator).
Tel: 01322 625759
Email: Quality@oxleas.nhs.uk
2.6.5 Registration with the Care Quality Commission
(CQC)
Oxleas is required to register with the Care Quality Commission and its current registration status is
‘Registered with no conditions applied’.
The percentage of records in the published data that included the patient’s valid general practitioner
registration code was:
• 100 % for admitted patient care;
• 100% for outpatient care; and
for accident and emergency care. (This is not applicable as Oxleas does not submit data
•0%
in relation to accident and emergency care. This is an acute trust indicator).
The Care Quality Commission has not taken enforcement action against Oxleas during 2012/13.
Oxleas NHS Foundation Trust has participated in special reviews or investigations by the Care Quality
Commission relating to the following areas during 2012/13:
• Kent Prisons HMP Elmley, May 2012
• Kent Prisons HMP Rochester, January 2013
• Green Parks House, January 2013 – Our inpatient mental health unit in Bromley.
Oxleas NHS Foundation Trust
Quality Report 2012/13
34
35
Oxleas NHS Foundation Trust
Quality Report 2012/13
Quality report
2.6.7 Information Governance Toolkit
Oxleas Information Governance Assessment Report overall score for 2012/13 was 77% and was
graded ‘red’. This was due to us attaining two Level 1 scores for clinical coding; we achieved level 2
or more in the other indicators.
In order to meet level 2 Information Governance Toolkit requirements, we had to achieve the
following:
• Primary diagnosis clinical coding - >=85%
• Secondary diagnosis in clinical coding - >=75%
staff completing training on clinical coding so that they can code effectively and improve
•Clinical
data quality.
In our 2012/13 audit we attained our level of compliance with primary diagnosis (91%); however
full compliance with secondary diagnosis was not achieved by 2% (we achieved 73%). A 13%
improvement of has been made with secondary diagnosis from the previous year’s audit due to
ensuring our clinicians code appropriately at discharge. We will continue to maintain a focus on
improving our accuracy of secondary diagnosis coding.
We will work in partnership with the London Clinical Coding Academy to hold clinical coding
awareness training in line with standards for our identified staff during the course of 2013/14.
2.6.8 Clinical Coding error rate
Oxleas NHS Foundation Trust was not subject to the Payment by Results clinical coding audit during
the reporting period by the Audit Commission.
2.6.9 Performance against Key National Priorities
In addition to the Quality Improvement priorities that we have achieved this year, we are also
monitored against national targets and standards set by the Department of Health and Monitor.
This section highlights how we have performed as a Trust against these key national priorities.
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36
2.6.10 Performance against the Compliance Framework
(Monitor)
Detailed below is our performance against the compliance framework
Table 15
Target or Indicator
(per Compliance Framework 12/13)
Target or Performance
Threshold
2012/13
Status
Clostridium Difficile -meeting the C.Diff objective
4
0
Achieved MRSA - meeting the MRSA objective
0
0
Achieved Cancer 31 day wait for second or subsequent treatment
- surgery
94%
N/A
Not relevant Cancer 31 day wait for second or subsequent treatment
- anti cancer drug treatments
98%
N/A
Not relevant Cancer 31 day wait for second or subsequent treatment
- radiotherapy
94%
N/A
Not relevant Cancer 62 Day Waits for first treatment (urgent GP referral for
suspected cancer)
85%
N/A
Not relevant Cancer 62 Day Waits for first treatment (from NHS cancer
screening service referral)
90%
N/A
Not relevant
Maximum time of 18 weeks from point of referral to
treatment in aggregate, admitted patients 90%
94.3%
Achieved Maximum time of 18 weeks from point of referral to
treatment in aggregate, non-admitted patients 95%
99.9%
Achieved Maximum time of 18 weeks from point of referral to
treatment in aggregate, patients on incomplete pathways
92%
99.3%
Achieved Cancer 31 day wait from diagnosis to first treatment
96%
N/A
Not relevant Cancer 2 week wait from referral to date first seen, all
urgent referrals (cancer suspected)
93%
N/A
Not relevant Cancer 2 week wait from referral to date first seen,
sympomatic breast patients (cancer not initailly suspected)
93%
N/A
Not relevant
A&E: maximum waiting time of 4 hours from arrival to
admission/transfer/discharge
95%
99.6%
Achieved Community care data completeness - referral to treatment
information completeness
50%
100.0%
Achieved Community care data completeness - referral information
completeness
50%
93.3%
Achieved
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Table 15, (continued)
Target or Indicator (per Compliance Framework 12/13)
Target or Performance 2012/13
Threshold Status
2.6.11 Performance against NHS Outcome Framework
Priorities
We have also been set national core quality indicators that we are required to report on in our
Quality Report related to the NHS Outcomes Framework and the 5 domains as mentioned above in
section 2.5.1.
Community care data completeness - activity information
completeness
50%
92.1%
Achieved
Community care data completeness - patient identifier
information completeness
50%
90.5%
Achieved Community care data completeness - End of life patients
deaths at home information completeness
50%
25.0%
Achieved There are 5 indicators which are relevant to the services we provide. Our performance against these
indicators is shown below; this data has been obtained from the Health and Social Care Information
Centre (HSCIC) and is the latest information published by the HSCIC:
Care Programme Approach (CPA) patients receiving
follow up contact within 7 days of discharge
95%
99.6%
Achieved For indicators 1 and 2 relevant to the services we provide shown in table 16 below: Oxleas considers
that this data is as described for the following reasons:
Care Programme Approach (CPA) patients having
formal review within 12 months
95%
99.4%
Achieved
≤7.5%
2.7%
Achieved
Admissions to inpatient services had access to
crisis resolution / home treatment teams 95%
99.8%
Achieved
Meeting commitment to serve new psychosis cases
by early intervention teams
95%
112.1%
Achieved Data completeness, MH*: identifiers
97%
99.1%
Achieved Data completeness, MH*: outcomes for patients on CPA
50%
75.7%
Achieved Ambulance Category A call - emergency response within
8 minutes (Red 1 & 2 calls consolidated for Q1)
75%
N/A
Not relevant Ambulance Category A call - emergency response within
8 minutes (Red 1 calls)
75%
N/A
Not relevant
Ambulance Category A call - emergency response within
8 minutes (Red 2 calls)
75%
N/A
Not relevant
Ambulance Category A call - ambulance vehicel arrives
within 19 minutes
95%
N/A
Not relevant
Certification against compliance with requirements regarding
access to healthcare for people with a learning disability
N/A
Compliant
Achieved
Minimising MH* delayed transfers of care
* MH - Mental Health
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• These are Monitor targets that we report on monthly
the NHS Outcomes Framework domains of preventing people from dying prematurely
•Itandmeets
enhances the quality of life for people with long term conditions
• The data for these indicators are recorded on RiO and submitted to the HSCIC and Monitor.
Oxleas intends to take the following actions to improve the percentages (97.6% and 100%
respectively) and so the quality of its services, by continuing our focus of following up patients
within 7 days after discharge from psychiatric in-patient care and ensuring all of our admissions to
acute wards are gatekept by our Crisis Resolution Home Treatment Teams.
For indicators 3 and 4 relevant to the services we provide shown in table 16 below: Oxleas considers
that this data is as described for the following reasons:
• These are based on our involvement in the National Patient and National Staff Surveys
the NHS Outcomes Framework domains of enhancing the quality of life for people with
•Itlongmeets
term conditions and ensuring people have a positive experience of care
• The data for these indicators are provided by the CQC and Department of Health.
Oxleas intends to take the following actions to improve the percentage of 70% and rate of 85.4
respectively) and so the quality of its services, by continuing our focus on the following:
Patient Survey - we have put a robust plan in place to tackle the areas that require
•National
further improvement as identified earlier in the report in section 2
Staff Survey - Our 2012 staff survey was the best in London and the South of England;
•National
we are determined to maintain these high standards throughout 2013/14.
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1
2
Domain 1:
Preventing
People
from dying
prematurely
Domain 2:
Enhancing
quality
of life for
people with
long-term
conditions
Domain 2:
Enhancing
quality
of life for
people with
long-term
conditions
Oxleas NHS Foundation Trust
Quality Report 2012/13
Percentage of patients CPA
who were followed up
within 7 days after discharge
from psychiatric in-patient
care during the reporting
period
4
97.10%
Percentage of admissions
to acute wards for which
the Crisis Resolution Home
Treatment Team acted as
a gatekeeper during the
reporting period.
97.60%
97.60%
100%
90.70%
5
99.80%
40
100%
98.40%
100%
92.50%
Highest Trust
Performance
Lowest trust
Performance
Lowest trust
Performance
Highest Trust
Performance
National Average
Oxleas 2012/13
Performance
Oxleas 2011/12
Performance
Quality
Indicator
NHS Outcomes
Framework
Domain
3
National Average
Table 16
Oxleas 2012/13
Performance
Oxleas intends to take the following actions to improve the patient safety incidents that result in
severe harm or death and so the quality of its services, by continuing our focus by reviewing trends
and themes, learning from events and embedding learning across the trust.
Oxleas 2011/12
Performance
is patient safety information we report to the National Reporting and Learning System
•This
(NRLS)
meets the NHS Outcomes Framework domains of treating and caring for people in a safe
•Itenvironment
and protecting them from avoidable harm
• The data for this indicator is recorded on Datixweb (our local incident reporting database).
Quality
Indicator
Table 16, (continued)
NHS Outcomes
Framework
Domain
For indicator 5 relevant to the services we provide shown in table 16 below: Oxleas considers that
this data is as described for the following reasons:
Domain 4:
Ensuring
that people
have
a positive
experience
of care
Percentage of
staff employed
by, or under
contract to, the
trust during the
reporting period
who would
recommend
the trust as a
provider of care
to their family
or friends.
75%
70%
60%
96%
33%
Domain 2:
Enhancing
quality
of life for
people with
long-term
conditions
Domain 4:
Ensuring
that people
have
a positive
experience
of care
Domain 5:
Treating and
caring for
people
in a safe
environment
and
protecting
them from
avoidable
harm
Patient
experience of
community
mental health
services
indicator score
with regard
to a patient’s
experience of
contact with a
health or social
care worker
during the
reporting
period.
Number and
rate of patients
safety incidents
reported within
the trust during
the reporting
period, and the
number and
percentage of
such patient
safety incidents
that resulted in
severe harm or
death
87.2
85.4
86.6
83.0
91.8
indicator
value
indicator
value
indicator
value
indicator
value
indicator
value
*Comparison
with Mental
Health Trusts
*Comparison
with Mental
Health Trusts
Rate per
1000 days
= 70.29
Rate per
1000 days
= 5.44
Severe Harm
= 8.9%
Severe Harm
= 0.1%
Death = 4.3%
Death =0.1%
Rate per
1000
days = 5.72
Rate per
1000
days = 20.5
Severe harm
= 0 (0%)
Severe harm
= 2 (0.1%)
Death
= 10 (1.2%)
Death
= 16 (0.8%)
Comparison
with Mental
Health Trusts
Rate per
1000 days
= Not
provided
nationally
Severe Harm
= 1.0%
Death = 0.3%
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Please note:
The information published on the previous page is taken from different reporting periods by the
HSCIC.
for indicators 1 and 2 in the table above is the latest information available from the HSCIC,
•Data
covering the period of October to December 2012.
• Data for indicator 3 has been published by the HSCIC and covers the period of 2012
for indicator 4 has been published by the HSCIC in April 2012 and covers the period of
•Data
2010-2012
for indicator 5 has been published by the HSCIC covering a 6 month period between
•Data
1st April 2012 and 30th September 2012
For domain 5 – comparator rates shown were not all taken from one Trust but were the highest
•*national
rate for that indicator in the published HSCIC report
is important to note that the data shown in the above table for indicators 1, 2 and 5 only
•Itreflects
the last data available from the HSCIC and does not reflect the full year 2012/13 data
3.1 Changes to Quality Indicators
Not all Quality improvement goals published in our 2011/12 Quality Report have been replicated in
the quality goals published in this 2012/13 report. We changed one of the Community Health Services
clinical effectiveness indicators:
“To undertake the National Audit on diabetes across Community Health Services to assess compliance
with NICE guidance”
We found on further investigation of the requirements of the national audit that the measures were
applicable to primary and acute secondary care services. However, the trust Clinical Effectiveness
Group decided to undertake an audit of compliance with NICE guidance on foot care for people with
diabetes and this was carried out in our Podiatry (Foot Health) services as reported on in section 2.5.3.
3.2 Quality Highlights and Case Studies
submission for Oxleas. However the full year position is available directly from the trust.
We would like to provide examples of good practice that are aligned to the three quality domains;
our trust values of having a user focus, excellence, learning, being responsive, partnership and safety
and to our 4 must do priorities.
reporting period, and the number and percentage of such patient safety incidents that resulted
in severe harm or death covered Oxleas full year period of 2012/13.
3.2.1 Our New Patient Experience website section:
www.oxleas.nhs.uk/your-views
external audit carried out by Pricewaterhouse Coopers (PwC) on the local patient safety
•The
indicator - number and rate of patients safety incidents reported within the trust during the
Part 3 - Other Information
3.0 Other Quality Performance Information
In this section of our Quality Report, we give further detail on other areas of improving the quality
of services we provide to our patients.
We have given you an overview on the quality of care offered to patients based on how we
performed against the quality improvement goals set for 2012/13 in section 2.1.
As mentioned earlier in section 2, our priorities are agreed by our Quality Board taking into account
the views of our stakeholders to improve the quality of our services. We identified these by working
in partnership with staff, patients, carers, the wider public, our members and the local primary care
trusts. Not all areas of focus have been included in our quality improvement goals as some are
aligned to our Service Development Strategy and our internal quality improvement initiatives in the
Trust. Progress on these will be reviewed through our quality board and quality sub-groups: Patient
Experience, Patient Safety and Clinical Effectiveness.
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A priority of the Trust’s Patient Experience Group in 2012 was to develop a dedicated patient
experience area on the Trust’s website to openly demonstrate how we are listening and responding
to feedback. Working in partnership with directorate patient experience leads, the communications
and engagement team developed a comprehensive patient experience area on our website, offering
a range of information including how our services get feedback from our service users, carers and
family members, and what we are doing in response. This includes information by directorate, about
patient experience activities and events, survey results, patient stories and videos, staff stories and
‘You told us... so we’ - a quick snapshot of how a service is listening and responding to its service users.
The site also shows our commitment to improving patient experience through several exciting projects
and initiatives such as our Care, Compassion and Engagement project, Experience based co-design,
Goldfish Bowls, Oxleas Patient Experience Questionnaire (OPEQ) and Researchnet (a group of people
who have used our services who work to develop and implement new ways of learning about patient
experience.
The site also shows how our patients’ rate a service on the basis of whether they would recommend
the service they have used to a friend or relative.
We have moved from developing an engagement strategy with our service users and carers, through
to implementing and are now in the third stage of responding to feedback. We will continue to work
to improve on this initiative.
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3.2.2 Care Compassion and Engagement Initiative
Patients told us:
We launched a Care, Compassion and Engagement Initiative’ in our Adult Acute mental health
services in 2011/12. This was because there were indications that there had been improvement
in how we collect information, but not in the experience of service users who use our services as
evidenced by their feedback and themes from incidents.
2
There was a lot of inconsistency when relatives visit regarding going into patient bedrooms.
3
The smoking pod was being used inconsistently at night times.
We would like to showcase the results of this initiative within one of our acute mental health wards.
This was also identified by the CQC as an area of best practice.
4
That group activities needed to be reviewed as some groups were no longer relevant.
5
Patients complained of feeling unsafe due to another confrontational patient.
New ways Of Responding to Meaningful positive And
Negative feedback through the Patient Experience
Group (PEG)
Norman Ward successfully runs a weekly Patient Experience Group every Wednesday morning
in addition to the well-established daily community meetings. The main objective is to get direct
feedback from patients whilst they are in care in order to facilitate imminent patient experience
co-design of the acute inpatient service and promote positive experience. This group is well
attended by both staff and patients including the Unit Psychologist & Assistant, Ward Based
Occupational Therapist, all Nursing Staff on duty and medical colleagues who have recently shown
keen interest. Initially it was slightly challenging for patients to give direct feedback to staff who
would continue to look after them for the duration of their stay but once they saw how quickly
issues can be resolved their confidence was instilled and they suddenly felt listened to.
The PEG group is chaired by the activities coordinator who protects the Ward Manager’s agenda
slot to have an open discussion on specific areas which impact on patient experience. This is further
reinforced by a feedback form which is completed by patients. Feedback is usually balanced in
terms of positive and negative. An action plan is drawn immediately in response to highlighted
areas of improvement. This is used in conjunction with the 360 degrees Primary Nurse Feedback
questionnaire which focuses on the Primary Nurse’s role in enabling positive experience for patients.
This tool has specific questions about inpatient experience, involvement in treatment and care, carer
involvement, information giving, discharge planning and the general attitude of staff. The Ward
Manager and Clinical Charge Nurses complete this for individual staff with their allocated patients.
This feedback is then discussed in supervision with the staff members concerned. The tool is not
used as a punitive measure but genuinely seeks to allow reflection and responsiveness through
factual information. Staff are fully aware of the tool and they willingly embrace it. A snapshot of
significant improvements (the list is not exhaustive) so far as follows:
1 That it would be nice to have cooked breakfast as this is not provided throughout their
admission period.
6 1:1 was not being offered consistently on each shift.
7They would like to know their provisional discharge dates so that they have something to work
towards.
8
Our relatives/carers travel far to get here but sometimes staff are too busy to talk to them.
9Staff were not meeting with patients to prepare for Ward round and their input was not
considered.
10It would be helpful to have draft excluders as it can be extremely cold especially when the
smoking pod is in use.
11
Patient’s computer internet access was down.
12
Shower in the male toilet was not working.
13
The TV in the female lounge was too old, too small and the DVD player was not working.
What we did about it:
1A bacon sandwich is provided once a week and considerations are given to specific dietary
needs.
2Posters have been put up on each patient’s bedroom to inform both patients and relatives.
3 Protocol for use of smoking pod has been developed including hours of operation from 6am
till midnight.
4Group activity programme has been revised and more items were purchased including a pool
table, extra Wii games, board games and more DVDs including Zumba and Karaoke CDs.
5
Medication for specific patient was reviewed and patients were encouraged to speak to staff
if they feel unsafe. Dignity and respect issues are constantly explored in daily community
meetings and reassurance given to all patients.
61:1 sessions were discussed and reinforced in team meetings and handover to ensure it takes
place every shift. Additionally the 360 degrees Primary Nurse feedback questionnaire is now in
use for direct feedback to primary nurses which is reviewed in supervision every month.
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7 Discharge Dates are now routinely discussed in ward round for each patient.
8
The Carers evening tea group has been implemented to take place during the Protected Meal
Times in order to encourage discussions with relatives and carers.
9Ward Round Preparation questionnaire was implemented to prompt patient’s involvement and
capture their views around experience, therapeutic engagement, medication, care planning
and progress.
10Ward Manager to email the Facilities Manager to see what adjustments can be made. In the
meantime patients are encouraging to ensure the smoking pod door is closed when in use.
11
Internet access resolved by IT the following day.
12
Shower was fixed by maintenance on the same day.
13
A 32” TV with inbuilt DVD was purchased.
3.2.3 Police Custody Liaison Scheme
A team of Forensic Community Psychiatric Nurses have worked jointly with Metropolitan Police
staff to develop a pathway to screen and identify individuals with mental health issues in police
custody. In doing so, their aim is to promote a safer custody environment and facilitate entry to the
appropriate care pathways at the earliest opportunity, thus reducing re-offending.
In the last 6 months, over 2,000 detained people have been screened to establish whether they
are known to Oxleas services. Of those, over 10% have had further assessments with various
interventions including; changing cell observation levels, arranging formal Mental Health Act
assessments, signposting to GP or specialist drug/alcohol service, re-establishing contact with
community mental health teams or referring to court diversion service.
3.2.4 Prison scheme to improve patients’ health
We are involved in a pioneering scheme, believed to be unique in English and Welsh prisons aimed
at improving the health of prisoners through pulmonary rehabilitation (PR). It will bring the standard
of treatment of prisoners in this field up to that of patients in the wider community.
The project is being run at Her Majesty’s Prison Maidstone in Kent and was the brainchild of one of
our nurses, Nina Turner. It involves patients that suffer from chronic obstructive pulmonary disease
(COPD). Together with Specialist Physiotherapist, Helen Jefford, they are presently running the course
to improve the physical health and the burden of disease in a group of 12 prisoners.
Engaging and Improving Access for Children
In 2007, we undertook a significant consultation exercise with young people in order to identify and
overcome the barriers some young people experienced in accessing CAMHS (Child and Adolescent
Mental Health Services). The outcome of this was that the feedback from young people led to a
number of service pilots and a re-design of how services were offered. An important part of the
feedback was that young people told us they wanted to know more about CAMHS and to have a
variety of forms of age appropriate information. Based on this feedback, we commissioned a film
which showed two adolescent siblings who developed mental health difficulties and their ‘journey’
to accessing help at CAMHS. This film was used in schools as part of PSHE to help to educate young
people about mental health and to reduce stigma. A teaching pack was developed and some
sessions were led by peer mentors.
With this experience in mind, we wanted to produce another film which would be used for a
different purpose. The idea of the film emerged from the work being done by a participation worker
who was on secondment to the Trust from Young Minds. The aim was to develop a film which could
address some of the questions and concerns that young people had when they are referred to
CAMHS - such as...... is it confidential?, what happens at CAMHS?, who will I see there? Do my parents
have to know what I say at CAMHS?
So, in partnership with Greenwich and Lewisham Young People’s Theatre (GLPT), our participation
worker and 2 clinicians from CAMHS, recruited volunteer young people involved with GLPT and
CAMHS to work on creating a film. The young people worked on the messages and the story they
wanted to communicate and the methods for doing this. The filming was done around Woolwich
and on a very cold Sunday at Highpoint House. Once produced, the film was launched at the Tram
Shed (GLPT) in Woolwich in March. The film is called “I got this letter” and shows a number of young
people and their thoughts about themselves as having mental health difficulties and their concerns
prior to coming to CAMHS. One young man is seen in his first session and as he leaves, he hands
the CAMHS PROMISE to another young person who is arriving for her first session. The film is very
moving and particularly so because it conveys messages and the voice of young people who have
used our services.
We will be sending a copy of the film out with all first appointment letters with a copy of the
PROMISE to young people aged 12 and over. We hope that the messages in the film speak to other
young people who may have worries about coming to CAMHS so that it empowers them and makes
it easier for them to engage in the healing process.
Nina described the operation: “Here at Maidstone we have an ageing population of prisoners many
of whom smoke or have been smokers. All 12 patients on our course are COPD suffers and have
been identified by a comprehensive screening process to take part. They participate in two sessions
each week, which involves an hour of exercise and an hour of education during each one.” COPD is a
chronic condition affecting the lungs, often of people who smoke or have smoked for a long time.
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3.2.5 Occupational Therapy Employment Audit
3.2.6 Koestler Award
Background:
The Work Foundation (2013) identified that low expectations & discrimination contribute to an
employment rate of just 8% of people with Schizophrenia. A key task of Early Intervention Teams is
to help maintain and restore pathways to education or employment: “Ultimately, length of time out
of work or education determines successful re-integration” (IRIS, 2012).
Year after year the Bracton Centre, our medium secure unit, is improving the collection of prizes it
gains in the annual Koestler Awards.
Rationale for audit:
To provide a baseline of vocational status (what are people doing now?) & vocational aspirations
(what do they want to do in the future?).
Method:
A questionnaire was given to service users (n=53) willing to participate from the Bexley, Bromley and
Greenwich Teams. The data were presented as descriptive statistics.
Findings:
• 85% of service users had been asked about their work goals in past 6 months.
• 40% of service users were currently in paid or voluntary work.
to paid work included ‘mental health/physical health problems, lack of confidence &
•Barriers
limited qualifications.
• 80% want to work in the future & value help in finding work.
• 50% of service users were currently in education or training.
Patsy Fung, Head of Occupational Therapy, said: “In 2009 we won 13 awards, in 2010 we won 14
awards, in 2011 we won 25 awards and this year we won 32 awards. They just seem to get better
and better. Some of our service users have never won anything in their lives. These awards really
build their self-esteem and help them to believe that they can achieve positive things.”
The Koestler Trust is the UK’s best-known prison arts charity. It has been awarding, exhibiting and
selling artworks by offenders, detainees and secure patients for 50 years, inspiring entrants to take
part in the arts, work for achievement and transform their lives. Its national exhibition at London’s
Royal Festival Hall shows the public the talent and potential of people in secure settings.
The awards were handed out at a special ceremony on Tuesday 20 November at the Bracton Centre.
There were a record number of Bracton entries this year - 116.
3.2.7 Dignity Action Day – Lesney Ward
As part of our Care Compassion and Engagement initiative in the trust, there has been a variety
of activity across our wards to improve patient care. An example of this is seen in Lesney Ward.
A dignity tree was placed on the patient experience board in the communal area, where visitors,
patients and staff could post what dignity means to them on a leaf, then the ward was asked to
come up with an action plan from these suggestions.
2Occupational Therapists to prioritise work with service users at risk of losing employment/
education
A group discussion with patients and staff also took place where members were asked about dignity
and respect: what does it mean to them? What you can do for others to make a difference? As part
of this process patients were given a red balloon, with a label attached where they could also write
what dignity and respect means to them. Patients and staff ended the day by going to the garden
to release the balloons.
3 All service users should have a vocational goal on their care plan
A few quotes from the day:
Recommendations:
1 Ask all new service users about their current and previous vocational status.
4Teams to address the barriers to work identified through individual,
group work and use of community resources.
69% of service users
were in paid
employment, education
or voluntary work
Oxleas NHS Foundation Trust
Annual Report and Accounts 2012/13
Patients:
Treat others how you would like to be treated.
Being honest with yourself and others.
Carers:
Empathy, honesty and trust. Don’t be judgemental.
Staff:
Value diversity. Respect other peoples views.
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3.2.9 Improving Physical Health
Patients with serious mental illness die about 15-20 years earlier than the general population due
to an increased risk in treatable physical health conditions such as diabetes and coronary heart
disease.
As part of our vision to improve the physical health of our mental health patients we have piloted
and are now implementing across all our bed based services a new chart which will be used by staff
to assist them in being able to recognise the deteriorating patient. This new chart uses modified
early warning scoring (MEWs) to identify where patients’ physical health needs are out of the normal
range so that we can intervene and support people sooner. This is an important aspect of our
ongoing work to improve the monitoring of our patients physical health.
3.2.8 Bluebell House – Short Breaks Service
3.2.10 Older People’s Mental Health Patient Experience
Bluebell House at Wensley Close in Eltham (formerly known as the Short Breaks Service) which
provides short breaks for children with complex health needs has had a significant revamp. The
building and garden area has been greatly improved following a major refurbishment and the
service has improved, integrated with other services and expanded the range of support provided.
Following a reconfiguration of the community mental health teams, the Older People’s directorate
undertook a patient experience survey between the months of April to June 2012. 175 patients
completed the survey across Bexley Bromley and Greenwich. A summary of the survey results and
patient quotes are shown below:
Staff have been focussing on improving communications with parents, family members and the
children themselves. The children came up with the new name of Bluebell House and inspired a new
logo which staff will soon be wearing on their uniforms.
Chart 8: Has the service that you received from Oxleas helped you deal more effectively with
your difficulties?
100
90
Percentage of patients
Bluebell staff work closely with physiotherapists, music therapists and other professionals from
the Children’s Community Nursing Team who joined Oxleas last year. This integration has been key
to the service developing and there is now a single care plan across these teams and the Special
School Nursing teams. The Bluebell House Team have also started providing an outreach service for
children under five years old and a ‘step down’ support service for children who are discharged from
hospital following surgery.
80
70
60
50
40
30
20
10
40.57% 41.71%
7.43%
0
Definitely
Oxleas NHS Foundation Trust
Quality Report 2012/13
50
Quite a lot
Not very much
51
0.57%
Not at all
5.71%
Don’t know
Oxleas NHS Foundation Trust
Quality Report 2012/13
Quality report
Chart 9: Did you have sufficient information from us about other help available to your family
or carer, if appropriate?
Chart 11: How likely is it you would recommend Oxleas’ service to a friend or relative?
100
90
Percentage of patients
100
Percentage of patients
90
80
70
60
50
40
30
20
10
29.71% 34.29% 12.57%
0
Definitely
Quite a lot
Not very much
80
70
60
50
40
30
20
60.57%
31.43%
10
2.86%
Not at all
0
4.57%
Definitely
Quite a lot
2.29%
0.00%
2.86%
Not very much
Not at all
Don’t know
Don’t know
Chart 10: Did you feel you were treated with dignity and respect by Oxleas’ staff?
100
100
90
90
80
80
70
60
50
40
82.86%
30
14.29%
20
10
0.57%
0
Definitely
Oxleas NHS Foundation Trust
Quality Report 2012/13
Quite a lot
Not very much
52
0.00%
Not at all
0.57%
Percentage of patients
Percentage of patients
Chart 12: How good do you think the service is overall?
70
60
50
40
30
20
59.43%
10
32.57%
0
Don’t know
Execellent
Good
3.43%
0.57%
Fair
Poor
53
2.29%
Don’t know
Oxleas NHS Foundation Trust
Quality Report 2012/13
Quality report
Someone who visits
me at home, that
I can talk freely about
problems.
Good forward planning
in respect of my condition.
Kind doctors who are
very considerate and
understanding.
The kindness without
patronisation from staff.
Sincere interest expressed
when one feels very exposed
one could trust them.
Intelligent questioning and
listening by them.
3.3 National Staff Survey
We take part in the annual Care Quality Commission national NHS staff survey. The staff survey is an
important piece of evidence in demonstrating that the Trust achieves compliance with Care Quality
Commission and national standards and targets. The staff survey key findings are aligned to the
pledges to staff made in the NHS constitution and therefore gives assurance both internally and
externally that the trust is meeting its staff obligations as set out in the constitution.
The Francis report requires organisations to use a variety of ways to understand how ‘front line
staff’ feel about the organisation and services they provide. The staff survey is one such measure.
Research by Aston University shows a direct correlation between staff survey results and patient
outcomes. The areas we excelled in the survey such as whether staff would recommend the trust
as a place to work and be treated; satisfaction with the level of care they provide and overall staff
engagement are important indicators of staff contributions to the quality of care we provide.
•
•
•
•
•
Nine scores were the top scores nationally for any mental health or learning disability trust
satisfied with quality of work and patient care delivered
• Feeling
Effective
working
• Receivingteam
well-structured appraisals
• Support from
immediate line manager
• Fairness and Effectiveness
of incident reporting
• Able to contribute to improvements
at work
• Job Satisfaction
• recommending the trust as a place to work and receive treatment
• Equal opportunities for career progression.
•
The composite score for staff engagement places Oxleas in the top 20% of mental health and
learning disability trusts.
Scores in the bottom 2 categories were:
Below Average
Working extra hours
Experiencing Physical violence from staff in last 12 months.
•
•
Worst 20%
• Experiencing Discrimination in the last 12 months.
Summary
Results
The overall response rate was 51% (418 staff). The response rate is average when compared with
other mental health & learning disability trusts.
The Care Quality Commission report groups the responses of all the questions into 28 key findings
with an additional composite finding about staff engagement. There are 10 less key findings than
the previous years’ surveys due to rationalisation of questions. This makes a direct comparison of
overall performance slightly harder. Despite the changed nature of Oxleas, the CQC continues to
compare the trust with other mental health and learning disability services, nonetheless a number
of mental health trusts in London as well as elsewhere also provide community services.
Oxleas NHS Foundation Trust
Quality Report 2012/13
Oxleas comparative scores are
18 key findings were in the 20% of mental health trusts
7 key findings were above average for mental health trusts
0 key findings were average for mental health trusts
2 key findings were below average
1 key finding was in the worst 20%.
54
number of staff who completed the survey represents 13% of the whole organisation and
•The
is proportionate to the relative sizes of the directorates. On that basis therefore the trust can be
satisfied that the data received gives an accurate reflection as to the overall picture of the trust.
he numbers of staff who have reported violence from colleagues is small. Neither HR nor the
•Tstaff
side (trade union) have any evidence of reported or informally reported cases of violence
from other members of staff. This does not however mean that such events did not occur and the
trust and trade union colleagues will need to be absolutely explicit that such behaviours will not
be tolerated and will if reported be investigated thoroughly.
continue to compare well with other Mental Health and Learning Disability trusts and have
•We
again achieved the best results of any trust within this group in both London and the South East.
55
Oxleas NHS Foundation Trust
Quality Report 2012/13
Quality report
3.4 National Patient Survey 2012
3.4.2 Comparison to the National Average
We took part in the National Patient Survey for 2011/12, 238 people responded giving us a response
rate of 28%; the national average was 32%.
The chart below gives you a summary of how we compared with other trusts nationally.
3.4.1 Comparison to other London Mental Health
Providers
Section scores
Survey of people who use community mental health services in 2012
Health and Social Care Workers
Medications
Talking Therapies
Care Co-ordinator
Care Plan
Same
Table 17 below gives an overview of our performance for each section of the National Patient Survey
and how we compare to other London mental health trusts. We were in the top 20% of London
mental health (MH) trusts in 7 categories; in terms of overall care 60% of Oxleas respondents rated
the care they received in the last 12 months as excellent or very good placing Oxleas ahead of all
London mental health trusts (range 50% - 60%). A further 14% rated the care as ‘good’ and another
14% as ‘fair’ (11% rated it as poor or very poor).
Care Review
Crisis Care
Table 17
Day to Day Living
Categories
Red AmberGreen
Worst 20% of London MH Trusts
Middle 60% of
London MH Trusts
Best 20% of
LondonMH Trusts
Overall
012345678910
Best performing trusts
About the same
Worst performing trusts
medications 440
This trust
talking therapies
0
1
1
The results are not shown if there were fewer than 30 respondents.
care coordinator
0
3
0
care planning
2
1
2
care review
0
4
2
crisis care 1
0
1
support with
day to day living
2
3
1
overall view
of the service
0
0
2
Total
10
18
13
For questions about: health and
social care workers
Oxleas NHS Foundation Trust
Quality Report 2012/13
1
2
56
4
57
Oxleas NHS Foundation Trust
Quality Report 2012/13
Quality report
3.5 Oxleas Complaints Report 2012
Each of these identified three areas are part of our trust 4 must do priorities:
In 2012/13 there were approximately 170,000 patient contacts with our services; in the same period
of April 2012 to March 2013 we received a total of 161 formal complaints. This is in comparison to
179 complaints received last year in 2011/12.
Of the 161 complaints received:
• 62 (39%) relate to Adult Acute Mental Health (13 Bexley, 30 Bromley, 19 Greenwich)
• 48 (30%) relate to Adult Community Health (28 Bexley, 20 Greenwich)
• 19 (12%) relate to Recovery Mental Health (5 Bexley, 4 Bromley, 10 Greenwich)
• 13 (8%) relate to Older Persons (2 Bexley, 7 Bromley, 4 Greenwich)
• 10 (6%) relate to Children and Young Persons (2 CAMHS and 8 Community)
• 4 (3%) relate to Forensic Services
• 3 (2%) relate to Corporate services
• 2 (1%) relate to ALD.
• Increasing support for families and carers
• Providing better information for our service users and carers
• Enhancing care planning
• Improving the way we relate to both our service users and carers.
We will continue our focus on these areas in 2013/14 to improve the quality of the services
we provide.
Complaints handling
In line with the trust’s Complaints Policy the aim is to respond to complaints received within
25 working days and that extensions are agreed with the complainant when it is not possible to
complete the investigation within this time frame. Of the 156 complaints investigated, 122 (78%)
were completed within the agreed timescales.
Parliamentary and Health Service Ombudsman
Complaints investigated
156 complaints have been investigated for this period and of which 415 concerns were raised. Of
these 415 concerns raised, 182 (44%) were upheld or had elements within the complaint that were
upheld. (The investigation for a complaint received in any one month may not be completed until
the next month, so issues are carried over. There is therefore a discrepancy between the in-month
number of complaints raised and the number investigated.)
Complainants who are dissatisfied with the trust response have the right to ask that the
Parliamentary and Health Service Ombudsman (PHSO) reconsider their complaint. During the year,
17 complainants have asked for their case to be reviewed by the Ombudsman’s Office since April
2012. To date, the ombudsman has not identified any areas that require further action.
Our review of the concerns raised has picked up 3 themes:
Raised
Upheld
% upheld
Care planning
158
56
35%
Attitude of staff
69
23
33%
Information 36 1747%
Oxleas NHS Foundation Trust
Quality Report 2012/13
58
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Oxleas NHS Foundation Trust
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Quality report
Annex 1: Feedback from our Stakeholders
Statement from Stakeholders – Lead Clinical Commissioning Groups Bexley, Bromley and
Greenwich
Thank you for submitting a draft copy of Oxleas 2012/13 Quality Accounts for comment, to be
included in your stakeholder response section of the report. CCGs welcome the report which gives us
a clear indication of how the Trust prioritises and monitors quality within its organisation. Please see
below comments from BBG CCG stakeholders as requested:
We can confirm that the content of the quality accounts for 2012/13 pertaining to our contractual
agreement is accurate and correct, reflecting information that has been reported quarterly
throughout 2012/13.
4) Physical Health Checks
Although it is recognized that Physical Health Checks remain a high priority, it was a disappointment
to note that in the national POMH UK audit on ‘improving physical health checks and screening for
metabolic side effects of medications’ there was a decrease in Physical Health Checks completed in
2012/2013, given the significant amount of work that has taken place over recent years to improve
this. CCGs are keen to ensure that this remains a priority as people with Serious Mental Illness are
dying earlier than expected, and will continue to be reflected as our priority through the new CQUIN
indicators agreed for 2013/2014.
5)Prescribing
The areas that particularly stood out for us in 2012-13:
The CCGs are particularly pleased to see the improvements in prescribing outlined in the quality
accounts, and would like to work with Oxleas to consider ways in which we can work to include
primary care more closely in the future.
1) Smoking Cessation – Recording smoking status on Rio – Target 95%
We would like to see the following areas referred to in the quality accounts:
We have been particularly impressed with Oxleas commitment to addressing smoking cessation
across all Oxleas mental health services and the continued commitment to improve the smoking
cessation of patients in mental health services onwards into 2013-14. We recognise this was
not a particularly easy task at the beginning of the year, but Oxleas have demonstrated marked
improvement throughout the year to reach the year-end target of 95% of all patients smoking
status being recorded on RiO.
Reference to Francis Report
2) Introduction of on-site blood tests at Clozapine Clinics
The development and implementation of on-site blood tests for patients prescribed clozapine
medication, demonstrating innovation and quality improvement in monitoring the safety and
effectiveness of clozapine. This initiative has drastically improved the patient experience and
quality of life by making the monitoring of this drug more manageable and providing on the spot
confirmation of the safety and effectiveness of the drug. This scheme has been rolled out across the
trust due to the successful initial pilot in Bexley.
3) Support to Carers and Families
We would like to see a trust response to the Francis Report including measures that are being taken
to implement recommendations from this report.
Serious Incident Management
We would like to see reference to SIs in the account which are an important indicator of quality.
The CCGs would also like to recognise that the Trust has been working in an open and transparent
manner with all three CCGs on this area resulting in an improved local procedure and much closer
working with commissioners. The CCG welcomes the reporting of SIs onto STEIS.
Safeguarding Reporting
We would like to see a reference to Oxleas safeguarding reporting as part of the quality accounts
as there is no reference in the quality accounts to safeguarding and how well Oxleas perform their
duties under safeguarding.
We are keen to ensure that carers assessment remain a priority and were pleased that increasing
support for families and carers is one of the 4 must do priorities. However, young carers where
adults have mental health problems are a particularly vulnerable group and know to be under
identified. Oxleas has not specifically referenced this group within the quality account and it appears
that the focus on carers may be on adult carers. We would like to see some specific focus and
reporting on the work being carried out to support young carers.
Oxleas NHS Foundation Trust
Quality Report 2012/13
60
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Oxleas NHS Foundation Trust
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Quality report
In Summary
We believe BBG have worked very successfully with Oxleas FT over the past 3 years, on developing
challenging CQUIN’s that ‘stretch’ Oxleas and encourage innovation and on-going improvement.
We look forward to working with Oxleas throughout the 2013/14 CQUIN scheme and hope that
we will continue to see on-going improvements in patient experience, patient safety and clinical
effectiveness throughout the year.
Yours sincerely
Simon Evans-EvansSonia ColwillNicola Havutcu
Director of Governance
Director of Quality
Director of Integrated
& Quality
Governance & Patient Governance
Bexley CCGSafety Bromley CCGGreenwich CCG
NHS Greenwich Clinical Commissioning Group
Comments in response to the draft Oxleas NHS Foundation Trust 2012/13 Quality Report
1. Background:
The draft Oxleas NHS Foundation Trust Quality Report for 2012/13 was reviewed by the NHS
Greenwich Clinical Commissioning Group’s Quality Committee on 20th May ‘13. The coordination
of feedback on the Quality Report has been historically undertaken across Bexley, Bromley and
Greenwich CCG’s Governance Leads, who welcome the opportunity to respond to this document.
This is the NHS Greenwich Clinical Commissioning Group response as part of this joint process.
NHS Greenwich Clinical Commissioning Group is committed to working closely with Oxleas NHS
Foundation Trust to ensure the on-going delivery of high quality services. NHS Greenwich Clinical
Commissioning Group has established processes for regularly review of quality issues with Oxleas
NHS Trust, via regular Clinical Quality Review Group Meetings (CQRG) as well as a number of other
quality review mechanisms. The Terms of Reference and membership of the CQRG have been
recently revised (May 2013). Commissioners have been involved in Oxleas pressure ulcer panel
and commissioners across Greenwich, Bexley and Bromley have initiated a Pressure Ulcer Working
Group, which seeks to share good practice on pressure ulcer management, attended by adult
safeguarding leads and commissioners.
Oxleas NHS Foundation Trust outlined the 45 improvement goals set in 2012/13 that span the three
key domains of quality - patient experience, patient safety and clinical effectiveness. Progression
against these goals were monitored by Oxleas Quality Board. Issues arising, where performance
targets were not met, have been addressed in the quality improvement goal.
Oxleas NHS Foundation Trust
Quality Report 2012/13
62
There is evidence that CQUINs have being used as an enabler to better achievement and this has
been specified. An example of this includes an action plan that has been endorsed by the Oxleas
Trust Quality Board and Oxleas Clinical Effectiveness Group, ensuring that patients are given
information on side effects of their medication, feel listened to and are treated with dignity and
respect. This was in response to results being lower than expected during 2011/12 (national patient
survey data).
NHS Greenwich Clinical Commissioning Group acknowledges that there have been no CQC
enforcement actions during 2012/13 and that three unannounced visits took place (two to Kent
Prisons and one to an Oxleas in-patient mental health unit in Bromley) which provides external
assurance that the services inspected were fully compliant with standards. CQC have also drawn out
a specific area of good practice in Oxleas work with a Patient Experience Group (PEG) for the Norman
Ward and NHS Greenwich Clinical Commissioning Group commends this.
2. Areas of notable good practice are outlined:
meeting the goal to increase numbers of carers who have been offered a carer
•consistently
assessment
• Improved discharge planning process in Kent prisons
in use of antipsychotic drugs in people with dementia (from 16% to 9%) which is higher
•Reduction
than the national average (16% to 13%).
• Good improvement in use of Doppler Assessments.
in NICE guidance diabetes audit on prevention and management of foot problems in
•Participation
patients with Type 2 diabetes and a repeat of the audit being undertaken in six months.
• Notable good practice recognized by CQC on PEG on the Norman Ward.
• A collection of prizes for the Bracton Centre in the annual Koestler Awards.
Priorities reflect the breadth of services Oxleas provide as follows:
• Mental health and adult learning disability services across Bexley, Bromley and Greenwich.
• Community health services across Bexley and Greenwich
• Adult musculoskeletal services to Kent and
• Mental health in-reach services to Kent prisons.
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Quality report
3. Quality Improvement priorities for 2013/14 have been reviewed and agreed to be:
4 must do priorities (increasing support for families and carers, providing better information
•The
for service users and carers, enhancing care planning and improving the way the Trust relates
to both service users and carers).
• To monitor key quality indicators.
• Commissioning for Quality and innovation goals agreed with commissioners.
• Current priorities where trend data is available to measure improvement year on year.
• Linked to the 5 Domains within the NHS Outcomes Framework.
Commissioners have worked closely with Oxleas in the design of CQUINs for 2013/14, particularly on
the Trusts participation and delivery of the NHS Safety thermometer CQUIN 2013/14 and a CQUIN to
improve and embed a learning culture and the principles embedded within the Francis Report.
4. CQUINs for 2013/14 areas of focus are:
1.To improve the collection of data to promote harm free care through reductions in falls, pressure
ulcers, urinary tract infections in people with indwelling catheters and venous thromboembolism
(VTE)
Annex 2: Statement of directors’ responsibilities
in respect of the Quality Report
The directors are required under the Health Act 2009 and the National Health Service Quality
Accounts Regulations to prepare Quality Accounts for each financial year.
Monitor has issued guidance to NHS foundation trust boards on the form and content of annual
quality accounts (which incorporate the above legal requirements) and on the arrangements that
foundation trust boards should put in place to support the data quality for the preparation of the
quality report.
In preparing the Quality Report, directors are required to take steps to satisfy themselves that:
content of the Quality Report meets the requirements set out in the NHS Foundation Trust
•the
Annual Reporting Manual 2012/13;
content of the Quality Report is not inconsistent with internal and external sources of
•the
information including:
o Board minutes and papers for the period April 2012 to May 2013
o Papers relating to Quality reported to the Board over the period April 2012 to May 2013
o Feedback from the Bexley, Bromley and Greenwich commissioners dated 28/05/2013
o Feedback from local Healthwatch organisations (not available at 28.5.13)
3.For Oxleas staff to receive training on smoking cessation and refer patients on to local smoking
cessation services
oFeedback from other stakeholders involved in the sign-off of the Quality Report
(not available at 28.5.13)
4. To improve and embed a learning culture within the organization in line with the Francis Report.
5.To increase the numbers of women receiving an ante natal assessment from community health
visitors (Bexley CQUIN)
oThe trust’s 2011/12 complaints reports published under regulation 18 of the local authority
Social Services and NHS complaints regulations 2009
o The 2012 national patient survey
2.To improve cognitive impairment screening for patients aged 75 and over following admission to
hospital
6.To increase the number of patients on an end of life pathway dying at their preferred place of
death (Greenwich CQUIN)
The analysis of the areas in which the Trust did not achieve its targets last year is helpful and gives
good assurance to commissioners that clear action plans are in place. Trust plans for 13/14 include
areas of concern to commissioners and NHS Greenwich Clinical Commissioning Group supports
this plan.
o The 2012 national staff survey
o CQC quality and risk profiles dated 31/03/2013.
o T
he Head of Internal Audit’s annual opinion over the trust’s control environment dated
2012/13.
Yemi Osho
Chair of the NHS Greenwich Clinical Commissioning Group Quality Committee
May 2013
Oxleas NHS Foundation Trust
Quality Report 2012/13
64
65
Oxleas NHS Foundation Trust
Quality Report 2012/13
Quality report
No issues came to our attention that led us to believe that the Quality Report is not consistent with
the other information sources detailed above.
Annex 3: Criteria applied to mandated indicators
Quality Report presents a balanced picture of the NHS foundation trust’s performance over
•the
the period covered;
• the performance information reported in the Quality Report is reliable and accurate;
are proper internal controls over the collection and reporting of the measures of
•there
performance included in the Quality Report, and these controls are subject to review to confirm
Our external auditors, PwC, as part of the annual quality report requirements, have undertaken work
on the two mandated indicators below.
data underpinning the measures of performance reported in the Quality Report is robust
•the
and reliable, conforms to specified data quality standards and prescribed definitions, is subject
PwC are required to base their work on the performance against the definitions outlined below, not
the performance published on Health and Social Care Information Centre (HSCIC).
that they are working effectively in practice;
to appropriate scrutiny and review; and the Quality Report has been prepared in accordance
with Monitor’s annual reporting guidance (which incorporates the Quality Report s regulations)
(published at www.monitor-nhsft.gov.uk/annualreportingmanual) as well as the standards to
support data quality for the preparation of the Quality Report (available at www.monitor-nhsft.
gov.uk/annualreportingmanual).
The directors confirm to the best of their knowledge and belief they have complied with the above
requirements in preparing the Quality Report.
By order of the Board
1)100% enhanced Care Programme Approach (CPA) patients receiving follow-up contact within
seven days of discharge from hospital – National Mandated indicator
2)Admissions to inpatient services had access to crisis resolution home treatment teams - National
Mandated indicator.
PwC’s conclusions in relation to these indicators is outlined in Annex 4
The trust’s performance against these two indicators was as follows:
Mandated
Monitor Indicator
Threshold
Trust performance against the
national mandated indicator based on the definitions outlined below
100% enhanced Care Programme
Approach (CPA) patients receiving
follow-up contact within seven days
of discharge from hospital
95%
98%
Admissions to inpatient services
had access to crisis resolution
home treatment teams
95%
99.5%
The definition used by Oxleas when measuring and reporting performance against the national
mandated indicators are set out below.
100% enhanced Care Programme Approach (CPA) patients receive follow up contact within seven
days of discharge from hospital
Signed
Signed
29 May 2013
29 May 2013
Stephen Firn, Chief Executive
Oxleas NHS Foundation Trust
Quality Report 2012/13
Archie Herron, Deputy Chairman
66
indicator is expressed as a proportion of those patients on Care Programme Approach (CPA)
•The
discharged from inpatient care who are followed up within 7 days.
discharged’ includes patients discharged to their place of residence, care home,
•‘Patients
residential accommodation, or to non psychiatric care, or to prison.
•The indicator excludes patients who die within 7 days of discharge.
indicator excludes patients removed from the country as a result of legal precedence within
•The
7 days of discharge.
67
Oxleas NHS Foundation Trust
Quality Report 2012/13
Quality report
•
indicator excludes CAMHS (children and adolescent mental health services), i.e. patients aged
•The
under 18.
• Those that are recorded as followed up receive face to face contact or a telephone conversation.
7 day period should be measured in days not hours and should start on the day after
•The
discharge.
The indicator excludes patients transferred to NHS psychiatric inpatient ward when discharged
from inpatient care.
Oxleas guidance states that in the first instance the healthcare professional should make every
effort to have a face to face contact with the patient, however if this is not possible then a telephone
conversation with the patient, another healthcare professional or carer depending on where the
patient has been discharged to should suffice as long as assurance of patient’s safety is gained.
The trust also adopts a policy whereby if a patient is discharged and readmitted within seven days
and before follow up has occurred, they are recorded as followed up.
Admissions to inpatient services had access to crisis resolution home treatment teams
indicator is expressed as a proportion of inpatient admissions gate kept by the crisis
•The
resolution home treatment teams in the year ended 31 March 2013.
indicator should be expressed as a percentage of all admissions to psychiatric inpatient
•The
wards.
admission should be reported as gate kept by a crisis resolution team where they have
•An
assessed* the service user before admission and if the crisis resolution team were involved** in
the decision-making process which resulted in an admission.
* An assessment should be recorded if there is direct contact between a member of the team and
the referred patient, irrespective of the setting, and an assessment made. The assessment may be
made via a phone conversation or by any face-to-face contact with the patient.
** Involvement is where a patient is either offered an informal admission or an alternative
to hospital admission: the latter means being treated in their own home environment with
network support. This is always assessed with the patient and is based on ensuring adequate risk
management without compromising their care/choice.
the admission is from out of the trust area and where the patient was seen by the local
•Where
crisis team (out of area) and only admitted to this trust because they had no available beds
in the local areas, the admission should only be recorded as gate kept if the CR team assured
themselves that gatekeeping was carried out.
Oxleas NHS Foundation Trust
Quality Report 2012/13
68
Oxleas policy is to assess all admissions to inpatient beds to ensure that such admission is in the
best interest of the patient and manages relevant risks. As a result categories of patients excluded
from this indicator as described in the Monitor guidance are also assessed although in practice
gate keeping rarely takes place. Therefore the following exclusions, as defined for this indicator by
Monitor, are not applied by the trust:
•Patients recalled on Community Treatment Order should be excluded from the indicator.
atients transferred from another NHS hospital for psychiatric treatment should be excluded
•Pfrom
the indicator.
transfers of service users between wards in the trust for psychiatry treatment should
•Ibenternal
excluded from the indicator.
atients on leave under Section 17 of the Mental Health Act should be excluded from the
•Pindicator.
admission for psychiatric care from specialist units such as eating disorder unit
•Parelanned
excluded.
Annex 4: Independent Auditor’s Limited Assurance
Report to the Council of Governors of Oxleas NHS
Foundation Trust on the Annual Quality Report
We have been engaged by the Council of Governors of Oxleas NHS Foundation Trust to perform an
independent assurance engagement in respect of Oxleas NHS Foundation Trust’s Quality Report
for the year ended 31 March 2013 (the “Quality Report”) and specified performance indicators
contained therein.
Scope and subject matter
The indicators for the year ended 31 March 2013 in the Quality Report that have been subject to
limited assurance consist of the following national priority indicators as mandated by Monitor:
1.100% enhanced Care Programme Approach (“CPA”) patients receiving follow-up contact within
seven days of discharge from hospital; and
2. Admissions to inpatient services had access to crisis resolution home treatment teams.
We refer to these national priority indicators collectively as the “specified indicators”.
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Respective responsibilities of the Directors and auditors
The Directors are responsible for the content and the preparation of the Quality Report in
accordance with the assessment criteria referred to in Annex 2 of the Quality Report (the “Criteria”).
The Directors are also responsible for the conformity of their Criteria with the assessment criteria
set out in the NHS Foundation Trust Annual Reporting Manual (“FT ARM”) issued by the Independent
Regulator of NHS Foundation Trusts (“Monitor”).
Our responsibility is to form a conclusion, based on limited assurance procedures, on whether
anything has come to our attention that causes us to believe that:
he Quality Report does not incorporate the matters required to be reported on as specified in
•TAnnex
2 to Chapter 7 of the FT ARM;
•The Quality Report is not consistent in all material respects with the sources specified below; and
he specified indicators have not been prepared in all material respects in accordance with the
•TCriteria.
We read the Quality Report and consider whether it addresses the content requirements of the FT
ARM, and consider the implications for our report if we become aware of any material omissions.
We read the other information contained in the Quality Report and consider whether it is materially
inconsistent with the following documents:
•Board minutes for the period April 2012 to May 2013;
•Papers relating to Quality reported to the Board over the period April 2012 to May 2013;
eedback from Bexley Clinical Commissioning Group, Bromley Clinical Commissioning Group and
•FGreenwich
Clinical Commissioning Group dated 24 May 2013;
he trust’s 2011/12 complaints report published under regulation 18 of the Local Authority Social
•TServices
and NHS Complaints Regulations 2009;
•The patient survey report 2012;
•The 2012 national NHS staff survey;
•Care Quality Commission quality and risk profiles dated 31 March 2013; and
Head of Internal Audit Opinion 2012/13 over the Trust’s control environment dated
•T29heMay
2013.
We consider the implications for our report if we become aware of any apparent misstatements or
material inconsistencies with those documents (collectively, the “documents”). Our responsibilities
do not extend to any other information.
Oxleas NHS Foundation Trust
Quality Report 2012/13
70
We are in compliance with the applicable independence and competency requirements of the
Institute of Chartered Accountants in England and Wales (ICAEW) Code of Ethics. Our team
comprised assurance practitioners and relevant subject matter experts.
This report, including the conclusion, has been prepared solely for the Council of Governors of
Oxleas NHS Foundation Trust as a body, to assist the Council of Governors in reporting Oxleas
NHS Foundation Trust’s quality agenda, performance and activities. We permit the disclosure of
this report within the Annual Report for the year ended 31 March 2013, to enable the Council of
Governors to demonstrate they have discharged their governance responsibilities by commissioning
an independent assurance report in connection with the indicators. To the fullest extent permitted
by law, we do not accept or assume responsibility to anyone other than the Council of Governors as
a body and Oxleas NHS Foundation Trust for our work or this report save where terms are expressly
agreed and with our prior consent in writing.
Assurance work performed
We conducted this limited assurance engagement in accordance with International Standard on
Assurance Engagements 3000 ‘Assurance Engagements other than Audits or Reviews of Historical
Financial Information’ issued by the International Auditing and Assurance Standards Board (‘ISAE
3000’). Our limited assurance procedures included:
valuating the design and implementation of the key processes and controls for managing and
•Ereporting
the indicators.
•Making enquiries of management.
imited testing, on a selective basis, of the data used to calculate the specified indicators back to
•Lsupporting
documentation.
omparing the content requirements of the FT ARM to the categories reported in the Quality
•CReport.
•Reading the documents.
A limited assurance engagement is less in scope than a reasonable assurance engagement.
The nature, timing and extent of procedures for gathering sufficient appropriate evidence are
deliberately limited relative to a reasonable assurance engagement.
Limitations
Non-financial performance information is subject to more inherent limitations than financial
information, given the characteristics of the subject matter and the methods used for determining
such information.
71
Oxleas NHS Foundation Trust
Quality Report 2012/13
Quality report
The absence of a significant body of established practice on which to draw allows for the selection
of different but acceptable measurement techniques which can result in materially different
measurements and can impact comparability. The precision of different measurement techniques
may also vary. Furthermore, the nature and methods used to determine such information, as well as
the measurement criteria and the precision thereof, may change over time. It is important to read
the Quality Report in the context of the assessment criteria set out in the FT ARM and the Directors’
interpretation of the Criteria in Annex 2 of the Quality Report.
It is not possible to calculate Oxleas NHS Foundation Trust’s performance against the specified
indicators as if they had applied the DH guidance without interpretation. Our conclusion is not
modified in this respect.
The nature, form and content required of Quality Reports are determined by Monitor. This may result
in the omission of information relevant to other users, for example for the purpose of comparing the
results of different NHS Foundation Trusts.
PricewaterhouseCoopers LLP
In addition, the scope of our assurance work has not included governance over quality or nonmandated indicators in the Quality Report, which have been determined locally by Oxleas NHS
Foundation Trust.
Conclusion
Based on the results of our procedures, nothing has come to our attention that causes us to believe
that for the year ended 31 March 2013:
Signed
Chartered Accountants
London
29 May 2013
The maintenance and integrity of the Oxleas NHS Foundation Trust’s website is the responsibility
of the directors; the work carried out by the assurance providers does not involve consideration of
these matters and, accordingly, the assurance providers accept no responsibility for any changes
that may have occurred to the reported performance indicators or criteria since they were initially
presented on the website.
he Quality Report does not incorporate the matters required to be reported on as specified in
•Tannex
2 to Chapter 7 of the FT ARM;
he Quality Report is not consistent in all material respects with the documents specified above;
•Tand
he specified indicators have not been prepared in all material respects in accordance with the
•tCriteria.
Emphasis of matter
We draw your attention to the fact that the reported performance in relation to the specified
indicators is based on the NHS foundation trust’s interpretation of DH guidance set out in Technical
Guidance for the 2012/13 Operating Framework. The local interpretation is included within the
Oxleas NHS Foundation Trust Quality Report at Annex 2. In summary:
are Programme Approach (“CPA”) patients receive follow up contact within seven days of
•Cdischarge
from hospital – where the Trust cannot make contact with a patient directly for follow
up, the follow up can be performed with a suitably qualified healthcare professional.
dmissions to inpatient services had access to crisis resolution home treatment teams – the Trust
•Ainclude
all patients in their assessment of performance but do not exclude those patients the DH
guidance says can be excluded from the assessment.
Oxleas NHS Foundation Trust
Quality Report 2012/13
72
73
Oxleas NHS Foundation Trust
Quality Report 2012/13
Useful contact numbers:
Trust Secretary
Oxleas NHS Foundation Trust
Pinewood House
Pinewood Place
Dartford
Kent DA2 7WG
Email: anne.rozier@oxleas.nhs.uk
Tel: 01322 625700
Fax: 01322 555491
Patient Advice
and Liaison Service
If you require information,
support or advice, please
contact us free on:
Tel: 0800 917 7159
Trust membership
To become a member of
Oxleas NHS Foundation Trust
contact us on:
Tel: 0800 389 6642
Email: foundation.trust@oxleas.nhs.uk
or join online at
oxleas.nhs.uk
Careers
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on vacancies at Oxleas,
please visit our website at
oxleas.nhs.uk
oxleas.nhs.uk
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