PRIORY HEALTHCARE
QUA L IT Y ACC O U NT 2012 -1 3
PROVIDING QUALITY
INSPIRING INNOVATION
DELIVERING VALUE
Introduction and background
The Priory Group of Companies is the UK's leading provider of mental healthcare and specialist education services.
We work in partnership with our service users and their families, as well as commissioners, regulators and other stakeholders,
to provide the best possible outcomes at every stage of an individual's care pathway.
By providing a seamless transition for service users as they progress between higher and lower dependency services,
we ensure continuity of care that underpins the delivery of successful outcomes*.
Priory Pathways are our range of services that provide accessible expertise appropriate to each service user as part of their
personalised care pathway. This integrated approach to treatment supports the service user's progression by providing
sustainable placements and, where appropriate, reintegration back into a community setting.
P A T H W A Y S
Behavioural, emotional and
social difficulties
Acute mental health
Addictions
Eating disorders
Child and adolescent
mental health
Secure
Complex care
Autism including
Asperger’s syndrome
Positive Behaviour
Support
Community and
domiciliary options
(‘Supporting You’)
re
Our
integrated
approach to
treatment
Ca
Hea
lt
m
Edu
c
oo
or
e
Autism
are
c
h
eg
Learning disabilities
Fostering
C ra
Mental health
Specialist further
education
ion
at
Neuro-disabilities
Learning disabilities
Autism including
Asperger’s syndrome
r
Am
Residential care
Nursing care
Dementia care
Day care
Respite care
Re-ablement and
convalescence care
End of life care
* Priory Healthcare satisfaction results based on opinion surveys completed during 2012-13. All service users' quotes within this Quality Account have been retrieved from
anonymous comments within these surveys. Clinical outcomes based on standard metrics used across all Priory hospitals, 2012-13. All commissioner quotes are their own.
Detailed information on the scope of data inclusion in relation to the outcomes highlighted in this Quality Account are outlined in the appendix, from page 43.
2
External review by PricewaterhouseCoopers
In 2012, the Priory Group commissioned an external
review of the Group’s quality assurance and governance
processes, performed by PricewaterhouseCoopers (PwC).
The findings from the review were largely positive, and
our aim is to continue to develop market leading practices
to ensure that all Priory sites maintain their high quality
standard of service.
Seven key senior positions have since been created,
including a Director of Corporate Assurance and Chief
Nursing Officer, who has led the improvements in safety,
quality and compliance, with a Director for each of the
three functions to ensure effective delivery. Heads of
Quality for each division within the Group have also been
appointed, to take divisional responsibility for proactively
driving improvements in quality; ensuring quality
indicators, care standards and regulatory requirements
are fully satisfied.
•
the implementation of a quality dashboard,
which contains information on key quality performance
indicators, that can be interrogated down to site level.
This allows the Quality team to adopt an overarching
view of quality across the organisation, and can
also drill down to divisional, regional and site level
information if required. Divisional management
teams are also able to access the information on the
dashboard to enable them to work closely with sites
where potential issues are highlighted
PricewaterhouseCoopers will return in 2013-14 to review
the changes that have been made and present their
findings to the Quality Assurance Committee.
A Quality Review Project Board was formed during the
year to ensure delivery of the planned improvements
in 2012-13. In addition, a Quality Assurance Committee
was established, which reports to the Board on all matters
relating to safety, quality and compliance. The Quality
Assurance Committee is chaired by a Non-Executive Director.
Key achievements and improvements to date include:
•
strengthening the risk register process to ensure
risks are identified at site level, with mitigating action
taken when required. Divisional risk registers feed into
the Group Risk Register and ultimately the Board
Assurance Framework
•
the introduction of an e-compliance system,
along with a strengthened internal team of compliance
inspectors. Separate tools have been developed to
cover all Priory Group services as well as the different
regulatory bodies (a total of 23 tools). There is a
proactive internal programme of inspections, which
enable any issues to be picked up immediately, with
actions put in place to resolve them. Action plans are
monitored by the divisional Heads of Quality
3
Providing
Inspiring
Delivering
4
4
Contents
Part 1 – Statement from the Chief Executive
Statement from the Chief Executive
7
Quality statement from the Director of Corporate Assurance
and Chief Nursing Officer
Overview of the Priory Healthcare division
9
10
Part 2 – Performance against objectives
Performance against 2012-13 objectives
12
Detailed review of performance against 2012-13 objectives
14
Part 3 – Priorities for improvement
Priorities for improvement 2013-14
16
Part 4 – Additional information
Service user satisfaction – delivering value through clinical excellence
18
Outcomes – the success of our service users
20
Investing in staff, education and training
22
Regulatory compliance
25
Focus sites during 2012-13
27
Working in partnership with our commissioners and regulators
28
Improving safety for our service users
29
Continuous improvement in the delivery of our services
30
Part 5 – Appendix
Statement of assurance from our lead commissioner
32
Statement of directors' responsibilities in respect of the
Quality Account
33
Independent auditor’s limited assurance report
34
Format of this Quality Account
37
Glossary of terms
39
Commissioning for Quality and Innovation framework
40
Scope of data inclusion
43
5
Our promise
PROVIDING QUALITY
Quality is not only applied to the care and services we deliver, it also stretches across our staff
and facilities, ensuring optimum standards of delivery in the appropriate surroundings.
What quality means to us:
•
•
•
•
•
Consistent delivery of care and education at the highest level
Safe, effective and regulated services
Listening to our service users
The highest calibre of staff
Investing in our facilities
INSPIRING INNOVATION
As a service provider, we are always looking for new ways to do things better. Innovation can
be in the form of a new idea or by simply being innovative with an existing one.
What innovation means to us:
•
•
•
•
Constantly reviewing the way we work to ensure we continually develop best practice
Not accepting the status quo if things could be improved
Being at the forefront of treatment and care-led trends and solutions
Creating unique and market leading practices
DELIVERING VALUE
We offer the best quality individualised programmes at competitive prices, tailored to specific
treatment goals. These programmes offer flexibility as well as the ability to reduce costs
throughout treatment.
What value means to us:
•
•
•
•
6
Tailored and cost effective treatment
Remaining highly competitive in the market
Transparent and flexible pricing models
Regular pricing reviews
Part 1 – Statement from the Chief Executive
Welcome to our third Healthcare Quality Account, my first
as Chief Executive Officer of the Group, which provides a
summary of the achievements of our Healthcare division
during 2012-13 and outlines our priorities for quality
improvement during 2013-14.
mental health service where 97% of service users rated
the overall quality of their therapy treatment as good
or excellent and in our complex care service where 99%
of service users wholly or partially achieved all of their
treatment goals.
All of us at the Priory Group are passionate about the
quality of service that we provide to all of those entrusted
into our care. Over the course of the last 12 months
we have made significant further improvements in
performance against key quality measures and, at the
date of writing this report, I am pleased to announce that
we have no embargoes in place across the Healthcare
division from any of our regulators.
In our addictions and eating disorders services, 99% and
98% of service users respectively, said they were treated
with respect and dignity and 95% of service users from
our child and adolescent mental health services (CAMHS)
were satisfied with the care and treatment they received.
96%
of outcomes inspected by
our regulators were met
Thanks to the hard work of our staff, we have successfully
delivered against the quality priorities we set ourselves
in our 2011-12 Quality Account as well as achieving our
Commissioning for Quality and Innovation (CQUIN)
targets for the year. Providing innovative treatments across
our service lines is key to the success of the business;
as such, we are working on developing integrated care
pathways that cross our divisions to ensure we can offer
a complete package of care to service users throughout
the key stages of their lives, from inpatient care to supported
living and then out into the community. Our ultimate goal
is to provide excellence in mental healthcare across the
communities we serve.
We have a hugely dedicated, professional workforce,
who continue to deliver care to an excellent standard.
The commissioning landscape has changed significantly
over recent months and it is my aim to successfully
navigate the Group through the evolving environment,
ensuring that the wellbeing of service users and the health
of our organisation is protected and the highest quality
standards are upheld.
I work closely with the Healthcare division’s senior
management team and, to the best of my knowledge,
the information contained in this report is a true and
accurate reflection of the services and outcomes that
we have delivered.
Tom Riall
Chief Executive Officer
June 2013
Our focus is always on service user safety, clinical
effectiveness and the service user experience. Achievement
of these goals is clearly demonstrated within the acute
Our ultimate goal is
to provide excellence
in mental healthcare
across the communities
we serve
7
Highlights from this year’s Quality Account
What our service users think
94%
of our younger service users
felt that their healthcare
professionals listened to and
understood their problems
90%
of service users within
complex care services
said they were treated
with dignity and respect
98%
of service users within
addiction services were
satisfied with their overall
quality of care
What our staff think
8
90%
of our staff feel that
service users are given
choice and flexibility
regarding their care
89%
of our staff feel that they
are able to contribute to
the success of their team
90%
of our staff feel motivated
to go the extra mile for the
people they care for
Quality statement from the Director of Corporate Assurance and
Chief Nursing Officer
The Priory Group ensures that our clinical teams are
supported by an arms-length Corporate Assurance
function, which has been made possible by the significant
investment in this area that was made during 2012.
This ensures that our services are safe and effectively
regulated and enhances the effectiveness of services
and care provided.
Achieving positive outcomes, coupled with the experience
of our service users and staff, defines the quality of
our service and is at the heart of everything we do.
This approach is also reflective of the national agenda
for quality.
Our priorities for driving quality within the Priory Group
are to:
•
exceed national standards of care
•
improve outcomes for both our adult and adolescent
service users
•
deliver safe and secure services
•
ensure a positive experience of care from all who use
our services
In addition, we will continue to invest in our staff through
education and training, which ensures that the high levels
of care that we expect are delivered.
variations from England, Scotland, Wales and Northern
Ireland. This not only helps us to satisfy our regulatory
bodies, but also enables us to produce policies and
procedures that are relevant and aimed at providing
the highest standard of care.
The Priory Group is responsive to any external
investigation that may highlight areas for improvement
within the healthcare industry. As such, we have reviewed
the recommendations from the Francis Inquiry that were
published in March 2013, and have already committed to
take forward a number of actions arising from the report.
Therefore, I am delighted to accept the role of Chief
Nursing Officer for the Group; strengthening the voice
of nursing and leading on professional standards.
We will continue to support our staff, hear the voice of
our service users, and safeguard our vulnerable adults
and children in the changing health and social care
landscape to ensure we are well equipped to meet the
challenges ahead.
Siân Wicks
Director of Corporate Assurance and
Chief Nursing Officer
June 2013
The way in which we aim to improve on best practice
standards is by listening to our service users; our experts
by experience. This, along with benchmarking ourselves
against National Institute for Health and Care Excellence
(NICE) quality standards and other national and
international standards, is fundamental as we strive to
make a difference to the people who use our services.
We ensure that our policies and procedures are up to date,
evidence-based and take into consideration regional
Quality is at the
heart of everything
we do
9
Overview of the Priory Healthcare division
Acute mental health services
Eating disorder services
With the largest network of mental healthcare hospitals
and clinics in the UK, we offer a flexible range of treatment
programmes that feature:
As the market leader in specialist acute care and high
dependency treatment, including naso-gastric and PEG
feeding, Priory hospitals offer a broad range of innovative
therapy programmes and creative workshops alongside:
comprehensive, multidisciplinary therapy services
with a single point of access
integrated and personalised treatment programmes,
tailored to the needs of the service user
bespoke therapeutic interventions, including
dialectical behaviour and mindfulness therapies
treatment programmes for service users with
a dual diagnosis
close working relationships with commissioners, which
have delivered a 30% reduction in length of stay
structured pricing plans, including episode pricing and
relapse guarantees
95%
rated the quality of their care as good
or excellent
80%
demonstrated improvement in their
attitude to their diet, shape and weight
91%
gained weight
one-stop, direct access into our therapy services
99%
86%
rated the overall quality of their therapy
treatment as good or excellent
showed improvement in their overall
mental wellbeing
Child and adolescent mental health services (CAMHS)
75%
demonstrated recovery or significant
improvement at discharge from therapy
Addiction services
Offering 12 months of aftercare and family support
included as part of personalised addiction treatment
programmes, Priory hospitals provide:
specialist programmes to address underlying
psychological issues, such as trauma reduction
10
We accept referrals into our CAMHS facilities 24 hours
a day, seven days per week and provide a two hour
response time to emergency requests. Our service is
designed to enable children and young people to improve
their long term wellbeing, which promotes effective
reintegration into the community by providing:
a wide range of specialist therapeutic interventions
innovative treatment programmes that are tailored
to the unique needs of each young person
second stage residential rehabilitation
a focus on promoting safe and sustainable recovery
within the least restrictive environment possible
30 years of experience in treating addictions
structured pricing plans
a free initial assessment
facilities across the UK
98%
rated the quality of their treatment
as good or excellent
95%
of young people were satisfied with
the overall quality of their care
93%
showed improvement in their overall
mental wellbeing after seven days
24%
reduction in absconsions
99%
felt that they were treated with dignity
and respect
77%
showed improvement in their overall
mental wellbeing
Complex care services
Autism and Asperger’s syndrome services
With personalised packages of care for people with
complex and intensive or rehabilitative needs, the Priory
offers the highest quality of rehabilitation and recovery
as well as:
Our residential homes provide high quality, supportive
community living within safe, structured and engaging
environments. Our aim is to enable each person to develop
essential social, educational and vocational skills that will
help them to progress towards a more positive future and
successful independent living wherever possible by:
active engagement with the service user and their
family in their care plan wherever possible
high success rates in reducing levels of aggression
and behaviours which challenge generic services
tailoring therapy treatment to each service user's
unique needs
an adapted recovery model for individuals with
cognitive impairment
emphasising the development of appropriate social
behaviours, communication and interpersonal skills
bespoke pricing and care packages
providing the opportunity to access a wide range
of activities, facilities, clubs and social groups within
the community
85%
rated the overall quality of their care as
good or excellent
99%
wholly or partially achieved their goals
Secure services
Offering a comprehensive care pathway and intensive
rehabilitation programmes for service users from medium
and low secure services through to step-down provision
and independent living, we provide:
providing seamless access to services that facilitate
continuity of care and support
100%
of support plans include personalised,
outcome driven goals
100%
of residents engage in activities within
the community
89%
of residents have accessed education
or work in the last six months
high levels of support for service users that have
failed in multiple placements
Neuro-disability services
a recovery focused philosophy that encourages
service users to take more control over their lives
Offering the highest quality of long term care and
rehabilitation to people with a neuro-developmental
disorder or brain injury, we:
episode pricing for medium and low secure units
based on predicted lengths of stay
adaptable and flexible pathways
structured pricing plans and volume discounts
63%
64%
0
showed improvement in their overall
mental wellbeing
combine a personalised approach to treatment with
the practice of some of the most experienced and
well respected clinicians within the UK
provide evidence-based treatment programmes
that demonstrate real life changing results for those
in our care
100%
believed that staff communicate in a way
that is easy to understand
93%
felt that they received enough
emotional support
100%
believed they are cared for and supported
showed improvement in their risk profile
never events
11
Part 2 – Performance against 2012-13 objectives
To ensure that we achieve the highest standards of quality,
we continually strive to improve in the areas that define
both the experience and outcomes of our service users.
This includes scrutinising the processes and practices that
we adopt to achieve these goals, alongside investment in
our staff, services and facilities.
We have identified eight priorities for improvement in
2013-14 at a divisional and service level, which are
detailed in Part 3 on pages 16 and 17.
In this section, we will analyse our progress against the
objectives prioritised within the 2011-12 Quality Account,
using data held in our service user management system
CareNotes and other IT systems, to demonstrate our
achievements in these areas. To ensure the most accurate
and effective evaluation of the objectives identified, we
have used baseline indicators from the 2011-12 Quality
Account where possible.
Our Quality Account will make reference to a number of
acronyms and these have been detailed in the glossary
at the end of this report (page 39) for ease of reference.
Results of our service user satisfaction surveys 2012-13
To improve the quality of services that we offer, it is
important to understand what people think about their
care and treatment. The service user satisfaction survey
is one way that the Priory Healthcare division obtains the
opinion and experiences of people who have recently used
our services. Using the results of these surveys, we are able
to constantly improve our services to ensure they meet the
needs of our service users.
Theme
Acute mental
health
Addiction
Satisfaction of Priory service users remains high within
our acute mental health, addiction and eating disorder
services, with some improvement required within complex
care and secure services in relation to care planning and
communication. More detailed outcomes, including
satisfaction results from our child and adolescent mental
health services, are included on pages 18 and 19.
Eating
disorder
Secure
Complex
care
Average
NHS
benchmark*
Involved in care planning
and communication
96%
97%
97%
73%
82%
89%
90%
Treated with dignity and
respect
99%
99%
98%
82%
90%
94%
87%
Given information regarding
side effects of medication
82%
88%
80%
66%
73%
78%
72%
Friend or family
recommendation
97%
98%
92%
n/a
n/a
n/a
data not
available
* NHS benchmarking information taken from CQC Community Mental Health Survey 2012, which incorporates 61 NHS Mental Health Trusts in England, including combined
community mental health and social care trusts. Since the most recent acute mental health service user satisfaction survey conducted by the CQC was undertaken in 2007,
it is not possible to compare like for like outcomes directly.
12
Summary of progress against 2012-13 Quality Indicators
In 2011-12, our Quality Account incorporated the feedback from service users, Priory staff, commissioners and other
external stakeholders, to identify four priority areas and 12 priority goals for 2012-13.
In this section, we will summarise our achievements against these priorities and provide a detailed breakdown on pages
14 and 15, covering the domains of:
improving outcomes for service users (under the 2013-14 domain of: clinical effectiveness)
delivering safe and secure services (under the 2013-14 domain of: service user safety)
ensuring a positive experience (under the 2013-14 domain of: service user experience)
investing in staff, education and training (under the 2013-14 domain of: clinical effectiveness)
Page ref
Priority
Service
Outcome
Improving outcomes for service users in 2012-13
14
Improve risk assessment and management of all service users, including
informal service users
Acute mental health and
addiction services
Achieved
14
Spread innovation in severe anorexia across all eating disorder facilities
Eating disorder services
Achieved
14
Improve care planning and other clinical documentation so that it is more
tailored for adolescent service users
Child and adolescent
mental health services
Achieved
14
Improve multidisciplinary team working across all sites
Complex care services
Achieved
Delivering safe and secure services in 2012-13
14
Spread innovation in risk assessment practice
Secure services
Mostly achieved
14
Reduce absconsions from units by 25%
Child and adolescent
mental health services
Mostly achieved
(24%)
Ensuring a positive experience of care in 2012-13
15
Improve service user perception of family involvement in care planning by 25%
Child and adolescent
mental health services
Mostly achieved
(24%)
15
Increase service user involvement in the appointment of senior clinical staff
at site level
Child and adolescent
mental health services
Mostly achieved
15
Improve service user representation at ward and site level meetings
Secure services
Achieved
15
Improve standards of nutritional care
Neuro-disability and
complex care services
Achieved
Investing in staff, education and training in 2012-13
15
Introduction of General Medical Council (GMC) revalidation for all doctors,
with individualised clinical governance data
All services
Achieved
15
90% of staff to undertake training relating to the Mental Capacity Act
All services
Achieved
13
Detailed review of performance against 2012-13 objectives
>>Improving outcomes for service users
Complex care services
Acute mental health and addiction services
Improve multidisciplinary team working across all sites
Improve risk assessment and management of all
service users, including informal service users
•
•
Measure: Audit of inpatient and day patient risk
assessment quality by September 2012; resulting
action plan to be completed by March 2013
•
Measure: Audit and act on the results of:
– ward round frequency documentation and attendance
– consultant performance of medical reviews and CPAs
– internal compliance inspections
•
Achieved: Internal inspections were undertaken, which
generated action plans as required. Clinical governance
minutes are sent to the internal compliance team
monthly and outstanding actions relating to internal
compliance inspections are monitored via the monthly
Healthcare dashboard pack
Achieved: Care plan and risk assessment audit was
completed across both services. A training module
was formulated and cascaded to all sites
Eating disorder services
Spread innovation in severe anorexia across all eating
disorder facilities
•
•
Measure: All adult eating disorder facilities to organise,
or contribute to, the development of a local multiagency group to develop protocols for the management
of physically ill service users with anorexia nervosa
>>Delivering safe and secure services
Secure services
Spread innovation in risk assessment practice
•
Measure: For each unit to produce a training and
implementation plan for moving towards
implementation of the Structured Assessment of
Protective Factors (SAPROF) clinical risk assessment
tool by December 2012
•
Mostly achieved: Fully implemented in some sites and
partially in others. All sites have a training plan towards
implementation
Achieved: CQUIN achieved in this area. Procedures,
training and action plans in place
Child and adolescent mental health services
Improve care planning and other clinical
documentation so that it is more tailored for
adolescent service users
Child and adolescent mental health services
•
Measure: New set of adolescent specific documents
on CareNotes by December 2012
Reduce absconsions from units
•
Achieved: CAMHS specific multidisciplinary team
meeting formats and Care Programme Approach (CPA)
reports have now been developed. In addition,
capacity and family feedback procedures have
been implemented
•
Measure: A reduction in absconsions by 25% between
April 2012 and April 2013
•
Mostly achieved: A 24% improvement noted –
from 42 absconsions in quarter 4 of 2011-2012 to
32 absconsions in quarter 4 of 2012-2013
50
Q4 2011-12
Improve quality and frequency of consultant and
therapist reports to GPs
Measure: Audit by September 2012, action plan to be
completed by March 2013
Due to a strategic review, this objective was changed to
improve the quality of clinical documentation, which has
been reported in the priority above
14
Linear (2012-13)
Absconsions
•
2012-13
25
0
Q4
2011-12
Q1
2012-13
Q2
2012-13
Q3
2012-13
Q4
2012-13
>>Ensuring a positive experience in care
Neuro-disability and complex care services
Child and adolescent mental health services
Improve standards of nutritional care
Improve service user perception of family involvement
in care planning
•
Measures:
• Every service user will have a nutritional screening
using a recognised tool
• Therapeutic diets to be provided when required
• All menus to provide balance and choice
• Staff to be trained in nutrition and dysphagia
management
• Staff to be trained in supporting service users
at mealtimes
•
Achieved: A dietetics assessment on admission is
followed by therapeutic diets, which are prescribed by
the dietitian as required. Menus are developed on site
by the head chef and reviewed by the dietitian to
ensure they are balanced and meet the service users’
needs. Care and catering staff are trained by both the
dietitian and speech and language therapist
•
Measure: 25% improvement in service user
satisfaction within this aspect of care
•
Mostly achieved: The average satisfaction score for
2011-12 was just over 85%, and the score achieved
in quarter 4 of 2012-13 was 89%. The 24% overall
improvement just misses the 25% target
90%
2011-12 average
2012-13
85%
80%
>>Investing in staff, education and training
2011-12
Q1
2012-13
Q2
2012-13
Q3
2012-13
Q4
2012-13
All services
Increase service user involvement in the
appointment of senior clinical posts at site level
Introduce GMC revalidation for all doctors, with
individualised clinical governance data
•
Measure: To have a service user representative on
all new appointment panels for senior clinical posts
at site level
•
•
Mostly achieved: Following a two year pilot, learning
and guidance will now be shared across our CAMHS
wards, and training tools and guidelines for young
people to participate in recruitment will be developed.
Staff retention and performance will also be analysed
Measures:
• Full approval of the policies and procedures from the
SHA and GMC by June 2012
• 50% of appraisers to be trained by the end of 2012
• All doctors to move towards revalidation by the end
of 2012
• Active management of doctors in difficulties
• Good consultant level quality information to
support revalidation by June 2012
•
Achieved: 65% of doctors had completed appraiser
training by December 2012. All doctors are in the
appraisal cycle and are being tracked. There is a policy
in place for managing doctors in difficulty with active
monitoring and review. Quality data is monitored and
included in the revalidation process
Secure services
Improve service user representation
•
•
Measure: All secure facilities to establish a service
user forum with representation from each ward,
and facilitated by a senior manager. Service user
representatives to attend business or clinical
governance meetings and clinical governance
committees for the ward
Achieved: In all facilities, a service user representative
attends for part of the clinical governance meeting to
raise issues from the ward meetings and hospital-wide
service user councils or forums
Improve staff knowledge of Mental Capacity Act
•
Measure: Staff completion of Mental Capacity Act training
to increase to 90% via online e-learning, from 2011-12
baseline of 67%
•
Achieved: 90% compliant
15
Part 3 – Priorities for improvement 2013-14
In addition to the requirements laid out by the Commissioning for Quality and Innovation (CQUIN) framework and other
nationally prescribed standards of clinical excellence, the Priory Healthcare division has included feedback from our service
users, Priory staff, commissioners and other external stakeholders to identify eight priorities for improvement during
2013-14. These priorities have been determined in accordance with the guidelines issued by the healthcare regulator
Monitor, which will ensure a transparent and consistent approach to our quality reporting going forward. Our priorities
will be measured via monthly Business Review Meetings and fall under the three domains of:
clinical effectiveness
service user safety
service user experience
>>Quality performance indicators for the Priory
Healthcare division
>>Quality performance indicators by service
Clinical effectiveness and service user safety
Secure services
Service user experience
All service users to have their physical healthcare
needs assessed and a plan put in place to address
areas of physical health need
Service users to participate in the recruitment of
senior clinical posts (Ward Manager equivalent and
above) across all our secure sites
•
•
Rationale: NHS nationally prescribed CQUIN within
the secure service specification
•
Target: Service users to be involved in 80% of
interviews for senior clinical posts at their sites
•
How will it be measured: Audit of appointments within
secure services at site level via the HR electronic records
•
•
Rationale: In 2012 the Schizophrenia Commission
report, The Abandoned Illness noted that “people with
severe mental illness such as schizophrenia still die 15 to
20 years earlier than other citizens”. The NHS has also
focused on this aspect of care, including it in the
nationally prescribed CQUIN for mental health services
Target: 90% of CPAs to have a physical healthcare plan
in place and address needs in the following areas:
alcohol consumption, smoking intake, previous illegal
drug use, body mass index, cholesterol, blood glucose
Complex care services
Clinical effectiveness
How will it be measured: The first quarterly audit of
clinical health records (via CareNotes) will commence
in September 2013
Increase service user involvement and engagement
in meaningful activity to support their recovery
and rehabilitation
•
Rationale: NICE Quality Standard (QS14): Meaningful
activities on the ward and Service user experience in
adult mental health (NICE clinical guidance 136);
which states that service users in hospital should have
access to a wide range of meaningful and culturally
appropriate occupations and activities seven days per
week, and not restricted to 9am to 5pm. These should
include creative and leisure activities, exercise, self care
and community access activities (where appropriate).
Activities should be facilitated by appropriately trained
health or social care professionals
•
Target: 25 hours of diverse and meaningful activity
to be offered to every service user each week
•
How will it be measured: Audit of clinical health
records (via CareNotes) to evidence the offer of activity
and the number of hours taken up by the service user
Clinical effectiveness and service user safety
Ensure that unmet need is recorded for all
service users to assist in the CPA and discharge
planning process
•
Rationale: National specialist NHS prescribed services
CQUINs and service specifications requirement
•
Target: 95% of CPA minutes and multidisciplinary
team (MDT) review minutes to record any unmet need
and if there is no unmet need, that there is a clear
statement outlining this
•
16
How will it be measured: The first quarterly audit of
CPA minutes and MDT review minutes will commence
in September 2013
Eating disorder services
Service user experience
Acute mental health services
Service user safety
Increase family and carer engagement
and wellbeing
Ensure that the service user is signposted to
appropriate support services in the event of a crisis
upon discharge from acute services
•
Rationale: NHS nationally prescribed mental health
specification and standard for the Quality network for
Eating Disorders (QED)
•
Target: 90% of families or carers to be offered
a Priory Carer Wellbeing Workbook and to attend
a wellbeing planning meeting
•
How will it be measured: Sites to keep a record of the
number of workbooks given out and wellbeing planning
appointments taken up
Child and adolescent mental health services
Service user experience
Service users to be more involved and to participate
in the planning and review of safe, sound and
supportive services
•
Rationale: NHS nationally prescribed CAMHS service
specification and Quality Network for Inpatient CAMHS
(QNIC) standard
•
Target: Service user presence at 90% of clinical
governance meetings
•
How will it be measured: Clinical governance minutes
to record service user attendance and sites to submit
a quarterly report to be included in the quarterly service
user action plan
•
Rationale: Standard 17.6 Accreditation for Inpatient
Mental Health Services (AIMS): standards for
inpatient wards – working age adults; which states that
service users should be given information on discharge
in a written aftercare plan, which includes the action
to be taken should signs of relapse occur or if there is
a crisis, or if the service user fails to attend treatment
•
Target: 90% of service users to be offered a crisis card
upon discharge
•
How will it be measured: Each hospital to keep a
record of the number of cards offered, and the number
of times a discussion took place to explain the purpose
of the card
Secure services
Service user experience
Increase service user satisfaction in relation to care
planning and communication
•
Rationale: National specialist service specification for the
NHS for medium and low secure mental health services
•
Target: Service user satisfaction to increase by 10%
from the 2012-13 baseline of 73%
•
How will it be measured: Through the service user
satisfaction survey
Group therapy helped me to share
my thoughts and feelings with others
and made me feel less alone
with my problems
17
Part 4 – Additional information
Service user satisfaction – delivering value through clinical excellence
Service user satisfaction provides a key stimulus to service
development both across the Priory Healthcare division
itself and between services within the Priory Group of
Companies. We know that service users who are engaged
with the care that they are receiving from healthcare
professionals they can trust, is a fundamental driving
force to ensure the best possible outcomes.
Service users with a forensic history who have been
admitted into our low and medium secure facilities have
demonstrated a lower level of satisfaction with the service
in 2012-13 than within other areas of the Healthcare
division. This may be partially attributed to the length
of their formal detainment, but will be an area of focus
for us in 2013-14.
Overall satisfaction with the quality of care by service
97%
acute mental health services
95%
child and adolescent mental
health services
99%
day therapy services
100%
neuro-disabilty services
98%
addiction services
85%
complex care services
95%
eating disorder services
71%
secure services
Highlights from the service user satisfaction survey by service
18
Acute mental health services survey
Day therapy services survey
Key findings from our service users:
Key findings from our service users:
97%
would recommend us to a friend
99%
felt treated with courtesy and respect
99%
said that they were treated with
dignity and respect
97%
said that we understood their needs
and difficulties
98%
reported that they felt safe during
their stay
97%
felt that their therapy was as good
as expected
Addiction services survey
Complex care survey
Key findings from our service users:
Key findings from our service users:
99%
said that when they arrived,
staff made them feel welcome
88%
were happy with the support they
got from their support worker
98%
would recommend our services
to a friend
87%
felt cared for and supported
99%
said that they were treated
with dignity and respect
90%
said that they were treated
with dignity and respect
Eating disorder services survey
Secure services survey
Key findings from our service users:
Key findings from our service users:
98%
said that when they arrived,
staff made them feel welcome
79%
felt that they were consulted on
decisions about their medication
98%
said that they were treated
with dignity and respect
82%
said that they were treated with
dignity and respect
97%
reported that they felt safe
during their stay
74%
felt that they were well supported
with the moving on process
Child and adolescent mental health services survey
Neuro-disability services survey
Key findings from our service users:
Key findings from our service users:
91%
felt that the service helped
to deal with their problems
100%
felt safe and secure
94%
felt that their healthcare
professionals listened to and
understood their problems
100%
believed time spent on their
interests was encouraged
93%
were satisfied with the services
offered to them
94%
felt they are able to attend
service user meetings
19
Outcomes – the success of our service users
One of the central objectives of the Priory Healthcare
division is to enable every service user to be an active
participant in their own recovery process, where possible.
Outcomes demonstrate the progression that each service
user has made, and as such, are an intrinsic element of
every personalised care pathway.
When appropriate, we regularly feed outcomes back to the
individual, alongside families and carers, as well as those
who commission our services and form an integral part
of the individual's wider care pathway.
Clinical outcomes within acute mental health, addiction
services and eating disorder services use the nationally
recognised Health of the Nation Outcomes Scales (HoNOS).
The HoNOS assessment is undertaken upon admission
and again at discharge (or bi-annually within our secure
services) to ascertain the level of improvement in a service
user’s clinical condition during their inpatient stay.
Acute mental health services
86%
showed improvement in their overall
mental wellbeing
75%
demonstrated significant improvement
or recovery at discharge from therapy
Within child and adolescent mental health services, we use
the Health of the Nation Outcomes Scales for Children
and Adolescents (HoNOSCA), and the HoNOS Secure tool
is used within our low and medium secure facilities.
All of the HoNOS outcomes quoted below that relate to
improvement in overall mental wellbeing refer to service
user outcomes at the point of discharge.
Across the Healthcare division, additional outcome tools
may also be used, according to the nature of each service.
We believe that progress is made in many forms, and
achieving outcomes is relevant to the unique needs of
each service user. This means that we also consider the
social, emotional and physical development of the
individual alongside their clinical progression.
For this reason, we place great emphasis on qualitative
outcomes alongside clinical metrics to reflect the success
of our service users.
Complex care services
99%
Addiction services
86%
were still abstinent 12 months post
discharge*
93%
showed improvement in their overall
mental wellbeing**
Child and adolescent mental health services
77%
showed improvement in their overall
mental wellbeing
Eating disorder services
80%
wholly or partially achieved their goals
100
demonstrated improvement in their overall
attitude to their diet, shape and weight
50
91%
gained weight
0
77%
showed improvement in their overall
mental wellbeing
Discharge
3 months
6 months
9 months
12 months
Abstinent since last PARQ
Abstinent but relapsed since last PARQ
Abstinent but improved
Not abstinent
Service user abstinence over 12 months
* 86% of service users admitted into a Priory hospital, who were not readmitted and could be contacted, were still abstinent 12 months post discharge using the Priory
Addiction Recovery Questionnaire (PARQ) outcome measure
** 93% of service users showed improved overall mental wellbeing where their length of stay was greater than seven days
20
Secure services
63%
showed improvement in their overall
mental wellbeing
64%
showed improvement in their risk profile
26%
overall reduction in the rate of incidents
during the second six months of admission*
I'm very thankful for the
professional and engaged
treatment I received at the Priory.
It exceeded all expectations and
has been a turning point
in my life
Realising dreams
... at the Priory Grange Heathfield
Staff at a Priory hospital in East Sussex have helped to
make a dream come true for one of their residents who
expressed a wish to take part in a half marathon.
Darren, who has Huntington’s disease, a progressive
neurological condition that requires him to use a wheelchair,
has been called ‘an inspiration’ after completing the 2013
Hastings half marathon. With the support of his team at
the Priory Grange Heathfield, Darren completed the course
in four hours and raised £800 for the charity MIND.
The race organisers have been so impressed by his
achievements that they presented Darren with a special
achievement award at a ceremony in April 2013.
The Registered Manager at the Priory Grange
Darren’s desire to take part in a race emerged after an
Heathfield said:
occupational therapy assistant at the hospital ran the
Brighton Marathon.
“We are all very proud of what Darren has achieved.
Despite his illness, he maintains a real zest for life.
Darren went along to support him, and a few days later
Our aim is to provide staff and services which inspire
revealed he would have loved to have done a marathon
an individual to achieve their best possible outcomes.
before he became ill. As soon as staff heard this they made
Helping Darren to realise one of his dreams reflects
every effort to help make his dream come true. A team
this ethos.”
of ten Priory staff volunteered to assist Darren on the day,
with some pushing his wheelchair and others running
Darren, who has lived at the Priory Grange Heathfield
alongside him.
since 2010, added: “The day was great and I loved it.”
* Reduction in rate of incidents during the second six months of admission compared to the first six months of admission
21
Investing in staff, education and training
Learning and development
We recognise the important contribution that staff make both in terms of the quality of care delivered and service user
experience. Foundations for Growth, our internal e-learning programme for staff, was launched seven years ago and in
2012-13 alone, the programme has enabled Healthcare staff to complete 81,409 e-learning modules and 17,674 face
to face training sessions.
However, we also recognise the importance of learning and development within the wider context of delivering quality
and inspiring innovation within our services. For this reason, over £90,000 was invested in the continuing professional
development of 288 people in order to supplement their ongoing training during 2012-13.
Percentage of allocated e-learning modules completed by Priory Healthcare staff during 2012-13
Safeguarding vulnerable adults
94%
Safeguarding children
99%
Confidentiality and data protection
99%
Infection control
92%
Managing challenging behaviour
92%
Safe handling of medicines
97%
Suicide and self harm
98%
Mental Capacity Act
90%
Deprivation of liberty
90%
Staff opinion
The annual Colleague Opinion Survey is well received by staff from the Healthcare division, with a response rate
of 63% for the 2012 survey (the highest response rate in the Group). Where possible, the results of this survey have
been benchmarked against the NHS.
We recognise that, although staff recognition is higher within the Priory Healthcare division than the NHS benchmark
identified below, it is still an area of focus for the Group. Therefore, we will be launching an internal awards scheme in 2013,
which aims to recognise the many significant contributions made by staff members across the Group. Achievements are
also highlighted in the weekly staff e-newsletter, which was launched in 2012.
The Group also undertook a Culture Survey in 2012, and results for the Healthcare division were positive, with highlights
included on page 8 of this Quality Account.
Staff opinion key findings:
22
Theme
Result
NHS benchmark
Feel they are able to contribute to the success of their team
89%
66%
Feel they are able to do their job to a standard they feel pleased with
79%
63%
Would recommend Priory as a good place to work
74%
48%
Would recommend Priory for treatment or care to a friend or relative
67%
60%
Feel they will still be working for Priory in 12 months time
91%
78%
Feel they achieve recognition for good work
54%
49%
Completed the Colleague Opinion Survey and gave positive answers to all of the
questions asked
71%
data not available
The Commissioning for Quality and Innovation (CQUIN) framework
All services contracted using the national standard bilateral or multi-lateral contract may be subject to a CQUIN scheme.
For our contracts in 2012-13, this was principally for specialised commissioned services such as secure services, child and
adolescent mental health services and eating disorder services. The full CQUIN framework is detailed from page 40 in
the appendix.
The quarter four reports have been submitted to the commissioners to review and so far indicate that we have achieved
100% of our targets.
Service
Target
Outcome
Eating disorder
Implementation of the recommendations from the Royal College of Psychiatrists
report – Management of Really Sick Patients with Anorexia Nervosa (MARSIPAN)
Achieved
Child and adolescent
mental health
Education, training and meaningful activity: ensuring that the service user experience
features activities which lead to effective rehabilitation and hence timely discharge
Achieved
Service user involvement in recruitment
Achieved
Patient flow annual report
Achieved
Patient Safety Thermometer: improve responsiveness to personal needs of
service users
Achieved
Improvement in outcomes
Achieved
Improving physical healthcare and wellbeing of service users
Achieved
Payment by Results (PbR) feasibility project: to implement, review and feed back the
requirements set out in the Feasibility Implementation Booklet within a clear reporting
structure. This includes: clustering, five care pathway indicators, benchmarking and
reporting feasibility
Achieved
Shared pathway: recovery and outcomes
Achieved
Shared pathway – implementing standard secure pathway: to introduce and monitor
key milestones on the service user pathway in order to make the pathway more efficient
and reduce length of stay
Mostly achieved
Access to specialised mental health services
Achieved
25 hours of meaningful activity per week
Achieved
Quality dashboard: to implement the routine use of specialised services’ clinical
dashboards
Achieved
User defined CPA standards: to introduce and monitor the 20 service user defined
CPA standards
Achieved
Optimising length of stay: to understand the total care pathway, and plan how it might
work differently in order to optimise length of stay
Achieved
Secure
Applicable to all three of the
above services
23
Participation in clinical audits and National Confidential Inquiries
All sites across the division have completed safeguarding
and ligature audits during the year and action plans have
been produced to address any areas not meeting the
required standard. Hospitals also complete bespoke
audit schedules based on local need.
Ashtons, our pharmacy suppliers, have increased the
frequency of their audit programme and now undertake
monthly audits of prescribing and administration of
medication within Healthcare. The auditors’ results are
fed back to sites on a weekly basis allowing them to rectify
any errors as soon as they occur. The increased frequency
of audits has led to an improvement in the quality of
medicines management across the Healthcare division
(see table below).
There is one National Confidential Inquiry which is relevant
to the Healthcare division: the National Confidential
Inquiry into Suicides and Homicides by people with
a mental illness (NCISH) and information is provided
to the Inquiry as requested.
No. of
prescription cards
MHA compliance
errors %
Patient details
errors%
No. of
prescription items
Prescription
writing errors %
Administration
errors %
Q1
11573
2.3
1.4
109127
1.5
2.2
Q2
11273
1.5
1.3
109006
1.3
2.3
Q3
10804
1.7
1.0
105515
1.2
1.9
Q4
11560
1.1
1.1
112858
0.9
1.6
Total
45210
1.7
1.2
436506
1.2
2.0
I was anxious –
it was clearly
identified that
I was anxious
and I was treated
with kindness,
respect and
dignity
24
Regulatory compliance
The Healthcare division covers England, Scotland and Wales, and is therefore required to work under the standards set out
by regulators within each respective area.
43 of our 54 healthcare sites were inspected by regulators between 1st April 2012 and 31st March 2013. These are broken
down by regulator as follows:
Care Quality Commission 37
Health Inspectorate Scotland 1
Health Inspectorate Wales 2
Care and Social Services Inspectorate Wales 3
96%
of outcomes inspected by our regulators were met
Care Quality Commission
Health Inspectorate Scotland
The Care Quality Commission inspected 217 outcomes
identified in the Essential Standards of Quality and Safety
across Priory Healthcare English sites between April 2012
and March 2013.
The Health Inspectorate Scotland inspected five outcomes
identified in the Scottish regulations at the Priory
Healthcare Scottish site between April 2012 and March
2013. The Inspectorate deemed this site to be fully
compliant within all areas assessed.
of outcomes were judged to have
been met
95%
Of the 217 outcomes assessed, nine were found to be
unmet within eight areas of inspection. The graph below
highlights the number of unmet outcomes compared
to the total number of met outcomes within these
eight areas.
40
100%
of outcomes were judged to have
been met
Outcomes inspected
Met
Quality of information
1
Quality of care and support
1
Quality of environment
1
Quality of staffing
1
Quality of management
1
Unmet
Met
20
Records
Unmet
Quality of service
Medicines
Infection control
Safeguarding
Care and welfare
Consent to care
Respecting/involving people
0
Met
25
Healthcare Inspectorate Wales
Care and Social Services Inspectorate Wales
The Healthcare Inspectorate Wales inspected 11 standards
identified in the Welsh regulations at Priory Healthcare
Welsh sites between April 2012 and March 2013. There
were no unmet standards identified by the regulator in
the time period.
The Care and Social Services Inspectorate Wales inspected
12 standards across Priory Healthcare Welsh sites between
April 2012 and March 2013. 11 of the standards were
judged to have been met. One standard was deemed to
have been unmet – quality of environment – at one site,
Newhouse, which has since been relocated to a new site.
100%
of standards were judged
to have been met
92%
of standards were judged
to have been met
Standards inspected
Met
Medicines
1
Standards inspected
Met
Unmet
Statement of purpose
2
Quality of information
3
0
Quality of service provision
2
Quality of care and support
3
0
Notification of other incidents
2
Quality of environment
2
1
Financial position
2
Quality of staffing
3
0
Notification of death
1
Notification of death and the MHA
1
Embargoes and warning notices
Currently there are no embargoes in place at any Priory Healthcare site. Across the division during 2012-13, the following
action was carried out as a result of issues detailed on page 27 at the Priory Hospital Middleton St George, the Priory
Ticehurst House, the Priory Highbank Centre, Newhouse, the Priory Hospital Widnes and Cefn Carnau:
Sites with Warning Notices 2
Site with Regulatory Embargoes to Admissions 1
26
Focus sites during 2012 -13
From time to time, particular areas of care or service delivery fail to achieve the high standards of quality that our
regulators and service users rightly expect. This section details areas in which compliance with our regulatory bodies
may have fallen short and required remedial action to be taken.
On the rare occasion that an issue should arise, we communicate openly and always work as closely as possible with
our regulators and commissioners, service users, their families and carers and other external stakeholders for as long
as necessary to ensure full confidence in our service is restored.
The Priory Hospital Middleton St George
Newhouse
As a result of an inspection in January 2013, the CQC
raised concerns about our recruitment procedures at the
hospital, which were followed up with a warning notice.
An action plan was promptly implemented to address
these issues.
Newhouse in Cardiff was acquired by the Priory Group as
part of the wider acquisition of Craegmoor services in
2010. Since acquisition, the site had some issues around
the physical environment of the buildings.
Following re-inspections from the CQC and rigorous
responsive intervention, the hospital was found to be
compliant with the regulations. The internal compliance
team and the operational management at the hospital
continue to implement and monitor improvements to
ensure future and ongoing compliance.
The Priory Ticehurst House
Following a serious incident in November 2012, a decision
was taken by the Group to commence a voluntary
restriction on admissions whilst an investigation took
place. The hospital worked closely with regulators and
commissioners throughout this time to ensure compliance
with regulations were maintained.
The CQC inspected the hospital in November 2012 and
found the site to be compliant with all outcomes
inspected. On completion of the investigation and
implementation of actions arising, the voluntary restriction
was lifted on the 1st March 2013 with the support
of commissioners.
The Priory Highbank Centre
In response to a serious allegation of abuse towards
a service user at the Priory Highbank Centre, a temporary
suspension was placed on the site. The CQC carried out
an investigation immediately following the allegation,
and found the site to be compliant in all areas assessed.
An external investigation was later carried out by the
safeguarding lead for NHS Bury and NHS Liverpool in
conjunction with the safeguarding lead for the local
authority, which concluded that this was not a systemic issue.
As a result, the commissioners lifted the suspension on the
site. A thorough internal investigation was also carried out.
In March 2012, a restriction on new admissions was
agreed with the regulator to allow an effective solution
to be adopted. The Group made a decision to relocate the
service to a new purpose-appropriate facility in Aberdare,
which opened on 16th April 2013.
The Priory Hospital Widnes
Following the acquisition of the Priory Hospital Widnes
in 2011, the Group was unable to sustain improvements,
and ongoing quality issues led to enforcement action
from the CQC. After a number of discussions with regulators
and commissioners, it was decided to de-register the
service in September 2012.
At this time, the Priory Group worked closely with
commissioners, service users and their families to ensure
the safe transfer of service users to new locations suitable
for their needs.
Cefn Carnau
After a detailed analysis of challenges facing the clinical
team on one of the wards at the hospital, a decision was
taken to review the admission processes to the ward.
In order to achieve this, the hospital voluntarily suspended
admissions to ensure that these processes could be
reviewed effectively. This commenced on 25th May 2012
and remained in place until 28th September 2012.
This process was carried out with the full knowledge
and support of the regulator and commissioners of
the service.
27
Working in partnership with our commissioners and regulators
Within the Priory Healthcare division alone, 78% of our services are commissioned on behalf of the NHS and other public
bodies throughout the UK. It is therefore essential to us that our services are delivered in close collaboration with referring
commissioners and other external care providers to ensure the optimum outcome for each service user as part of their
overall care pathway.
This means ensuring early visibility of the service user’s progression throughout each treatment phase relevant to their
individual goals and objectives and, where possible, developing a stepped care approach to treatment, with transparent
and flexible pricing frameworks.
As a commissioner, I use the Priory because they have a very comprehensive range
of services, and I have generally found they are of a high clinical standard.
When I am tasked, as is frequently the case, with finding an inpatient service for
a client with complex needs, the Priory Group is one of the providers I think of first
for the above reasons.
They usually have a specialist service that potentially offers what I need... (and) I find
my point of contact to be helpful, responsive and a great ambassador for
the Priory Group...
Lastly, in my experience as a Group, they are responsive to requests for assessment;
responding quickly both with the assessment as well as a proposal of care for
a particular client
Steve Southall
Out of Area Placements Manager at Berkshire Healthcare NHS Foundation Trust
The Priory's range of services enable us to place people quickly and
appropriately. They are our largest contracted provider of eating disorder
services, providing a specialist service for people with complex needs, who often
present with high levels of risk and physical difficulties.
We often source CAMHS beds from them, because they provide a full care
pathway of services for young people and are always very responsive,
admitting 24 hours a day, seven days per week.
Priory have a full and diverse multidisciplinary team across all their services,
providing a high standard of clinical care and good outcomes. We find them
easy to work with, good at communicating with us and local teams, and
they are well embedded in the local healthcare economy
Steve Hamer
Supplier Manager at NHS England (Cheshire, Wirral and Warrington Area Team)
28
Improving safety for our service users
As a Group, Priory strives to foster an open and transparent culture, in which staff feel able to report incidents as they occur.
We believe that this approach is fundamental to driving improved processes and practices within our services.
Priory Healthcare reports all incidents using a bespoke electronic reporting system, to which all clinical staff are provided
access. Its use is explained during the staff member’s induction, and an overview of the importance of incident reporting
is also included within the e-learning modules on Safety, Quality and Compliance.
In line with the ethos of the National Patient Safety Agency, we encourage our staff to report all incidents, serious incidents
and near misses using this reporting system*.
2012-13
2011-12
NHS average
(2012-13)
Total number of incidents reported (per 1000 ordinary bed days)
21.8
21.29
23.8
Serious incidents relating to the death of a service user
0.2%
0.2%
0.8%
Incidents resulting in the permanent harm of a service user
0.3%
0.04%
0.8%
During 2012-13 there were no incidents that would be classified as never events as defined by the National Patient
Safety Agency.
Life-long learning
... at the Priory Hospital Keighley
Service users at the Priory Hospital Keighley, a complex
mental health and rehabilitation hospital in West Yorkshire,
have recently taken part in a session at Jamie Oliver’s
Ministry of Food in Bradford.
The ten week scheme offers the opportunity for service
users with complex mental health problems who require
longer or ongoing hospital care to learn to cook traditional
recipes, whilst promoting core independence skills as part of
their rehabilitation.
The scheme enabled the mixed functional ability group to
master cooking skills, whilst building their confidence and
developing time management and team working skills.
Funders, including the NHS and local councils, have helped
to establish Ministry of Food sites across the country,
teaching how to cook from scratch using fresh, seasonal
ingredients and in doing so, lead healthier lives with
improved eating habits.
“The response we have had from service users has been
great; they are very relaxed, laughing and presenting
as high functioning when usually they struggle with
everyday daily living. It has also had a really positive
and unexpected impact on my working relationship
with individuals who now feel empowered to take more
control over their recovery journey.”
Occupational therapist
* A new incident reporting system was implemented during 2012 to provide closer alignment with NHS categorisations of incident reporting. Therefore, it is not possible to
compare safety performance between 2011-12 and 2012-13 directly. More information on the reporting of incidents can be found in the appendix on page 45.
29
Continuous improvement in the delivery of our services
Providing a high quality service for both our service users and those who commission our services is a central objective for
the Priory Healthcare division. As such, we take all complaints very seriously and utilise this feedback as part of an overall
ethos to drive service development through continuous improvement. Over the course of 2012-13, we have implemented
a more thorough and effective reporting mechanism in order to ensure that the management and resolution of
complaints is handled with greater efficiency and transparency.
We operate a robust and thorough framework for managing all complaints, which comprises of three stages:
Stage one
Complaints are resolved at a local level by the individual service or site within an agreed response timeframe. Whilst the
majority of complaints are satisfactorily resolved in this manner, a complainant may request in writing that the issue be
referred to stage two if they remain dissatisfied, following a final attempt to resolve by further dialogue or meetings
Stage two
The complaint is reviewed and/or reinvestigated by the Group Complaints Co-ordinator (part of the Safety, Quality and
Compliance team) within an agreed response timeframe
Stage three
Further and final recourse for unresolved complaints is available through the Parliamentary Health Service Ombudsman
(PHSO) for NHS-commissioned service users, or to the Independent Sector Complaints Adjudication Service (ISCAS) for
those who are privately funded
Complaints during 2012-13
Complaints per 1000 occupied bed days
2012-13
1.32
2011-12
1.45
2010-11
1.40
Due to the more robust reporting systems implemented
during 2012, as well as the inclusion of new sites to the
Priory Healthcare division following the acquisition of
Craegmoor and Affinity Healthcare, the number of
complaints referred to stage two review has increased
during 2012 to 22 cases, compared with four in 2011.
Two cases were referred to stage three (ISCAS) during
2011-12 and 2012-13 respectively.
Following consultation with the Priory Healthcare division,
the PHSO concluded that further investigation of one
complaint made to the Ombudsman during 2012-13
was unnecessary.
30
Part 5 – Appendix
31
Statement of assurance from our lead commissioner
This statement is given to the best of my knowledge for the period 2012-13 in respect of secure services, adult
eating disorder services and child and adolescent mental health services commissioned by South Central Specialised
Commissioning Group.
Priory Healthcare has been compliant with the performance reporting cycle and have provided good quality,
timely reporting in relation to the key quality indicators as defined in the contract.
Priory Healthcare has complied with submissions of serious incident and safeguarding notifications, related reports and
action plans. This has supported the robust monitoring of the safety and quality of placements, with areas of concern
identified being addressed promptly.
Priory Healthcare has enthusiastically and successfully implemented the national CQUINS across secure services,
and has provided commissioners with good evidence to support the monitoring of achievements each quarter.
Commissioner meetings with service users and the advocacy service at Thornford Park* have been supported and
encouraged by Priory, and this has provided commissioners with invaluable feedback on the quality of service provision.
Louise Doughty
Head of Mental Health and Programme of Care Lead
Wessex, NHS England
* Thornford Park is a low and medium secure facility in Berkshire
32
Statement of directors’ responsibilities in respect of the Quality Account
In preparing the Quality Account, directors are required to take steps to satisfy themselves that:
1. The content of the Quality Account meets the relevant requirements set out in Monitor’s Annual Reporting
Manual 2012-13
2. The content of the Quality Account is not inconsistent with internal and external sources of information including:
•
Board minutes and papers for the period April 2012 to June 2013
•
papers relating to quality reported to the Board over the period April 2012 to June 2013
•
feedback from commissioners
•
feedback from external auditing reviews (conducted by PricewaterhouseCoopers)
3. The Quality Account presents a balanced picture of the Priory Healthcare division’s performance over the
period covered
4. The performance information reported in the Quality Account is reliable and accurate
5. There are proper internal controls over the collection and reporting of the measures of performance included in the
Quality Account, and these controls are subject to review to confirm that they are working effectively in practice
6. The data underpinning the measures of performance reported in the Quality Account is robust and reliable, conforms
to specified data quality standards and prescribed definitions and is subject to appropriate scrutiny and review
7. The Quality Account has been prepared in accordance with Monitor’s annual reporting guidance (which incorporates
the Quality Account regulations) as well as the standards to support data quality for the preparation of the
Quality Account
The directors confirm to the best of their knowledge and belief they have complied with the above requirements in
preparing the Quality Account.
By order of the Board
June 2013
Signed:
Mike Jeffries
Chairman
The Priory Group
Tom Riall
Chief Executive Officer
The Priory Group
33
Independent Limited Assurance Report to the Board of Directors
of the Priory Group No. 1 Limited on the Annual Quality Report
We have been engaged by the Board of Directors of
the Priory Group No. 1 Limited (“the Company”) to perform
an independent limited assurance engagement in respect
of the Company’s Quality Report for the year ended
31 March 2013 (the ‘Quality Report’).
Scope and subject matter
The Company has voluntarily applied certain principles
of the guidance provided by Monitor to NHS Foundation
Trusts ‘Detailed Guidance for External Assurance on
Quality Reports 2012/13’ (published 22 March 2013)
(“the guidance”), and Annex 2 of the NHS Foundation
Trust Annual Reporting Manual (“the ARM”).
These principles have been selected based on those
deemed applicable to the Company and have been set
out in the ‘Format of the Quality Report’ section of the
Appendix to the Quality Report. Monitor’s guidance for the
Quality Report incorporates the requirements set out in the
Department of Health’s Quality Accounts Regulations and
additional reporting requirements set by Monitor.
• the Quality Report is not consistent in all material
respects with the sources specified below.
We read the Quality Report and consider whether it
addresses the content requirements of the ARM applicable
to the Company, as set out in the ‘Format of the Quality
Report’ section of the appendix to the Quality Report,
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
March 2013;
• the Company’s monthly complaints scorecard;
• the quarterly patient surveys;
• the annual staff survey dated May 2013;
• papers relating to quality reported to the Board over
the period;
• feedback from the Commissioners (NHS England); and
• feedback from Directors.
We provide assurance in respect of:
i) the content of the Quality Report, in line with the
principles of the guidance and Annex 2 of the ARM
that are applicable to the Company, as set out in the
‘Format of the Quality Report’ section of the Appendix
to the Quality Report; and
ii) the consistency of the Quality Report with the
documents specified below
Respective responsibilities of the Directors
and auditors
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.
The Directors are responsible for the content and the
preparation of the Quality Report in accordance with those
principles of the guidance and Annex 2 of the ARM that
are applicable to the Company, as set out in the ‘Format
of the Quality Report’ section of the appendix to the
Quality Report.
This limited assurance report, including the conclusion,
has been prepared solely for the Board of Directors of the
Company as a body, to assist the Company in reporting
the quality agenda, performance and activities. We permit
the disclosure of this limited assurance report within the
Quality Report for the year ended 31 March 2013.
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:
To the fullest extent permitted by law, we do not accept or
assume responsibility to anyone other than the Board of
Directors as a body and the Company for our work or this
report save where terms are expressly agreed and with our
prior consent in writing.
• the Quality Report does not incorporate the matters
specified in the guidance and Annex 2 to Chapter 7
of the ARM that are applicable to the Company; and
34
We consider the implications for our report if we become
aware of any apparent misstatements or material
inconsistencies with those documents. Our responsibilities
do not extend to any other information.
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:
• making enquiries of management;
• comparing the guidance and content requirements
of the ARM that are relevant to the Company, as set
out in the ‘Format of the Quality Report’ section of
the Appendix to the Quality Report; and
• reading the relevant documents and comparing
their consistency with the information within the
Quality Report.
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.
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 content requirements of the ARM and the Directors’
determination of its applicability to the Company, as set
out in the ‘Format of the Quality Report’ section of the
Appendix to the Quality Report.
The nature, form and content required of Quality Reports
are determined by the Company based on Monitor’s
guidance for the purposes of this assurance engagement.
This may result in the omission of information relevant to
other users.
In addition, the scope of our assurance work has not
included governance over quality or performance
indicators in the Quality Report, which have been
determined locally by the Company.
Basis for qualified conclusion
The ARM requires Part 2 of the Quality Report to include
priorities for improvement then statements of assurance
from the Board. Part 2 of the Quality Report does not
include priorities for improvement, and instead these are
included in Part 3 of the Quality Report. The applicable
contents of the Statements of Assurance have been
included in a number of sections throughout the report
rather than in Part 2.
The ARM requires information relating to registration with
the Care Quality Commission and periodic/special reviews
in a prescribed form of statement to be included in Part 2
of the Quality Report. This is not included within the
Quality Report.
The ARM requires Part 3 of the Quality Report to include
performance against the relevant indicators and
performance thresholds set out in Appendix B of the
Compliance Framework. This has been included in the
Quality Report, except for:
• percentage of patients on Care Programme Approach
who were followed up within 7 days after discharge;
• percentage of admissions to acute wards for which
the Crisis Resolution Home Treatment Team acted
as a gatekeeper during the reporting period;
• percentage of patients re-admitted to hospital within
28 days of discharge;
• minimising mental health delayed transfers of care;
• admissions to inpatients services had access to crisis
resolution home treatment teams;
• meeting commitment to serve new psychosis cases
by early intervention teams;
• data completeness: identifiers; and
• data completeness: outcomes for patients on CPA
35
The ARM requires Part 3 of the Quality Report to include
an overview of the quality of care offered by the NHS
Foundation Trust based on performance in 2012/13
against indicators selected by the board in consultation
with stakeholders, with an explanation of the underlying
reason(s) for selection. The Quality Report does not directly
provide an overview in the format prescribed by the
guidance, and it is included within Part 2 instead of Part 3.
Qualified conclusion
Based on the results of our procedures, except for the
matters described in the basis for qualified conclusion
paragraph, nothing has come to our attention that causes
us to believe that for the year ended 31 March 2013;
• the Quality Report does not incorporate the matters set
out in the guidance and Annex 2 of the ARM that are
applicable to the Company as set out in the ‘Format
of the Quality Report’ section of the appendix to the
Quality Report
• the Quality Report is not consistent in all material
respects with the documents specified above.
Date:
PricewaterhouseCoopers LLP
Chartered Accountants
Benson House
33 Wellington Street
Leeds
The maintenance and integrity of the Priory Group Limited
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.
36
Format of this Quality Account
This Quality Account has been produced using the NHS Foundation Trust Annual Reporting Manual for 2012-13, published
by Monitor in March 2013. There is currently no requirement for the Priory Group to produce a Quality Account and, whilst
we have broadly adhered to the guidelines produced by Monitor, the format of the Account does not directly follow that
stipulated in the guidance. This decision has been taken to improve the readability of the Account and to exclude sections
that are not relevant to the Priory Group. Deviations from the Monitor guidance are listed below:
•
Priorities for improvement 2013-14 are documented in Part 3 of our report. Performance against 2012-13 objectives
have been fully documented in Part 2 (rather than split between Part 2 and 3 as suggested by the guidance)
•
Where applicable, areas of the Statements of Assurance that the guidance indicates to include in Part 2, have instead
been included within appropriate sections throughout the Quality Account
•
The verbatim text suggested in the Monitor guidance regarding the CQC registration has not been included in this
Account. The Priory Group is a national organisation and as such, is not only regulated by the CQC. The Regulatory
compliance section of this Account details information for all of our regulators
•
Additional information has been included in Part 4 rather than within Part 3 – Other information to improve the clarity
and readability of the Account
•
Views and opinions of third party organisations (including local Healthwatch organisations and Overview and Scrutiny
Committees) are required to be presented under Monitor's guidance but are not applicable to the Priory Group
Criteria which are not relevant to the Priory Group
As an independent healthcare provider, the following criteria within the NHS Foundation Trust Annual Reporting Manual
are not relevant to the Priory Group:
•
Schedule 2 row 1
•
Schedule 2 row 2
•
Schedule 2 row 3
•
Schedule 2 row 4
•
Information in relation to income conditional upon achieving quality improvement and innovation goals
•
Schedule 2 row 5
•
Schedule 2 row 8
•
Schedule 2 row 9
•
Information relating to clinical coding
37
Data items from the NHS Quality Accounts content checklist not included in the Priory Healthcare
division’s 2012-13 Quality Account
The table below documents items which were not reported according to the NHS Quality Accounts content checklist annex
within the NHS Foundation Trust Annual Reporting Manual for 2012-13 because they were not applicable to the services
delivered by the division.
Data guidance item
Rationale for exclusion
Care Programme Approach (CPA) service users, either receiving follow-up contact
within seven days of discharge or having formal review within 12 months
Minimising mental health delayed transfers of care
Priory service users are generally discharged back to the NHS
Percentage of service users readmitted to a hospital within 28 days of being
discharged
Admissions to inpatient services have access to crisis resolution home
treatment teams
No crisis resolution home treatment service provided
by Priory hospitals
Meeting commitment to serve new psychosis cases by early intervention teams
No early intervention in psychosis service provided by
Priory hospitals
Data completeness: identifiers
Data completeness: outcomes for service users on CPA
Service user experience of community mental health services
38
No mental health minimum data set submission required for
Priory hospitals
Priory hospitals do not provide community mental health services
Glossary of terms
CAMHS
Child and Adolescent Mental Health Services
CPA
Care Programme Approach
CQC
Care Quality Commission
CQUIN
Commissioning for Quality and Innovation framework: a national incentive scheme to improve
quality and innovation in healthcare
CSSIW
Care and Social Service Inspectorate Wales
GMC
General Medical Council
HIW
Health Inspectorate Wales
HoNOS
Health of the Nation Outcome Scales
HoNOSCA
Health of the Nation Outcome Scales for Children and Adolescents
MDT
Multidisciplinary team
MHA
Mental Health Act (2007)
NCISH
National Confidential Inquiry into Suicides and Homicides by people with a mental illness:
this inquiry features research into suicide, unexplained death and homicide by service users with
a mental health condition across the UK. It produces regular national reports for England, Wales,
Scotland and Northern Ireland
NICE
National Institute for Health and Care Excellence
Never events
Refers to serious, largely preventable service user safety incidents that should not occur if the
available preventative measures have been implemented
PARQ
Priory Addiction Recovery Questionnaire: the outcome metric used by Priory addiction services to
monitor abstinence following discharge from treatment
PEG feeding
Percutaneous Endoscopic Gastrostomy feeding: process of feeding via a tube that is placed
through the skin and into the stomach
Priory Carer
Wellbeing
Workbook
Inspirational stories, poems and other thought-provoking content is included in this workbook,
which aims to provide guidance and advice for the carer. A follow up wellbeing appointment is made
with the carer by the nursing staff, and a care plan is drawn up to ensure that the carer is signposted
to relevant services within the community
QED
Quality network for Eating Disorders
QNIC
Quality Network for Inpatient Child and adolescent mental health services
SHA
Strategic Health Authority: a now defunct commissioning body responsible for running or
commissioning regional NHS services
39
Commissioning for Quality and Innovation framework
The CQUIN framework accounts for 2.5% of the overall NHS contract in place across the Priory Healthcare division.
The table below shows the overall schemes required for these targets to be achieved:
Secure services
South of England
Specialist
Commissioning
Group
West Midlands East Midlands
North West
North East
Yorkshire and
the Humber
East Midlands
Quality dashboard: implement the routine use of specialised
services clinical dashboards
Payment by Results (PbR) feasibility project: implement,
review and feedback the requirements set out in the
Feasibility Implementation Booklet. This includes: clustering,
five care pathway indicators, benchmarking and reporting
feasibility within a clear reporting structure
Shared pathway: recovery and outcomes
Shared pathway – implementing standard secure pathway:
introduce and monitor key milestones on the care pathway
in order to make the pathway more efficient and reduce
length of stay
User defined CPA standards: introduce and monitor the
20 service user defined CPA standards
Optimise length of stay: understand the total care pathway
and plan how it might work differently to optimise length
of stay
Access to specialised mental health services
25 hours of meaningful activity per week
Eating disorder services
Quality dashboard: implement the routine use of specialised services clinical dashboards
User defined CPA standards: introduce and monitor the 20 service user defined CPA standards
Optimise length of stay: understand the total care pathway and plan how it might work
differently to optimise length of stay
Implement the recommendations from the report Management of Really Sick Patients with
Anorexia Nervosa (MARSIPAN)
40
South of England
Specialist
Commissioning
Group
Child and adolescent mental
health services
South of England
Specialist
Commissioning
Group
West Midlands East Midlands
North West
North East
London
Quality dashboard: implement the routine
use of specialised services clinical
dashboards
User defined CPA standards: introduce and
monitor the 20 service user defined CPA
standards
Optimise length of stay: understand the
total care pathway and plan how it might
work differently to optimise length of stay
Education, training and meaningful activity:
ensure that service user experience features
activity which leads to effective
rehabilitation and hence timely discharge
Service user involvement in recruitment
Patient flow annual report
Patient safety thermometer: improve
responsiveness to personal needs of
service users
Improve outcomes
Optimise length of stay and improve
outcomes
Improve physical healthcare and wellbeing
of service users
Kent and Medway CQUIN scheme
Complex care services
Kent and
Medway
Patient safety thermometer: improve responsiveness to personal needs of service users
Shared pathway – recovery and outcomes
User defined CPA standards: introduce and monitor the 20 service user defined CPA standards
Optimise length of stay: understand the total care pathway and plan how it might work differently to optimise length of stay
Access to specialised mental health services
41
Future plans for CQUIN schemes in 2013-14
Going forward, the specialised commissioners have standardised the CQUIN schemes for 2013-14 and the following will
apply to specialist commissioned mental health services. The Secure Recovery and Outcomes Group have already devised
an action plan to look at all areas of the CQUIN requirements as below.
Optimising pathways: all services
Clarify admission and discharge pathway
Design system to collect data on days spent at each stage for service user and specify variance, cluster, key issues, action taken and outcomes, as well
as whether treatment targets were met
Physical healthcare: all services
Analyse national guidelines on performing health checks and ensure we are following them
Ensure that each service user has a physical health care programme in place and it is recorded in the staying healthy section of CPA reports
Look into checklist for coronary heart disease
Ensure a diabetes and hypertension assessment is in place
Document a health promotion programme for the hospital
Care Programme Approach: all services
Baseline audit of CPAs in Q1
Ensure CPA minutes reflect unmet need
Provision of literacy and numeracy: secure services
Baseline audit of current literacy, IT and numeracy opportunities
Develop action plan for improvement in literacy and numeracy
Improve service users' experience through innovative access to and for secure services: secure services
Baseline audit of current use of technology
Identify units in service users' pathways and share contact numbers
Develop plan to work with other units
Look at financial costs of new technology
Develop local guidance on promoting the use of technology, which includes positive service user experience, testing before use, maintaining
confidentially and governance, staff training
Set date for roll out of new technology
Provide information for service users, families and carers on new technology
42
Scope of data inclusion
The 2012 -13 Quality Account provides an overview of the performance of the Priory Healthcare division against
a wide range of internal measures and metrics, relevant to the division itself, or particular services and sites therein.
This data may not represent the entire breadth of services or sites within the Priory Healthcare division; therefore, this
appendix sets out the scope of data inclusion, as well as any relevant considerations (such as the methods by which
samples were selected for analysis).
Some sites were not fully integrated into the Priory Healthcare division’s systems for the entirety of the period and are
therefore not included in all figures, although all sites are reflected in some way across the indicators used in this report.
In this appendix, we will refer to two groups of sites, according to their implementation of the service user management
system CareNotes. These are:
CareNotes sites
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
The Priory Hospital Altrincham
The Priory Hospital Brighton and Hove
The Priory Hospital Bristol
The Priory Hospital Cheadle Royal
The Priory Hospital Chelmsford
The Priory Hospital Dewsbury
The Priory Hospital Glasgow
The Priory Hospital Hayes Grove
The Priory Hospital Keighley (previously the Willows)
The Priory Hospital Market Weighton (previously
Holme House)
The Priory Hospital Middleton St George
The Priory Hospital North London
The Priory Clinic Nottingham
The Priory Hospital Preston
The Priory Hospital Roehampton
The Priory Hospital Southampton
The Priory Hospital Widnes (now closed)
The Priory Hospital Woking
Woodbourne Priory Hospital
•
•
•
•
•
•
•
•
•
•
•
•
•
•
The Priory Grange Coombe House (now closed)
The Priory Grange Heathfield
The Priory Grange Hemel Hempstead
The Priory Grange Potters Bar
The Priory Grange St Neots
The Priory Grange Sturt House
The Priory Cloisters
The Priory Highbank Centre
The Priory Ticehurst House
Chadwick Lodge
Cefn Carnau
Farmfield
Thornford Park
Ty Gwyn Hall
•
•
•
•
•
•
•
Highfields
Longhouse (now closed)
Princes Street
Rookery Hove
Rookery Radstock
The Vines
Ty Ffynu
Non-CareNotes sites
•
•
•
•
•
•
•
The Priory Hospital Church Village (previously Caerlan)
The Priory Hospital Aberdare (previously Newhouse)
Avalon
Beechley Drive
Brynawel
Caewal Road
Egerton Road
43
Autism and Asperger’s syndrome services
outcomes (p10)
Analysis includes three of the four Priory Healthcare sites
providing autism and Asperger’s syndrome services,
specifically Rookery Radstock, Rookery Hove and Highfields.
Data is based on a census of service users on 30-06-2012.
The Priory Hospital Hayes Grove did not participate in the
outcomes data collection involving the division’s wider
specialist services sites and as such, no data was available
for inclusion.
Results of our service user satisfaction surveys
2012-13 (p12)
Data was sourced from CareNotes sites only. Surveys are
offered to all service users upon discharge, apart from
within neuro-rehabilitation services, secure services and
complex care services, where surveys are offered during
an annual census period. Neuro-rehabilitation service user
satisfaction data includes only The Vines and the Priory
Highbank Centre, as other sites have not yet undertaken
their service user satisfaction survey. Acute patients (acute
mental health services, addiction services, eating disorders
services and child and adolescent mental health services)
are included where the following criteria is met:
1. The service user was discharged from the relevant
service in the period from 1st April 2012 to 31st March
2013 inclusive
2. The service user submitted a paper satisfaction
form having answered at least one question
3. The form was recorded on CareNotes
‘Agreement’ or ‘Satisfaction’ is defined as those people
scoring 3, 4 or 5 on a 5 point scale.
Detailed review of performance against 2012-13
objectives (p14)
All relevant sites included, including non-CareNotes sites.
Service user satisfaction – delivering value through
clinical excellence (p18)
Data was sourced from CareNotes sites only. Data covers
all forms submitted in the reference period. Surveys are
offered on discharge, other than for neuro-rehabilitation
services, secure services and complex care services, where
surveys are offered during an annual census period.
Neuro-rehabilitation service user satisfaction data includes
only The Vines and the Priory Highbank Centre as other
sites have not yet undertaken their service user
satisfaction survey.
Outcomes – the success of our service users (p20)
Data sourced from CareNotes sites only. Service users
within an acute service (acute mental health services,
addiction services, eating disorder services and child and
adolescent mental health services) are included in the
HoNOS/ HoNOSCA outcomes where the following criteria
is met:
1. The service user has both an admission and discharge
HoNOS completed and recorded on CareNotes
2. The service user is discharged in the period from
1st April 2012 to 31 March 2013 inclusive
3. At least nine of the 12 HoNOS measures are
completed
4. Within addiction services, the service user stayed within
the service for at least seven days
The proportion of discharges included for each service are
detailed below:
Completion rates for the period are documented below:
Acute mental health services: 88%
Acute mental health services: 52%
Addiction services: 62%
Eating disorder services: 52%
Addiction services: 74%
Eating disorder services: 70%
Child and adolescent mental health services: 71%
Child and adolescent mental health services: 55%
Summary of progress against 2012-13 Quality
Indicators (p13)
All relevant sites included, including non-CareNotes sites.
44
Data relating to other outcome measures has been
included if the service user has at least an admission and
discharge or review outcome score, with the latter score
being in the period from 1st April 2012 to 31st March
2013 inclusive.
Investing in staff, education and training (p22)
All relevant sites included, including non-CareNotes sites.
Regulatory compliance (p25)
All relevant sites included, including non-CareNotes sites.
Improving safety for our service users (p28)
All relevant sites included, including non-CareNotes sites.
Incidents which meet all of the following criteria are
included:
1. The incident involves at least one service user as a
participant (incidents involving more than one service
user are counted as one incident)
2. The incident is reported on the Priory Group clinical
governance system
The number of ordinary bed days includes beds that have
been contracted by an NHS commissioning body. Whilst
under contract, these beds are considered to be fully
occupied (regardless of service user occupancy). As a
consequence, this may result in a slight understatement
of the indicator result.
Incidents leading to permanent harm are rated as having
a "high" level of harm (second highest on a five point scale)
and are defined as "any incident that appears to have
resulted in permanent harm to one or more persons.
Serious injury resulting in brain damage, loss of limb or
impaired use".
Incidents leading to the death of a service user are defined
as those incidents which have resulted in the death of a
service user, and are the highest grade on the five point
scale. This is defined as: "any incident that directly resulted
in the death of one or more persons".
Both of the above have been manually checked to
eliminate obvious errors.
Improving safety for our service users (p28) and
Continuous improvement in the delivery of our
services (p30)
The Priory Group implemented a new incident and
complaint reporting system on 1st January 2012, including
a revised incident management and reporting policy.
Because of the inherent differences between the previous
and new systems, it was not feasible to combine the data
with our 2011-12 data. Therefore, where we present
2011-12 incident and complaint data, we have used the
period 1st April 2011 to 31st December 2011.
45
The Priory Group of Companies is dedicated to helping
people
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Priory Healthcare, 80 Hammersmith Road, London, W14 8UD
PG04443/Jun13
About our group
About our Group